DIAUMOSIS
MEDICATION
H616.07
544
R3
SCUDER
A 522808
DUPL
+

ARTES
1837
SCIENTIA
VERITAS
LIBRARY
OF THE
UNIVERSITY OF MICHIGAN
PLUR BUSUNUM
MINIHIL
FLEBUR
SI QUAERIS PENINSULAM AMOENAMI
CIRCUMSPICE
HOMOEOPATHIC
LIBRARY
SPECIFIC DIAGNOSIS:
A
STUDY OF DISEASE
WITH SPECIAL REFERENCE TO THE
ADMINISTRATION OF REMEDIES.
BY
JOHN M. SCUDDER, M. D.,
Professor of the Principles and Practice of Medicine in the Eclectic Medical
Institute; author of "The Practice of Medicine," "The Practice
of Medicine in Diseases of Children," "The Principles
79 46
of Medicine," Diseases of Women, Specific
Medication and Specific Medicines,” etc.
TWELFTH EDITION.
Reprinted by request, not revised since 1890,

ἐκλέψω
CINCINNATI, O.:
JOHN K. SCUDDER
1913.
Entered according to Act of Congress, in the year 1874,
BY JOHN M. SCUDDER,
In the office of the Librarian of Congress.
Copyright, 1903, by
THE SCUDDER BROS. CO.
Fb El
1
PREFACE.
IN presenting this volume to the profession, as a com
panion to "Specific Medication and Specific Medicines,"
my object has been to make a study of the prominent ex-
pressions of disease, with reference to the administration of
remedies. However learned we may be in pathology, and
associate branches of medical study, unless we can make our
knowledge point to means for the relief of suffering, the
arrest of disease, and restoration to health, it will be of but
little use.
We believe that the expressions of disease are uniform, and
always have the same meaning, and that the action of reme-
dies is something definite aud uniform-" that like causes
always produce like effects." If we properly study our cases,
so as to determine a definite condition of disease, and know
the direct action of remedies in such conditions, we will
have a certain and rational practice of medicine.
250230
iv
PREFACE.
і
I concede that the study is difficult, but it is difficult
principally lecause it is new, and sufficient observations have
not been made. Physicians have so long practiced by rote,
and taken it for granted that there was no "certainty in medi
cine," that we have not the material we would wish for spe
cific diagnosis. But attention is being-directed to it, and the
time is coming in which the field will be full of observers.
No apology is made for the shortcomings of this little book.
though I hope that in the main, experiment will prove the
correctness of its statements. It would be singular if there
were not some errors, and some things to be corrected by
further experiment and study. It does not profess to be a
complete treatise, or to give all the information that might
be thought desirable. But it is a study of disease, which
may be continued by other books and at the bed-side of the
sick.
If it serves the purpose of stimulating investigation and
thought, pointing the road to a better system of medicine, I
will be fully compensated for the labor.
CINCINNATI, Nov. 15, 1874.
i
ON THE
STUDY OF DIAGNOSIS.
WE
E wish to make a new study of Diagnosis--one
that will show us the relation between symptoms
of disease and the curative action of drugs. Evi-
dently this is what we need to give us a rational prac-
tice of medicine-very certainly it must be the founda-
tion of specific medication.
It is yet the opinion, that "diagnosis" has reference
to the classification of disease according to the received
nosology; that it means naming the affection "bilious
fever," "typhoid fever," "pneumonia," "nephritis," etc.
And so it does with the genus doctor, at large, and their
souls travail in diagnosis until a suitable name is deliv-
ered. And then they consult their memories and books
for recipes to throw at this name, which to them seems
almost an entity.
It looks absurd when thus plainly stated, yet it is
true to a far greater extent than the majority suppose.
If we examine the literature of the profession, we find
that writers on the "Practice of Medicine" labor to
(9)
10
STUDY OF DIAGNOSIS.
}
make diagnosis in this way, and so arrange the symp
toms of disease that their readers may be enabled to
follow in their lead. The student would certainly think,
from this teaching, that getting a name for a disease,
was the first and principal object in medical practice.
Not only does this seem the principal, but the only end
of medical study, and men pride themselves on their
skill in naming diseases-calling it diagnosis.
What can be more natural than that medicines should
be prescribed at names, when so much trouble is taken
to affix them? And so we find that treatises on thera-
peutics are efforts to associate drugs with names of dis-
ease, with a-"this has been used with advantage".
"this has been employed in," etc., etc. The trouble is
that almost every remedy in the materia medica has
been prescribed at the more common diseases—pneu-
monia, for instance-and the student has difficulty, not
from the paucity of his means, but from their abun-
dance.
Some go a little further than this. They want a
name for their disease, it is true, but they also make
their diagnosis extend far enough to guide their thera
peutics. Thus they determine a condition of the stom-
ach that indicates an emetic, constipated bowels a ca-
thartic, dry skin a diaphoretic, scanty urine a diuretic,
periodicity Quinine, sleeplessness or pain an opiate,
heat and dry skin baths, etc. Add to this counter-irri-
tation for the relief of local disease, and we have the
ordinary round of treatment.
This kind of diagnosis is well enough-is very much
better than that which simply names the disease—but
it also is very crude at times. For we find at times that
there are very much better means to relieve the stom-
STUDY OF DIAGNOSIS.
11
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ach than an emetic; and that in some, where seemingly
indicated, it would do more harm than good. That
constipation is not an indication for cathartics, and that
this class of remedies are so used as to do a vast amount
of harm. That impaired secretion from the skin does
not mear diaphoretics; for when most indicated they
will frequently not cause secretion; and that other
means, not directed to the skin, will cause it. That
scanty urine does not mean diuretics, for they will fre-
quently fail to influence the kidneys when they seem to
be indicated most, and will sometimes still further ar-
rest secretion. Periodicity does not always mean Qui-
nine, for Quinine fails nine times where it succeeds
once, sometimes intensifying disease, at others produ-
cing a disease peculiar to itself-quinism-worse by far
than the disease for which it is given. And sleepless-
ness does not mean Opium, for it fails frequently, and,
as generally used, does far more harm than good.
It is still worse when the physician thinks he sees
the need of cathartics. diuretics, diaphoretics, tonics,
Quinine, nervines, etc., and gives them all at once, or in
a miscellaneous hodge-podge. The common result is to
intensify the disease, derange the stomach, and impair
the vegetative nervous system. The remedies are fre-
quently given so that the action of one opposes that of
another, as for instance a cathartic with a diaphoretic,
or at such times that they can not possibly do what they
are intended for.
How, then, shall we study diagnosis? Is there any
better method than that usually pursued?
I believe there is a right way to study diagnosis—one
that will prove satisfactory to patient and physician-
will name the disease for the one, and determine a ra-
12
STUDY OF DIAGNOSIS.
tional therapeutics for the other. Such a way I endeav-
ored to point out in my Principles of Medicine, to which
my readers are referred for my opinions in extenso.
Man has but one body, and though it may be divided
into parts, each has the same life, is supplied from the
same blood, governed by the same nerves, and has tre
same nutrition and waste. Only in so far as drugs act
on special parts or organs, need we study disease of
these independent of the organism at large.
Man has but one life, and it is the same for all parts.
The normal manifestations of this life we call health;
the abnormal manifestations of it disease. If we can
always think of disease as a method of life, in a living
body, we will have gotten rid of an old error, and have
made the first step toward a correct diagnosis, and a
rational therapeutics.
Disease, then, is not an entity-something to be for-
cibly expelled from a living body-but is actually a
method of life. It can not be purged from the bowels,
vomited from the stomach, strained from skin and kid-
neys, or exorcised by counter-irritation. Such means
may do good, as when they remove an offending sub-
stance, or when they establish a function that is defi-
cient, but they should have a rational use.
The life of disease is not as good as the life of health,
neither in the whole nor in any individual part. It is
always exhaustive, impairing the life now, and the life
to come by renewal of tissue. It makes no difference
what may be the seeming condition of the body or a
part in disease, the real condition is, an impairment of
life. We study disease, therefore, as a method of living;
and we treat the diseased body as a living body, which
STUDY OF DIAGNOSIS.
13
-
has been placed in such position that its life has been
enfeebled or deranged.
We next want to understand clearly the structure and
uses of the various parts of this one body. We want to
know clearly the conditions necessary to healthy life,
and how their change works that we call disease. If
we can understand clearly the relation of a condition
or function to healthy life, we are in a position to learn
how the change in condition or function produces dis-
ease, and a correct therapeutics is at once suggested.
Examining the human body, we find certain condi-
tions and functions underlie others, and seem to be first
elements in the sum of life. Of these I may name tem-
perature, circulation, innervation, nutrition and waste,
and the blood. We always study these first, and we
want to know the exact character of the wrong, in one
or all, and how that wrong may be corrected.
There
Going one step farther, we want to know the relation
of these conditions and functions to one another.
is a general relation in health; possibly they are of equal
importance in the problem of life. But in disease one or
other may stand first, and serve as a basis for wrong of
life in many directions. Thus a disease involving every
function of life, may arise in a wrong of the temper-
ature and circulation of the blood. There is a want of
appetite that tonics will not reach; a wrong of secre-
tion that can not be righted with cathartics, diaphoretics
and diuretics; a wrong of innervation that can not be
reached with narcotics and nervines. Direct remedies
that restore normal temperature and circulation, control
the entire process of disease; like a card-house, the re-
moval of a first card is sufficient for the overthrow of
the entire structure.
· 14
STUDY OF DIAGNOSIS.
It is not so easy, always, to determine which wrong
is thus first, yet with care it may be determined-and
this is an essential in good diagnosis. A disease pre-
senting similar symptoms-the same symptoms to an
ordinary observer—may rest equally upon a first lesion
of the circulation, innervation, nutrition and waste,
blood-making, or the conditions of the blood. We want
to know which stands first, and then rectifying the first
wrong the treatment is easy and successful.
Disease has certain expressions, which we call symp
toms, as health has certain expressions. We find that
the manifestations of life in health are very uniform, and
consistent, and one can hardly mistake their meaning.
So in disease, the expression of morbid life is uniform,
and constant, and does not vary in different individuals,
as many have supposed. If we determine in any given
case the expression of diseased life, we will find it the
same in all cases.
It has been claimed, and tacitly admitted that symp-
toms of disease were so changeable and inconstant, that
they could not be depended upon with any certainty.
This was certainly true to those who made their di-
agnosis according to the recived nosology, and then pre-
scribed at the name. For as very diverse pathological
conditions would be grouped under each name, the
symptoms would of course vary, and the treatment
would show the element of uncertainty in so marked a
maner that idiosyncrasy would be constantly called in to
explain the trouble.
We propose studying the expressions or symptoms of
disease with reference to the administration of reme-
dies. It is a matter of interest to know the exact char-
acter of a lesion, but it is much more important to know
STUDY OF DIAGNOSIS.
15
the exact relationship of drug action to disease expres-
sion, and how the one will oppose the other, and restore
health. If I can point out an expression of disease.
which will be almost invariably met by one drug, and
health restored, I have made one step in a rational
practice of medicine.
I have no hesitation in affirming that if we have once
determined such relationship, we have determined it
in all diseases alike, in all persons, and for all time to
come. If, with this symptom or group of symptoms,
my Aconite, Nux or Podophyllin cures to-day, it will
cure to-morrow, next year, and so long as medicine is
practiced. If it cures Tom, it will be equally applicable
in the same condition to his father, mother, wife, or
mother-in-law.
"Do you mean to say," asks the reader, "that the
present system of nosology is useless?" Yes, so far as
curing the sick is concerned, that is just what I mean
to say. Not only useless, but worthless-a curse to
physician and patient-preventing the one from learn-
ing the healing art, and the other from getting well.
But you may ask, "how would you make out the certifi-
cate for the Undertaker?" That's just what we wish to
avoid, we don't care about furnishing subjects, and
would very much rather people should die of old age,
and then we would write it in English-" old age."
The first lesson in pathology we want to learn is, that
disease is wrong life. The first lesson in diagnosis is,
that this wrong finds a distinct and uniform expression
in the outward manifestations of life, cognizable by our
senses. The first lesson in therapeutics is, that all
remedies are uniform in their action; the conditions be-
ing the same, the action is always the same. We learn
16
STUDY OF DIAGNOSIS.
to know the healthy man-know him by exercising all
our senses upon him. We want to know how he feels,
how he looks, how he smells, how he tastes, and what
kinds of sound he makes. Then we want to learn the
diseased man in the same way, and compare him with
our healthy standard-certain expressions of life mean-
ing health, and certain other expressions meaning dis.
Then we study the action of drugs upon the
sick, and when we find them exerting an influence op-
posed to disease and in favor of health, we want to
know the relation between the drug and the disease-
between disease expression and drug action.
tase.
I do not say that we should not study drug action in
health-indeed I think it a very important study. You
may, on your own person, study a wholly unknown
drug, and determine its proximate medicinal action.
How? Easy enough. You will feel where it acts; that
points out the local action of the drug, and as a matter
of common sense, you would use it in disease of that
part, and not of a part on which it had no action. You
will feel how it acts-stimulant, depressing, altering the
innervation, circulation, nutrition and function. If now
you want to use it in disease, use it to do the very things
it did in health, and not as our Homœopathic brethren
would say, to do the very opposite things.
This might not seem altogether pertinent if we were
studying old diagnosis, but new diagnosis means medi-
‹ine, and must point out the cure for the particular case
in hand.
STUDY OF DIAGNOSIS.
17
THE STUDY OF LIFE.
The diagnosis that we are studying has a physiologi-
cal basis, and we want to learn something of the kind
of physiological knowledge necessary. Is it that which
may be learned from Carpenter, Draper, Huxley, etc. ?
Most decidedly it is not. The knowledge from books is
most important, excellent in its place, but worth nothing
here unless supplemented by a new study.
We must study the living man, and learn to recognize
every manifestation of this life by our senses.
Nothing less will serve the purpose in rational mcd-
icine. We want to bring our own senses to bear upon
him, and know how he feels, tastes, smells, and how he
looks and what sounds he makes. This study of the
living man, the most important study in medicine, is al-
most wholly neglected. Men live a lifetime, and know
nothing of the manifestations of life. Students become
conversant with books, attend their lectures, pass their
examinations, and yet have no practical knowledge of
human life. And physicans will practice medicine a life-
time, and yet fail to know what healthy life is.
How would you make a good surgeon? There is but
one way. He must exercise his senses on the human
body, and learn to know it for himself. He studies upon
the cadaver, and learns the relation of parts; and he
also studies the living man, and learns to recognize
these relations by the sense of touch. Your accom-
plished surgeon recognizes a displacement or fracture,
as soon as his eyes rest on the part. Let him pass his
fingers over a limb in the dark, and he will tell you if
anything is wrong, and just what the wrong is. He is
a good surgeon, just exactly as he is an expert in this.
18
STUDY OF DIAGNOSIS.
Not a year passes but what we have one or more
suits for malpractice against physicians of our school,
arising out of bad bone-surgery. (They have quite as
many in other schools.) Why these cases? Simply be-
cause they have not taken the trouble to learn on the
cadaver and living body for themselves, just how it is
made, and the relation of one part to another. Any
man, whether he is a surgeon or not, can so train his
senses, and know the anatomy of man, that mistakes
would be impossible, and cases of malpractice would
be the result of accident, or the fault of patients.
1
say
to the student, study anatomy and physiology
on the living man. Observe him closely with your eyes,
until you learn his varied expressions. See him walk,
sit, lie, work, eat, breathe, talk, etc.. Feel of him, and
sce how he is made, and what he feels like in different
parts. Learn every prominence of bone in the body,
and its relation to articulations, blood-vessels, nerves,
organs, etc. Hear every sound he makes, and learn to
recognize its character. And, lastly, learn to recognize
all of the many smells of which he is the base. Learn
him from the crown of his head to the sole of his foot,
and analyze him with your own senses, and you will
have the foundation for a good physician.
I place very great stress on this method of studying
physiology, and recommend it to the old practitioner as
well as the medical student. No knowledge in the
memory can take its place. It must be the basis of a
rational practice of medicine, for unless we know what
health is, we can not know disease, and unless we know
disease we will have a random and very uncertain
therapeutics.
I have already called attention to the necessity of
STUDY OF DIAGNOSIS,
19
training all our senses so that we may be able to observe
well. These faculties are like many others, they may
be so trained under the influence of the will, that
after a time they work automatically, and with a rapid-
ity that is astonishing. This is the work of time-but
time placed where it will do the most good. All that
one need do, to have good, active senses, is to use what
he has rightly.
There is no mistake about these things, and I will
guarantee any physican a success that will astonish him,
if he will put them in practice. Need I say that the
reward is great. Outside of professional reputation,
and the ordinary rewards of successful business, there
are sufficient returns. A man's conscious life is in and
through his senses, and as these are educated and en-
larged, his life becomes larger, and his pleasures in-
creased. Nature is a most bountiful mother, and her
laws bring certain compensation; and of these there is
none truer than that "a man grows as he is rightly
used."
APPLIED ANATOMY.-The ordinary study of anatomy
is a good thing, and is the basis for a sound medical
education. Yet I am sorry to say that the study of
anatomy with the majority of physicians is very " ordi-
nary." It is a good thing to be able to name the
various bones, processes, muscles, and organs of the
body, but it is very much better to know them, as a
man knows his best friend. I may know a man's name,
and yet know really nothing about him, physically,
mentally, or morally. So it is in the common study of
anatomy, the memorizing of names takes the place of
that study which will enable one to really know the
structure of the human body.
20
STUDY OF DIAGNOSIS.
1
A good anatomist will strongly insist on dissection as
an important means of learning. He well understands
and endeavors to impress the fact that it is only by
personal examination that one may know the various
tissues and organs, and their relation to one another.
The surgeon supplements this by the additional state-
ment that the most important preparation for the use
of the knife in surgery, is the use of the knife in dis-
section. Not only to acquire anatomical knowledge,
but to know the resistance of different tissues to the
scalpel, and to train the sense of touch.
An accomplished physician should be a good anato-
mist—the skilled diagnostician is a good anatomist.
No one need say he has no opportunity, for every one
can make opportunity. A dead man is a good thing in
this study, but any animal or part of an animal wili
serve the purpose of the man who really wishes to
know, and there is not so very much difference between
man and the remainder of the mammalia. The nearest
butcher shop will furnish material in abundance-from
eyes, to tongue, larynx, trachea, bronchial tubes and
lungs; the digestive canal and its associate organs;
kidneys, etc. whilst a quarter of lamb or veal gives
pretty good muscular dissection.
The worthless curs prowling about the village or
town, give excellent facilities for dissection or vivisec-
tion. Chloroform the brute, and he is ready for work,
and you may educate your touch on living tissue, as
well as learn anatomy..
In the olden time the study of anatomy was com-
menced with the bones-pot with pictures or plates of
bones This study in which bones are tangible reali-
ties, and convey to the sense of touch and the eye their
?
STUDY OF DIAGNOSIS.
21
peculiarities is the right study. Every physician
should be able to recognize any bone by the sense of
touch, and at once give it its proper position. Just as
he should be able to recognize the normal from the ab-
normal in shape, size and position. The skeleton prop-
erly articulated is a valuable adjunct, and if it was
thoroughly studied by the hands in a dark room, we
would have but few cases of mal-practice in bone-
surgery.
But this study of anatomy from the skeleton, and by
dissection, assisted by reading and lectures, is but pre-
liminary to a more important study. We want to study
anatomy upon the living man. We want to know the
situation and the relation of various parts, sc that we
may be able to put our finger upon them at once, and
detect the slightest variation. We want the impress
of this living man upon our senses, so that they may
know him intimately. What does he look like? What
does he smell like? What does he taste like (in so far
as taste is applicable)? What sounds does he make?
And how does he feel?
We want to know his every cassion, standing,
sitting, lying, on his back, sides, etc.
His expression
scles in life,
nfluence in
'uation of
in activity, and at rest. We study his
their arrangement on the bones, and their
giving the body motion. We study the
blood-vessels in the same manner, and lea.. to trace
their course by the prominences of bone, elation to
muscles, etc., and going deeper, we study osteology
again, as the bones are clothed in tissue.
No man need excuse himself for want of opportu-
nity, so long as he possesses a body of his own, «nd
there are so many other bodies that might be engag、d
for the purpose.
•
1
22
STUDY OF DIAGNOSIS.
There are two objects in this study, both important.
The one is to know the mechanism of life, and the
other is to educate the senses. The importance of the
first will not be disputed, and before we have concluded
this study, I think the other will be conceded.
APPLIED PHYSIOLOGY.-The knowledge of physiology
from the books is a good thing, but it is not sufficient
for our purpose. We not only wish to learn that Car-
penter, Huxley, and others, have witnessed certain phe-
nomena, and learned to know them as constant expres-
sions of life, but we wish to know them of ourselves,
and through our senses.
Dr. Huxley introduces the study of physiology by
saying "The body of a living man performs a great
diversity of actions, some of which are quite obvious;
others require more or less careful observation; and yet
others can be detected only by the employment of the
most delicate appliances of science
"Thus, some part of the body of a living man is
plainly always in motion; even in sleep, when the
limbs, head and eyelids may be still, the incessant rise
and fall of the chest continue to remind us that we are
viewing slumber and not death.
"More careful observation, however, is needed to de-
tect the motion of the heart; or the pulsation of the
arterics; or the changes in the size of the pupil of the
eye with varying light; or to ascertain that the air
which is breathed out of the body is hotter and damper
than the air which is taken in by breathing.
"And lastly, when we try to ascertain what happens
in the eye when that organ is adjusted to different dis-
tances; or what in a nerve when it is excited; or of
STUDY OF DIAGNOSIS.
23
!
what materials flesh and blood are made; or in virtue
of what mechanism it is that a sudden pain makes one
start—we have to call into operation all the methods of
inductive and deductive logic; all the resources 01
physics and chemistry; and all the delicacies of the art
of experiment."
Huxley is an admirable teacher, probably the best
living, and we will do well to get an idea of these
methods. The first lesson we learn from these brief,
but expressive paragraphs is, that we are to observe this
man, who "is plainly always in motion," and that we
are not to be satisfied with the observations of another.
Then follows the natural sequence in these observa
tions. At first the gross expressions of the body, and
the difference between the man awake, asleep, dead
Next a "more careful observation," determining the
motion of the heart, etc. And lastly, the skilled obser-
vation, from a trained mind, aided by the various in-
strumentalities and appliances of science.
Books are useful in this study, though not the object
of study; it is the man we want to know, not the book
nor its author. The book may serve as a guide-board,
pointing the way, and at the same time give us a
standard of comparison. It tells us what to exercise
our senses upon-what to observe-and it informs us
what others have observed, and what is the common
standard of healthy activities.
There is nothing in the life of the man but should
be a subject of close scrutiny. We want to know him
in the entirety of his action, as we wish to know him
in every detail. And we want to know him so inti-
mately and thoroughly, that this physiological man
shall be always present with us as a standard of com
parison.
24
STUDY OF DIAGNOSIS.
The reader will at once see the necessity of this study
as a basis for diagnosis. The physiological man is the
man of health, the pathological man is one who has left
this common standard of being. The physiological
man is the standard of measurement, the common mean
that we measure from. To have a measurement at all,
it is necessary to have a fixed point to start from; this
healthy man is the fixed point.
Measurement has reference to certainty, and certainty
is what we most desire in medicine. A measured mile
is a definite distance, an imaginary mile, having its
origin and termination in the cranium of Paddy
Ochhone, is a very different thing, though very like the
ordinary measurements in medicine.
The first thing that the physician wants, then, is a
sound physiological standard, which he carries with
him as he makes his rounds. It is lain by the side of
the patient in bed, sits by him on the chair, stands by
him, walks by him, puts out its tongue, extends its
hand to give the pulse, has lungs, bowels, kidneys, re-
productive apparatus, etc., always at your service, and
open for comparison.
Disease is wrong life, and a wrong presupposes a
right. To determine the existence of a wrong, we must
know what the right is; to determine the character of
the wrong, we must compare it in all its parts with the
standard right. This is diagnosis, as the reader can at
once see.
How now shall we get this physiological standard.
Clearly by observation with our own eyes, and the use
of our own senses. Each man must make it for him-
self, and give it distinctness by the education of his
own senses. Theoretical knowledge will not do.
STUDY OF DIAGNOSIS.
25
If we take Huxley's first example, "awake, asleep,
dead,” we find an excellent study. Can you tell the
difference between the appearance of sleep, sleep and
death? Hardly by the first glance, and possibly only
by a very close examination, and some experimenta-
tion, (the last especially evidences a state of uncer-
tainty). But if we carefully observe the phenomena
of sleep, in the infant, the child, the adult, we will soon
have a healthy standard, and the expressions of sleep
are so distinctive, that no one could deceive us by
slamming sleep.
So, too, if we carefully observe and study death, we
will never mistake it. There are distinct expressions
of body in death that can never be counterfeited. It is
not only the absence of motion, of respiration, of pulse,
or heart-beat, of heat, but there is an absence of the
expression of life in its totality, and an expression of
lifelessness that is characteristic. The relaxation of
death is distinctive, as is the rigor-mortis, as is the de-
composition of tissue.
It is a good thing to have a standard of death for
comparison as well as of life. Not that we usually
have any doubt of death, but that we require it as a
measure of life. It is well to have two points to mea-
sure from-the standard of life and the standard of
death. There is an approximate death, as well as a
total death; a dying by degree, or part, as well as a
dying at once and in entirety.
Taking a man in entirety, we find a distinct expres-
sion when he walks, stands, sits, or lies. Every part
of the man talks to us, his hands, his arms, his legs, his
feet, even his "calves may wink," as described by
Dickens in one of his Christmas stories.
3
26
STUDY OF DIAGNOSIS.
We not only learn from this much of the physical life
of the outer man, but learn of the life within. The
expression is the shadowing forth of the underlying
nervous system, and this again of the real or spiritual
man behind this. As physical, mental and moral
health has a distinct expression in the outer man, which
we purpose using as a standard of admeasure; so all
diseases, physical, mental and moral, have a distinct
expression in the outer man. You will no more find
disease under a healthy exterior, than you will find a
devil in the garb of an angel.
We have a standard temperature, which we may
learn to recognize by the hand, though it is best to
measure it with a thermometer. We have a standard
electrical condition as an important factor of life, which
we will learn to recognize in the general expression
and movement, the special expression of the face and
eyes, and by the touch. And we have a standard
formative force, which we will recognize in the expres-
sion of tissues, and the sensations they give to touch.
We have a standard color for the general surface,
and for special parts that the eye will learn to recog-
nize, and use for comparison. We make this study
thorough; it is the skin at large, and then those por-
tions where the circulation is less free, where it is very
superficial and free, the nails, hair, veins, etc. We have
a standard color for mucous membranes, for lips, gums,
tongue, teeth, etc.
We have a standard in touch-of smoothness, resist-
ance, elasticity, size and association; and we have it of
every part of the body. Of course we have not learne
it of Huxley or Carpenter, but by the use of our own
hands on the human body.
STUDY OF DIAGNOSIS.
27
We have a standard respiration, in frequency, full-
ness, depth and freedom, which is distinct and clear,
and which we know of ourselves by observation.
We have a standard circulation, which we know at
the radial artery, by the even, distinct, regular blood
wave that passes under our finger, as well as by the ex-
pression and color of the surface, and the expression of
parts associated with the heart in action.
We have a standard condition of the digestive organs,
which we learn from books and by observation. It
don't take long to learn, even by the general expres-
sion, and the special expression of the muscles of the
mouth, whether a man has a good appetite, good diges-
tion and good blood-making. Even constipation will
be shadowed forth in the outer man so that one may re-
cognize it.
Blood-making and nutrition must have distinct ex-
pression, and a standard for measurement will be readily
formed, for all functional activity is dependent upon
nutrition.
The standard of healthy excretion by skin, kidneys,
and bowels is readily formed by observation. Not ob-
servation on the sick, and under the influence of drugs,
as many suppose, but upon the well.
Thus we see it is possible to so learn our physiology,
that it may serve as the basis of a rational practice of
medicine. And I think every reader will see that this
education is essential to good diagnosis, and that its at-
tainment is the first object in medicine. This is not a
question of schools; it is a question of sheer empiri-
cism, (call it quackery if you will), or rational medi-
cine; it is a question of whether the physician is to be
a coadjutor and aid to death, or whether his influence
will be upon the side of life and health.
28*
STUDY OF DIAGNOSIS.
METHODS OF DIAGNOSIS.
Where do we find the expressions of disease? When
you think of this question a moment, it does not seem
so easily answered; indeed it furnishes good material
for thought. Probably we had better preface it with
another. How do we find the expressions of disease?
Man has knowledge of things external to him, by means
of the general sense of touch, and the special senses-
sight, hearing, smell, taste. We may ask, then, when
brought in contact with the sick, what do we feel, see,
hear, smell, taste, that differs from the normal condi-
tion-health. What the patient feels, sees, hears, smells
and tastes is not so important, for his senses are im-
paired by disease, they have never been educated,
and his mind is not in a good condition to receive im-
pressions.
I imagine the reader saying to himself-well-really
-I don't know about that. I don't feel my patients
much, and am not sure that I learn much by feeling. I
see them-but-I don't know that I can tell the char-
acter of disease by sight. I hear-yes-I hear all the
patient has to tell me about his bowels, number of ope-
rations, whether he passes wind up or down, or both,
makes water, where he has aches and pains, etc. I
don't smell much, unless I examine; the bed-pan or
chamber utensil, and I don't want to taste in the sick
room. That is he makes his diagnosis, from the
patient's feelings, and not by the use of his own senses,
-a very imperfect way of making a diagnosis.
We have called attention to the uncertainty of diag-,
nosis from "what the patient says," yet it is the com-:
44.
STUDY OF DIAGNOSIS.
29
mon means of diagnosis with all schools of medicine.
If the patient was wholly truthful there would be suf-
ficient uncertainty, for they have little knowledge of
disease, little skill in observation, and from disease they
are incapacitated for reasoning. The patient can not, in
the very nature of the case, know very much of his dis-
ease, and does not know that little well.
If now we supplement this by the well known ten-
dency to exaggeration by the sick and friends, we find
still more uncertainty. You ask when you visit a
patient whether he slept. The wife answers—“ not a
wink," and yet you know from the patient's expression
that he has rested during the night, though his sleep
may have been broken. Or the nurse answers, “Oh,
yes, he had a good night's rest," though the only
ground she has for supposing so is because she slept
herself, but the patient's expression shows you he has
passed a restless night. You ask if the patient has
taken food-"no, he hasn't been able to take a bite,"
though you find on persistent inquiry, that he has had
broth, or milk in sufficient quantity. You ask if he has
passed urine-" Oh, yes, sufficient," yet you see by the
pinched, anxious countenance, and position of abdomen
and pelvis, that he is suffering from retention or sup
pression of urine. You ask if the patient suffers much
—“Oh, yes,” is the reply, "I have had severe pain,"
or "I have suffered intensely," yet you see by the
countenance that the statement is false or overdrawn.
I do not believe that my patients are worse in this
respect than others, yet I have occasion to say to
myself every day, when listening to the patient's or
nurse's story—" Madam, or sir, you are lying." Indeed,
I have always made it a rule to believe nothing that
30
STUDY OF DIAGNOSIS.
was told me in a sick room, unless it was corroborated
by my examination of the patient.
I have tried the experiment several times, of seeing
how far the patient and attendants would go in their
exaggeration. Take one that is imaginative, and by
leading questions and promptings you can get the
symptoms of every ailment to which man is subject;
and the story will have more consistence and semblance
of truth, the more the patient knows of disease. The
nurse is frequently as bad as the patient in this respect,
and quite as easily led to exaggeration. I had an illus-
tration of this a few weeks since in the person of a
monthly nurse. The mother and child were doing well,
yet you would think from the nurse's description that
they were just on the point of having every ailment
that the puerperal state would afford. The mother was
not easily influenced, or the nurse would really have
made her sick.
Why has a good physician better success in diseases
of children than in other cases? There is no doubt of
the fact, and I have heard it remarked many times-
"I would much rather treat children than adults-
medicines act better." You can't question the child, and
you learn but little that is important from the mother-
how do you get your information? True, the mother
and friends will say "it is so hard to doctor children,
you can't find out what is the matter with them" But
a good practitioner knows better than this, and though
possibly he has never thought about the subject, he
knows he can treat children better than grown persons.
Why? For the very good reason that he uses his
senses, and prescribes from what he knows, instead of
taking the say-so of patient or nurse as a basis for the
STUDY OF DIAGNOSIS.
31
1
prescription. If I should suggest to you, that in the
practice of obstetrics you should place dependence
upon the statement of nurse and patient, instead of
making an "examination "-you would think it most
absurd. Yet, in reality, it is not more absurd, than de-
pending upon the story of nurse and patient in ordi-
nary diseases.
If these are facts, and I think the experience of every
reader must satisfy him that they are, we want to
change our method and get a better basis for diagnosis
and prescription in diseases of the adult. Let us sup-
pose every patient a child-which they are in fact, so
far as medicine is concerned-and give them the same
careful examination that we would to the child, and
thus reach conclusions from what we know, rather than
from what patients or nurses say.
We do not wish to lose the advantage of any infor-
mation we may get from patient or nurses, but we pro-
pose to make no suggestions in the manner or charac-
ter of questions, that will bring false answers. There
are some things the patient will know, and a little care
will frame the questions so as to get at the real facts.
There are some things the friends or nurse will know,
and direct questions will usually bring straight replies.
But there are many things that neither can know any-
thing about, at least with any certainty, and these
should always be avoided.
All answers should pass in review of our own senses,
and what we know of health and disease. These are
the judges, and if the evidence is good it will have their
approval; if it does not have their approval we throw
it to one side. We do not purpose receiving anything
that is opposed to what we know of disease, and we do
32
STUDY OF DIAGNOSIS.
not purpose believing anything that is opposed to the
evidences of our senses.
THE EDUCATION OF THE SENSES.
We have already seen that the education necessary
to make a good physician, is not from books, or of the
memory-both good in their place, but insufficient.
The education that gives the best results, and makes
the successful practitioner, is of the senses, and of the
brain to receive impressions, and make deductions.
We have called attention to the proper study of an-
atomy, by which one may know the structure of the
human body of himself; and the right study of phy-
siology, by which one may know the various activities
of this mechanism. To make these attainments re-
quires study-not midnight oil burned in reading
books, but the continuous exercise of our senses upon
the human body, living and dead.
The same course of study is necessary to know dis-
ease. The description from Aitkin, Wood or Scudder,
is not the knowledge we want; it is not what another
man knows that is of advantage to us, any more than
it is another man's dinner that sustains our life.
want to know disease for ourselves, and we learn it by
the exercise of our senses upon diseased bodies.
Wo
If the senses, then, are the instruments by which we
obtain knowledge, it will at once be patent to the reader
that their development and goodness will be the mea-
sure of our ability and our attainments. Hence the
man of educated and acute senses will be far superior
to and have every advantage over the man who has nót
been thus trained and developed.
'
STUDY OF DIAGNOSIS.
38
Most persons seem to think that the human senses
are natural, not acquired-that they are born to us, and
not the result of education. This is a very great mis-
take, and a grave error to the physician. Man is born
with an organism that, so to speak, has germinal capaci-
ties for use, and its future development is by normal
use. The child at birth has perfect hands and arms,
every bone, muscle, blood vessel and nerve being there;
but they are as yet wholly useless. Its feet and legs
have all the parts of the adult, but it can not walk, or
even wag its toes under the influence of the will. Its
eyes are perfect, yet the images formed upon the retina
are wholly without meaning, and might quite as well
be a blank.
The child slowly learns to use its hands, and months
pass before it can hold an object, and a still further time
before it can move the object in obedience to the will.
We see it day by day learning to see, slowly taught by
its surroundings. And the adaptation of the nether
limbs to walking is the persistent work of the first
twelve or sixteen months. Compare the child of these
attainments of one year with the child of two years,
and you see a wonderful difference. The education has
been continually going on during this period, and with
continued use in right directions comes increased devel-
opment. At the third year there is further improve-
ment, and thus, as we go on to the fifth, the tenth, the
twentieth year, we observe a continued education of
the senses, and a better development of them.
I want to call attention to the fact that we find every
grade of development in different individuals, from the
first year up to maturity, and that this development
does not always depend upon the original capacity. A
34
STUDY OF DIAGNOSIS.
difference in use or in education, so to speak, gives dif-
ferent capacities. It is not in the initial or starting
point, but in the method of progress, that gives the
fully developed sense. If the child has been rightly
directed, and the senses have been rightly used, they
will have proportionate capacity.
Many who would admit that the human senses are
acquired, think of them as being acquired very much
as the man increases in stature and weight, and some-
thing essentially belonging to this period of growth.
They conclude that the senses grow with the body, and
attain maturity when it has reached the full size and
stature of a man; and now a man, having his full
capacity, will find neither increase nor diminution so
long as he may live. They measure a man in all his
parts in this way; his every function is now developed
for life. A greater mistake could not. be made.
The law of development is always in operation in the
human body, as it is throughout the animal and vege-
table world. As any organ or part is rightly used, it grows
in capacity. Not only in infancy, in childhood, up to
adult years, but each and every year of a man's life to
old age. It is more marked, of course, when the repro-
ductive powers are active, but it is always a law of life.
The man between thirty and forty years, will find that
he still has the germs of a large capacity, which needs.
but the right use for development. He may grow legs,
arms, body, chest, lungs, brain, the sense of touch, of
taste, of smell, of hearing, of sight, if he will; all that
is necessary is, that he should rightly use that he has.
Shakspeare makes his typical Dogberry say,
"To be a well-favored man is the gift of fortune;
But to write and read comes by nature,"
STUDY OF DIAGNOSIS.
35
But however it may be with reading and writing, very
surely acute sight, smell, taste, hearing, touch, do not
come by nature. We all recollect the tedious process
of education-how we slowly attained our A, B, C's,
and what a work we had done when we could spell b-a
ba, k-e-r her, baker-and so on through, whether it has
been little or much. This is the type of education, and
this is the way it is obtained-little by little, and by
continuous application.
But there is another view of the question, quite as
important to many persons. The law is not only ope-
rative in the one direction-to increase functional
capacity but quite as much so in the other direction-
to lessen or take away that we have. The part or organ
disused loses its functional capacity, becomes atrophied,
and finally loses the power of reproduction-is wholly
gone. The Indian Faakar, who vows to hold his arms
above his head, finds after years are passed, that they
are no longer obedient to the will, are lost. This is the
case with any part of the body-with the organs of
special sense, and with the brain and its functional ac-
tivities. It is the application in the human body of
Christ's parable of the talents:
"For the kingdom of heaven is as a man traveling
into a far country, who called his own servants, and de-
livered unto them his goods. And unto one he gave
five talents, to another two, and to another one; to
every man according to his several ability; and straight-
way took his journey. Then he that had received the
five talents went and traded with the same, and made
other five talents. And likewise he that had received
two, he also gained other two. But he that had re-
ceived one, went and digged in the earth and hid his
lord's money."
36
STUDY OF DIAGNOSIS.
The reader will recollect the application of the para-
ble-the one who had used his talents found them in-
creased; the one who buried his, had taken away from
him that which he had. The divine Teacher enunci-
ated a law as wide as the universe, and as applicable to
physical and mental growth, as to moral development.
It is just as applicable to the training of the senses of
the physician, as it is to the growth of the moral nature
of man.
The lesson is clear: if we want anything, we
must work for it; if we will not work, we lose that we
have.
Man has conscious life in his brain and through his
senses. Take away his senses, and he has lost all com-
munication with the world without. Through his
senses he has pleasurable life, and it is deep and broad
in proportion to their development. One would think
that this would be sufficient incentive to their full de-
velopment. But, unfortunately, men dislike work, not
realizing that even this will prove a pleasure.
It is the continued and orderly exercise of parts that
gives them increased capacity. Not by fits and starts,
but continuously, day by day, week by week, month by
month, year by year. The organs of special sense have
in them a mechanism for skilled use, as well as for the
gross purposes of life, and it is this skilled use we pur-
pose to call forth in diagnosis.
Man has five senses-of touch, of sight, of hearing,
of smell, of taste-all of which are useful in this study,
and all require training. The physician of unskilled
touch, sight, hearing, smell, taste, can never be suc-
cessful. It is hardly necessary to give examples of
this, as every reader's experience will show it a truism,
but a few may stimulate thought.
STUDY OF DIAGNOSIS
37
í
In the obstetric art the skilled touch is the important
element of success to the accoucheur. Without it he is
groping in the dark, and is obliged to sit passively by
the bedside and wait. He can not know, and of course
can not give intelligent assistance when assistance may
be required. In the saine way the unskilled touch
could never use a knife in surgery, could not pass a
catheter, could not recognize the variations of the pulse,
could not determine the condition of the skin, could not
do a great many things that might be done if the touch
were educated.
The untaught eye can not distinguish the variations
of form, size, color, and other physical properties of
bodies, which tell of condition, and functional activity.
To the extent that it is uneducated the man is blind,
and of necessity is groping in the dark.
"
The untaught ear has no use for the beautiful mechan-
ism that adapts the organ to receive the varied impres-
sions of sound. It can hear thunder, and it can hear
noise, but to the "concord of sweet sounds it is deaf.
In medicine the ear requires education by use in order
to detect some of the minute sounds, as the " respira-
tory murmur," and a still further education to detect
the minute shades of difference in sound, which tell of
disease.
-
The same may be said of the educated senses of smell
and taste. The uneducated nose may recognize the
genus stink, but has no power of analysis; as it may
recognize fragrance, and have no pleasure from it. To
the uneducated taste all substances are savory, or un-
pleasant, and with this gross classification the sense is
satisfied. To the educated taste there is every grada-
tion of the one and the other, and a power of discrimi
38
STUDY OF DIAGNOSIS.
1
nation that is sometimes really wonderful in its acute
ness.
HOW MAY WE CULTIVATE THE SENSES ?--This is the
really important question, though the answer has been
partly given in the above study. We cultivate the
senses by continuously using them, and their education
is the work of months and years. We can always find
objects to exercise them upon, the training school is all
about us, and we have only to make intelligent use of
the facilities at our command. It is, well, however, to
have an intelligent plan, and follow it up assiduously,
recollecting that "time, patience and perseverance will
accomplish all things."
The senses are intimately associated with the brain,
and their education implies a mental training as well.
Whilst we develop the organ of sense by use, we develop
the brain upon which the impression is made, and the
higher brain which takes cognizance of, and analyzes
the sensations. The development is thus a double one,
and both are essentials in correct diagnosis. A plan
presupposes thought, the act of the rational, mind, as
well as orderly activity.*
*SENSATIONS AND JUDGMENT.-(That the reader may have
before him a brief synopsis of the physiology of sensation, I give
the following description from Huxley's Physiology:)
"In explaining the functions of the sensory organs, I have
hitherto confined myself to describing the means by which the
physical agent of a sensation is enabled to irritate a given sen-
sory nerve; and to giving some account of the simple sensations
which are thus evolved.
"
Șimple sensations of this kind are such as might be produced by
the irritation of a single nerve-fibre, or of several nerve-fibres
by the same agent. Such are the sensations of contact, of
STUDY OF DIAGNOSIS.
39
:
:
THE TOUCH.-The tactile sense has its highest de-
velopment in the hands, and it is in this locality, espe-
cially, that we purpose cultivating it. Delicacy of touch
is associated with a normal condition of the skin, and
necessitates care of the hands. It does not mean a life
of idleness, but it means proper protection from cold,
cleanliness, and an avoidance of such work as thickens.
the epidermis, or gives it unnatural hardness. "Clean
hands and a pure heart" is a gospel expression that
we can well apply to medicine, both essentials. Show
me the physician with rough, unpleasant, grimy hands,
and I will show you the man who is unsuccessful in his
calling, and is being gradually imbruted in his nature.
The hand is the characteristic feature of man, and is
the outer expression of the reason within, and the
spirit that is above the beast. A French writer once
remarked, "Show me the man's hand, and I will tell
you what manner of man he is."
A plan of use? It suggests itself at once-we will
exercise our touch upon every object we come in con-
tact with. Here are objects large and small, long and
short, rough and smooth, of varied form, with special
inequalities of surface, of varied consistence, and we
warmth, of sweetness, of an odor, of a musical note, of whiteness,
or redness.
"But very few of our sensations are thus simple. Most of
even those which we are in the habit of regarding as simple, are
really compounds of different sensations, or of sensations with
ideas, or with judgments. For example, in the preceding cases,
it is very difficult to separate the sensation of contact from the
judgment that something is touching us; of sweetness, from the
idea of something in the mouth; of sound or light, from the
judgment that something outside us is shining, or sounding."
40
STUDY OF DIAGNOSIS.
purpose feeling them until we can recognize them as
well in the dark as in the light.
We take the bones of the skeleton, and learn to re-
cognize them by the touch as well as by the sight. Our
Profs. Freeman or Howe will tell you the bones as well
by touch as by sight. We take the dead body, and
train the touch to recognize every part, by its form and
resistance. We take the living body, and learn to re-
cognize the impressions given by the skin, fasciæ, mus-
cles, bones, and by the cavities of the body.
Attention has already been called to the necessity of
the skilled touch in the obstetric art. You know a ver-
tex presentation by the impression made upon the fin-
gers brought in contact with the head. You determine
fontanelles and sutures in the same way, and thus know
the position. The nates give a different impression,
and the finger recognizes the genitalia of male and
female, as additional evidence. It recognizes a shoulder
or elbow, a hand, a knee, or foot. How? Not intui-
tively; we have no natural knowledge of this kind, it is
cultivated. Shall we wait until in obstetric practice we
learn and acquire a skilled touch? That would be very
bad policy, especially for our patients. The sense of
touch is first trained by general use, and then we find
opportunity upon the child already born, to acquire the
knowledge of how a cranium, suture, fontanelle, nates,
genitalia, shoulder, elbow, hand, knee, foot, feels-it is
easy enough to find the opportunity, if one is inclined
to learn, and it is easy to get this necessary skill in
obstetric diagnosis if one is inclined to improve his
opportunities.
SIGHT.—The sense of sight is one of the most impor-
tant in diagnosis, and it, like others, requires education,
STUDY OF DIAGNOSIS.
41
both as to the eye which receives and the brain upon
which impressions are made. The eye receives im-
pressions of color, and by education learns to detect
the form, size, distance, and many of the physical prop-
erties of objects.
Color being one of the prominent characteristics of
health and disease, the ability to accurately distinguish
colors must be a great aid to the physician. The un-
educated eye receives the impress of color very much
as it does light and shade, attaching about the same
meaning to it, but when trained by use, it readily de-
tects slight variations.
It is quite easy to form a cabinet of colors, from
natural objects which may be studied in detail, and
this is suggested to the reader in preference to giving
the color sheets here as first intended. The vegetable
and insect worlds furnish them in great abundance, and
specimens can be readily preserved. Quite soon the
eye has learned to distinguish color from light and
shade, and in a few weeks will become quite skilled,
and yield much pleasure by the habit of observation
thus acquired. There is nothing trivial in nature, and
nothing so poor or worthless that it should not be
known; this is especially true to the physician because
he must be a student of nature, to be able to deal with
nature's greatest work, the human life.
The practical education of the eye to color is com-
pleted upon the human body. We find distinct varie-
tics of color in health-of skin, of mucous membranes,
of parts where the circulation is superficial, showing
arterial blood, of veins, of the eye, the nails and the
hair. We want to learn to know the healthy man by
his color, and we may know him by this.
1
· 4
42
STUDY OF DIAGNOSIS.
+
There is also abundant opportunity to educate the
eye to the variations of color in disease, so that they will
be readily recognized, and their true meaning known.
We may procure types of these morbid colors, so that
we will be enabled to refresh the memory with them.
Some of these will be given further along in this work,
but the reader is advised to select samples of other
colors for himself.
The training the eye to the determining of size is not
so important, yet will be found quite useful. One phy-
sician will recognize a swelling, which evidences local
disease, which another has failed to notice. So one
will recognize a fullness of skin, of cellular tissue, of
mucous membrane, of tongue, which another fails, to
see.
Training the eye to recognize form is very important,
both to the physician and surgeon. The trained eye
of the surgeon at once detects a deformity, and deter-
mines its cause, whether from fracture, dislocation, or
structural disease. The trained eye of the physician /
should be able to recognize at once the general form of
health, in the posture and expression of the patient,
and the evidences of disease in the changes of form, in
position, in sitting, lying, in the position of the limbs,
and in the expression of the features. The trained eye
recognizes changes in the form of the tongue, which
express conditions of disease, and call for special reme-
dies.
HEARING.-Physicians do not seem to have realized
the importance of the ear in diagnosis. It is true that
we have a system of physical diagnosis for diseases of
the chest, which the student is advised to learn; but,
STUDY OF DIAGNOSIS.
43
unfortunately, the advice is not supplemented by the
lesson we are trying to teach-that these organs must
be educated. The student applies his untrained ear,
and hears nothing, or is unable to distinguish variations
in sound, and becoming disgusted, gives physical diag
nosis over to the expert or the specialist. Even if he
persists in trying to learn, he finds that he can not hear
the sounds described in the books, (simply because there
are no such sounds produced), and is thus discouraged.
concourse of
All nature is vocal with sound, and the sounds are
the expressions of life. The old Hebrew poet recog-
nized this fact, and gives expression to it—even “the
morning stars sang together." All nature is vocal with
sound, but to the uneducated ear it might quite as well
be still, for it expresses naught to him. Train the ear,
and educate the brain, and we have a
sweet sounds," taking the entire range of life, express-
ing all its feelings, its hopes, its fears, its griefs, its
cares, its pleasures, its pains. It recognizes the love
song of the bird, the tone of wedded bliss, the gush of
parental affection, the cry for assistance, the shriller cry
of assault, the song of victory, the wail of defeat, and
the moan of death.
There is a fascination in the study of sound when
once commenced, that will carry the observer on, and
he will find a continued reward from it. If we take up
the single study of the expression of animals in their
cry, we find it of wonderful interest. We learn to re-
cognize the speech of bird and beast, though we may
not have slept with the fairies, as did the little boy of
old. The cry of pain in the animal kingdom is so ex-
pressive, that it will be recognized at once, and pretty
soon we will find ourselves locating and giving charao
44
STUDY OF DIAGNOSIS.
TUDY O
ter to the disease by this expression. One of the most
striking examples of this I have ever witnessed, was in
the case of a pet goat that was poisoned by eating
paint. The cry was as expressive as that of a child,
and one involuntarily located the wrong in the intes
tinal canal-it was lead colic.
"Ears ye have but ye hear not," is applicable to the
physician in ordinary. He is diligent in questioning
the sick, and seems to think there is wisdom in the
thoughts of the poor sick brain. The expressions of
the voice, which tell the condition of the brain, and of
the life of the man, to a considerable extent, is never
heard, the doctor is deaf.
In auscultation, the first lesson is in learning to hear.
It requires close and continued study to hear the respi-
ratory murmur distinctly, and this study must be con-
tinued if we expect to recognize the variations of this
and the sounds produced in the bronchial tubes. Skill
in physical diagnosis does not come by nature; it is the
result of study, and the education of the ear and brain.
No man can expect to succeed in it unless he is willing
to give months to it, first to educate the ear to the hear-
ing and analysis of sound, and next to the hearing and
analysis of the sounds heard in the chest.
SMELL. Of still less importance is the sense of smell,
and yet it has its place in diagnosis. A good nose is a
good thing, and the sense of olfaction should not only
be a safeguard to the individual, warning him of noxious
influences, but should be a source of pleasure as well.
To some extent this sense is instinctive, especially as it
warns against irritant substances, and leads to their
avoidance. But it is one that may be educated to a
STUDY OF DIAGNOSIS.
45
▼
very high degree. We have examples of this in some
varieties of merchandising. The wine merchant grades
his wine by its boquet, as well as the taste. The tea
dealer will classify his wares, and price them, by their
odor, as will the fancy grocer with a majority of the
edibles he deals in.
We want a good nose for the purposes of diagnosis,
and we especially want a good nose that it may look
after the hygienic surroundings of our patients. There
is an abundance of bad smells about the sick room,
some peculiar to the condition of disease, and some the
result of want of cleanliness and ventilation. We want
to know them, and to do so we require an educated
nose.
What is an educated nose? It is one so trained by
use that it transmits sensations to the brain, which has
also been trained by use to receive and analyze them. In
other words, it is the association of brain and nose in
the work. This sense is educated in the same manner
as the others. We find odorous objects, and use this
sense in their cognition. Pursuing the study we learn
to discriminate between odors, and to recognize them
immediately, and the character or condition of bodies
they express.
It will require but little training to enable this sense
to detect the unpleasant surroundings of a patient. The
first impression of the air of the sick room tells of a
want of ventilation, of a deficient supply of oxygen, a
superabundance of carbonic acid gas, and a surplus of
foul gases. The nose not only recognizes these wrongs,
but will insist upon their abatement. It says, open the
windows and doors, let in the sunlight, build an open
fire, and wash up. There is no mistaking the language,
46
STUDY OF DIAGNOSIS.
f
and the physician feels that he must carry out its
orders.
It recognizes a want of bathing upon the part of the
patient, dirty clothing, dirty bed-clothes, a foul chamber
utensil under the bed, dirty dressings, dirty or bad
food, dirty medicines, and says in unmistakable lan-
guage, get these things away. "Cleanliness is next to
godliness," and of far more importance in the recovery
of the sick.
It will also point out conditions of disease, and talk to
you of special medicines. It says, typhoid, sepsis, loss
of life and breaking down of tissue plainly; and sug
gests for your consideration an individual of the group
antiseptic chlorate of potash, sulphite of soda, sul-
phurous acid, carbolic acid, baptisia, permanganate of
potash, etc.
TASTE.-Whilst the sense of taste is a good thing,
and should be well cared for, we do not propose to
make much use of it in medicine. It is well, however,
to use it upon the food prepared for the sick, because
we find a great many wrongs here. People have not
lost the old impression that the sick need no food, and
that it makes but little difference what kind is given, or
how it is prepared. If the physician does not look
after this, he will find many times that his patient is
being starved because food is unpalatable, or so badly
prepared that it is indigestible, or so changed in char-
acter, that it really does the patient a wrong.
If the physician has a right appreciation of the ne-
cessity of good food, and the nurse or friends know
that he will make it his business to look after it, and
see that it is well prepared, they will probably use
1
STUDY OF DIAGNOSIS.
47
more care, and will ask for information when it is re-
quired.
There are some things that the physician will do well
not to cultivate a taste for or in. He should not be a
connoisseur in liquors. It is far better that the patient
run the risk of getting bad whisky, brandy, or wine,
than that his medical attendant should have acquired
the ability to determine for him. If there is any one
road shorter than another to want of success, loss of
character, poverty and wretchedness, it is the habit of
tippling. The road seems especially broad, smooth and
direct to the doctor, and he may well apply the old
Latin quotation from Virgil: "Facilis descensus Averni";
and the second line-" but to escape is indeed a work
of difficulty."
We have thus briefly examined the means by which
one is prepared for the practice of medicine. The
reader will have noticed that we place great stress on
self-education, as the basis of skilled diagnosis and
therapeutics. All knowledge is available in medicine,
and we do not wish to depreciate the ordinary medical
course of study, and would advise that the study of
medicine and the collateral sciences should be carried as
far as possible-and it is possible, even with the busiest
man, to make very considerable attainments outside, as
well as inside the range of studies usually pursued.
Still, unless the physical organism be trained to use,
our other education will prove a dead letter. It is the
means that brings man in relationship to, and gives him
cognizance of his surroundings and the world at large.
He not only has knowledge of things through his
senses, but his practical knowledge is in proportion to
their education and acuteness.
f
48
STUDY OF DIAGNOSIS.
In the study of disease it will be best to change the
order in which we have noticed them here. The phy-
sician sees his patient first, and then the examination
commences with the sight, touch, hearing, smell, taste.
This may be regarded as the natural order, and we will
observe it in the further study of the subject.
THE USE OF THE SENSES IN THE DIAG-
NOSIS OF DISEASE.
It is well to notice that we have a two-fold object in
studying. We wish to determine the locality and
nature of disease-its pathology; but we also wish to
determine those agencies which will oppose disease and
restore health-its therapeutics. These are both im-
portant studies, and we do not wish to neglect either,
yet the reader will see that the last is the practical one.
If we can determine what will cure, we have accom-
plished the important object of medicine.
The means of cure have held a secondary place in
medicine, and indeed it seemed sometimes that it held
no place. Physicians would be very learned as to
patliology, and able to divide and subdivide the lesions
of function and structure until they would be “ an im-
mense multitude," yet you could count their remedies
upon your fingers, and these were of the olden time,
devitalizing, and most absurd. You would find an im-
mense volume on pathology and diagnosis, teeming
with wisdom, and a therapeutics meager and feeble in
everything but its power to do harm.
STUDY OF DIAGNOSIS.
In this study we wish to make therapeutics occupy
the first place, and the diagnosis will mean remedies,
whenever this is possible. We do not care so much to
affix a name, by which the wrong may be known, as to
prefix a remedy by the means of which the disease will
not be known. Or to put it in plainer form, the object
ɔf examination is to determine what will cure.
It is my opinion that we can so study disease, that
its symptoms or expressions will talk to us of individual
remedies, and in language so plain that it can not be
misunderstood. As this is the first object of study, we
will keep it constantly in view.
DIAGNOSIS BY THE EYE.
The educated eye requires no prompting to do its
work in the examination of the sick-its training is to
this end. It takes in the appearance of the patient and
his surroundings in all their detail. An effort of the
will is required to make the mind attentive, and to co-
ordinate the impressions, and reach conclusions from
them.
It would seem unnecessary to say
that many
many conditions
of disease find outward expression through the muscu-
lar system and its investing connective tissue and skin,
and that the physician should recognize them as soon
as his eyes have made their examination, and yet the
study of medicine is pursued as if this were not so.
The doctor is very eager to see the patient's tongue and
feel his pulse, and ask all manner of questions pertinent
and absurd, but he is blind to these natural expressions,
or if he learns, it is slowly and because the facts are
5
50
STUDY OF DIAGNOSIS.
1
forced upon his consciousness. The reason is obvious-
his attention has never been directed to it, and he has
failed to study the subject as it was presented to him
in practice.
This study requires an exercise of the mind, and that
the reader may commence thinking to advantage, we
will take some very familiar examples in the animal
kingdom. Let us see, for a moment, how animals ex-
press emotion (the action of the mind in so far as it is
developed). If you notice your dog or cat for a few
days, you will see the clear expression of the entire
range of the emotions, anger, fear, love, hate, joy, grief,
consideration, conclusions reached, etc., and so plainly
that you can make no mistake. Examine your horse,
and you will find the same clear and striking language
of expression. It is really wonderful, this voiceless
language of animal life, and well repays study.
Supposing now we study the expression with refer-
ence to rest. You notice the dog taking his siesta, and
carefully scan his posture and feature, and the idea of
rest is so strongly impressed that you are sure you
could not be mistaken. Whistle sharply, and notice the
change to a position and expression of activity and ex-
pectant attention. Give his ear a sharp pinch, and you
will see the evidences of pain as clearly as you would
in the expression of man.
Think of the sickness you have seen among animals.
The cat or dog with a "sick stomach "—before they
have made an effort at vomiting you have jumped for
the door to let them out. In ordinary ailments the
drooping head, ears and tail, the expressionless eyes
and face, and indeed the entire want of muscular ex-
pression, tells the story of impairment of life. Take
STUDY OF DIAGNOSIS.
51
an irritative disease, of the intestines for instance, and
the marked contraction of muscular tissue; the rough
ened coat, the strong drawn lines of the face, the re-
tracted lips, tell you the kind of wrong.
Would you know if your horse was sick by his ex-
pression? I think you would, and if the subject had a
little study you would know the kind of sickness as
well. If you found him in the morning with drooping
ears and tail, expressionless eyes and nose, you would
bardly take him out for a day's ride. You recognize
the expression of exhaustion from over-work, and feel
so much for your companion that the stable is visited
before retiring, and you probably know from his pos-
ture and expression in the stall whether he is resting,
or in a condition that precludes rest.
If in driving you notice the ears drooping or turned
backward continuously, you know there is something
wrong. That the one means a wrong of exhaustion,
and the other a wrong of irritation. If you notice his
tail fall helplessly between his legs, you feel sure he is
in no condition for work, is suffering from exhaustion.
Suppose you observe an unnatural twist in his tail to
one side, and you are quite as sure he is sick, the dis-
ease one of irritation, probably colic.
Carry this observation a little further, and watch the
process of labor in animals, and you will be still more
surprised at the wonderful mechanism of voiceless ex-
pression. You will be able to read the history as plainly
as if expressed in language. The process of dilatation,
the expulsive second stage, the tedious and difficult
labor, the irregular and inefficient uterine contractions,
the rigid soft parts, etc. Let us watch the case of a
cow with puerperal fever, (yes, she has puerperal fever,
52
STUDY OF DIAGNOSIS.
and other puerperal diseases as has the human mother),
and you will see every phase of suffering, and see it so
distinctly that you can not forget it if you would.
You notice a horse put out one of his feet in stand-
ing, and at once you think of disease. By the expres-
sion of the leg and its position, your accomplished
horseman will locate the wrong for you; telling you
whether it is in the shoulder, leg, knee, in the lower
articulations, or in the hoof. How does he tell? Be-
cause the leg has a language, and he has learned it.
I have cited these examples as subjects of thought.
This study requires thought, and the doctor is so little
in the habit of right thinking with reference to human
disease and diagnosis, and so certain that everything
must be known, that it is better to get a basis for
thought outside. If the reader recognizes the truth of
these statements, and can confirm them by observation,
he will say at once-"if disease is thus clearly ex-
pressed in the lower animals, there must be similar ex-
pressions in man, and the subject is well worth my
attention." Disease has a voiceless language, and it is
this we wish to study, but in order to do so successfully,
the reader must get a basis for thought, commence to
think of it, and find his illustrations in every-day life.
It is well to have clearly before us at the commence-
ment, the objects of the examination, and the facts that
may be determined; they may be classified as follows:
1st. The right life that we designate as health; 2d. The
wrong of life that we call disease-the amount of vital
impairment; 3d. The condition of rest; 4th. The con-
dition of unrest; 5th. Disease of excitation; 6th, Dis-
ease of depression; 7th. Pain; 8th. The evidence of
local disease, both as to structures involved, and kind.
STUDY OF DIAGNOSIS.
53
DECUMBENCE. In acute disease, the impairment of
life is usually such that the patient assumes and keeps
a horizontal position, as this requires the expenditure of
much less power than any other. We use the term de-
cumbence in preference to the old medical one, decubi-
tus, and it is defined by Worcester as "The act, or the
posture of lying down, prostration." In health the de-
cumbent position is associated with the idea of rest,
and when assumed at unusual times, with the idea of
debility. Thus the first idea obtained from seeing the
patient in bed is, that there is impairment of life. It
would be a blessing to the sick if the physician could
get this fact so thoroughly impressed, that he would re-
fuse to depress the life still more by the administration
of drugs.
Evidently this fact is one of much importance, and
whilst the general expression may not be absolute evi-
dence, it is among the best we have. If in acute dis-
ease the patient keeps his bed all the time, there is con-
siderable impairment of life. If in ordinary chronic
disease we find the patient frequently assuming the de-
cumbent position, and maintaining it for a considerable
time, we have to consider it an evidence of enfeeble-
ment, and we husband our patient's strength, and em-
ploy the class of remedies known as restorative, with
appropriate food.
Studying the patient's expression in bed, we find that
it gives us additional information. If he lie on his
sides, changes his position readily, holds his shoulders
and extremities in position, we conclude that the im-
pairment is not great as yet. But if we see him in-
clined to lie upon the back, or if upon the side that the
shoulder falls forward or down, the arm falls and is
54
STUDY OF DIAGNOSIS.
expressionless, the upper leg and hip show the inclina-
tion to fall, and even the soft tissues of the face droop,
we are certain there is great impairment of life, and the
treatment must be conservative and restorative. In the
worst case, where the patient lies continuously upon his
back, and is inclined to slip toward the foot of the bed,
physicians usually recognize the approach of death.
There can be no mistake about the importance of the
inquiry, or the character and certainty of these expres-
sions. If we know that the life is feeble, we will care-
fully husband it, and guard against unnecessary expen-
diture. If we know the life is feeble, we will be sure
to avoid unpleasant and harsh medicines, especially the
class antiphlogistic. If we know the life is feeble, we
will appreciate the importance of keeping the digestive
organs in good condition, and giving the necessary
food. If we know the life is feeble, and we have any-
thing in our Materia Medica that will aid and strengthen
it, we will realize the importance of its use.
To determine the condition of rest or unrest is of
great importance. When a man or a part is sick, rest
is necessary to recovery, and very much of the treat-
ment used looks to procuring rest. The position of de-
cumbence is assumed to get rest, yet we find that many
times it is not sufficient. It is well to know that we
have to think of this with reference to sleep as when
awake, for though sleep usually means rest in health, it
may not give rest in disease.
It is well to get an idea of perfect rest in health, as a
standard of comparison. Observe the child sleeping,
and the perfect equipoise of the entire muscular system,
and the natural position of the extremities show the
condition of rest. Even when the child falls asleep in
STUDY OF DIAGNOSIS.
55
a constrained and unnatural position, the body so
adapts itself to it, that we have the idea of rest. A
group of harvest workmen, taking their noonday rest
on the grass under the shade of a tree, will give every
shade of this restful expression, and is well worth our
study. We learn something here that can not be told
in words, but which serves as an excellent standard of
comparison at the sick bed. Notice the position of a
healthy person in sleep, especially how the body accom-
modates itself to bed and pillows, so that one position
will sometimes be maintained the whole night, with
rest to every part.
Now when we come to examine the sick, the condi-
tion of unrest is clearly expressed. The body does not
accommodate itself to the bed, and the effort to main-
tain the position shows itself in the constraint of dif-
ferent parts. We see it in the evident contraction of
the cervical muscles to hold the head in position; in
the unnatural flexure of the extremities to maintain the
body and themselves in position. We have every
gradation of these expressions, from that which comes
some time after the position of the body has been
moved, when the patient is tired, to that which is so
continuously marked, that we know the patient has not
one moment's rest.
The position of the body also tells us something with
reference to the fifth and sixth propositions-whether
the disease is one of excitation or depression, especially
as regards the circulation. This also is an important
element in diagnosis, and refers us to appropriate remo
dies.
Te condition of excitation is marked by constraint
and indue contraction. We notice it in the expression
}
56
STUDY OE DIAGNOSIS.
of the entire person, and of special parts. In the first
it has reference to the entire body, in the second it is
more the expression of local disease. The ideas that
we get is of want of ease, and of constant effort on the
part of the muscular system to obtain it. An unusual
· and constrained position of one or more of the extremi-
ties is quite a common expression. It may be but
flexure of one leg, throwing it out or from the body, or
a contraction and elevation of one shoulder, or a prone
fore-arm and hand with marked muscular contraction,
or an unpleasant constrained position of the head, with
prominence of the cervical muscles, or we may have it
in facial expression. Once the mind is directed to it,
these features are quickly learned, and having the
knowledge of health, we quickly determine the extent
of the lesion.
The evidences of enfeebled function-depression, are
just the opposite. Whilst in the previous case, we have
an unusual excitement of the nerves, and of the vascu-
lar systems, in this we have deficient innervation, and
impaired circulation. In this there is want of expres-
sion, the body lies, so to speak, as if no effort were made
to hold it in position; parts fall of their own weight.
This want of expression is noticed especially in the
subcutaneous muscles, and in the skin, giving an un-
pleasant uniformity of surface, and a sodden expression
to the soft tissues.
PAIN, or suffering, is expressed in every portion of
the body, and one may learn to recognize it as soon as
the eyes strike the body, and yet it would be difficult
to describe the expression. When pain is associated
with, or the result of undue excitation, the expression
will be that just named under this head. But if asso
STUDY OF DIAGNOSIS.
57
1
ciated with, or the result of an enfeebled condition,
either of the entire body, the part suffering, or the
brain, the general expression may be quite the reverse,
and will more resemble the exhaustion that follows ex-
cessive grief-one of anguish.
As has been clearly shown by Darwin,* expression is
most marked in those muscles in most common use, or
those associated with mental activity. Thus we would
*I have now described, to the best of my ability, the chief ex-
pressive actions in man, and in some few of the lower animals.
I have also attempted to explain the origin or development of
these actions through the three principles given in the first chap-
ter. The first of these principles is, that movements which are
serviceable in gratifying some desire, or in relieving some sensa-
tion, if often repeated, become so habitual that they are per-
formed, whether or not of any service, whenever the same desire
or sensation is felt, even in a very weak degree.
Our second principle is that of antithesis. The habit of volun-
tarily performing opposite movements under opposite impulses
has become firmly established in us by the practice of our whole
lives. Hence, if certain actions have been regularly performed,
in accordance with our first principle, under a certain frame of
mind, there will be a strong and involuntary tendency to the
performance of directly opposite actions, whether or not these
are of any use, under the excitement of an opposite frame of
mind.
Our third principle is the direct action of the excited nervous
system on the body, independently of the will, and independently,
in large part, of habit. Experience shows that nerve-force is
generated and set free whenever the cerebro-spinal system is ex-
cited. The direction which this nerve-force follows is necessarily
determined by the lines of connection between the nerve-cells,
with each other and with various parts of the body. But the
direction is likewise much influenced by habit; inasmuch as
nerve-force passes readily along accustomed channels.
"
58
STUDY OF DIAGNOSIS.
expect to find the most marked expression in the face,
and next probably in the hands and the extremities.
If the reader will think for a moment, he will probably
recall distinct expressions in these forms. He will
especially recollect the common expressions of pain in
the muscles of the orbits and frontal region from con-
traction of the corrugator supercilii, some of the fibres
of the occipito frontalis, the orbiculars, and sometimes.
the zygomatic. His attention will only need be called
to the forced contraction of the flexors of the hand
during labor, the involuntary expression of pain, and
to similar contraction in the feet. Indeed here is a
most excellent study, and one may learn the natural
history of pain by closely observing a few labors.
There is nothing like having a familiar example for
study, and we may look still further at the phenomena
of childbirth. I need hardly say that these expressions
have the same meaning as in ordinary disease, though
here we find them greatly intensified. Possibly we will
get as good an idea of rest during the absence of pain
in a natural labor, as we can get anywhere. And in a
difficult labor we will get as distinct an idea of the state
of unrest. We observe the pain finding expression in
marked muscular contraction of the muscles of the
upper and lower extremities and the forced flexion of
the muscles of the hands and feet. We also see the ex-
pression of pain in the countenance, but in natural
labors it is evanescent and not very marked. In diffi-
cult labors, especially where the pains are inefficient, we
find the constant contraction of the "muscles of pain,"
and it is one of the evidences of this condition.
The evidence of local disease will be found in the po-
sition of the body with reference to removing pressure
STUDY OF DIAGNOSIS.
59
from the part, or giving it support. This is sometimes
so distinct that the attention is at once directed to the
affected part. If the position of the body is such as to
take off muscular pressure, we conclude that the disease
is one of excitation. If, on the contrary, the position is
such as to give additional support, we would think of
it as being one of impaired innervation and circulation,
possibly congestion. A man gives a diseased leg rest
in the same manner as a horse. Flexion takes off ten-
sion, and if the disease is one of irritation, the limb is
flexed. Disease of bladder or rectum will be indicated
by flexure and, crossing of one thigh over the other.
Disease of the abdominal viscera, by flexion of the
thighs upon the trunk and probably flexion of the trunk.
Disease of one kidney will be announced by flexion of
the body on the affected side. Disease of stomach by
marked flexion of the trunk, and relaxation of the ab-
dominal muscles and diaphragm, and thoracic respira-
tion. Disease of one lung will be indicated by the
flexion of the body on the affected side, and the droop-
ing of that shoulder. Disease of the upper lobe of the
lungs will be indicated by the falling of the shoulders
forward, the additional curvature in the upper dorsal
and cervical spine, and by abdominal respiration.
A very natural expression of disease is the involun-
tary movement of the hand to it. In typhoid fever,
when the patient is seemingly wholly unconscious, we
find the hand over the bladder in retention of urine, as
it seeks the umbilicus when disease of Peyer's patches
is marked. The child suffering from disease of the
ear involuntarily carries the hand to the affected part.
In acute disease of the kidneys the hands are carried to
the loins. In some gastro-intestinal disease the hands
60
STUDY OF DIAGNOSIS.
sometimes go to the mouth, and it seems as if the child
wanted to get something out of its throat. It is always
well in low forms of disease to carefully watch these
expressions, as they give us early intimations of local
trouble. And in diseases of children, when we have to
depend almost wholly upon our own observation, it is
also well to carefully observe every expression.
FACIAL EXPRESSION.-The fact has already been no-
ticed that mental states find easiest expression in the
usual channels of innervation, and through those mus-
cles in common use. This is not only true of mental
activity, but is also true of disease. There is no disease
without a wrong of the nervous system, and I think I
may add with truth, that there is no wrong of life that
is not represented upon the surface through the nervous
system. We may not be able to read it, because our
senses have not been trained to observation, and we
have not sufficient experience, but the fact that disease
is thus expressed should stimulate to study.
The face will show clearly the right life that we call
health; and the wrong life we call disease. If one will
closely study the expression of the face in health, and
compare it with the expression seen in sickness, this
fact will be clearly seen. It not only tells us of im-
paired life, but also of the kind of impairment, and of
the remedies that will remove the wrong, and restore
health. It will be well to make this study with refer-
ence to-1st. The condition of the brain; 2d. With
reference to the condition of the sympathetic nervous
system, and associated spinal cord; 3d. With reference
to the condition of the circulation and the blood; 4th.
With reference to local disease; 5th. With reference to
pain; 6th. Resistance of disease.
1
STUDY OF DIAGNOSIS.
61
+
The CONDITION OF THE BRAIN is very clearly ex-
pressed in the face, and we have learned quite a good
deal of its language. We may subdivide this study
into-a. With reference to the circulation, determiuation
of blood, congestion, inflammation, effusion; b. The nu-
trition of the brain; c. Its functional activity.
DETERMINATION OF BLOOD is marked by flushed face,
bright eyes, contracted pupils, and general but moderate
contraction of the facial muscles. The expression is
one of excitation, and the patient is restless and uneasy.
The direct remedy is Gelseminum. The indirect
means are those which relieve vascular excitement, and
the old-fashioned derivatives-counter-irritation, etc.*
CONGESTION is marked by dull eyes, dilated pupils,
immobile pupils, expressionless face, patient dull, in-
clined to sleep, and eventually coma.
*A bright and sparkling eye is as characteristic of a pleased or
amused state of mind, as is the retraction of the corners of the
mouth and upper lip with the wrinkles thus produced. Even the
eyes of microcephalous idiots, who are so degraded that they
never learn to speak, brighten slightly when they are pleased.
Under extreme laughter the eyes are too much suffused with tears
to sparkle; but the moisture squeezed out of the glands during
moderate laughter or smiling may aid in giving then lustre;
though this must be of altogether subordinate importance, as they
become dull from grief, though they are then often moist. Their
brightness seems to be chiefly due to their tenseness, owing to the
contraction of the orbicular muscles and to the pressure of the
raised cheeks. But, according to Dr. Piderit, who has discussed
this point more fully than any other writer, the tenseness may be
largely attributed to the eyeballs becoming filled with blood and
other fluids, from the acceleration of the circulation, consequent
on the excitement of pleasure. He remarks on the contrast in
the appearance of the eyes of a hectic patient with a rapid cir-
STUDY OF DIAGNOSIS.
+
The direct remedy is Belladonna. In some cases,
and when associated with local disease with impairment
of the involuntary muscles, Ergot The indirect means
are counter-irritation, dry or wet cupping, stimulant
cathartics.
An intermediate hyperomia, observed in apoplectic
conditions is marked by fullness of eyes, which are
protruded, fullness of face, prominent veins, and from
contraction of the platysma a drawing down of the face
and angles of the mouth.
For this condition the direct remedies would be
Ergot, Lobelia in stimulant doses, Apocynum. The in
direct remedies, dry or wet cupping, stimulant hydra
gogue cathartics.
INFLAMMATION is marked by still greater contraction
of the muscles, especially those of the orbits and the
frontal region, the deeper flushing of the face, the
sharper expression of the eyes, which are dry and
pinched, the contracted pupils, and as the life is im-
paired, by the appearance of constriction of all the tis
sues around the base of the brain.
The direct remedies in the first stage of an inflamma-
tion of the brain are: The proper sedatives, Aconite or
Veratrum, and Gelseminum. These may be followed
and aided by such as increase the action from skin, kid-
neys and bowels. The indirect remedies are such as
may call the excitation to other parts.
culation, and of a man suffering from cholera with almost all the
fluids of his body drained from him. Any cause which lowers
the circulation deadens the eye. I remember seeing a man-
utterly prostrated by prolonged and severe exertion during a
very hot day, and a bystander compared his eyes to those of a
boiled codfish.—Darwin.
STUDY OF DIAGNOSIS.
63
EFFUSION is marked by the dullness, and finally by
coma. The eyes lose their sharp, bright expression and
become dull; the muscles of the lower part of the face
relax, as do the muscles that move the inferior maxillary
and the mastoid. If the irritation still continues, the
contraction of the orbiculars and frontal muscles per-
sists, and the evident constriction or pinched appearance
around the base of the brain becomes more prominent.
If the irritation passes away with the effusion, these
muscles gradually lose their power, and the upper part
of the face assumes a dull, soddén appearance.
The direct remedies are small doses of Aconite and
Belladonna, alternated with Apocynum. The indirect
means will consist in cupping the spine, and the use of
a stimulant hydragogue cathartic.
The NUTRITION of the brain is not so easily deter-
mined, yet I think we may reach correct conclusions in
the majority of cases. The enfeebled nutrition will be
marked by a want of expression, especially in the mouth,
showing a want of decision. The eyes may have a
normal appearance at first sight, yet as we watch them
uncertainty is shown in their movements. In some
cases, the expression when the patient's attention is not
attracted, is very like that which follows exhaustion
from excessive emotion.
SOFTENING OF THE BRAIN, so called, will be marked
by a smooth, placid countenance, the want of expres-
sion in the forehead being especially marked. In some
of these cases the tissues have their ordinary fullness,
and sometimes the soft tissues of the face are unusually
full, yet they look soft and flabby, and hang in un-
natural folds.
ATROPHIC IRRITATION OF THE BRAIN is marked by
64
STUDY OF 'DIAGNOSIS.
i
the pinched and uneasy expression of the upper facial
muscles, the muscles of the orbits and the frontal region.
The patient holds his head in a constrained position,
frequently inclined to one shoulder, and the face turned
to one side, giving the eyes an unpleasant expression of
obliquity. The elevation of one eyebrow and the fall-
ing of the other, with an apparent divergence in the
axis of the eyes, will locate the lesion in or near the
cerebellum.
The evidences of structural disease vary with the situ-
ation and character of the lesion. They may be
divided into irritative and atonic, the one showing
marked contraction of some muscle or muscles of ex-
pression, the other a want of contraction, and conse-
quent fullness and drooping. Sometimes in the severest
structural disease there is no external expression.
The FUNCTIONAL ACTIVITY is very clearly shown in
facial expression, and we will observe the entire range
from normal function to furious delirium on the one
hand, and to entire loss of function and conscious life
on the other.
ACTIVITY is not only shown in muscular contraction,
but in alternate contraction—the play of the emotions—
of the muscles. This change of expression is one of
the most familiar examples of mental activity. In de-
lirium we observe that the play of the muscles is exag-
gerated, as indeed is the expression of all the emotions.
This is especially noticeable in the expression and
movement of the eyes, and their external muscles.
WANT OF ACTIVITY is expressed by want of contrac-
tion of the facial muscles; dull, immobile eyes, and full
lids.
The condition of the sympathetic nervous system is
¢
STUDY OF DIAGNOSIS.
65
}
pretty clearly shown by the eyes, the orbital muscles,
and the tissues about the base of the brain. The disease
of irritation is shown by the contraction of the tissues
which form the bed of the eye, the retraction of the
eye, especially upward, the thinned and constricted
eyelids, and the tissues about the temples. In some
cases the pinched or contracted alæ nasi is a marked
feature. The disease of atony is shown by the full, ex-
pressionless eyes, fullness of the lids, pallid and waving
alæ nasi, and fullness and want of expression about
the mouth.
A temporary want of sympathetic innervation that is
rectified by Podophyllin, is shown in the fullness of all
the tissues of the face, especially the upper portion, and
by fullness of the veins.
For the disease of irritation, I prefer Aconite, Rhus,
Bryonia, Muriatic Acid, Nitric Acid, the selection being
made by the other symptoms present. Temporary re-
lief is obtained by the local application of Chloroform
before and behind the ears, and over the first cervical
ganglion. The Chloroform is so applied as to prevent
evaporation, and a change in the pulse will usually be
noticed in a few minutes from its first application, and
the relief is marked, and very frequently it lasts for
some time.
The disease of atony is met by Nux, Phosphorus,
Quinine, stimulant doses of Lobelia, minute doses of
Podophyllin, Digitalis, more rarely Veratrum, the bitter
tonics and food.
Whilst the expression of the face will give us pretty
accurate information with regard to the circulation, we
may obtain this information more directly elsewhere.
If the cellular tissue is full, we think of Veratrum. If
6
66
STUDY OF DIAGNOSIS.
it is shrunken, Aconite. If the expression of the eyes
and associate muscles is dull, with fullness, we think of
capillary congestion, and Belladonna. If the cellular
tissue is full, the face expressionless, and the veins
prominent, Podophyllin. If the eyelids are especially
full, Apocynum. If the eyes have a pinched expres-
sion, dry in acute disease, secretion of tears in absence
of fever, dry, shriveled epidermis, flushed left cheek,
Rhus Toxicodendron. Right eyebrow drawn down, and
expression of eye changed, flushed right cheek, Bryonia.
These are the most prominent examples, and in each
case there is a wrong of the circulation, which may be
the predominant wrong. At any rate, the remedies
thus indicated will prove curative.
With reference to the condition of the blood, we may
find more direct expressions than in the face, yet these
are not unimportant. The sodden tissue evidences
poor blood and poor nutrition, as the firm elastic tissues
show good blood and good nutrition. The typhoid con-
dition of the blood will be clearly shown in the con-
tracted and opaque skin in the one case, and the sodden
inelastic tissues in the other. Pyæmia will show itself
first, in the marked contraction of tissue about the base
of the brain, sinking in of the bed of the eyes, and espe-
cially by retraction in the upper part of the orbit.
Some local diseases are clearly indicated by facial ex-
pression. Disease of the respiratory apparatus will be
shown by the expression of the nose and accessory
muscles. The lesions of irritation by contraction, the
lesions of atony by relaxation. Any one who has
watched the progress of an acute inflammation of lungs,
of pleura, of bronchia, with irritative cough, must have
seen the pinched expression of the nose, and the con-
STUDY OF DIAGNOSIS.
67
}
traction of the alæ. So marked is this, that sometimes
it seems to precede the trouble, and will be marked, be-
fore the disease of the respiratory apparatus has full
development. The relaxed and waving alæ nasi gives
an unpleasant impression of disease, and as before
named, has reference to the lesion of innervation, as
well as to impairment of the respiratory function.
The expressions of the mouth are associated with dis
ease of the abdominal and pelvic viscera. Let us take
the familiar examples of intestinal worms as an illus-
tration. The full upper lip, with pallor, the white lines
around the mouth, and picking the nose, is the most
pronounced evidence of ascaris lumbricoides. This
worm inhabits the small intestine, and the conditions
present are atony of mucous membranes, with impaired
function, and increased secretion of mucus, and at once
we think of the associated symptoms and the intestinal
wrong.
The remedies will be those which will give normal
stimulation to the structures involved, Podophyllin,
Santonine, some of the ordinary cathartics, the sto-
machic bitters, and sometimes the alkaline salts, or
acids, as may be indicated by other symptoms.
If fullness in this case means atony and impaired
function, and increased mucous secretion, it must mean
it always, and we will always think of such remedies
as will influence the small intestine and associate viscera,
giving normal stimulation and circulation, and restoring
functional activity. There is a peculiar expressionless
mouth, or an expression of "loss of spirits," with a little
depression of the angles of the mouth, that invariably
means Nux Vomica.
Nausea is shown by depression of the angles of the
-
68
STUDY OF DIAGNOSIS.
mouth, and slight incurving of the lower lip. If the
tissues are full, we know that there is atony; if pinched
and shrunken, that there is irritation and determination
of blood.
It is a singular fact, and one not heretofore noticed,
so far as my reading extends, that simulation of these
expressions will provoke sensations in the parts referred
to. The instance just given affords a marked example.
Let a person draw down the angles of the mouth and
incurve the lip, and he will be quite certain to feel
nausea after a time. In two persons who tried it the
sense of nausea was very marked; in one producing
vomiting, in the other an arrest of digestion and head-
ache. Try to simulate the frontal expression of pain,
and it will be singular if you do not wake up unpleasant
sensations somewhere, perhaps real pain.
Contraction of the orbicularis oris is usually found in
some diseases of the reproductive organs, especially of
the female. In chronic disease, there is distinct retrac-
tion from the other muscles of the face, and the entire
tissues seem thinned. In some of these cases the zygo-
matic muscles are also prominent.
ی مردان
PAIN AND SUFFERING are distinctly expressed in the
features, yet not always in the same way. Firm con-
traction of muscles is the most common expression.
Thus every reader will recollect the contracted brow as
evidenting pain, especially pain with irritation of the
nerve centres. We involuntarily associate contraction
of the structures about the eyes, and the wrinkled skin,
with pain, or with suffering. But we have the evidence
of pain in this region without muscular contraction;
indeed there is the reverse, drooping of the tissues, the
expression is sad, of the exhaustion that follows exces-
STUDY OF DIAGNOSIS
69
sive grief, and we are assured that there is enfeebled
circulation in the brain, and the pain is the expression.
of atony.
It is very important to make these distinctions in
order to select remedies. Pain
Pain is the result of two very
opposite conditions-an excited circulation and an en-
feebled circulation. In the one case we use Gelsemi-
num, the sedatives, salines, Rhus, Macrotys, Bryonia,
as may be indicated. In the other we use Quinine,
stimulant doses of Opium, Nux, stimulants, tonics,
beef tea or other histogenetic food.
Pain in the abdomen, pelvis, or lower extremities,
finds expression in the mouth. Acute pain almost
always finds expression in contraction of the mouth;
when very severe the lips are firmly drawn in, the
angles of the mouth retracted, and somewhat depressed.
In some other cases, the angles of the mouth are drawn
in, and there is that action of the muscles of the upper
lip that gives it and the cheeks a full expression.
I hardly need call attention to the fact, that some
patients resist disease by an influence of the will, and
that sometimes this effort is very important. Others
yield to it from the first, and thus favor its progress.
Every one has made these observations, and will recog-
nize the importance of knowing whether a patient re-
sists or yields, as it may determine whether he will re-
cover or die.
Darwin remarks that-"The firm closure of the
mouth tends to give an expression of determination or
decision to the countenance. No determined man
probably ever had an habitually gaping mouth. Hence,
also, a small and weak lower jaw, which seems to indi-
cate that the mouth is not habitually and firmly closed,
70
STUDY OF DIAGNOSIS.
is commonly thought to be characteristic of feebleness
of character. A prolonged effort of body or mind im-
plies previous determination; and if it can be shown
that the mouth is generally closed with firmness before
and during a great and continued exertion of the mus-
cular system, then, through the principle of association,
the mouth would almost certainly be closed as soon as
any determined resolution was taken.”
I do not think any one can make a mistake here, and
certainly it is important to know whether the patient is
inclined to resist disease, and is determined to get well,
or whether he is yielding, despondent, hopeless. The
firm mouth means that the patient will get well if he
can. The relaxed, drooping mouth, falling jaw, trem-
bling muscles, show us the need of giving the patient
courage, and strengthening the will power. It also
shows the necessity of increased care to conserve vital-
ity, and of the employment of restorative remedies.
EXPRESSION IN MOTION. We not only find disease
expressed in position, and in persistent muscular con-
traction, as heretofore named, but it is also shown in
motion. We see a man standing or sitting, and ob-
serve that his soft tissues seem to sit on him like a
badly fitting suit of clothes, and we think at once of
impaired nutrition and degeneration of tissue. But it
may be only a want of innervation, from habitual
torpor of the nervous system. Set him in motion, and
we will soon see whether this is so or not, for there are
none so sluggish in this respect, but what they may be
aroused.
We notice the movements of the person that we may
confirm the diagnosis of expression, especially as re-
STUDY OF DIAGNOSIS.
71
gards the important point of undue irritation and cir
culation, or impaired innervation and circulation.
The quick, restless movement is characteristic of the
first. The desire to lie still, and the slow movements,
of the second. Possibly there is no evidence of disease
more definite than this, and it should be allowed its full
weight in diagnosis.
In some cases the rapid movement is but a means of
removing excessive excitement of the brain and spinal
cord, as in great grief or joy, or in case of severe, but
temporary pain. In such cases it may be looked upon
as a means of relief, for if the excessive emotions, or
pain were pent up, the person might suffer severely
from it.
But in other cases, whilst it tells of nervous irrita-
bility, the bodily movements give no relief, but even in-
tensify the wrong, besides causing exhaustion. In
these cases we endeavor to get bodily rest from the
first, as a means of allaying the nervous excitation.
Every one will have noticed the influence of the phy-
sician, nurse, or friend, who with kindness but firm-
ness, insists on keeping still. The hand placed upon
the body of the sufferer to give support, seems to
strengthen the will power, and frequently with an effort
on the part of the patient comes rest and relief.
There is a case of restlessness from an enfeebled and
atonic condition of the nerve centres that requires
notice. The unsteady movement, or the evidence of
exhaustion following it, with the anxious, depressed
countenance, tells the story. In the other case we will
find almost continued tension of the muscular system.
Whilst in the case of irritation and determination of
blood, we would employ the sedatives, with Gelseminum,
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STUDY OF DIAGNOSIS
or remedies exerting a like influence, in that of atony,
we would use Quinine, Nux, Phosphorus, stimulants,
tonics, and histogenetic food-beef-tea.
Increased movement is not associated with structural,
or even with severe local functional disease, so that un-
less it points to a wrong of the cerebro-spinal centers
we do not regard it as an unpleasant symptom. In or-
dinary colic the patient is restless, and seems to get re-
lief from motion, but in the severer forms of colic,
called "bilious," and in acute enteritis, he remains
very still.
In local disease the patient favors the affected part in
movement. Frequently the first evidence we have of
morbus coxarius, is the care shown in moving the leg
and placing the feet in walking, and the elevation of
the hip to remove pressure from the joint. Turning
the toes inwards, both in movement and rest, has the
same signification. One can readily distinguish a wrong
of the pelvic viscera by the movement of the hips and
extremities, showing the constant effort to prevent
stress or pressure of the parts. This will be noticed in
some uterine disease (irritative) as well as in displace-
ments. In chronic disease of the kidneys, a forward
curvature of the spine is frequently marked, and the
patient is observed to put the hands upon the hips in
rising from the chair, and sometimes in walking. If
but one kidney is involved, or the liver, or spleen, we
observe the slight flexure to one side, and the effort to
save the part from the movement of muscles. Evi-
dently the drawing forward of the shoulders-" winged
scapula," is a symptom of similar import so far as the
lungs or thoracic region is concerned. So certain is
this, that with the marked falling forward of the
STUDY OF DIAGNOSIS.
· 73
!
shoulders, and separation of the scapula, one may be
sure there is some disease in the thorax. The head
drooped forward has a similar import, though this is
sometimes an indication of a wrong of the sympathetic
nervous system.
+
In irritative disease of the cerebrum, or of the organs
of special sense the head is flexed, but in disease of the
medulla oblongata, cerebellum, pons and crura, the
head is drawn backwards. Forced extension, or head
drawn backward, will be recollected as a prominent
symptom in cerebro-spinal meningitis.
In all these cases flexion and favoring the part in
muscular movement are evidences of irritative disease,
and indicate the treatment. First, remedies that influ-
ence the affected part; and second, remedies that re-
move excited innervation and circulation or functional
activity.
In another class of cases, we will find flexion from or
opposite the affected part, and the position of the body,"
and muscular motion is such as to give support and
moderate pressure. The evidence in this case is of im
paired circulation, congestion, effusion, and enlarge-
ment. It is safe to say that in the majority of these
cases the remedies will be such as will give additional
stimulus.
If one will closely observe the movements of the ab-
dominal muscles, they may determine conditions of dis
ease in pelvis or abdomen. The careful, slight move-
ment evidences disease of the pelvic viscera if especially
marked below-the chylopoietic viscera, if especially
marked above. The full abdominal walls, with slug-
gish movement, evidences atonic disease and congestion.
If we examine with reference to the thorax, we will
7
74
STUDY OF DIAGNOSIS.
find that free movement of the abdominal muscles and
diaphragm, and but slight movement of the upper
thorax, is evidence of disease of the upper lobes of the
lungs. On the contrary, thoracic respiration, with but
slight and careful movement of the abdominal muscles,
evidences disease of stomach or liver.
We have already examined the expression of the face
sufficiently, and the movements of the muscles do not
give much additional evidence. Twitching of the
muscles is an unpleasant expression, and indicates un-
due spinal irritation, or irritation of the basilar brain,
the cause being frequently extrinsic. If of the mouth,
our attention is directed to the abdominal organs; if of
the upper lip and face, to the stomach; if of the nose, to
the lungs; and if of the eyes and forehead to the brain
and spinal cord.
The quick, involuntary movement of the eyes, refers
us at once to the excito-motor nervous system, and at
once we make an examination to determine the source
of the lesion, its cause, and adopt means to prevent
its further progress, and convulsions. The forced con
traction of one of the muscles of the eyeballs, turning
them upwards, downwards, to one side, or causing stra-
bismus, evidences disease of the brain, which may or
may not be associated with wrong of the spinal cord.
The character of the disease may be determined by the
expression of the eyes and associate muscles, or by
other symptoms.
In diseases of children we will notice that sudden
contraction of muscles and movement of parts is a pre-
cursor of convulsions. The quick movement of the
hand, with contraction of the fingers, the quick move.
ment of the lower extremities, with forced flexion, or
STUDY OF DIAGNOSIS.
75
the quick movement of the head upon the pillow, or
the sharp, jerking movement of the shoulder, should
never be neglected.
This is but a mere outline of the subject, yet if it
stimulates to observation, pointing out the way, it will
serve its purpose. It is something one must learn from
observation, and not simply store up in the memory.
Indeed, unless the senses can be trained with the
memory of facts, but little benefit will follow.
COLOR OF THE SURFACE.
As has already been named, the education of the eyes
to distinguish colors, is of much importance in diag-
nosis; and the reasons will be obvious to the reader.
There is no property of living bodies so sensitive as
color. It is usually thought of as evanescent, change-
able, fleeting, and the expressions of poetry in this re-
gard, but represents the results of close observation.
The florist is guided by it to a very considerable ex-
tent. When he visits his green-houses in the morning,
his eye closely scans the plants with reference to their
health. Change of color, even so slight that it would
not be noticed by an ordinary observer, is to him evi-
dence of disease. He recognizes in change of color,
the escape of gases from his flues, want of ventilation,
a wrong in the temperature, the want of, or a wrong
plant food, the presence of parasites, etc. He not only
makes his "diagnosis" from change of color, but gives
the prognosis as well.
The farmer, without any special training, or knowing
why, recognizes the wrong color in his plants, and
76
STUDY OF DIAGNOSIS.
speaks of their sickly appearance. If he has been a
close observer, there is a something about their expres-
sion, and usually in their color, that tells him of the
character of the wrong-from drouth, from wet, from
too much heat, from cold, from atmospheric changes,
from want of plant food, from excess of certain foods,
or from a wrong kind. He recognizes the coming of
blight, rust, mildew, and the various parasitic diseases,
by these changes, before the diseases are fully de-
veloped.
These are familiar examples, and should prompt to
diligent study on our part. For, if in the vegetable
world, disease may be recognized in changes of color,
should it not be a means of diagnosis in animals and
man? And if so definite in determining the kind of
disease in vegetable life, will it not be equally. definite
in determining disease in man? It will be noticed
further that color has reference to the life; to the life of
the blood, to the nutrition of tissue, to the oxygenation
and decarbonization of the blood, and to the waste and
excretion.
Even here the popular expression should have stimu-
lated professional inquiry-he has a healthy color -
what is the color of health? he has a sickly appearance,
what is a sickly color? If the popular mind recognizes.
health in color, and disease in color, is it not well that
we should make a careful study of it?
Color in man has two sources-a, from the blood; b,
from pigment—and it is well to distinguish these. In
the first case the changes of color are referred to wrongs
of the blood; in the second they are referred to changes
in the quantity or character of the pigmentary matter
of the body. A simple division would be into--a, color
STUDY OF DIAGNOSIS.
77
which has red for a basis; b, color which lacks red, is
a shade of yellow, brown, black..
In making examinations with reference to the blood,
we select parts where the circulation is free and the
epidermis or epithelium is thin-where the skin is thin,
and the mucous membranes delicate. We examine the
nails, the lips, the cheeks, the hands, scmetimes the
feet, the tongue, and mucous membranes of the mouth.
What is the color of health as shown from the blood?
It is rosy, a light shade of carmine and lake, and is
clear, transparent, and offers no darkness, or admixture
with blue, purple, or brown. As the finger is pressed
upon the surface, or pressed over it, toward the heart,
the rosy color is removed, leaving the structures clear
and transparent, and the color comes back quickly when
the pressure ceases. It is difficult to describe color
in words, but if the reader will now make his examina-
tions of health he may readily learn to distinguish the
color of health.
The shade of rose color in mucous membranes differs
somewhat from the skin, because it is modified to some
extent by the pigment in the rete-mucosum. It is well
to get a clear idea of it by examinations of the lips, the
tongue, the mucous membranes of the mouth, and
fauces. The color of mucous membranes is quite
changeable to a slight degree, even in health, having
shades of blue, violet, white, probably from the secre-
tions of the mouth, and the food and drink; and we
never regard these slight variations as diagnostic.
The pigment color of health varies in different races,
and in different individuals. But if we say it is some-
what transparent and clean, we may express its char-
cter for all races. If we take a negro for example, we
>
+
78.
STUDY OF DIAGNOSIS.
will find the jetty black has a transparency and clean-
ness-glossy and smooth, which will be readily recog-
nized. Let this man become sick, and the color grows
dingy and opaque. If we take the olive or brown
skin, the same cleanness and clearness of color is
marked, and it seems so transparent that you may
almost look into the skin. If you take the Caucassian,
the brunette will show the same clearness in the skin
pigment, and in the healthy blonde it seems as if you
could look quite through the skin, it is so transparent.
We may even notice these peculiarities in the color of
the hair, as it shows health and disease like other parts,
but modified more by local conditions.
In studying color, especially that given by the pres-
ence of blood, it is well to note that it may be changed
in quantity (so to speak), and in kind. Change in
quantity has reference to an increased circulation, and
an increased amount of blood in the capillaries; change
in kind, to the condition of the blood.
Simple excess may be noticed from any cause increas-
ing the circulation to the surface, or to a part. We ob-
serve this excess of color in slight acute diseases, where
the activity of the heart is increased, and there is gen-
eral vascular excitement. It is not an unpleasant
symptom, and points clearly to the arterial sedatives,
Aconite and Veratrum, as the special remedies.
If a part of the surface shows this excess, we at once
think of its relation to internal organs and functions.
If of the upper portion of the face and eyes, we refer
the wrong to the brain. If of the cheeks, one or both,
we refer it to the respiratory organs or apparatus of
circulation. If of the mouth and lower part of the face,
we refer it to the abdominal viscera.
STUDY OF DIAGNOSIS.
79
As the excess refers to vascular excitement, and
means general sedatives, so these local excesses mean
local vascular excitement and local sedatives if we have
them. Thus for the brain it would mean Gelseminum ;
for the thoracic organs, Veratrum; for the abdominal
viscera, Aconite, Ipecac, etc.
It is well to note the condition of the capillaries in
this examination, and we may determine somewhat of
their condition by the effects of pressure. If the capil
laries are in normal condition, pressure should efface
the redness, but it is but momentary. If the finger is
drawn across the reddened surface we notice the white
line made by displacing the blood, but it rapidly passes
away, and the blood flows quickly in and fills the ves-
sels. If now we examine the redness in scarlet fever
in the same way, we will find that the fingers carried
over the part with pressure, effaces the redness, and
leaves a distinct white line, more or less persistent, as
the fever is severe.
This shows enfeeblement of the capillary circulation,
especially from the arterial side, and is an indication for
Belladonna. In the larger number of cases, Aconite is
the arterial sedative. The next best remedy to Bella
donna is the Carbonate or Hydrochlorate of Ammonia.
If the capillary wrong is from venous obstruction,
the color will be deeper, and the wrong will be asso-
ciated with fullness of cellular tissue in many cases,
and the white line made by pressure is not so clear.
In this case, Podophyllin, Lobelia, Bryonia, are reme-
'dies.
We not only find an excess, as above named, but in
other cases a defect in color, showing poor blood, leuco-
cythæmia, or an impaired circulation to the surface. The
80
STUDY OF DIAGNOSIS.
pallor of anæmia is shown in all-parts of the busty, and
is associated with evidence of impaired nutrition. In
the rare pathological condition, leucocythæmia, there is
sometimes marked pallor, but usually it is disguised by
increase or change in the pigment of the skin. In de-
ficient circulation to the surface, we have want of color,
but no evidence of want of blood in totality, or impaired
nutrition.
Deepening of color-dark red-is usually associated
with zymosis, and has reference to sepsis of the blood.
It is associated with asthenia, and when observed it
tells of impaired function But it especially shows the
need of acids, and in this respect refers to a direct
remedy. It makes no difference where we find it most
marked, its meaning is quite the same, of course modi-
fied to some extent by local disease.
•
If the reader will think for a moment of the cases he
has seen presenting deep redness of the surface, he
will recognize the truth of these statements. In typhus
fever, the gravity of the disease is shown by the flushed
skin-dark-red. If in smallpox, we find the skin
assuming this dark-red color, we are confident the dis-
ease will be severe, showing depravation of the blood,
and marked asthenia. If we observe it in measles, we
anticipate trouble from tardy appearance of the erup-
tion, depravation of the blood, respiratory trouble, and
impairment of function. If seen in pneumonia, it talks
to us of approaching "typhoid symptoms," of a low
grade of inflammation, and great prostration. So clear
is the evidence, and so rare the exceptions, that it be-
comes one of the most reliable evidences of disease we
possess.
The meaning is modified to a certain extent by the
STUDY OF DIAGNOSIS.
81
+
results of pressure-whether the color is solid and un-
yielding as the finger is pressed over the surface-or
whether it is effaced by such pressure as heretofore
named in simple excess. In the first case it has refer-
ence wholly to the lesion of the blood, in the other in
part to the lesion of circulation-at least the evidence
is less grave.
If the dark redness is an evidence of zymosis-sepsis
-it speaks directly of antiseptics as a necessary part of
the treatment. It says clearly-this patient must be
kept clean, his clothing and the bed-clothing must be
frequently changed, and kept clean and sweet, all the
surroundings must be clean, he must have good air, fre-
quently changed by good ventilation. It means further,
that proper means shall be employed for disinfection
when this becomes necessary.
If the dark-redness is associated with asthenia and
impairment of life, and gives us timely warning of such
impairment, it will caution us against the use of all de-
pressant remedies, or anything that will impair any of
the important functions of the body. And it suggests
the necessity of keeping the stomach in condition to
receive food, and the proper selection and preparation
of food during the progress of the disease.
But it directly refers to acids as remedies, and this is
of much importance. Acids here are the antiseptics
and antizymotics. We give Muriatic Acid, Acetic
Acid in the form of good cider, and Lactic Acid in the
form of whey, and we find the condition of the patient
markedly improved. Muriatic Acid is especially the
antiseptic, though the others have an influence in this
direction.
The dull purple (bluish) of venous blood has reference
82
STUDY OF DIAGNOSIS.
to imperfect venous circulation, and imperfect decarbon-
ization of the blood. It may be caused by disease of
heart or lungs; if not we recognize a lesion of sympa-
thetic and associate spinal nervous systems. It evi-
dences an unpleasant condition of life, and one that
should be removed if possible. In some cases the dull-
ness of color becomes so marked, that we designate it.
as leaden.
If we find local structural disease to account for it,
this will receive our attention. If it is sudden, and
associated with præcordial oppression and constriction.
of the chest, Lobelia is the remedy. If less marked and
chronic, we will think of Cactus, Digitalis and Pulsa-
tilla. In acute cases, Chloroform counter-irritation
around the lower margin of the thorax, gives speedy
and marked relief.
In the lesion of cholera we will find the blueness of
hands and feet dependent upon enfeebled capillary cir-
culation, the blood being loaded with carbonic acid
gas. If the condition of the blood can be so changed,
as to enable it to circulate, this passes off. This blue-
ness with pallor is one of the most marked indications
for common salt as a medicine.
Want of color, with a shade of solid blue where the
blood shows freely as under the nails, the lips, the
cheeks, and thin skinned portions of the body, may be
assumed to indicate the want of Iron.
A violet tint with increase of redness uniformly, or
only where the circulation is superficial, is a prominent
indication for Nitric Acid.
Deep color, with purplish, brown, or black tinge, is a
prominent indication for Baptisia
Color not deep, but muddy or dirty, of parts freely
STUDY OF DIAGNOSIS.
83
supplied with blood, is an indication for Sulphurous
Acid. If there is this dirty shade with pallor, we would
use Sulphite of Soda.
When we come to study the local changes of color
referred to the blood, we divide them into two classes,
the one in which the change is to be referred to a lesion
of some other part-sympathetic; the other in which
it is dependent upon local disease. The reader will
notice that the significance of color must depend very
much upon this, for whilst the one may have no refer-
ence to the condition of the blood at large, or to any
structural lesion, the other is wholly referred to the
lesion of the structures, and to changes in the blood.
We always want familiar examples to show that a
method of study is likely to prove advantageous—that
is a basis of fact, and we will adduce the three familiar
cases of change in the color of areola of the nipple,
the dark line under the eyes in certain conditions of
women, and the white line around the mouth in some
intestinal diseases of children.
In
Every practitioner will have noticed the darkened
areola of the nipple as an evidence of pregnancy, but
may not have had his attention called to it as an evi-
dence of disease of the reproductive function.
wrongs of this function simulating spermatorrhoea, we
will find this change of color marked, as we will in
scanty menstruation with congestion, and in hyper-
trophy of the cervix uteri. Of course we do not look
for this, except in the diagnosis of pregnancy, but in
this case it is one of the most valuable symptoms.
If you should notice the deep color under or around
the eyes in women, you would say at once there was a
wrong of the reproductive organs or function, and you
84
STUDY OF DIAGNOSIS.
would rarely make a mistake. If the tissues seemed
dry, the eyelids sunken and contracted, it would be
safe to say that the disease was one of irritation, and
would probably be relieved by Pulsatilla and Macrotys,
(especially if functional.) And if the eyelids were
full, swollen, relaxed, that the disease was of congestion
or atony, and would be benefited by Hamamelis, Apc-
cynum, Staphysagria, Phosphorus, Iron, etc.
Many cases present themselves where we do not wish
to suggest an examination of the reproductive organs
at first, or there may be some reason why it should not
be made at present, hence the importance of other
means of knowing the character of the wrong, and the
class of remedies we may select from.
If one should notice the white line around the mouth,
with full pallid upper lip, full or contracted mouth, he
would at once refer the symptom to a wrong of the
gastro-intestinal apparatus. The reference is undoubt
edly right, if we except the rare case in which the
symptom is dependent upon lesion of the brain. There
is a wrong of the stomach and bowels. What is the
character of that wrong? If the structures are full, it
is pretty surely one of atony-a want of innervation
and a sluggish circulation. If the structures are con-
stricted and pinched, the wrong is very certainly one
of irritation, excited innervation and circulation.
Is it worth our while to read the evidences of disease
in the patient's face? I think it is, especially when the
remedies are at once suggested. The white line around
the mouth-gastro-intestinal disease. With fullness of
tissue-Podophyllin, Hydrastia, Santonine. With con-
striction and thinning of structures-Aconite, Ipecac.
But suppose we notice a peculiar bluish or leaden
STUDY OF DIAGNOSIS.
85
:
tint to this white line around the mouth, and see a
slight dragging down of the corners, we would recog-
nize the gastro-intestinal lesion-remedy, Bismuth, or
sometimes minute doses of Arsenic.
Increased color of cheeks has been noticed as a symp-
tom of thoracic disease for thousands of years.
What
relation has this flushing of cheek to the condition of
the lungs? Can you explain the nervous and vascular
connections? Evidently we can not tell why, and I
doubt if the evidence would be any more valuable if we
could tell why. This is one of many examples that the
interrogatory-why? is not always a profitable study
in medicine.
We know the fact, that a habitual recurring flush
of one or both cheeks has reference to an irritable or
discased lung. The persistent high color, even though
it be a distinctly circumscribed spot, has a different
meaning. If we notice this circumscribed flushing of
the checks, our attention is at once attracted to the re-
spiratory apparatus. Associated with frequency of
pulse and increased temperature, it tells us of com-
mencing tubercular deposit. In this case the one cheek
is usually flushed.
It may be remarked further, that this symptom is
always associated with a wrong of the sympathetic
nervous system, especially in its relation to circulation
and nutrition, and in phthisis we only find the bright,
flushed cheek with irritation. Sometimes there is quite
as marked pallor, and the evidence would be a want of
innervation.
The bright-red flush of left cheek in acute disease is
usually referred to thoracic disease, but does not always
indicate it. It evidences a lesion of sympathetic and
86
STUDY OF DIAGNOSIS.
t
spinal innervation, but is especially valuable as calling
our attention to Rhus Toxicodendron as the probable
remedy.
The deeper flush of right cheek is more frequently
seen in disease of serous membranes and fibrous tissues,
but is especially valuable because it points out Bryonia
as the probable specific remedy.
Whilst the bright color of the cheeks, where it has
reference to disease of the respiratory organs, tells us
of irritation and activity of circulation, deep color in-
dicates impairment of the circulation and of the life.
The livid, purplish color in some cases of angina pec-
toris, may be taken as the type. We have it in much
less degree in thoracic ancurism, in apoplexy of lungs,
and in some very severe cases of asthma with conges-
tion. The dark redness is always evidence of a difficult
and imperfect circulation.
There is a pinkish color of parts freely supplied with
blood, that is regarded by some as an unpleasant symp-
tom. As this color becomes more pronounced, we ob
serve it in the veins as well. In women we may usually
refer it to a menstrual wrong, which will be corrected
by the use of small doses of Pulsatilla, Actea Alba,
Helonias. For the chronic lesion we think of Phos-
phorus, the Hypophosphites, the bitter stomachics, and
food.
Among the things that old women know 18--that
prominent blue veins crossing the nose in children is a
sign of feeble vitality, and it is quite as true as if a phy-
sician knew it. There is something wrong in the life.
when you observe these cutaneous veins showing the
distinct and constant blue line, whether it is across the
nose, at the wrists, upon the back of the hand, over the
STUDY OF DIAGNOSIS.
87
breast or abdomen, or elsewhere. Whilst it may not
point out any special medicine, it does prompt us to ad-
vise that the child have abundant out-door exercise,
good blood-making food, and that it shall not commence
study early, or be much confined until there is a much
stronger and robust life.
Unusual blueness of veins is a very good indication
for Iron. If associated with pallor of surface, we may
select Iron by Hydrogen, or Valett's mass, but if there
be deep color of tongue, Tincture of Muriate of Iron.
The color of the conjunctiva and sclerotic will some
times give us information in regard to the circulation
of the brain. If we find an injected conjunctiva (not
the result of local disease), we conclude that the cere
bral circulation is similarly affected. If the color is
bright, and the surface looks smooth and moist, we have
evidence of determination of blood. If the color is
deep and the surface looks dull and dingy, or dry and
pinched, it represents hyperæmia, with obstruction to
the return of blood-the apoplectic condition. The
dull, colorless eye is the best indication for Belladonna,
though we use it when the eye is injected, with tortucus
vessels.
In superficial disease, the color of the part is a means
of determining its condition, If we take the ordinary
symptoms of inflammation, increased color-redness-is
one of the first named as constant. Given increased
color, with heat, pain and swelling, and we say there is
inflammation; but which of these will best tell us the
real condition of the part? I should answer, color.
If the color is bright, healthy red, we know at once
that the inflammation is simple, and is not very likely
to work a very great wrong to the part, or to the body
88
STUDY OF DIAGNOSIS.
at large. It tells us of irritation, determination of
blood, and of activity of circulation; the second part
of the wrong of circulation-stasis-is in but small pro-
portion. It says, give general arterial sedatives, use
local sedatives, get rid of increased heat, and establish
secretion. The evidence is quite the same, whether we
are looking directly at the inflamed part, or at some
distant surface, that is influenced by sympathy.
If the color is deep-red and dull, we are confident
there is marked impairment of life and arrest of circu-
lation. The fact that there is too much blood in the
part is evident, that the capillaries are enfeebled, and
the circulation in them is sluggish or arrested, that
change has commenced in the stagnant blood, and that
the life of the part will be destroyed, unless these
wrongs are corrected. It says distinctly, strengthen
the general circulation, whilst you lessen its frequency,
and conserve and sustain the life of the blood by rest
and food. If a local application is to be made, it is now
stimulant—we want to strengthen the life of the part.
If we select an internal remedy that is to influence the
part from the blood, this remedy must be stimulant or
tonic in its character.
If the part assumes a blue or purplish color we recog-
nize venous stasis, and an obstruction to the circulation
from the part. With our attention called to the nature
of the wrong, we will find its cause and remove it if
possible. My attention was first called to this evidence
of venous obstruction in a case of fracture of the fore-
arm, with laceration of the hand, in which a roller was
applied before the splints, yet not very tight. Inflam-
mation sprang up in the hand, and the third day came
this bluish discoloration, with a great deal of local
STUDY OF DIAGNOSIS.
89
trouble.
The roller was removed, and the difficulty
slowly passed away. I have seen the same wrong arise
from the position of an extremity being such as to im-
pede the circulation of blood.
In some cases the wrong being general, venous im-
pairment is cardiac. We do not know why, but we
rarely find an impairment of the right heart, when the
left is sufficient for the systemic circulation. Lobelia in
stimulant doses exerts a very favorable influence in these
cases. If there is fullness of cellular tissue, Apocynum
may be associated with it, or given alone. If the
wrong is from venous impairment, and is chronic,
Hamamelis is probably the remedy.
The erysipelatous redness is so distinctive, that being
once seen it can hardly be forgotten. The vivid color-
ation, evident dryness, shining appearance, give the be-
holder a sense of burning. It makes no difference so
far as the significance of this coloration is concerned,
whether we have the local inflammation of the skin or
not, it refers us to a lesion of the blood, zymotic in
character. If the surgeon find this tint of vivid red-
ness on the edges of a wound, or the flaps of an ampu-
tation, he would be at once on the alert to get rid of
the lesion of the blood. If the physician observed this
erysipelatous flush on the cheek in inflammation of the
lungs, or any where on the surface during the progress
of an inflammation or fever, he might feel sure he would
have a more than usually serious case to manage.
We may distinguish four shades of this erysipelatous
redness quite well marked in many cases, pointing out
the remedies for the disease of the blood, and the locaì
inflammation. In the first the redness is quite vivid,
and the edges of the local disease show a simple erythe-
8
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STUDY OF DIAGNOSIS.
1
matous flush, and the part does not look dry and con-
stricted. Sometimes there is arterial throbbing of the
part, and the pulse is full. In this case Veratrum is the
general and topical remedy. In the second case the
redness is very vivid, and the parts dry and constricted,
with sometimes the appearance of a slight pustular
eruption. The pulse is small, sharp, vibratile; the
remedy is Rhus Toxicodendron. In the third case the
redness has a deeper shade, sometimes vivid, sometimes
dull. The remedy, both general and local, is Tincture
of Muriate of Iron. The fourth case shows more or
less of a blanched appearance, as the disease advances :
sometimes in the centre, sometimes at the borders,
sometimes of the deep structures—you seem to be look-
ing through the superficial redness. In these cases the
general remedy is Sulphite of Soda, the local remedy
Sulphurous Acid, Permanganate of Potash, or Carbolic
Acid.
The variations of pigment color in different individ
uals is so great in health, that it might seem almost im-
possible to get definite information from its variations
in disease, yet I think we will find it quite as certain
as other evidences of disease. Of course we must have
a correct idea of normal pigment coloration, and some
guide to the natural tint of the individual. Transpa-
rency and cleanness are the characteristics of health,
whatever may be the shade. The lesions might be
divided into those of excess, defect and perversion,
though the last is the most important.
Excess of pigment, when it retains the clearness and
transparency of health, is usually evidence of active
life, and good nutrition and excretion. Of course out-
door exposure is always taken into consideration, as
!
STUDY OF DIAGNOSIS.
91
•
causing an increase of pigment. Local excesses of
pigment have a variable meaning, though if still clear
and transparent we think of functional activity. If we
take the areola of the nipple, the clean, transparent,
deep color evidences healthy gestation, as does the
deepened color over the gland. The increase of abdom-
inal pigment has the same meaning, as has the increased
pigment color of the vulva. Even the increased pig-
ment of face observed during gestation is an index of
healthy function. Not so the unequal and unpleasant
brownish coloration known as morph.
The deep pigment coloration of the neck in brain
workers is a sign of healthy nutrition of the nerve
centres, whilst the want of pigment would indicate
anæmia, and the dirty pigment would show a wrong of
nutrition.
The coloration of the skin and hair have the same
associations. The clear, transparent color is the evi-
dence of health, especially of the skin. The deepened
color is evidence of an active life, especially of the vege-
tative functions; whilst a loss of color is at once re-
ferred to impaired nutrition. Even the color of the
hair is subject to slight changes, and one may learn to
distinguish by this the condition of the nutritive func-
tions. It is an unpleasant sign to find the hair becom-
ing dull and sickly in color.
There is an increase of pigment distinctly brown,
and in patches on various parts of the body, which is
known as "liver spots." They generally make their
appearance on parts covered by the clothing, and may
be quite large and extensive. We refer them to a
wrong of the bile pigment, and frequently find it asso-
ciated with a wrong of digestion, and impairment of
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STUDY OF DIAGNOSIS.
\
the function of the brain. The remedy is Podophyllin,
associated with its natural bitter principle, Bebeerina,
(Hydrastia).
The brownish-yellow coloration is evidence of a
wrong of the organs of digestion. We may find it
only about the mouth or the face, or we may find it
pretty general where the lesion is chronic. It refers
us to Nux Vomica as the remedy.
Give us the same color, but dull and opaque, or with
a leaden tinge of adjacent skin, and we again refer it
to a lesion of the organs of digestion. The remedy is
Chelidonium; Podophyllin, if the tissues show more
than usual fullness.
The bright yellow of jaundice is a symptom of wrong
of the liver. What the condition of the liver may be,
other symptoms must decide. But in so far as the
color is concerned, we expect to wash it out through the
kidneys.
There is a peculiar sallowness with a tinge of green
that indicates great impairment of blood-making and
nutrition. The remedy is Copper; we usually give
Rademacher's Tincture.
No one could mistake the opaque, tallow-like color
of hypochondria, and associate states. It tells us of
impairment of the digestive and blood-making organs,
of nutrition, and of waste and excretion. There is a
slow renewal of life, and the tissues are old and feeble.
Very clearly in this case we want a more active "re-
newal of life," and we stimulate the processes of retro-
grade metamorphosis and excretion on the one hand,
to remove the old structures, and see that the function
of digestion is well performed, that we may have in-
creased nutrition.
1
STUDY OF DIAGNOSIS.
93
One could hardly mistake the evidence of the dingy,
dull, grimy, dirty color of skin. It refers us to a wrong
of the blood-" bad blood," and we conclude that the
blood is as dirty as the skin. Of course it would not
do to mistake the dingy, dirty skin of the “great un-
washed," but this is not very likely. Soap and water
will show the difference. In this case remedies to in-
crease secretion, and sometimes to promote retrograde
metamorphosis, hold the first place, though we do not
forget the importance of improved nutrition.
There is a deepened tint of skin, dull and opaque,
that is a very good indication for Arsenic or Phos-
phorus. The tissue seems to have lost life, and is in-
elastic. Dullness of color and opacity, may be regarded
as the special features; and opacity where the color is
lighter than usual may indicate the remedy.
If we have a distinct want of pigment, the want of
color not dependent upon anæmia, or an enfeebled cir-
culation of blood, we think of Sulphur as a possible re-
storative. Given in small doses, we sometimes find it
exerting a marked influence upon the nutritive pro-
cesses.
毋
​EXAMINATION OF THE TONGUE.
"Let me see your tongue," says the doctor at every
visit, though what he expects to learn from "seeing
the tongue" he would be puzzled to tell you, unless it
was that the patient was "bilious." Of course habitu-
ally seeing the tongue in disease will, unconsciously,
many times, grow some knowledge of its diagnostic
value, and if the physician is a close observer, it will
give him valuable aid in determining the character of
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STUDY OF DIAGNOSIS.
ནཱ་
disease. But many men are so little in the habit of
using their eyes, and thinking for themselves, that they
learn but very little.
If we think for a moment, we will see that the tongue
may tell us of-a, the condition of the digestive appa-
ratus; b. the condition of the blood; c, the condition of
the nervous system and d, of the functions of nutri-
tion and excretion. As these are important inquiries,
indeed just the things we want to know, we will make
the tongue talk as plainly as possible.
We find the expression of disease in-a, its form; b,
its condition of dryness or moisture; c, its coatings; d,
its color; and e, its motion. It is well to think of the
subject in this methodical way, even though we are not
able to follow it wholly in this study.
The common idea of physicians is, that the tongue
expresses the condition of the stomach and intestinal
tract, and it should be examined with reference to this;
few think that it may give further information. Being
a part of the digestive tract, supplied by the same
nerves, and invested by the same mucous membrane,
we would naturally expect it to show something of the
condition of parts below.
If we say that its condition may be taken as the type
of the condition of parts below, we will not be far out
of the way. True, there are many exceptions, but the
rule is a very good one, and will hardly lead to serious
error. The mind at once recognizes the changes of
form, movement, condition, color, and secretion, as ex-
pressions of local disease. It will not be far wrong, if
it recognizes them as expressions of disease of the entire
digestive apparatus.
Change of form is quite expressive, and rarely leads
STUDY OF DIAGNOSIS.
95
us into error. The elongated and pointed tongue ex-
presses the condition of irritation and determination of
blood to stomach and intestinal canal very distinctly,
and it is safe practice to give it full weight, and be very
careful in the administration of remedies. As it is
associated with excitation of the nerve centres, this is
to be taken into consideration, when we value the evi-
dence with reference to the stomach and bowels. If we
observe this change of form early in the disease, we not
only anticipate unpleasant gastric irritation through
the sickness, and use care in avoiding irritants, but we
employ means to remove it. Among these may be
named minute doses of Aconite, Ipecac, Hydrocyanic
Acid, Peach-bark infusion, small doses of Rhubarb, and
Bismuth.
The full tongue, broad and thick, is the evidence of
atony of the digestive tract, especially of the mucous
membranes. In this case the stomach and intestinal
canal tolerates the common medicines given, and the
use of cathartics is less harmful, and may be more bene-
ficial than in others.
The pinched, shrunken tongue expresses a want of
functional activity in the digestive apparatus. It is the
tongue of advanced acute disease, and is usually asso-
ciated with dryness. "Want of functional activity"
hardly expresses the condition, for the life of the diges-
tive apparatus has suffered to such an extent, that there
can be but little function. Whilst it is one of the indi-
cations of want of food, it causes us to be very careful
in its selection and administration, giving small quan-
tities at a time, and at such periods as the unpleasant
symptoms are least marked.
The fissured tongue in chronic disease points us to
96
STUDY OF DIAGNOSIS.
1
lesion of the kidneys inflammatory in character. In
some cases the fissures are transverse only, but in severe
cases, they are somewhat irregular, and by pressing the
tongue down it is seen to separate in irregular patches.
of prominent villi. The symptom is so definite, that
one may be assured of inflammation when this tongue
presents.
The fissured tongue in the advanced stage of febrile
diseases refers us to lesion of the kidneys, or irritation
of the nerve centres. In many cases we find a wrong
in the secretion of urine, and close examination shows
a.condition of kidneys bordering on inflammation. It
deserves careful consideration, and especially means to
place the skin in better condition, and to allay irrita-
tion of the cerebro-spinal centres.
The conditions of dryness and moisture are important
evidences of the condition of the intestinal tract. If
the tongue is dry, we are sure the stomach and intes-
tinal canal can do but little digestive work, and we give
it as much rest as possible. In such cases food is always
given in fluid form, and usually above the temperature
of 100°. It is also carefully selected and prepared,
that the labor of digestion may be as small as possible.
If the tongue is dry we are confident there is want of
secretion from the intestinal canal and associate glands,
and indeed that there is a condition present which will
prevent the action of direct remedies to favor secretion.
It is most absurd to employ cathartics in such cases,
unless the object is simply to remove irritant accumula-
tions. Moisture, on the contrary, expresses a condition
favorable to functional activity. True, there may be
impairment of function, as when the tongue is full
showing atony, or heavily coated, showing increased
STUDY OF DIAGNOSIS.
97
mucous secretion, or dirty, showing depravation of the
blood and secretions.
If in acute disease with dryness of the tongue, we
observe it becoming moist, we are confident of improve-
ment, of the establishment of secretion, and indeed of
all the vegetative processes. Having this meaning, it
is nearly always regarded as a favorable symptom.
The coatings of the tongue are observed with care,
as they are thought to be especially symptomatic of the
condition of the digestive tract and the "liver."*
*APPEARANCE OF THE TONGUE AS A SYMPTOM OF Disorder
OF THE STOMACH -The aspect of the tongue was held by the
older writers in medicine to be one of the most important criteria
of the state of the digestive organs; and its morbid appearances
were therefore carefully observed and minutely described by
them as indications for both diagnosis and treatment
In more recent periods, however, the value of the evidence
furnished by this organ has been, if not entirely denied, at least
so greatly depreciated, that it seems desirable to ascertain what
are the limits of our knowledge with regard to the association of
changes on its surface with those occurring in lower portions of
the alimentary canal.
The question appears to be capable of being resolved into three
principal divisions:
1. What are the nature and causes of the alterations in the
tongue which have been regarded as diagnostic of affections of
the stomach?
2. In what other diseases, occurring independently of stomach
affections, are these changes observed ?
3. What is the nature of the alterations of the digestive organs
with which these conditions of the tongue bave been found to be
associated ?
The appearances of the tongue which have been most com.
monly believed to be associated with the diseases of the rest of
the intestinal canal, are (a) an increase of its epithelial covering
9
.t
1
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STUDY OF DIAGNOSIS.
Whilst there is much of error in the common ideas of
"furred tongue," something valuable may be learned.
The vivid whiteness of the tongue, evidently a change
in the epithelium, evidences simple functional wróng,
and is associated with the febrile state. If observed at
other times, it may be taken as an indication that the
stomach and digestive tube want rest.
The thin, transparent mucoid coating of the tongue,
evidently upon and from the secretions of the mouth,
evidence enfeebled, digestive function, frequently from
intemperate eating or drinking.
or "fur," which may present various degrees of thickness, and
different shades of color; (b) enlargement of its pa pil; (clæ)
various shades and degrees of redness of the mucous membrane;
and (d) certain alterations in its size and shape.
►
(1) The fur or coating (saburra) has been shown by micro-
scopic examination to consist of epithelium scales, which are
often fattily degenerated, and sometimes massed together, of free
fat drops, and of confervoid growths; of these the largest pro-
portion is formed of the epithelial cells which are derived from
the covering of the organ together with the saliva and buccal
mucus, which in drying form a thick glutinous material, con-
glomerating the other elements into a mass.
The fur may be of greater or less thickness, dry or moist, uni-
form, or accumulated more particularly at the posterior portions.
it is sometimes deeply fissured by sulci, which may extend into
the mucous membrane beneath. At other times it may separate
in flakes from the surface, which then may look raw, and of a
deeper red than natural, but which may, when the process of
separation is gradual, present no deviation from the norma¹
appearance.
Mixed with the fur may be sometimes found pigment, blood
corpuscles, mucous or pus corpuscles, or the remains of vegetable
and animal portions of food.
STUDY OF DIAGNOSIS.
99
The fur which has consistence is evidently upon the
tongue, and can be scraped off-evidences impairment
of function, and the wrong is generally in proportion
to its thickness. If uniformly distributed it may be
regarded as having reference to the entire intestinal
tract; if restricted principally to the base, we think of
greater wrong of the stomach. The heavily loaded
tongue would call our attention to accumulations in the
bowels, and would prompt to means (mild) to secure
their evacuation. The heavily loaded tongue at the baso
calls attention to accumulations in the stomach, and
The color may be white or milky, or may present various
shades of yellow or brown.
The nature and cause of some of the changes in color are very
imperfectly understood. Some of them arise from articles of
food, medicinal substances, tobacco, etc.; a large proportion, how-
ever, are caused by slight hemorrhages from the gums; while
some others, and especially those occurring in fevers, remain un-
explained. Excepting, however, those cases where there is direct
pigmentary discoloration from jaundice, when other tissues par.
ticipate in the change, there is no foundation for the common
belief that a yellow fur on the tongue has any necessary connec-
tion with hepatic disorder.
As regards the chief causes to which the production of this fur
is attributable, may be mentioned:
(a) Idiopathic conditions in which the tongue of some persons
may, consistently with apparently perfect general health, form
and throw off a much larger amount of epithelial covering than
is ordinarily the case; inquiry should, therefore, be directed tc
this point before any general conclusions are formed respecting
the indications to be drawn from its presence.
(b) States in which a coating is formed on the tongue by the
simple drying of inspissated mucus and saliva, owing to the
mouth being kept open, as is often the case during sleep.
(c) Conditions of irritation in the mouth itself, giving rise to
Bork
100
STUDY OF DIAGNOSIS.
г
1
suggests the use of an emetic to free this viscus, and
stimulate normal innervation and circulation.
Yellowness of coating is thought to arise from wrong
in the hepatic function, and to point to the use of "liver
remedies." Whilst it may have this reference in some
cases, it is well to avoid the usual cholagogues. It may
be said to call for Nux Vomica, small doses of Podo-
phyllin and Hydrastine. A dull, leaden, yellow fur is
an indication for Chelidonium. A dull, cheesy look-
an increased production of epithelium on the cheeks, gums and
tongue, and which, from their similarity to the state of other
mucous membranes, where increased secretion, attended with
shedding of the epithe.ial covering, is the result of irritation or
subacute inflammatory action, are usually termed catarrhal.
The belief that this is the true pathology of this state, is also
favored by the coincidence, in many such cases, either of a gen-
eral redness of the surface, beneath the thickened epithelium, or
of hyperemia and enlargement of the papillæ, especially of the
papillæ fungiformes of the lateral and anterior portions. In
some instances, also, the inflammatory state is further evidenced
by the production of aphthæ, giving rise to slight and superficial
ulcerations, with a reddened base, and often surrounded by a
reddened margin.
Many of those conditions of the tongue may, however, be due
to local causes, such as carious teeth, or other sources of irritation
to the fifth nerve, or to accumulation of food around the bases
of the teeth, or to medicinal agents affecting the salivary glands
and mouth, as Iodide of Potassium and Mercury, or to the habit
of smoking (though this does not ordinarily produce a thickened
epithelial fur, nor hyperemia of the papillæ fungiformes, its
effects being generally limited to an enlargement of the papillæ
filiformes, which gives to the surface a finely roughened aspect).
As smoking, however, is not an unfrequent cause of stomach
affections, our observations on this head are always attended
with certain grounds of fallacy.-Fox on Diseases of Stomach.
STUDY OF DIAGNOSIS.
101
ing fur, with slight green tinge, is an indication for
Copper.
The bright redness of tip and edges, especially of
papillæ is an evidence of irritation with determination
of blood. It always suggests care in the use of reme-
dies, rest to the stomach, and the special agents named
to remove irritation. A good condition of stomach is
of first importance in the treatment of disease, and
when these symptoms present, these means will hold a
prominent place.
The tongue gives us the best evidence of the condi-
tion of the blood, and of the remedies which rectify its
wrongs. All exudations or secretions from the blood
must give information of the character of this fluid,
and there is no better place to observe them than in the
mouth. The circulation of blood is also very free and
superficial in the tongue, and we are thus enabled to
observe its changes of color better than in other situa
tions. The reader will recollect the distinction between
the tongue itself and the fur or coating, when color is
spoken of, as the one is from the circulating blood, and
the other from the exudation.
The broad, pallid tongue-marked want of color in
the tongue itself-evidences the want of the alkaline
elements of the body. The evidence is clear and dis-
tinct, and the want one of much importance. It may
be the basis of the entirety of the disease, which will
fade away as soon as the proper alkali iş given, or it
may be but a portion of the wrong, and the alkaline
salt prepares the way and facilitates the action of other
remedies.
If there is no special indication for some other, we
prescribe Soda because it is the salt of the blood.
102
STUDY OF DIAGNOSIS.
Usually we direct the bicarbonate added to water to
make a pleasant drink, and given freely as the patient
wishes it. If there is predominant wrong of the mus-
cular system, we may select a salt of Potash. If of the
cellular tissue, a salt of Lime.
The deep red tongue, (usually contracted and dry)
evidences the want of an acid, as well as that condition
of the blood known as "typhoid." Here, as in the
preceding case, the want of an acid (undue alkalinity
of blood), may be the principal element of disease, and
all the symptoms are ameliorated, and the patient con-
valesces when it is given. In other cases it is but a por-
tion of the disease, and the acid facilitates the action
of other remedies. It is a very co
It is a very common symptom in
typhoid and typhus fevers, and the use of an acid in
these cases has been found a very successful treatment
by Chambers, Anstie and others in the London Hospi-
tals. Our Prof. King, some twenty-five years since,
suggested the use of good sharp cider in these cases,
and it has been employed with much success. He did
not say there was deep redness of mucous membranes,
but he might have said so, for he did name the dry and
contracted tongue with dark sordes, and they are asso-
ciated together.
In this case we select with reference to the condition
of the stomach, and the blood poisoning, and some-
times we may defer to the taste of the patient. Muri-
atic Acid usually receives the preference, as it is well
borne by the stomach, is a natural acid, and is a power-
ful antiseptic. It is added to water to make a pleasant
acid drink, and given ad libitum. In some cases sharp
cider is better borne by the stomach, is grateful to the
taste, and the small amount of alcohol in it is beneficial.
STUDY OF DIAGNÓSIS.
103
In others lactic acid, in the form of whey, answers an
excellent purpose, as it furnishes a calorifacient food as
well.
The deep red, or deep violet colored mucous mem
branes, with fullness, evidences sepsis, and is an indica-
tion for the special remedy, Baptisia. The acid should
also be given in some cases.
The full color, with violet shade, superficial and trans-
parent, is the indication for Nitric Acid, and it will be
found one of the most valuable remedies of the Materia
Medica.
The tongue large, thick in centre, with incurved.
edges, and of a dull blue, or leaden color, is one of the
strongest indications for Arsenic, and it will rarely fail
to arrest the progress of disease in such cases.
The same dull, leaden color, with no change in size
or shape of the tongue, is one of the best indications
for the use of Phosphorus, or the Hypophosphites.
The slick, raw-beef tongue, the papilla wholly effaced,
evidences sepsis of the blood, and is one of the most.
marked of the "typhoid" symptoms. The color of
the tongue is usually deep, and we will employ an Acid
or Baptisia.
The exudation or fur upon the tongue is a pretty
good index of the condition of the blood. Of course
we must weigh the influence of local disease of the
mouth and teeth, and the sympathetic relations with
the stomach and bowels, as heretofore named. (See
note.)
The dirty fur is an indication of sepsis of the blood,
as well as of depravation of the secretions. It is fre-
quently associated with moisture, and the redness is
rarely increased. We
e use the common word "dirty,"
104
STUDY OF DIAGNOSIS.
because it expresses our meaning clearly-the impres
sion upon the senses is that of dirt, and its meaning is
dirt. It may be a dirty-white, a dirty-gray, a dirty-
yellow, or a dirty-brown, but the dirty, grimy appear-
ance always assumes prominence in the mind.
If we have a dirty tongue, pallid, we usually think
of Sulphite of Soda. If the redness is natural, we may
use Sulphurous Acid or Sulphite of Magnesia. If dirty,
with increased redness, Muriatic Acid.
All shades of brown and black have reference to the
condition known as typhoid. We have every shade of
color from the slight tinge of brown to the deep brown
or almost black. It is not only the coating of the
tongue that shows this color, but accumulations of
sordes about the teeth, and sometimes crusts upon the
lips. As is the deepness of color, so is the wrong known.
sepsis," and so is the need of the class of reme-
dies known as "antiseptic." As is the deepness of
color, so is the impairment of life, and the need of care
and rest to conserve it, and of food and restoratives to
support it.
as
""
These dark coatings are so usually associated with
deep redness, that we usually think of acid remedies,
first of which is Muriatic Acid. But some of the cases
will need Baptisia, others Chlorate of Potash, and some
will be benefited by Carbolic Acid. Cleanliness is of
especial importance in these cases, as all decomposing
animal matter in the air or surroundings, increases the
wrong of the blood.
The reader may not have thought that the tongue
could tell him much with regard to the condition of
the nervous system, and yet a little study will show
that it does give very important evidence. It has
STUDY OF DIAGNOSIS.
105
1
special reference to the condition of the sympathetic
nervous system, and this may be regarded as the most
important, but we also learn much of cerebro-spinal in-
aervation.
We associate dryness of tongue with excitation of the
nerve centres, especially the ganglionic. So positive is
the evidence that it is not possible to mistake it. Dry-
ness of tongue is associated with vascular excitement,
and with arrest of secretion from this cause. If in
acute disease with dryness of tongue, we find it becom-
ing moist, we know that the nerve centres are being re-
lieved, and that the circulation is improved, and secre-
tion is commencing. If in a case of disease marked by
enfeebled innervation from the sympathetic, and moist,
relaxed tongue, the tongue commences to dry and be-
comes firmer, we know that this nervous system has
been stimulated, and many times it is a first evidence
of amendment.
Whilst dryness always evidences undue excitement
of the nerve centres, and calls for sedatives, or that
class of agents which remove this, too much moisture and
relaxation is evidence of the opposite condition. The
reader will recollect the typical salivation from Mercury,
and its influence in this regard, and will weigh the de-
pressant influence of the mineral upon the sympathetic
nervous system, by these conditions. If after miercu-
rial salivation, the nerve centres are stimulated by
Quinine, or Quinine and Opium with Ipecac, the tongue
will become firmer and may become dry, and if not too
great, this has been regarded as a good symptom
Moisture of tongue is one of the prominent conditions
assuring us of the kindly action of Quinine, and even
of Optum when indicated. If marked, and accompanied
106
STUDY OF DIAGNOSIS.
by full, relaxed tissues, the patient always requires
nerve stimulants.
Contraction is always an evidence of an excited nervous
system. Sometimes, indeed, we may measure the
wrong of innervation by this symptom, as in typhoid
and typhus fevers, and in the later stages of acute dis-
ease. The reader who has seen the great nervous
wrongs of those affections, will recollect the pinched,
contracted tongue as one of the prominent symptoms.
Fullness of tongue has the opposite meaning. If
marked, we are quite sure that innervation is impaired
from atony, or want of normal stimulus of the nerve
centres, especially of the sympathetic. It suggests
nerve stimulants as a part of the treatment, Podophyl-
lin and Lobelia for the solar and cardiac plexus, Nux
Vomica, Strychnia, Belladonna, Ergot, for the associate
sympathetic and spinal nervous systems, and Quinine
for the associate wrong of the three, or simply for the
brain alone.
Whilst the elongated and pointed tongue has especial
reference to the stomach and intestinal canal, it is one
of the expressions of disease of the base of the brain.
It is well to note this fact, for we may have the wrong
of the brain as the primary lesion, the nausea and vom-
iting being but the result, and if treatment was wholly
directed to the stomach, we would make a great mis-
take. Gelseminum assumes a prominent place here,
associated either with Veratrum or Aconite. Rest is
obtained by the topical action of Chloroform about the
ear.
The small tongue, full in the centre, which is covered
with a thick, tenacious mucoid coat, is an indication of
marked disturbance of the brain, unless we have evi-
STUDY OF DIAGNOSIS.
- 107
dence of acute disease of ears, the globes of the eyes,
or the sphenoidal or ethmoidal cells. It may indicato
a very grave lesion, or in the latter case will pass away
with the local disease. In those cases where the coat-
ing is removed, the surface is left slick, and very dark
colored.
The tongue covered with a grayish or yellowish fur,
showing small patches of red distributed uniformly
over the surface, is the tongue of scarlet fever. The
same appearance will be seen in other cases, where the
capillary circulation of the skin is enfeebled.
The eroded appearance of the papilla at the tip of
the tongue, looking like small, rose-colored bubbles,
evidences a peculiar wrong of the nerve centres and of
the blood, for which Rhus Toxicodendron is the
remedy.
The movements of the tongue are sometimes of im-
portance in determining the condition of the brain. If
the patient has complete command over it, we conclude
that the functions of the brain are still well performed.
But if it is protruded with difficulty, is tremulous, or is
inclined constantly to one side, we are confident we
have a proportionate cerebral lesion. Whilst we might
get the evidence elsewhere, it is quite as well to give
weight to these symptoms, and when observed, to adopt
means early for the relief of the brain.
From what has been said, the reader will draw the
conclusion that impairment of nutrition and secretion.
will be indicated by marked dryness and contraction
on the one hand; or increased moisture and relaxation
on the other. In the first case there is undue excita-
tion, and if we select remedies to increase secretion or
excretion, they will be of a sedative character. In the
108
STUDY OF DIAGNOSIS.
other case there is a want of innervation, and the reme-
dies will be those which will give stimulus and tone.
There is a sodden, unpleasant looking tongue, which
is quite as good evidence of cacoplastic material in the
'blood as any we can find. We recognize at once the
evidence of enfeeblement of the digestive functions,
and if there is local irritation we expect that the exu-
date will be of this character, readily breaking down
and destroying the tissues.
EXAMINATION OF THE DISCHARGES.
The examination of the discharges in common dis-
eases is usually quite superficial, and whilst it has some
diagnostic value is usually of little importance. The
physician from force of habit asks after the discharge
of urine and feces. Has the patient passed urine?
freely? was it high colored, or what was its color?
Has the patient's bowels been moved? how often?
These are the common questions, and the answers are
very uncertain and indefinite. Possibly the physician
wishes to examine "the vessel," but in these days he
is usually satisfied with these casual inquiries, and pre-
fers to get his information from pleasanter sources. In
the olden time examination of "the vessel" was of
greater importance, for the principal part of the phy
sician's business was to fill it-medicine meant dis
charges.
It may be well to give this subject' a brief study,
though we do not attach such great importance to it.
We may divide the study into five parts-a, with refer-
ence to the discharge from nose and mouth; b, with
STUDY OF DIAGNOSIS.
109
1
reference to the discharges from the skin; c, with refer-
ence to the discharges from the urinary apparatus; d,
with reference to the discharges from the bowels; and
e, with reference to the discharges from the reprodue-
tive organs.
FROM THE NOSE.-The discharges from the nose are
of local significance, and indicate changes of function
and structure in these cavities. In measles and typhus,
catarrhal symptoms are among the most prominent,
and in the first are almost pathognomonic; but these
and epidemic influenza are the only instances where the
disease is referred to the blood.
The thin, glairy secretion is evidence of irritation
and determination of blood. The white of egg looking
mucus of active inflammation. The yellowish, glairy
discharge of commencing suppuration-muco-pus, and
the opaque, yellowish, non-tenacious secretion, of the
subsidence of inflammatory action.
Dryness of the anterior nares is usually referred to
scanty or arrested lachrymal secretion; too much mois-
ture of the anterior nares, thin, watery, to increased
lachrymal secretion.
In chronic disease of the nasal cavities, the condition.
of the parts is pretty clearly shown by the character
of the discharges which have the entire range of mucus,
muco-pus and pus. In determining the diagnostic
value of these discharges, we will be guided by the same
rules as in other situations. We wish to know the phy-
sical properties of normal mucus, and of normal pus,
and we will then have a standard of comparison; this
we will study in discharges from the respiratory tract
below.
110
STUDY OF DIAGNOSIS.
FROM THE MOUTH.-The discharges from the mouth
proper are of saliva with some mucus secretion. But
through the mouth we have all the discharges from the
respiratory tract below, of mucus, pus, blood, exudative
material, etc. We also have occasionally discharges
from the digestive tract, the stomach, upper small intes-
tine, and secretion from the liver.
The saliva normally is a thin, transparent. slightly
viscid fluid, with a marked alkaline reaction to litmus
paper. If it loses these properties in degree, or is in-
creased, we will conclude that the first act of digestion.
is improperly performed. Physicians have not been
properly impressed with the importance of buccal diges-
tion, and frequently direct their remedies to the stomach
when it is not at fault.
We have already seen that dryness of the mouth evi-
denced arrest of secretion, and necessarily impairment
of the digestive process. If the salivary secretion is
found to be scanty, we anticipate a wrong of digestion,
especially of starchy foods, and a wrong of nutrition.
It is usually associated with excitation of the nerve
centres, and local disease presents unusual irritation.
We have the same results where the saliva is constantly
thrown off in chewing and smoking.
The remedies suggested in chronic disease by scanty
secretion of saliva are, Iris Versicolor, Phytolacca,
Panax, and some others of this class, with the Iodides
and Bromides, especially of Ammonium.
Increased secretion of saliva is found as a symptom in
some forms of chronic disease, and occasionally in
acute disease. If marked, it interferes with digestion,
and is a cause of depravation of the blood. This may
seem singular to the reader, and yet I think any one
!
STUDY OF DIAGNOSIS.
111
1
}
who has closely observed cases presenting this symptom
will bear me out. The tendency is always to low
grades of albuminoid deposits-cacoplastic, or aplastic.
In acute disease the remedies will be the Alkaline
Sulphites or Sulphurous Acid, or sometimes Chlorate
of Potash, or Chloride of Sodium. Quinine and Nux
Vomica are thought of for the wrong of innervation,
and Hydrastis and Podophyllin for the wrongs of the
intestinal canal. The same remedies will be applicable
in chronic disease, and in addition we may think of
Phosphorus, Sulphur, and sometimes Arsenic.
It is hardly worth while to speak of changes in the
character of saliva as regards its viscosity, as it is always
associated with excess in quantity, and the indications
for remedies will be as above. I would call attention,
however, to the need of antiseptics in these cases, for
very surely we will have sepsis as a prominent feature in
the progress of acute disease. If the proper antiseptic
is selected, as elsewhere described, whether Sulphite of
Soda, Sulphurous Acid, Chlorate of Potash, Baptisia, or
Muriatic Acid, this symptom will pass away.
The reaction of the secretions of the mouth to test
paper will be found to vary, and this will sometimes in-
dicate the class of remedies to be selected. The alka-
linity may be markedly increased, and acids will be as-
sociated with remedies to influence the digestive pro-
cess. In such a case, with dyspepsia, Muriatic or Lactic
“Acid, largely diluted, with the addition of a small por-
tion of Nux, will cure when the ordinary means have
failed. In infantile dyspepsia, we sometimes find the
saliva neutral, or in rare cases the entire secretions of
the mouth are slightly acid. We find the same condi-
tions in the adult, though not so often nor so marked.
112
STUDY OF DIAGNOSIS.
1
1
In such cases we would give Phosphate of Soda, and
surely expect the patient to amend rapidly.
FROM THE STOMACH.--Ejections from the stomach as
the result of disease may sometimes give valuable in-
formation, though usually we depend more upon what
the patient tells us than upon what we see. But as a
matter of interest we may examine the discharges.
Eructations in dyspepsia are very acid or feebly acid.
The first is very common and is usually met by an
alkali or Bismuth, though experience shows that this is
not good treatment, or at least but a part of good treat-
ment. It is associated with hyperesthesia, demanding
Aconite, Hydrocyanic Acid, Rhubarb, Ipecac, and like
remedies; with externally the wet pack, either of water
or water with an acid. The second evidences a condi-
tion of atony, and suggests Muriatic and Lactic Acids,
with Hydrastis and similar bitters, Podophyllin,,etc.
Eructations containing a yellowish, or yellowish-
brown coloring material, and of a bitter taste, shows
irritation of the upper small intestine, and sometimes
an irritation of the entire chylopoietic apparatus. The
remedies will be such as prove sedative to these parts.
Blood in the discharges has a variable significance.
If in small quantities, during violent vomiting, we may
conclude that some minute vessels have given away; if
dark colored and clotted, we conclude there is passive.
hemorrhage usually from congestion, except in the
rare case of ulceration, with erosion of some of the
vessels, when the discharge may either be of bright or
clotted blood.
Vomiting of considerable quantities of mucus is occa-
sionally noticed in persistent atonic dyspepsia, and its
STUDY OF DIAGNOSIS.
113
therapeutic value will be obvious. Vomiting of pus is
at once referred to ulceration, the result of chronic in-
flammation.
The "black vomit" of yellow fever, and some rare
cases of congestive, intermittent and remittent fevers,
shows the breaking down of the blood, as well as the
congestion of the digestive mucous surfaces.
FROM THE RESPIRATORY TRACT.—The discharges from
the respiratory tract are of mucus, pus, blood, and the
material of exudation. As heretofore remarked, we
wish to have a clear idea of the origin and value of
these discharges, and senses trained to recognize them
when seen. In health the respiratory mucous mem-
brane is continuously lubricated with mucus, but it is
not in quantity to be discharged by mouth; even the
increase of quantity is evidence of disease.
If mucus is thin, glairy, and very tenacious, we know
that it comes from a mucous membrane in a condition
of great vascular excitement-inflammation. The more
marked these proporties, the more active the excite-
ment. We see it in minor degree in catarrhal bron-
chitis, but most marked in sthenic bronchitis when
secretion is first established. The typical remedy is
Veratrum.
The opaque mucus, not so tenacious, is associated
with a subsidence of the inflammation and resolution.
The quantity may be such as to enfeeble the part or the
patient, but other than this it is regarded as a favor-
able symptom. The reader must not suppose from this
that abundant opaque mucous discharges are essential to
recovery, for they are not, and the patient convalesces.
better if the discharge is never in excess, and but little
10
114
STUDY OF DIAGNOSIS.
changed in character. The typical remedy is Ipecac.
Change of color evidences local structural disease, and
discase of the blood, whatever the color may be.
Shades of yellow and green show suppuration-the dig
charge is more or less purulent. Shades of brown, if
not from blood in this discharge, show a low grade of
inflammation and impairment of the blood. In some
of these cases thé discharges look like "prune juice,"
or still worse, like the washings of spoiled beef.
Globular sputa is characteristic of pneumonia, as the
glairy, tenacious mucus is of bronchitis. So marked is
this character of the expectoration in inflammation of
the parenchyma of the lungs, that it is evidenced, not
only in the single portions of mucus expectorated, but
when the patient spits in a vessel, they all run together
to form a globular mass.
The cheesy expectoration, lacking consistence, seem-
ing to be somewhat granular, is usually regarded as
tuberculous. Whilst there are exceptions, it is prob-
able that it may usually be regarded as evidencing
aplastic or cacoplastic deposits, and a condition favoring
tuberculosis, if it is not broken down tubercle.
Masses of dessicated mucus are sometimes expec-
torated, that are well calculated to deceive. They are
in larger and smaller granules, and fully meet the
popular idea of tubercular deposit. Yet when we take
a portion and soften it with water on a glass, it gives
the glairy, tenacious mucus, and not the friable, tuber-
cular matter. These little bodies are evidently from
accumulations in mucous follicles, principally in the
larynx, which are forced out in the act of coughing.
Pus from mucous membranes, will in appearance take
the entire range of this product. It is usually admixed
STUDY OF DIAGNOSIS.
115
1
with mucus, and thus has greater consistence. It is
laudable, or bad, thin, thick, bland, ichorous, yellow,
green, brown, etc. It evidences local destruction,
though it may be but superficial, the relationship be-
tween mucus and pus being very intimate. The grada-
tions of pus have the same significance here as elsewhere.
Blood may be discharged from the throat and pha-
rynx, from the stomach, from the larynx, and from the
lungs. From the throat and pharynx it is of usual
color, is not frothy, and is ejected by an act of the will.
Blood from the stomach is of darker color, is sometimes
admixed with food and the secretions of the stomach,
or is in part clotted. Blood from the larynx is but little
frothy, is of usual color, and is in part discharged by
an act of will. Blood from the lungs is usually bright,
frothy, and wells up into the mouth without the con-
sciousness of the patient.
We always want to know whether hemorrhage is
active or passive, as the treatment will depend upon
this. Very fresh and bright blood would evidence
active hemorrhage, whilst deeper colored blood would
evidence passive hemorrhage. Yet we will find better
evidence in the color and expression of the face and in
the pulse. Active hemorrhage calls for Veratrum and
Ipecac, whilst passive hemorrhage refers us to Erigeron,
Gallic Acid and Ergot.
Mucus streaked with bright blood evidences inflam-
mation, and is seen in sthenic bronchitis. If the blood
is less bright it evidences a lower degree of inflamma-
tion, or rather impairment of the life of the part, and
if it assumes the "prune juice" character, it evidences
an unpleasant condition. The blood in the sputa of
pneumonia is rusty, and may be found perfectly admixed
116
STUDY OF DIAGNOSIS.
with the mass of mucus, or forming a central nucleus.
If here it becomes brown, or has the "prune juice
character, it evidences a low grade of inflammatory
action and impairment of the life.
We occasionally see exudative material. First, as
fibrinous exudations from the mucous surfaces, in croup
and in croupous bronchitis; second, as broken down
tubercular material from the parenchyma of the lungs.
The last is sometimes very characteristic, but at others
it is so masked by the bronchial secretions and by the
breaking down of the structures, that we can hardly
recognize it. Call it cheesy, friable, and the fluid dif
fering in character from laudable pus in consistence,
color, etc., and the reader will get a fair idea of it.
EXAMINATION OF THE URINE.
The physician in common practice has but little
knowledge of the urine-possibly he may not know
the physical properties of normal urine. As we have
stated so often, this is the first thing that needs be
learned. If we can recognize normal urine when we
see it, it will be possible to tell its common variations
by sight. Yet here we find a serious obstacle in the
way-the very great variations of normal urine both in
color and in quantity. Yet there is a normal color, and
these differences are more in its concentration than in
any real change. The quantity may vary very greatly
without any marked change in the excretion-water
forming its bulk.*
*COMPOSITION OF RENAL EXCRETION.-The renal excretion has
naturally an acid reaction, and consists chiefly of urea, with some
uric acid, sundry other animal products of less importance, in-
麵
​STUDY OF DIAGNOSIS.
117
The majority of physicians attach but little value to
the ordinary examination of urine by the sight, which
is popularly known as " Uroscopy." Yet whilst we are
convinced that there is a broad basis of charlatanry,
there is evidently something real that serves as a basis
for selecting remedies. Evidently it is worth study,
and I think I can point out a method by which the
reader can learn all there is to be known.
It is claimed that all disease is represented in change
of the urinary secretions, and that these changes can
be recognized. Let us admit it, and then to study
diagnosis by the urine we will take cases of disease
cluding certain coloring-matters, and saline and gaseous sub-
stances, all held in solution by a large quantity of water.
The quantity and composition of the urine vary greatly ac-
cording to the time of day; the temperature and moisture of the
air; the fasting or replete condition of the alimentary canal;
and the nature of the food.
Urea and uric acid are both composed of the elements carbon,
hydrogen, oxygen, and nitrogen; but the urea is by far the more
soluble in water, and greatly exceeds the uric acid in quantity.
An average healthy man excretes by the kidneys about fifty
ounces, or twenty-four thousand grains of water a day. In this
are dissolved five hundred grains of urea, but not more than ten
to twelve grains of uric acid.
The amount of other animal matters, and of saline substances,
varies from one-third as much to nearly the same amount as the
urea. The saline matters consist chiefly of common salt, phos-
phates and sulphates of potash, soda, lime and magnesia. The
gases are the same as those in the blood-namely, carbonic acid,
oxygen,, and nitrogen. But the quantity is, proportionally, less
than one-third as great; and the carbonic acid is in very large,
while the oxygen is in very small, amount.
The average specific gravity does not differ very widely from
that of blood-serum, being 1.020.-Huxley.
118
STUDY OF DIAGNOSIS.
where the diagnosis is well made, and compare the urine
with the normal standard of health. Certainly we will
now be able to see these differences if they exist. Here
is the patient suffering with pneumonia, bronchitis, or
tuberculosis. Is there a urine that represents pncu-
monia, bronchitis, or tuberculosis? Here are patients.
suffering from well recognized nervous lesions, neural-
gia, paralysis, epilepsy, etc. Is there a urine that rep-
resents neuralgia, paralysis, epilepsy, etc.? Here are
certain well defined lesions of digestion, blood-making,
nutrition, and retrograde metamorphosis. Are there
urines that represent these lesions of digestion, blood-
making, nutrition, and retrograde metamorphosis?
But supposing we do not find that these diseases are
represented in the urines, and we can not diagnose the
situation of local disease from it, possibly we can diag
nose a general condition of disease. At least we will
very certainly learn what is to be learned, and we will
learn something that is valuable.
The ordinary examination is conducted with refer-
ence to-a, quantity; b, specific gravity; c, color; d,
deposits; and e, change in its constituents. In every
day practice the examination is of necessity superficial,
and it is only when symptoms point to lesions of the
urinary apparatus, or the disease is so obscure that we
resort to every known means, that a critical examina-
tion of urine is made.
To determine anything definitely with regard to this
secretion, the urine must be passed in a separate vessel,
(which should be clean), and the urine of twenty-four
hours saved for inspection. All tests of color should
be made in clear white glass containers by means of
transmitted light, and all deposits should be examined
in a similar manner.
STUDY OF DIAGNOSIS.
119
QUANTITY.—The normal quantity of urine in the
healthy man is about fifty ounces in the twenty-four
hours, and this is of a specific gravity of 1.020, contain-
ing 1080 grains of solid matter. The urine may mea-
sure but thirty ounces, yet the specific gravity being
high, 1.030, the secretion will be sufficient for blood
depuration. Again, the urine may be passed in normal
quantity, or as much as sixty or seventy ounces daily,
and yet being of low specific gravity, 1.010, the patient
will suffer from uræmia There is thus such indefinite-
ness, that even though we know the quantity of urine
in twenty-four hours, we can not tell whether depura-
tion is sufficient or not.
It may be remarked further that we do not expect
as large secretion from the kidneys in disease, when the
body is inactive, as in health when it is active. Scanty
urine is characteristic of all forms of disease, and even
accurate measurement of quantity and specific
gravity will not tell us so well whether it is sufficient,
as other symptoms that might seem to the casual ob-
server to be more indefinite.
an
SPECIFIC GRAVITY. The specific gravity is deter-
mined by a urinometer, and having the quantity passed
in twenty-four hours, we will, with this instrument, be
able to determine the amount of solids in this period.
But it does not determine what solids. If the urine be
of low specific gravity, and in small quantity, the blood
may be so freed from urea, that the function may be
regarded as normal, for there may be but little of the
"500 grains of other animal matter and saline sub-
stances" passing out, and the urea for excretion may
not be more than two or three hundred grains. Con-
120
STUDY OF DIAGNOSIS.
versely, if the urine be of high specific gravity, and
passed in considerable quantities, the patient may still
suffer from uræmic poisoning, for the adventitious solids,
sugar, albumen, saline matters, etc., take the place of
urea.
It is well to get an idea of the uncertainty of this
examination, otherwise we might be led into error. We
reach no conclusions from these examinations that are
not proven by other symptoms; and usually we make
these examinations to confirm conclusions reached by
more definite expressions of discase. If the patient is
suffering from the nervous excitation or coma of re-
tained urinary excretion, the examination determining
scanty urine becomes of value. If the patient shows
evidence of waste, and we find too free excretion, we
conclude that this drain upon the blood should be
stopped.
In any wrong of innervation, we think of the urinary
excretion as a possible source of disease, and if we do
not find the cause elsewhere, we give the urine a critical
examination. In any disease of debility, especially
when chronic, if we can not find the cause elsewhere,
we turn at once to the kidneys as a possible seat of the
trouble, and make the necessary examination.
COLOR.* The color of the urine has been regarded
as the best diagnostic evidence in the common` exami-
*Urohæmatin, the substance which gives to healthy urine its
peculiar tint, is of more importance to the Clinical Physician
than the majority of urinary ingredients: for the quantity passed
in the twenty-four hours is not only an index to the tear and
wear of the tissues, but the best measure we at present possess
of the rapidity with which man burns life's lamp. The amount
STUDY OF DIAGNOSIS.
121
nation of this fluid. Of necessity, if any definite in-
formation is to be had, the urine must be passed apart
from the fæces, and as before named, it should be exam-
ined in white glass by transmitted light.
The physician in ordinary, recognizes the normal
color varying from a pale straw to a yellowish brown
tint, and he classes the urine of disease as dark and
light or pale. Scanty and high colored urine is asso-
ciated with acute febrile and inflammatory diseases,
and pale urine with diseases of relaxation. Possibly
this is quite as definite as the ordinary professional
thought, and we may well ask ourselves if there is any
reason for this indefiniteness. Most assuredly there is;
and we find it in the wide range of coloration in health,
and also in diseases in which color has but little
meaning.†
of all the ingredients of the urine we have hitherto considered,
are much more under the influence of the diet than that of uro-
hæmatin, the quantity of which may be said to be a tolerably
exact measure of the destruction of blood corpuscles.-Harley.
†The color of the urine varies greatly in disease. It may be
perfectly white, yellow, brown, red, black, green, or blue, and
each of these tints, in the absence of ingesta capable of acci-
dentally producing them, invariably indicates the existence of
grave disease.
Normally colored urine does not, however, exclude the possi-
bility of disease, for the color of the freshly passed urine is no
absolute criterion either of the quantity or the kind of coloring
matter it contains. The abnormal like the normal pigments are
often combined with some of the other urinary ingredients in the
form of colorless compounds, and it is not until the compound is
decomposed, and the pigment set free, that we can take cogni-
zance either of its quantity or its quality. For example, here are
three urines: 1st. A pale, almost colorless urine from a healthy
11
122
STUDY OF DIAGNOSIS.
Let us take the opinion of Dr. George Harley, (and
I give it in extenso in the foot note,) a most excellent
observer, that the coloring matter of the urine-uro-
infant, aged 18 months. It has a specific gravity of 1 018. 2d.
An equally pale, almost colorless urine from a girl, aged 19, suf-
fering from chlorosis. It has also a specific gravity of 1.018. 3d.
A dark straw-colored, but perfectly transparent urine from a
healthy man, aged 33. It has likewise a specific gravity of 1.018.
In fact, these three urines have been purposely selected on
account of their having the same specific gravity. To each of
these add a quarter of their bulk of strong nitric acid, and bring
them to the boiling-point. Watch the change. The infant's
pale urine is scarcely altered; the man's dark urine is only
slightly deepened in tint; whereas the almost colorless urine of
the chlorotic girl has assumed an intensely red hue. What is the
cause of this difference? The infant is in the bloom of health-
there is no waste of blood-corpuscles in it-all the blood discs it
possesses are employed in the development of its frame. The
man has arrived at maturity; he is still in the prime of life, and
in the enjoyment of perfect health; his blood-corpuscles are not
wasted, but merely consumed in the tear and wear of every-day
life. The young woman, on the other hand, is suffering from
chlorosis; she has a pale lip, and a blanched cheek; her co¹ pus-
cles are being too rapidly consumed; her life's blood is oozing.
away by the kidneys, and there it appears as an excess of urohæ-
matin in her urine.
Take again these two urines so different in appearance. They
are from young men about the same age (24 years). The one
urine is perfectly colorless, like water; the other is of a deep red
color-case of hematuria from disease of the kidney. On adding
strong hydrochloric acid to the colorless urine it rapidly assumies
a port wine tint, whereas the same amount of acid added to the
red urine, instead of heightening, actually destroys the color it
already possesses. And why? Simply because the pale urine
contains an excess of combined urohæmatin, which is liberated
by the acid; whereas, the red urine contains merely a number
of free blood-corpuscles, which become coagulated, and, as the
STUDY OF DIAGNOSIS.
123
hæmatin-represents the wear and
and especially of the red corpuscles.
this to show us definitely the extent
tear of the tissues,
We might expect
of this wear and
coloring matter in them is insignificant in quantity when com-
pared with the amount of urohæmatin in the other, no sooner are
their cell-walls destroyed and the contained hæmato-globulin
set free and coagulated, than the red color disappears. Now
which of these two classes of urine denotes the most danger:
Most assuredly not that containing the free blood-cells. A very
small quantity of blood will sometimes color a great deal of
urine; whereas an immense destruction of blood-corpuscles may
take place in the body, and their debris be so eliminated as to be
invisible to the eye until the application of an acid sets it free
In fact, experience has shown me that the normally colored urine
of disease is a most treacherous guide to go by. It often lulis
the inexperienced into the belief that there is nothing materially
wrong, when a. grave lesion is making rapid strides toward a
fatal termination. Not very long ago I was told by an intelli-
gent practitioner that a young lady, regarding whose health we
were consulting, was laboring under hysteria "The secretions,"
as he termed them, being "all right," my opinion had been
asked more with the view of satisfying the friends who were get-
ting fidgety than anything else. The case appeared to be what
he said, until he added, "She is well fed, and yet she loses flesh,
and I don't know why." This remark at once brought us back
to the urine, which he assured me was perfectly natural in color,
and contained neither sugar nor albumen. I analyzed some, and
the case proved the very counterpart of the lad's just spoken of.
Although the girl's urine was natural in color, her life's blood
was imperceptibly oozing away with it. This is no solitary ex-
ample: I might cite many cases of so-called hysteria, which were
in reality cases of serious, though obscure disease; but that is
surely unnecessary. Who amongst us has not seen patients die,
and their disease put down as, only hysteria? The time is, nev-
ertheless, not far distant when we shall learn that hysteria is
something more than "mere functional derangement." Hysteria
may be a convenient term, but, after all, it is only a cloak of
124
STUDY OF DIAGNOSIS.
1
the
tear. But it does not; for as the cases given show,
color is not in proportion to the amount of urohæmatin,
but in proportion to that uncombined, and to its degree
of oxidation.
ample dimensions which hides the rags of ignorance. It is a
name instead of an explanation, a sham instead of a reality.
And what is still worse, it tends to keep us in ignorance by sti-
fling legitimate inquiry; for no sooner do the majority of practi-
tioners find a name for the disease than they cease to fathom its
cause. In some cases of cerebral and spinal disease the excess
of urohæmatin in the urine is so great that after it has been set
free by an acid and taken up with ether, the ether, after stand-
ing, solidifies into a red currant jelly-like mass, and may actually,
in some cases, be cut with a knife.
The best way of showing this is to boil four ounces of urine;
then add nitric acid to set the coloring matter free. When cool,
put the urine into a six-ounce bottle along with an ounce of
ether. Cork the bottle, thoroughly shake it, and afterwards place
it aside for twenty-four hours. At the end of that time the ether
will sometimes be found to be like a red tremulous jelly. Such a
case is, of course, a very bad one; but these are not nearly so
uncommon as one would imagine. In some of the worst cases of
urohæmaturia the urine is neutral or even alkaline, and the fons
et origo mali is to be looked for in the brain or spinal cord. In-
deed, we may often be led to a correct diagnosis of obscure cere-
bral and spinal disease, by finding urohæmaturia associated with
a saccharine or a phosphatic condition of the urine.
In a case of chronic cerebral disease, which I saw with Mr. T.
Carr Jackson, the quantity of urohematin regularly varied pari
passu with the severity of the paroxysms, nitric acid turning the
urine red, purple, or even bluish (blue matter being after a time
deposited on the bottom and sides of the test-tube), according to
the severity and duration of the attack. It ought never to be
forgotten that alkaline remedies, as well as certain vegetable
foods, may increase the urohæmatin. Even the external use of
carbolic acid sometimes turns it black.
¿
When urohematin exists in a free state, the urine is red in
STUDY OF DIAGNOSIS.
125
Notwithstanding this we always associate the high
colors or the wrong colors with severe disease. As Dr.
Harley remarks, "it may be perfectly white, yellow,
brown, red, black, green or blue, and each of these
color before any acid is added. These cases differ from hæmatu-
ria, in the urine being clear and transparent, and devoid of
blood-corpuscles, and from intermittent hæmaturia in the absence
of congestive casts. If it contains a deposit, the deposit may or
may not be high-colored; but in any case the supernatant liquid
is clear as well as red. Another fact, which is of great clinical
importance is, that the urohæmatin is not always in the same
state of oxidation; and, like indigo, its color depends on the
amount of oxygen it contains. It may be yellow, red, or brown.
In consequence of this, different acids act upon the urine differ-
ently. In one case nitric, sulphuric, or hydrochloric acid may
produce the same results; in another hydrochloric acid turns the
urine red, while nitric acid makes it blue, green, or yellow. In
a third sulphuric acid may develop the color better than the
others.
To illustrate these remarks: Take the case of a gentleman 33
years of age, whose urine to the eye appeared perfectly normal
in color. On adding strong nitric acid, however, to this urine it
immediately became of a blood-red hue, whereas hydrochloric
acid had no effect upon it until some minutes had elapsed, when
it gradually caused it to assume the same tint as that produced
by the nitric acid. When sulphuric acid is slowly added so as to
fall to the bottom of the test-tube, a reddish-brown line appears
at the point of contact, and this gradually deepens until, in the
course of six hours or so, it assumes a more intense color than
that produced by either of the other acids.
This is an important case in another point of view, namely, as
proving the value of urinary analysis in cases of obscure disease.
The only symptoms that this patient labors under are those of an
irregular kind of dyspepsia, with an occasional pain in the epi-
gastrium. He is in easy circumstances, takes plenty of nourishing
food, wants for nothing, yet he gradually gets weaker and
weaker, and has lost 17 lbs. in the course of the last year. Even
126
STUDY OF DIAGNOSIS.
tints, in the absence of ingesta capable of accidentally
producing them, invariably indicates the existence of
grave disease
But though we concede the general
indication, is there any one who can tell the diagnostic
"}
the locality in which the patient lives is a remarkably healthy
one (he was sent to me from Anglesey by Dr. D. Williams, of
the Menai Bridge), and if it had not been for the condition of
the urine, his symptoms would have remained a mystery. This,
too, was one of those cases in which the amount of urohæmatin
was so great that it caused the ethereal solution to solidify into a
jelly.
An excessive excretion of urohæmatin is not limited to cases
such as we have been describing. It occurs to some extent in
several diseases, especially those in which there is an excessive
tissue metamorphosis, and consequent too rapid blood consump-
tion. Hence we occasionally meet with it in low fevers, in diph-
theria, in pneumonia and some other inflammatory affections,
in lesions of the nervous system, during an attack of gout, after
the fit of ague, and during convalescence from nearly all grave
diseases. It is, however, in chlorosis (either in the male or
female), and the many unnamable obscure affections of that
class, where it becomes a dangerous symptom. In fact, it always
indicates the existence of a past or present mischief meriting the
closest attention of the physician, and where we can not remove
the cause we must at least attempt to check the effects of the
symptom, namely, to restore to the blood as much as possible of
the material which is being drained from it. Every one knows
the effects of iron upon the system, but iron alone is not always
sufficient for our purpose. Something more is wanted, and that
is best supplied by the preparations called the syrups of phos
phate of iron. Many syrups have been sold under this title.
There are the American syrups; the compound syrup of the
phosphate of iron, or "chemical food," as it is sometimes named;
the syrup of the superphosphate of iron and lime (excellent for
children); and a few others. One and all of them are good in
particular cases, but they must always be associated with a
:
STUDY OF DIAGNOSIS.
127
value of each or either of these colors, and make it point
us to the remedy? This, as the reader will see, is the
practical question, and I confess that I can not do it.
In exhaustive disease, in which we may suspect the
judicious selection of regimen in order that the full benefit may
be derived from them.
The preparations of zinc, in grain or grain and a half doses,
are also occasionally useful astringent tonics when the drain is
very great.
In some cases of disease the excretion of urohæmatin by the
kidneys appears to be diminished, but this is only when the sys-
tem has been so drained that there is little more to come away.
In the last stage of chlorosis a great diminution in the amount
of the urohæmatin in the urine takes place; so also in chronic
cases of hæmaturia, notwithstanding that the urine perhaps
looks red. Likewise in cases of chylous urine, in the albuminu-
ria of pregnancy, and in chronic Bright's disease. In all these
cases the blood has already been well drained of its constituents
before a marked diminution in the amount of the eliminated
urohæmatin-takes place.
Blue and Green Urine.-A great sensation was created some years
ago among Clinical Physicians and Pathologists when the first
cases of blue and green urine were reported; all doubted, and
many disbelieved in their existence. The least uncharitable
thought that the patient had hoaxed the doctor. Knowledge has,
however, advanced since then. Not one, but many observers
have met with the same conditions; and now the doubters and
disbelievers in the existence of either blue or green urine are
only to be found among the ignorant.
To Dr. Hassall we owe the first good report on the existence of
blue urine. It was entitled-"On the Frequent Occurrence of
Indigo in Human Urine, and on its Chemical, Physiological and
Pathological Relations."
I must here guard you against falling into the common error
of supposing that the urine is blue or green at the moment of
being voided, for, as far as I am aware, such a condition has
·
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STUDY OF DIAGNOSIS.
1
removal of the blood corpuscles by way of the kidneys,
the addition of Nitric, Muriatic or Sulphuric Acid to
the urine may give us the evidence of this masked
hemorrhage through these organs. The directions
given in the foot note may be followed.
never yet been observed. In the cases. hitherto reported it has
only been after exposure to the air, or after the application of
chemical agents, that the urine has been observed to become of
the colors alluded to. In Hassall's best-marked case, for exam-
ple, the urine was of a light brown color when voided, somewhat
alkaline, and had a specific gravity of 1.017. In the course of
three or four days it became thick and turbid, deep brown,
greenish, bluish-green, yellowish-green, and finally nearly black;
the scum on the surface remaining of a permanent, deep indigo-
blue color. All these changes followed upon simple exposure to
the air; but, as just said, chemical agents may produce one or
more of these changes. Thus, for example, in Munk's case of
green urine, when passed the urine was of a dark red color, but
on the addition of ammonia it became green. Like everything
else when properly understood, these changes have nothing mys-
terious about them. The body has not created anything new in
making blue or green urine. Indeed, as in disease no new func-
tions are ever created, but only a change occurs in the rhythm
and force of those already existing, so in disease no new sub-
stances are ever created, but only a change takes place in the
quantity or in the quality of those normally existing. It is now
twelve years since I adopted these views, and the longer and
deeper I peer into the wondrous workings of the human frame,
the more am I satisfied with them, and the easier do I find the
comprehension of disease. Physiology and Pathology are but
one study; and although a man may be a Physiologist without
being a Physician, no man can be a Physician without being a
Physiologist. The same laws that regulate health regulate dis
ease. The very effects we are now studying are a striking illus-
tration of the justice of these observations.
7
STUDY OF DIAGNOSIS.
129
DEPOSITS.*—A deposit from the urine is " always a
sign of something wrong," but, unfortunately, it does.
not always determine for us the character of the wrong,
or the remedy. To obtain a deposit, the urine is passed
in a separate vessel, which being covered, is allowed to
*A deposit in the urine is always a sign of something being
wrong, and although, as we have seen, it may occur from very
trivial causes, whenever it takes place without appreciable cause,
in the otherwise apparently healthy, it is a sign not to be disre-
garded, as, under such circumstances, it is not unfrequently either
the forerunner or associate of gravel or stone. Uric acid in
some form or other is the commonest ingredient of all calculi,
and there is no period of life exempt from them.
Urates are a very common deposit in the course of acute dis-
ease, and they even seldom fail to recur at some period or other
in the course of chronic affections. It is, however, only in dis-
eases of an acute febrile or inflammatory type that their sudden
appearance can be regarded as indicative of & crisis. Their sud-
den appearance is due to an important change having occurred
in the condition of the patient, and in general, though not
always, it is a change for the better. Such, for example, is ob-
served to occur in cases of gout and rheumatism where the climax
has been reached. So also in pneumonia and pleurisy when re-
solution and absorption commence.
Should a patient, not laboring under any febrile or inflamma-
tory affection, be every now and then troubled with a pink de-
posit in the urine without any assignable cause, it will be found,
in almost nine cases out of ten, that he is suffering from some
chronic affection of the heart, liver, or spleen, with which is asso-
ciated a tendency to gravel. In all such cases, therefore, steps
should immediately be taken to counteract this disposition by the
administration of alkaline tonics. Should there, however, be any
counter-indication to the direct alkaline treatment, those acid
salts are to be employed which, during their passage through the
body, are converted into alkaline carbonates-such, for example,
as citrates, tartrates, lactates, and acetates. Every now and then
૬
130
STUDY OF DIAGNOSIS.
\
stand from one to twelve hours. It is not well to ex-
amine deposits from old urine, urine admixed with
fæces, or urine in a chamber utensil that is continuously
foul for want of proper washing. Urine undergoes de-
composition, and this will give rise to some deposits;
fæcal matter will obscure the subject, and a utensil that
is allowed to contain decomposing matter will set up
processes of change in urine recently passed.
With regard to the value of deposits I can not do
better than quote from Golding Bird, as his methods
are the clearest I have seen:
"ON THE CLINICAL EXAMINATION OF THE URINE.—
The following observations may be of service to the
practitioner, as a guide to his proceedings in the super-
ficial examination of the urine, the most important part
of which can be readily performed in a few moments
in the sick room. Premising that the urine presented
for inspection is either an average specimen of that
passed in the preceding twenty-four hours, or at least
that resulting from the first act of emission after a
night's rest, unless the urine secreted at other times of
the day be specially required.
"Urine without any visible deposit, or decanted from the
sediment.-A piece of litmus paper should be immersed
in the urine, which, if acid, will change the blue color
of the paper to red. Should no change occur, a piece
of reddened litmus paper must be dipped in, and if thơ
secretion be alkaline, its blue color will be restored;
but if its tint remains unaltered, the urine is neutral.
an exceptional case may arise, where a mineral acid tonic is de-
manded; under such circumstances the above rule may be de-
parted from, and the case treated according to its special require-
ments.-Harley.
STUDY OF DIAGNOSIS.
131
“Some of the urine should then be heated in a pol-
ished metallic spoon over a candle, or, what is prefer-
able, in a test-tube over a spirit lamp, and if a white
deposit occurs, albumen or an excess of the earthy
phosphates is present; the former, if a drop of nitric
acid does not redissolve the deposit, the latter, if it
does.
If the urine be very highly colored, and not ren-
dered opaque by boiling, the coloring matters of bile,
or purpurine, are present. To determine which, pour
a thin layer of urine on the back of a white plate, and
allow a few drops of nitric acid to fall in the centre: an
immediate and rapidly ending play of colors, from
bluish-green to red, will be observed if bile, but no such
change will be observed if purpurine alone exists.
Should the highly colored urine alter in color or trans-
parency by heat, the presence of blood must be sus-
pected.
"If the addition of nitric acid to deep red urine, un-
affected by heat, produces a brown deposit, an excess
of uric acid exists. If a specimen of urine be pale,
immerse the gravimeter, and if the specific gravity be
below 1.012, there is considerable excess of water, but
if above 1.025, the presence of sugar, or a superabun-
dance of urea is indicated. To determine the existence
of either of these conditions, place a few drops of the
urine in a watch-glass, add an equal quantity of nitric
acid, and allow the glass to float on some cold water;
crystals of nitrate of urea will appear in two or three
minutes, if the latter exists in excess. Should this
change not occur, the urine must be examined specially
for sugar, which, it must be remembered, may exist in
small quantities, without raising the specific gravity of
132
STUDY OF DIAGNOSIS.
1
the fluid. For this purpose boil a small portion with
an equal bulk of liquor potassæ in a test-tube, and the
development of a brown color will at once afford evi-
dence of the almost certain existence of sugar. An
excess of coloring matter, rich in carbon, should always
be sought after, on account of its pathological import-
This is readily done by boiling some urine in a
tube, and, whilst hot, adding a few drops of hydro-
chloric acid. If an average proportion of the pigment
exist, a faint red or lilac color will be produced; but if
an excess is present, it will be indicated by the dark
red, or even purple tint assumed by the mixture.
ance.
"Should the urine be alkaline, add a drop of nitric
acid; if a white deposit occurs, albumen is present; if
brisk effervescence follows the addition of the acid, the
urea has been converted into carbonate of ammonia.
“Examination of the Sediment Deposited.—If the de-
posit is flocculent, easily diffused on agitation, and
scanty, not disappearing on the addition of nitric acid,
it is chiefly made up of healthy mucus, epithelial de-
bris, or occasionally, in women, of secretions from the
vagina, leucorrhoeal discharge, etc.
"If the deposit be ropy and apparently viscid, add a
drop of nitric acid; if it wholly or partly dissolves, it
is composed of phosphates, if but slightly affected, of
mucus. If the deposit falls like a creamy layer to the
bottom of the vessel, the supernatant urino being co-
agulable by heat, it consists of pus.
"Urine sometimes appears opaque, from the presence
of a light flocculent matter diffused through it, neither
presenting the tenacity of mucus, nor the dense opacity
of pus. Although scarcely sufficient in quantity to in-
terfere with the perfect fluidity of the urine, if a little
STUDY OF DIAGNOSIS.
133
be placed in a test-tube and agitated with an equal bulk
of liquor potassæ, the mixture will often become a stiff,
transparent jelly. This peculiar appearance is demon-
strative of the presence of the exudation, or large or-
ganic globules formed under the influence of irritation,
providing the urine does not coagulate by heat, for
should it do so, the existence of minute quantities of
pus may be suspected.
"If the deposit be white, it may consist of urate of
ammonia, phosphates, or cystine; the first disappears on
heating the urine, the second on the addition of a drop
of diluted nitric acid, whilst the third dissolves in am-
monia, and the urine generally evolves an aromatic
odor like the sweetbrier, less frequently being fetid.
"If the deposit be colored, it may consist of red par-
ticles of blood, uric acid, or urate of ammonia, stained
with purpurine. If the first, the urine becomes opaque
by heat; if the second, the deposit is in visible crystals;
if the third, the deposit is amorphous, and dissolves on
heating the fluid.
“Oxalate, and more rarely oxalurate (?) of lime are
often present diffused through urine, without forming a
visible deposit: if this be suspected, a drop of the urine
examined microscopically will detect the characteristic
crystals.
"If the urine be opaque like milk, allowing by re-
pose a cream-like layer to form on the surface, an emul-
sion of fat with albumen is probably present. Agitate
some of the urine with half its bulk of ether in a test-
tube, and after resting a few minutes, a yellow ethereal
solution of fat will float on the surface of the urine-a
tremulous coagulum of albumen generally forming be
neath it.
134
STUDY OF DIAGNOSIS.
!
"Much of the little time required for the investiga-
tion thus sketched out, may be saved by remembering
the following facts:
"If the deposit be white, and the urine acid, it in the
great majority of cases consists of urate cf ammonia;
but should it not disappear by heat, it is phosphatic.
"If a deposit be of any color inclining to yellow,
drab, pink, or red, it is almost sure to be urate of am-
monia, unless visibly crystalline, in which case it con-
sists of uric acid.
"The following tables briefly point out the readiest
mode for the examination of crystalline deposits, both
by chemical tests and by microscopic examination.
The latter mode is of course preferable to all others,
both for the accuracy and extent of the information it
affords, as well as for economy of time:
TABLE FOR DISCOVERING THE NATURE of urinarY DEPOSITS BY CHEMICAL RE-
1. {Deposit white.........
colored,
AGENTS.
25
2
2.{
8. {
ཝ.{
1. {
2 {
dissolves by heat,
Urate of ammonia.
3
Cystine.
4
...
insoluble by heat,.
soluble in liquor ammonia,...
insoluble in,
6.
::
soluble in acetic acid,...
Earthy phosphates.
insoluble in
visibly crystalline,
Oxalate and oxalurate of lime.
Uric acid.
pale, readily soluble by heat,
66
amorphous,...…………….
deeply colored, slowly soluble
by heat.....
6
Urates.
Urates, stained by purparine.
TABLE FOR THE MICROSCOPIC EXAMINATION OF UBINARY DEPOSITS.
Deposit amorphous,
visibly crystalline,.
.....
vanishes on the addition of
liquor potassæ,
permanent after the addition
of liquor potassæ.
Orystals in well defined octahedra,......
not octahedral,.
2
3
Urate of ammonia.
Phosphate of lime.
Oxalate of iime.
4
STUDY OF DIAGNOSIS.
135
{
Crystals in six-sided tables, soluble in
66
5.
{
6. {
•
8.
9.
{
:{
CL
not tabular, nor soluble in
ammonia,..
5
soluble in acetic acid,............ 6
insoluble in acetic acid,………………….. 8
in prisms or simple pennæ,.
radiated or foliaceous..........
soluble in acetic acid with ef-
fervescence,……………. ……………….
soluble in acetic acid without
effervescence.........
in dumb-bells or radiated,.....
spherical or colored,…………..
in lozenges or compound
crystals,
in spherical crystals
7
Cystine.
Neutral triple phosphate.
Carbonate of lime.
Bibasic-triple phosphate.
Oxalurate (?) of lime.
Uric acid.
Urate of soda or ammonia.
EXAMINATION OF THE FÆCES.
THE BOWELS.--Excretion by the bowels does not
hold that importance now that it did in olden times.
We learn by experiment that of the four to six ounces
of fæces, giving one to one and a half ounces of solid
residue, but about 100 grains are of excrementitious
matter.*
The liver, which was formerly thought to play so im-
portant a part in removing waste of tissue, and excre-
mentitious matter, yields but a few grains of this (four
to eleven grains). It has also been conclusively deter-
mined that there are no agents that act upon the liver,
increasing its secretion (cholagogues); that mercury in
any of its forms does not influence it in the least, ex-
cept when it produces its constitutional effect, and when
given to catharsis, it lessens the secretion. All cathar-
tics in cathartic doses diminish the secretion. Even
our Podophyllin, which has been regarded as a Samson
*See Principles of Medicine, p. 126.
136
STUDY OF DIAGNOSIS.
in its influence upon the liver, diminishes the secretion
in cathartic doses, and in minute doses lessens the bile
solids while it slightly increases the quantity excreted.
7
If we can learn that the liver performs an important
function in digestion and in blood-making, furnishing
its secretion for these purposes, and that it is admirably
adapted to these purposes, and rarely the subject of
disease, and that we have no medicines that influence
it directly, to increase secretion, we will have made ar
important advance in pathology, and will have much
improved our therapeutics. We may classify it with
the pancreas, and may expect to influence it only by
those remedies that control the circulation, act through
the sympathetic nervous system, and influence the pro-
cesses of blood-making.
Our inquiry in regard to the fæces will have refer
ence, first, to the increase or diminution of the secre-
tion; second, to the condition of the intestinal canal,
as an apparatus for digestion; and third, to any abnor-
mal constituent, or marked change in the character of
the excretion.
Increase of the fæces, in proportion to its extent and
duration, causes debility; for histogenetic material,
either as food or tissue, is proportionably removed.
Fluid fæces, whilst very frequently in excess as above,
deserve attention more particularly as evidencing such
lesion of the intestinal canal, as interferes with diges-
tion and blood-making; and also with that due degree
of distension of the blood vessels, which is necessary
to proper circulation.
Deficiency of fæces may depend upon the quality of
the food, or upon its quantity; the largest proportion
of fæcal material being furnished by the debris of
STUDY OF DIAGNOSIS.
137
food; or it may depend upon an arrest of secretion, in
which case we will have the same constitutional evi-
dence that we would have in similar arrest from the
skin and kidneys; or it may be dependent upon atony
of the intestinal canal, which allows the material to ac-
cumulate, without the natural effort at removal.
Simple constipation gives rise to derangements of
digestion, and the retention of effete material in the
bowels occasions a feeling of malaise and dullness, with
headache and fever, in so far as they are retained in
the blood, or re-absorbed.
The color of the discharges is sometimes of import-
ance in determining the character of disease. The
natural color, like the natural fetor, evidencing a con-
dition of the intestinal canal in which its functions may
be properly performed.
The dark-brown or almost black color of the fæces,
observed in typhoid disease, arises from the excretion
of the coloring material of the blood; the red globules
being broken down rapidly.
The use of iron in any of its forms, and occasionally
of sulphur or its salts, will darken the color of the fæces.
The dark-green color of the faces that followed the ad-
ministration of mercury, and was thought to be bile,
was due to the formation of sulphuret of mercury.
Greenish discharges are generally dependent upon an
increase of acid in the intestinal canal, with irritation
and consequent indigestion. It may, in part, be de-
pendent upon the coloring matter of bile, which is
thrown off by the fæces, in consequence of such irrita-
tion.
Clay-colored discharges refer to a general want of
secretion; not only of the solitary glands of the intes-
138
STUDY OF DIAGNOSIS.
tine, but of the associate viscera. It is an atonic con-
dition, with impaired innervation and circulation.
The natural odor of fæces seems to be dependent upon
a special secretion in the neighborhood of the cæcum.
It may be regarded as an evidence of normal activity
throughout the entire intestinal track.
Diminution of the odor is an indication of want of
functional activity, as an increase will indicate in-
creased activity.
Fetor refers to decomposition of the intestinal secre-
tions. It varies greatly from local causes, and can not
be relied upon as indicating any special condition of
the general system.
The cadaverous fetor may, however, be taken as evi-
dencing a septic condition, not only of the intestinal
secretions, but also of the fluids and solids.
It is difficult to determine change in the elements of
fæces, and it will hardly form a part of ordinary ex-
aminations. The principal of these I append, Lehman's
Chemical Physiology being the authority.
"The excrements in consumption are sometimes
found to contain more fat than usual. Sugar is occa-
sionally found in the fæces of diabetic patients. The
stools are found to be black, chocolate-colored, or tar-
like, when blood is contained in them, and this arises
from the upper intestinal canal; so also the semi-liquid,
green excrements which are observed occasionally in
typhus and other diseases, depend upon blood, which is
easily recognized by the microscope. Soluble albumen
is found in the stools in dysentery, typhus, and occa-
sionally in Bright's disease, and in cholera. The great-
est quantity of epithelial cells are found in the dejec-
tions of cholera. Cytoid corpuscles are very numerous
#
STUDY OF DIAGNOSIS.
139
in the excrements in catarrhal diarrhoeas, in dysentery,
and occasionally in typhus and cholera. Hyaline mucus
is observed in the excrements in catarrh of the large
intestine; it arises from the follicles of the colon, and
contains round or oval pale or granular cells and cell
nuclei. Fibrinous exudations occur in the fæces in folli
cular ulceration and in dysentery."
DIAGNOSIS BY THE TOUCH.
In our study of the senses, we found that the tactile
sense could be wonderfully developed. Marked exam-
ples of this may be found in the mechanic arts, not
only of extreme delicacy, but of complex and difficult
work accomplished through this sense alone. The
education of this sense in the blind is another marked
example, and it is well that a physician should make
himself acquainted with the education of the blind, to
see the range of this sense which in the majority has
such imperfect development.
What information can we gain by the sense of touch?
Not much, one would say at first thought; yet we find
it an important means of diagnosis if we study it care-
fully, and train the sense of touch. The obstetrician
relies wholly upon it, not only determining the presen-
tation and position of the child, but the condition of
every part engaged in the process. His touch tells him
the condition of the depending portion of the uterus as
an outlet, and also the condition of the organ as re-
gards the power of expulsion. It determines the con-
dition of the vagina as a parturient canal, and becomes
so sensitive that it recognizes intuitively changes of
•
140
STUDY OR DIAGNOSIS.
condition that will render the labor painful, protracted,
or difficult. In diseases of women, many physicians.
rely upon the sense of touch far more than sight, and
very rarely use the speculum. The finger tells the
condition of the uterus, not only as regards position,
but pathological changes as well. It determines dis-
eases of vagina, bladder, rectum, indeed of all these
parts, and does it so well that it becomes our most re-
liable guide to treatment.
I will guarantee that there is not one medical reader
but what could to-day, blindfolded, determine better
by simply placing his hand on the patient what kind
of a bath should be employed, or whether any at all,
than he can with his eyes open and without the touch.
Try the touch in cases of intestinal disease, shutting
your eyes to shut out ordinary impressions, and you
will be astonished at the result. Pass the hand over
the abdomen and at once you know whether a diarrhoea
is irritative or atonic, and a correct treatment is sug
gested. You may determine the character of a dys-
pepsia in the same way, and the general outline of
treatment. You can locate the disease and determine
its kind. Even in uterine disease the abdominal touch
becomes important. Try a case of pneumonia-let the
hand rest on the chest, slowly passing it over, and you
will be surprised to know how much may be learned-
a Winter's practice, and it becomes a means of physical
diagnosis.
A most excellent way of making this study is to take
a note-book and enter every question that may suggest
itself with reference to the various sensations given to
touch. Then question our experience-when and where
have I met each of these? what has been the nature,
1
STUDY OF DIAGNOSIS.
141
progress, duration, and termination of the disease
Now with what we know we will carry on a series of
experiments in every case of disease, making use of
what we have for the benefit of the patient, and learn-
ing what we can for the advantage, of others in the
future.
--
Let me put a few questions which will serve as an
example. If I put my finger on the tongue, and find
it dry, contracted, or rough, would you give Podo-
phyllin? an emetic? Quinia? Opium ? or a stimulant?
If I put my hand on the abdomen and find the walls
tense and contracted, the patient having diarrhoea,
what will be the remedy? If relaxed and tumid what?
If in uterine disease the abdominal wall is tense and
contracted, what is the nature of the disease? If all
the tissues are soft, full, doughy, what? If the hand
placed upon the forehead gets the sense of relaxation
and moisture, what would be the character of a head-
ache? If the forehead was tense and dry, what? I
offer these as examples of questions that one may ask
himself, and as the reader will see they can be greatly
varied, and asked of every part of the body, as well as
of the body as a whole. Ask then with reference to the
conditions of disease, but especially with reference to
remedies, as the diagnosis that suggests treatment is
that which we want especially.
In a case of labor, if the examination shows constric-
tion with want of secretion-pinched expresses the con-
dition of the parts, both of the lower segment of the
uterus, vagina, and perineal tissues—we know we will
have a protracted and difficult labor. If the hand is
placed upon the abdomen over the uterine globe and
we get the same sensation of unnatural contraction-
142
STUDY OF DIAGNOSIS.
pinched-there is possibly rigidity of os, or perineum;
what is the remedy? You answer Lobelia, because it is
the common remedy for rigid os and perineum. But you
give it without any advantage, and it sometimes causes
a very unpleasant irritation of the stomach and nervous
system, and makes things worse rather than better.
Let us ask your hand in place of your head. If this
was a headache, and you had a similar sensation when
your hand was placed on the patient's forehead, what
would you give? You answer promptly, Gelseminum
good, then give Gelseminum and not Lobelia. If upon
examining muscular tissues you had the same unplea-
sant sensation of contraction and irritability with pains.
what would you give? Aconite or Veratrum with
Macrotys-good, give Aconite and Macrotys in this
case. If in chronic disease of the pelvic viscera we ob-
tained the same sensation as the hand rested upon the
lower abdomen, what would we give? Gelseminum,
Aconite, Macrotys.
If in this examination during tedious labor, we found
the tissues thick and doughy, with rigid os and rigid
everything else, what would we give? With this con-
dition shown by an internal examination, the hand
placed upon the abdomen would receive the same sensa-
tion of unnatural fullness and want of action. Here
we would give Lobelia. The touch tells the story
clearly and explicitly, and names the remedy, which we
find upon trial acts "specifically." Supposing now it
should be pneumonia or bronchitis, and the hand placed
upon the chest gets the same sensation of unnatural
fullness, would the remedy be Lobelia ? Or if the
finger placed upon the tongue obtains the sensation of
doughy fullness, or the eye obtains it, would the remedy
STUDY OF DIAGNOSIS.
143
E
be Lobelia? Most assuredly, unless something else
acting in the same way is more prominently indicated
by other symptoms.
In speaking of the touch as a means of diagnosis,
we must not omit to notice the lesions of nutrition and
excretion-supply and waste. How do you determine
impaired nutrition? Surely not by the fullness or lean-
ness of the face? if you do you are frequently mistaken
You want to know if the loss of size and weight is
from want of fat or muscle, and your hand at once
seeks the covering of the false ribs for the one, and
grasps a group of muscles-say of the arm, for the
other. It would be absurd to feed a patient with beef
tea or other histogenetic material if we wanted fat,
though we might give calorifacient food to
to save
tissue.
We not only get the evidence of impaired nutrition
by the touch, and the food designated, but it tells us of
medicines that will prove curative. If the sensation be
of want of tone-tissues loose and flaccid-we think of
Bitter Tonics, Quinine, the Hypophosphites, and Iron.
If the sensation be of structures pinched and stringy,
we look for lesions of the nerve centres, and think of
Macrotys, Muriatic and Lactic Acids, Phosphoric Acid,
fatty inunction, etc.
The sensation of fullness without elasticity, would
suggest old tissues, and the necessity of active waste,
and would suggest Acetate of Potash, Iodide of Potas-
sium, and stimulant cathartics and diaphoretics. If
digestion remained good, these might be sufficient, for
the tissues would be renewed as fast as broken down.
But if their use gave soft and flaccid tissue, we should
supplement them by such a restorative as the triple
144
STUDY OF DIAGNOSIS.
phosphate of Quinia, Strychnine and Iron-"Com-
pound Tonic Mixture."
We would never give Iodide of Potassium in second-
ary syphilis, where the tissues give the pinched and
stringy sensation to the touch. Such a case would ask
for Veratrum, Cod Oil, Iodide of Ammonium, and some
would say Arsenic. Let one of those cases of secondary
syphilis, characterized by full, inelastic, lifeless tissues
fall into the hands of the routinist who prescribes Pro-
toiodide of Mercury in all cases, and he loses appetite,
digestion and blood-making, and grows worse rapidly.
This is but an imperfect and partial sketch of one of
our means of diagnosis, and one that has been regarded
as least useful. Yet it points out the method of rational
diagnosis, and the one we purpose studying in consid-
erable detail. As the reader thinks of the subject, and
recalls and arranges his experience, he will be surprised
how much he knows practically, and still more sur-
prised as he puts it in practice intelligently, how it aids
him in the selection of remedies.
•
THE PULSE.
Among the most important of the functions of life is
a normal circulation of blood, indeed it seems to serve
as a basis for the performance of all other functions.
Healthy life is dependent upon a regular and uniform
circulation of blood, and disease must follow any con-
siderable or continued variation in this function.*
*If the finger be placed upon an artery, such as that at the
wrist, what is termed the pulse will be felt; that is to say, the
elastic artery dilates somewhat, at regular intervals, which an-
STUDY OF DIAGNOSIS.
145
1
Whilst the heart is the centre and principal source
of power of the circulation, every vessel does its part
in aid of the movement of the blood. We have, there-
fore, to determine by the pulse the condition of the
heart, the condition of the arteries, the condition of
the capillaries, and to some extent the condition of the
veins. As these movements are stimulated and co-or-
dinated by the sympathetic nervous system, it should
also tell us of wrongs of innervation. As the move-
ment of the blood depends, to a certain extent, upon its
organization and condition, it may also determine for
us something of the wrongs of this fluid.
We will probably study the pulse to better advantage
if we analyze it, and think of its elements separately.
Put your finger on the radial artery and carefully ob-
serve the movement. It first divides itself into: (a) a
swer to the beatings of the heart. The pulse which is felt by the
finger, however, does not correspond precisely with the beat of
the heart, but takes place a little after it, and the interval is
longer the greater the distance of the artery from the heart.
The beat of the artery on the inner side of the ankle, for exam-
ple, is a little later than the beat of the artery in the temple.
The reason of this is that the sense of touch by finger is only
delicate enough to distinguish the dilatation of the artery by the
wave of blood, which is driven along it by the elastic reaction
of the aorta, and is not competent to perceive the first shock
caused by the systole. But, if, instead of the fingers, sufficiently
delicate levers were made to rest upon any two arteries, it would
be found that the pulse really begins at the same time in both,
the shock of the systole making itself felt all over the vascular
system at once; and that it is only the actual dilatation of the
arterial walls, which, traveling in the form of a wave from the
larger to the smaller arteries, takes longer to reach and distend
the more distant branch.-Huxley.
13
146
STUDY OF DIAGNOSIS.
dilatation of the artery, and (b) a succeeding contrac-
tion The wave of blood forced forward by contraction
of the ventricles, gives us the arterial dilatation, whilst
the contraction of the artery may represent the subse-
quent filling of the ventricles from the auricles.
To this extent the pulse evidences the time of con-
traction, or the rapidity of heart-beat. Even to this
extent the information is important, for a healthy life
can only be maintained when the movement of the
blood is well timed. If the heart beats too rapidly, we
must have a wrong in the life, as if it beats too slowly
we will have a wrong in the life.
With regard to frequency of pulse we are in the habit
of saying-as is the frequency so is the impairment of
all the vegetative functions-of the appetite, digestion,
blood-making, nutrition, excretion from skin, kidneys
and bowels-wrongs of the blood, the activity of zymotic
poisons, etc. There may be exceptions to this general
rule, but it is so constant that we find it important to
act upon it in every case of disease. Given, frequency
of pulse, the questions at once suggested are-what is
its cause? what is the remedy?
Whilst frequency of pulse suggests to us the use of
that class of remedies called sedative (special or arte.
rial sedatives), they will not always answer our pur
pose. If the wrong be purely one of the circulatory
apparatus, functional in its character, and depending
upon a wrong of sympathetic innervation, these reme-
dies will probably be sufficient. But if the frequency
of pulse represents and is dependent upon some other
lesion, as of the blood, or local disease, then other and
different remedies may prove the sedatives.
Frequency of pulse is associated with frequent respi-
STUDY OF DIAGNOSIS.
147
ration. The proportion is usually five beats of the
pulse to one respiration. Thus an adult man in the
sitting position will make thirteen to fifteen respirations.
each minute, and the proportionate pulse will be sixty-
five to seventy-five beats per minute. With a pulse of
one hundred and ten beats per minute, we will have
twenty-two respirations per minute. The relation of
frequent respiration to various wrongs of function wil:
be known to the reader, and evidently a slower respi
ration is something to be desired in all cases of disease,
and something that must be obtained in some cases if
the patient recovers health.
Without reference to the undue general excitation
that comes from frequent respiration, and the exhaus-
tion that must follow this severe muscular work, I
would call attention to the marked wrong it must work
in diseases of the respiratory apparatus. Rest is an
essential to recovery in all diseases of excitation, and
in most diseases of structure. With a rapid pulse, we
can not have rest of the respiratory apparatus, for the
movement of the chest is related to the movement of
the blood. Make the pulse go slow, and the movement
of the chest is likely to be slow in proportion.
The relation between the frequency of pulse and the
temperature will be borne in mind. For each increase
of ten beats per minute of pulse, there is an increase
of one degree in the temperature. Thus with a normal
circulation of seventy beats per minute, and a normal
temperature of 98°, we will find an increase of pulse to
ninety will give a temperature of 100°; with an in-
crease of pulse to one hundred and twenty we will have
a temperature of 103°, and so on. This rule does not
hold good in all cases, possibly not in the majority, for
148
STUDY OF DIAGNOSIS.
the high range of temperature, from 103° to 108°, does
not carry the pulse up proportionately.
When we come to consider the influence of changes
of temperature we find them similar to those that
follow change in the time of pulsation. In the ratio
of increased temperature we find arrest of excretion, of
nutrition, of digestion, of blood-making, and of inner-
vation, and that zymotic poisons propagate themselves
more rapidly. With the temperature maintained above
103°, death is a matter of time, indeed molecular death
is going on from the time the temperature strikes this
point.
It was mentioned that local processes of disease are
severe in proportion to the frequency of the pulse.
This will be noticed especially in inflammation-as is
the frequency of the pulse so is the intensity of the in-
flammation, the impairment of the life of the part, and
the danger of a termination in death. The local hyper-
æmia is increased by the rapid pulse, and the final
arrest of circulation is also promoted by it. If, there-
fore, we wish to stop the process of inflammation, we
select those remedies which will lessen the frequency
of the pulse.
If in any case we have a structural lesion, whatever
may be its nature-either an impairment of nutrition,
or from deposit—we will find, frequently, that its pro-
gress will be in proportion to the rapidity of the pulse.
In these cases remedies that influence the circulation,
giving it normal frequency and freedom, will be very
important.
It was also named that zymosis or sepsis was rapid
in proportion to the frequency of the pulse. This may
be noticed in those diseases known as typhoid, in ery-
STUDY OF DIAGNOSIS.
149
sipelas, the eruptive fevers, diphtheria, as well as in
typhoid and typhus fever. As is the frequency of the
pulse, so is the evidence of sepsis, as marked by dirty,
brown, or black coatings on the tongue, sordes on the
teeth, pungent heat, offensive discharges, etc. The
danger to life is frequently in proportion to the fre-
quency of the pulse, and means that will give a better
circulation as regards time, freedom, and uniformity
in all parts of the body, lessen these unpleasant
symptoms.
But frequency is only one of the wrongs of the cir-
culation, and but a part of the information we should
obtain from the pulse, Frequency has reference to the
rapidity of the blood-waves-the number that passes
under our finger in one minute. In addition to this we
have to notice that there are peculiarities in the blood-
wave, and in the current after this wave has passed.
The pulse has volume-referring to the size of the
artery. It has varying impulses in the wave of the
blood, and also in the interval between the waves.
Volume, or increased size of the artery may have
reference to the amount of blood, to its increased circu-
lation, or to some obstruction to its free movement.
We will have a large pulse in the plethoric, we may ex-
pect a small one in the anæmic, and these conditions
will be determined by other evidences. If the artery
is large, and the person is not plethoric, we ask the
question-is it dependent upon a more rapid movement
of the mass of the blood, especially to the surface, or is
it dependent upon an obstruction to its movement
through the capillaries? Freedom in the pulse-wave in-
dicates the one, and a want of freedom-oppression-
indicates the other condition.
4
150
STUDY OF DIAGNOSIS.
f
The sharp impulse of the wave of blood, as it strikes
the finger, may be referred to lesions of the nerve cen-
tres, especially of the sympathetic. The wrong is of
irritation, and calls for remedies that relieve it. If
the impulse be sharp, the wave short, and the inter-cur-
rent vibratile, the irritation is extreme.
The dull, elastic stroke of the wave refers us to an
impairment of innervation from the sympathetic and
spinal cord. The more marked this is, the greater the
necessity for those remedies which stimulate and give
strength to these nerve centres.
The length of blood-wave has reference to that con-
dition known as (6
sthenia," an excitation founded on
strong life. This is especially the case where the wave
is large in volume, and well supported by the column
of blood behind.
The oppressed pulse is marked by a want of power in
the stroke, and more especially by a feeling as if the
current in advance of the wave broke its force. Evi-
dently the blood-wave does not measure the amount of
blood passing through the artery. It refers us to ob-
struction in the capillary vessels, or possibly an impair-
ment of the large vessels as well, or a wrong in the
blood unfitting it for circulation.
If the finger be carefully trained it will notice a vari-
ation in the surface of the wave, as well as in its length.
Many times it is distinctly felt as two waves—a first
sudden and short, and a second full, even and prolonged
The first may be called the shock-wave, and the secon
the systolic-wave which represents the movement of
blood from the heart.
The shock-wave sharp and pronounced may always be
referred to undue excitation of the nerves distributed
STUDY OF DIAGNOSIS.
151
upon the vessels, and an undue contraction or tension
of their walls.
The full, strong, systolic-wave may be referred to ex-
citation of the heart and strength in its movement.
The short, systolic-wave evidences a want of cardiac
power, and especially of impaired innervation from the
spinal cord and sympathetic.
The inter-wave current sometimes gives valuable in-
formation, and it is well for the reader to observe it
carefully in health and learn its normal condition.
We find in disease that it has more or less volume, has
more or less strength, and has more or less of the vibra-
tile quality.
When we speak of a full pulse, we have reference to
the inter-wave current as well as to the wave, and the
condition of sthenia will be determined by this. It is
strong life in a state of excitation.
If now we add hardness, we have added an especial
lesion of innervation, of excitation steadily maintained.
If we speak of a small pulse hard, we refer it to im-
pairment of life from activity, still maintained.
If we have a small pulse soft and easily compressed,
we refer it to deficient innervation.
If we have a small pulse vibratile, we say it is the ex-
pression of impaired life, with great excitation of the
nerve centres.
If we have an empty pulse, the inter-wave current
hardly perceptible, it is the evidence of impaired life,
with enfeebled innervation from the sympathetic.
There are other changes of the pulse which might be
noticed, but they are difficult to describe and learn
I
do not think that we can tell every lesion by it, as
Chinese doctors believe, but to the educated touch
}
[
152
STUDY OF DIAGNOSIS.
gives most valuable information with regard to the most
important functions of life. I doubt not many physi
cians can locate lesions with very great certainty from
it alone; that they can distinguish lesions of the brain,
lungs, digestive apparatus, urinary apparatus, etc., and
determine, to some extent, their character.
But in the practice of medicine, there is something
of more importance than locating a disease, or even de-
termining the character of the lesion. The important
object is to associate the evidences of disease with reme-
dies for their cure, and to make the expressions of dis-
ease point to the medicine.
Feeling the pulse gives us a knowledge of the lesions
of the circulation-most important information in the
majority of diseases. Every lesion of the circulation
is distinctly announced to the cultivated touch, as is
some lesions of the blood and of the nervous system.
In so far as we study the pulse, I desire that it shall
mean special remedies-not names of disease.
Frequency calls attention to a wrong of the circulation
and prompts the asking of the question-why? It
does not necessarily mean Veratrum, Aconite, Gelsemi-
num, etc., though it is suggestive of them Why? Is the
wrong in the vessels an obstruction to the free circula-
tion of blood, requiring an increased movement of the
heart to compensate it? Is the wrong an enfeeblement
of the heart, requiring increased frequency of impulse
to compensate for want of power? Is the increased
frequency dependent upon irritation of the cardiac
plexus? Is the frequency dependent upon a wrong of
the blood? Upon a cerebro-spinal wrong?
The full pulse with strength means medicine-Vera-
trum. Whether full and hard, full and bounding, the
1
STUDY OF DIAGNOSIS.
153
special sedative named is at once suggested. It may
not be all that the patient wants, but it is one, and in
many cases will stand first.
The full pulse doughy (lacks the marked vibration)
means Lobelia ; or if marked and associated with full-
ness of mucous membranes and purplish discoloration,
Baptisia; or if accompanied with muscular pain, Apo-
cynum.
The full pulse open, is kindly influenced by Podophyl-
lin, and especially by Quinine in full doses.
The large pulse empty calls for the alkaline sulphites,
Sulphurous Acid, stimulant baths or fatty inunction,
Quinine, and histogenetic food. The sensation we get
in this case is of an artery of large calibre, but with too
little volume of blood-the sensation after the impulse
being of emptiness.
The full pulse vibratile calls for Gelseminum, usually
associated with Veratrum.
The full pulse oppressed, calls for Belladonna, alter-
nated with Veratrum; if sepsis, Baptisia.
The small pulse usually means Aconite.
The small pulse vibratile Aconite and Gelseminum.
The small pulse oppressed Belladonna and Aconite.
The small, soft, easily compressed pulse, Aconite,
stimulants. Small doses of Quinine with Opium and
food.
The small pulse, frequent, easily compressed, the wave
of blood giving a sense of squareness as it passes under
the finger, Opium.
Want of power in the impulse suggests Digitalis,
Capsicum.
The sharp stroke of the pulse with tremulous wave be
tween strokes, means Rhus.
}
154
STUDY OF DIAGNOSIS
13
The sharp stroke of pulse, with even, small, vibratile
current between strokes-Bryonia.
The duil stroke with tremulous or vibratile wave-
Phytolacca.
The open, tremulous pulse-Arsenicum.
The small or open pulse in which the wave of blood
drops suddenly as it passes the finger-Pulsatilla or
Cactus.
Irregularity of pulse, soft or open, with a distinct
wrong in the stroke-Cactus.
The steady, vibratile pulse, without marked wave-
Macrotys.
We have often reason to believe that Quinine is indi-
cated by the periodicity of the disease, and yet our ex-
perience with the remedy raises doubts of whether it
will be well received and exert a kindly and curative
action. If the pulse is hard and vibratile, wiry, we will
not give it; if it is soft and open we may expect its
kindly action. The physician who would administer
Opium or its salts with a hard, wiry pulse, would be
doing his patient a great wrong. Here, also, we want
a soft, open pulse for the kindly action of the medicine.
No one in his senses would give Podophyllin when
there was a small, wiry pulse, or when it had a sharp
stroke-the patient might get through safely, and it
might kill him.
This is only a partial consideration of the subject, ·
and the results of my own experience. It should agree
with what others know of the pulse as a means of
diagnosis, and I hope will be thoroughly proven.
Even if proven to be without foundation in fact, the
investigation will give practical knowledge, and will
increase our knowledge of the relationship between
the evidences of disease and remedies.
STUDY OF DIAGNOSIS:
155
If the reader will notice carefully, he will see a
marked resemblance between the touch of the pulse,
and the general sense of touch when the hand is applied
to the skin. The sensation from the slight œdema of
cellular tissue, that indicates Apocynum, and the pulse
that says Apocynum is wonderfully similar. The sen-
sation from the skin that says Lobelia and the pulse
that says Lobelia is the same. The pulse of Veratrum
is associated with the skin of Veratrum. And so we
will find it all the way through, if we see the indica-
tions for remedies rightly they never conflict.
THE TEMPERATURE.
Among the evidences of disease, none are more defi-
nite and important than changes in the temperature.
Heat is not only force in the animal body, but it is also
a condition of life; a man has activity through it, and:
he has life by it. The theory of Samuel Thomson-
"Heat is life, cold is death," was very simple, and had
much of truth in it—it was just one-third of the truth.
Cold is death, but so is too high a temperature, and an
unequal distribution of heat.
The human body maintains its healthy functions at a
temperature varying from 98° to 98.5°. This is a con-
dition absolute for health. If the temperature varies
from this above or below, disease must result. We may
state the proposition in a different form-no disease
can exist without changing the temperature of the
body, either raising it, depressing it, or rendering it
unequal. Thus, change of temperature becomes an
absolute evidence of disease, though it may not point
out the character or the location of the lesion.
156
1
STUDY OF DIAGNOSIS.
In the olden time changes in the temperature were
determined by the hand applied to the surface of the
body. With some physicians the touch would be so
educated that it would recognize these changes with
considerable accuracy. Whilst it would not note the
changes within one or two degrees when the tempera-
turé was above, it would recognize certain alterations.
of the skin, and modifications of heat or electricity,
that the body thermometer does not take cognizance
of. This information is of great importance, and whilst
we highly value the body thermometer, we purpose to
cultivate the touch as far as possible.
THE BODY THERMOMETER.-The thermometer is pre-
sented to us as a new means of diagnosis, but as far
back as 1754, one hundred and twenty years ago, An-
tonius De Haen, the first clinical teacher of medicine
at Vienna, insisted upon its use to determine the tem-
perature of the body, rather than to judge by the hand.
But though De Haen showed that it was the only cor-
rect index of heat, and seemingly indispensable in
diagnosis, if it was desirable to determine the temper-
ature, he was not able to convince the profession that
this was desirable, and its use lapsed with his death.
The use of the thermometer has been revived within
the last fifteen years, and is now exciting much attention,
and is employed by many as a most valued means of
diagnosis and prognosis. It is valued now, because we
appreciate the fact that the vital processes can only be
performed in perfection at the normal temperature of
98º, and that just in proportion as it varies from this,
either above or below, they are changed or arrested.
Indeed, it would seem, that heat, at this degree, was the
STUDY OF DIAGNOSIS.
157
most essential condition of life, and that if there be a
variation from it, those means which will restore the
thermal equilibrium are the most direct and important.
The difficulty in the way of using the thermometer
to determine the temperature of the body, seemed to
be in a want of sensitiveness, and precision in marking
fractions of a degree. This has been overcome by em-
ploying a large quantity of mercury in the bulb, and a
short stem graduated from 80° to 115°. By thus in-
creasing the quantity of mercury, the degree, as marked
upon the scale, was so lengthened that it could readily
be divided into fourths, and even eighths or tenths.
And the sensitiveness to heat was in direct proportion
to the increased length of a degree as marked upon the
scale.
A registering thermometer is one in which a small por-
tion of mercury is detached from the main column in
the stem of the instrument. This detached portion is
elevated by the expansion of the mercury below, which
ascends in the stem below it, and thus marks the degree
of heat. But it is not influenced by the descent of the
main column, but remains in its place, thus acting as a
register. In using this thermometer, the detached por-
tion of mercury is lowered in the stem below the
register by giving it three or four gentle taps with the
hand from below.
As the instruments require great accuracy in manu-
facture, they exceed in price the ordinary thermometer.
Yet very good instruments may be purchased for
$2.50 to $5.00; the self-registering, in morocco cases,
1 would recommend as preferable.
It may be remarked, that we employ thermometers
graduated to Fahrenheit's scale, but some of the
138
STUDY OF DIAGNOSIS.
cheaper German instruments have the scale of Reaumur
or Centigrade.
The majority of
APPLYING THE THERMOMETER.
writers direct that the thermometer be applied in the
axillæ, as it is there completely enclosed and sur
rounded by the soft parts. When it is convenient, as
in some acute diseases, the person being in bed, I think
the axillæ the best, yet there are many cases when we
should like to test the temperature, that it would be
very inconvenient for the person to unfasten the clothes
to reach this part. Women, especially, will object to
this method of examination.
To suit these cases, I apply the bulb of the ther-
mometer under the tongue, having the patient close.
the mouth. This is much more convenient, and so far
as my experience extends, just as reliable.
The thermometer should be retained in its place from
three to five minutes, as it requires this length of time
for the full influence of the body's heat. It is well
also, in some cases, to watch the register to see how
rapidly the mercury rises, as there is much difference
in this in different cases, and it also becomes an element
in diagnosis.
RANGES OF TEMPERATURE IN HEALTH.-The standard
temperature of the healthy body is 98.5°, and is sub-
ject to a slight variation during the day of about 0.820°.
The maximum temperature is in the early morning; it
fluctuates and gradually decreases during the day, and
is lowest at midnight.
"The observations of Drs. Edwards and Davy have
shown that the amount of animal heat may be consid-
erably altered by a number of collateral circumstances.
STUDY OF DIAGNOSIS.
159
But the great distinction between these alterations of
temperature in health, and those which are the result
of disease is, that these variations are generally tempo-
rary, and within narrow limits-amounting to mere
fractions of a degree-rarely more than 1.8° Fahr. to
3.6° Fahr. whereas those which are due to disease are
persistent so long as the disease exists.
"The following are the collateral circumstances
which mainly influence animal heat in our daily life,
and which require to be remembered in order that erro-
neous conclusions may not be drawn: 1. Active exercise
[not carried to the extent of exhausting fatigue] raises
the temperature proportionally to the degree of mus-
cular exertion made. 2. Exposure to cold without exer-
cise lowers the temperature. 3. Sustained mental ex-
ertion reduces temperature about half a degree 4. The
amount of heat is also reduced by a full meal and the
use of alcohol; but it rises again as digestion advances.
5. There are diurnal fluctuations capable of being thus
determined. 6. The temperature of the body rises
with the temperature of the air; and sudden transitions.
from a cold to a hot climate induce a feverish state
marked by increase of temperature on bodily exertion.
7. The average temperature within the tropics is nearly
1° Fahr. higher than in temperate regions. 8. The
temperature is more readily and rapidly affected-more
sensitive, so to speak-than either the pulse or the res-
piration; and this is especially the case in disease.".
Aitken.
RANGES OF TEMPERATURE IN DISEASE. We have to
study both an increase and a decrease in the temperature
of the body, the first being of most common occurrence.
160
STUDY OF DIAGNOSIS.
1
and having the greatest range. Thus whilst a decrease
of but one degree, if maintained for a considerable
time, will result in death, an increase of two to four
degrees may be maintained for a month with safety to
life.
The increase of temperature is usually proportionate
to the frequency of the pulse, one degree corresponding to
an increase of ten beats per minute. Thus :
With a temperature of 98°.
..pulse of 60
"L
6
99°
(6
100°.
(
101°....
102°.
แ
"
103°......
ce
((
104°...
((
แ
105°...
(6
106°....
((
70
"L
80
แ
90
((
100
46
110
120
130
140
This table is for adult males of good development,
and will not apply to those of feeble constitution, of
sedentary habits, or of a nervous temperament. In
such, with a normal temperature of 98°, the pulse would
be 70 or 80, and the increased frequency to each degree
would be but six or eight, until the 103° was passed.
In chronic disease we also find an increase of tem-
perature, and the thermometer becomes almost as cer-
tain a means of diagnosis and prognosis as in febrile
and inflammatory affections. Thus, for instance, in
phthisis pulmonalis, we find a permanent increase of
temperature to 99° and 100°, in the first stages, in
creasing to 101° and 102°, as the disease progresses.
This increase is so uniform that it will furnish the best.
evidence of the nature of the disease in its earliest stage.
The frequency of the pulse corresponds to the increase
1
STUDY OF DIAGNOSIS.
161
".
of temperature. Breaking down of the tubercles is
announced by a marked increase of temperature, cor-
responding to the destruction of lung tissue, and the
danger to life.
In acute fevers and inflammations, we find the tem-
perature increasing in the ratio of the severity of the
disease. It does not, however, remain uniformly the
same throughout the twenty-four hours, but presents a
marked morning decline and evening elevation. This
is very distinct, even in continued fevers, which we are
accustomed to think of as being uniform in all their
phenomena. This fluctuation is rarely less than one
degree, and is frequently two degrees or more.
The value of the thermometer, as a means of diag-
nosis, is thus estimated by Dr. Aitken:
"In the course of many diseases, whose diagnosis
has been accurately determined, if the temperature de-
parts from its normal or typical range, the thermometer
will furnish the best and the earliest indication of any
untoward event, such as the additional development of
disease, or other visceral complications, in its course.
"When once the typical range of temperature (nor-
mal, as it were, of the particular disease) is determined,
a basis is laid for appreciating irregularities or compli-
cations in its course in particular cases. For example,
a patient exhibits symptoms of fever of the typhoid
type, but during the progress of the first week his tem-
perature becomes normal, for however short a space of
time-the occurrence of this event proves that the fever
is not what it was supposed to be. Again, a patient
may suffer from all the general symptoms of incipient
pneumonia; but there still is a doubt as to whether in-
farction of the lung has taken place. The sputa being
14
162
STUDY OF DIAGNOSIS.
*
·
suppressed, or not procurable, does not assist the diag
nosis. If, however, the temperature is found to be
normal, it is certain that no croupous exudation has
taken place in the lung, and that there is no pneumonia.
Again, if a tuberculous patient has a sudden attack of
hæmoptysis, and if the temperature of his body is
normal during and subsequent to the.attack, no reactive
pneumonia, nor any exacerbation of the tuberculous
exudation need be expected. This is a new field open
for investigation in cases of phthisis.
Again: In all cases of convalescence, so long as the
defervescence proceeds regularly, as measured by the
temperature, no relapses need be feared; on the other
hand, delayed defervescence in pneumonia, the persist-
ence of a high evening temperature in typhus or
typhoid fever, or the exanthemata, and the incomplete
attainment of normal temperature in convalescence,
are signs of great significance. They indicate incom-
plete recovery, supervention of other diseases, unfavor-
able changes in the products of disease, or the continu-
ance of other sources of disturbance requiring to be
carefully examined into. The onset of even a slight
elevation of temperature during convalescence is a
warning to exercise careful watching over the patient,
and especially for the maintenance of a due control
over his diet and actions.”
THE INFLUENCE OF TREATMENT ON THE TEMPERA-
TURE.-By reference to table on page 160, it will be
noticed that there is a constant relation between the
frequency of the pulse and the temperature: that with
a range of temperature of 103° to 105°, we find a pulse
ranging from 110-115 to 130-140. It is evident, there-
STUDY OF DIAGNOSIS.
163
fore, that if we have any means that will control the
circulation lessening the frequency of the pulse-it
will also lower the temperature.
The question then arises, if a treatment will thus
control the pulse and temperature, may it not change a
severe and dangerous case into a mild one without
danger? We answer this question in the affirmative,
not as a theory, but from observations on many cases
of disease.
I think I am justified in stating, as an axiom, that
just in the ratio that the circulation is thus controlled,
and the temperature reduced, the fever is rendered
mild.
I wish it distinctly understood, however, that I refer
only to those influences which can be continued for
some days, and not to those which endure but a few
hours. The use of large doses of Veratrum will bring
down the pulse from 120 to 60 or 70 beats per minute,
in six to ten hours, and with a corresponding reduction
in temperature; but it is not possible to continue this
influence, as in a few hours the stomach becomes irri-
table and rejects it, or the depression of the sympathetic.
nervous system is such as to peril life.
But if the remedy is given in doses of half to one
drop, sedation is slowly produced, the stomach receives
it kindly, and instead of depression of the vegetative
functions, the remedy acts as a stimulant to them.
But is it possible to arrest a fever before it has run its
course? I am satisfied that this question may also be
answered in the affirmative. Not that every case can
be shortened, for in some the local lesion of Peyer's
glands proves an insurmountable obstacle; but many
can be arrested from the seventh to the ninth day, more
164
STUDY OF DIAGNOSIS.
by the fourteenth, and in nearly all the disease can be
restricted to twenty one days.
A fever terminates naturally-by a decrease in the
frequency of the pulse, a diminution cf the tempera-
ture, and the re-establishment of secretion, by which
the cause of the disease is removed. If, then, by the
use of sedatives, we lessen the frequency of the pulse,
and obtain an equal and uniform circulation, with a
corresponding decline in temperature, we find it easy
to establish secretion from the skin, kidneys and
bowels, by the usual means. And in a majority of
cases these processes may be sustained by the use of
nutritious food, and the use of small doses of the Bitter
Tonics.
But the question arises, does the temperature bear
the same relation in chronic disease, and will treatment
influencing the temperature have a like curative influ-
ence? I answer the question in the affirmative, and
adduce as an example phthisis pulmonalis, one of the
most intractable diseases we have to contend with.
In this, so long as the increased temperature is main-
tained, the disease progresses; and very frequently its
rapidity is in exact ratio to this. Diminish the temper-
ature, and the disease progresses more slowly. Reduce
it to 98.5°, and maintain it at this, and the patient re-
covers.
The wrong of temperature is but the expression of
disease. If the disease is favorably influenced by rem-
edies the temperature falls or rises towards the normal
standard. Thus in a given case of disease we may see
the pathological wrong, whether of the blood, the
nervous system, or of waste and excretion, and at the
same time the indications for the remedy which will
STUDY OF DIAGNOSIS.
165
1
right the lesion, and we know that its use will reduce
the temperature. Thus in a case of zymotic fever the
evidences of sepsis are marked, and with sepsis there
must be an exalted temperature. If now we select the
right antiseptic, say Sulphite of Soda, Chlorate of
Potash or Baptisia, the temperature will fall with its
use. If in any given case we have a special indication
for Nitric Acid, for Podophyllin, Quinine, etc., they
will influence the temperature toward the normal
standard.
But in many cases the wrong of temperature may be
regarded rather as a cause than as a result. If the
temperature is above the normal standard the functions
of life are impaired in the ratio of the excess.
Thus as
we have already seen-increase of temperature is asso-
ciated with acceleration of the pulse-increase of tem-
perature is associated with frequent respiration. With
an increase of temperature there is an arrest of diges-
tion, blood-making, nutrition, waste, retrograde meta-
morphosis, and secretion from skin, kidneys and bowels.
We also find that structural lesions are influenced in
the same manner. Inflammation is active in propor-
tion to increased temperature, as is also the tendency
to suppuration and death of the part. The influence
of zymotic causes of disease is also increased in the
ratio of increase of temperature, and the condition
known as typhoid is marked in proportion to it. In
surgical disease we find the processes of repair arrested
when the thermometer marks 103°; above this the pus
loses its laudable character, becomes thin, ichorous,
etc., and presently the structures soften and break
down.
The fact that increase of temperature is a condition
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STUDY OF DIAGNOSIS.
in many chronic diseases has already been noticed. In
phthisis pulmonalis the first advent of disease is an-
nounced by a temperature of 100°. In morbus coxa-
rius, white swelling, etc., increase of temperature is
one of the most pronounced and distinctive symptoms.
In all these cases we may say that the rapidity of dis-
ease is in the ratio of increased temperature, and so
long as the temperature is thus high no amendment
need be expected. If the temperature can be reduced
and maintained at or near the normal standard, the de-
structive processes are less active, and a cure rendered
possible.
•
If we decide that a wrong of the temperature is a
cause rather than a result, even though but in part, we
wish to know the means by which it may be rectified.
The first proposition-" as is the pulse so is the tem-
perature”—gives us the use of the very important
class of remedies-the special sedatives. If these rem-
cdies exert a direct influence in giving a slower and
better circulation, they will also lessen the temperature.
Certain remedies especially influence the temperature
through the nervous system, as Rhus, Gelseminum,
Bryonia, Belladonna, Nux, Nitric Acid. Others influ-
ence it through the constitution of the blood, as alka-
lies, acids, food, etc.
Then again we
heat in the body.
condition of this
part, of this lesion.
look to the skin as the regulator of
It is possible that a wrong in the
apparatus is the cause, in whole or
What is the condition of the skin?
Is it dry, constricted, full, relaxed? What remedies,
in the form of baths, or otherwise, will right these
wrongs?
If we take the simple lesion of excess of temperature
STUDY OF DIAGNOSIS
167
and frequency of pulse, as seen in febricula, we will
find a cure in the cold wet-sheet pack, as we would in
the early stages of a sthenic inflammation. Or in place
of this the ordinary vapor bath or spirit-vapor bath
might be employed. In many cases with a dry and
constricted skin the sponge baths are found to place
this organism in better condition, and lessen the tem-
perature.
If a bath is medicated, we select it as we would the
internal remedy. If an alkali is indicated internally
by pallid mucous membranes, it will be found best for a
bath. If an acid is indicated internally by deep colora-
tion of mucous membranes, we will employ an acid
bath. If the skin is relaxed and enfeebled, we think
of stimulant, tonic, or astringent baths. We employ
fatty inunction in two conditions-when the skin is dry
and constricted, and when it is relaxed and enfeebled—
in both the inunction answers a good purpose. In
some cases we combine with it a stimulant, or one of
the essential oils; in others we make it a vehicle for the
topical application of Quinine.
If the increase of temperature is associated with
waste of tissue, we find it important to provide a better
fuel for burning, and thus allay the excitation caused
by destruction of tissue. Thus in chronic disease wę
think of Cod Oil, and foods that contain calorifacient
material in excess, and that are at the same time easily
digested. In acute disease we furnish similar kinds of
food, whilst at the same time we modify the process of
combustion as much as possible.
In depression of temperature we find every function
of life impaired, but in this case the lesion is always of
depression, whilst in the preceding it was most fre
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STUDY OF DIAGNOSIS.
quently of excitation. It requires but a slight fall of
temperature to impair and finally arrest functional ac
tivity. With a depression of a single degree a man is
sick, and if this is maintained death will result in from
two or three days to a week.
In some cases of chronic disease we find a slight de-
pression of temperature, as a part of the lesion. At
once we ask the question, what is the cause? Is it de-
pendent upon want of food, or of proper food? A
wrong of digestion? An impairment of the respiratory
function, and of the burning? Or a wrong of the skin,
so that it permits a rapid escape of heat? On the
answer obtained to these questions, will depend the
treatment.
If it is a want of food, or of calorifacient food, a right
treatment will look to the selection of appropriate
kinds. If we find a lesion of digestion, either buccal,
stomachic, or intestinal, means to rectify these lesions
will be demanded. If it arises from deficient respira-
tion, we will direct such exercise as will call into activ-
ity the respiratory function, and facilitate combustion.
It is possible there may be a defect in certain materials
that favor combustion. Thus in some cases I have
found the want to be of Phosphorus, and its administra-
tion at once restored the calorific function. In others
it may be of Sulphur, or of Soda, or in some cases it
would be met by Cod-Oil. Wrongs of the skin, per-
mitting the escape of heat, are readily recognized by
the touch, as evidences of relaxation, of exudation of
water from the blood, or hyper-activity of the sudori-
ferous glands. The remedies will consist of stimulant
and tonic baths, or sometimes the use of fatty inunction
with stimulants or with Quinine.
་
STUDY OF DIAGNOSIS.
169
An irregular or unequal distribution of heat is a
source of trouble as well as its increase or diminution.
If we have too much heat in one place and too little in
another, we will find associate wrongs of circulation and
innervation, and there will be impairment of digestion,
blood-making, nutrition, waste, retrograde metamor-
phosis, and excretion. Wrongs of the blood are like-
wise increased, and there is the tendency to deposits of
imperfectly formed albuminoid material. Local dis-
eases are also more severe, and the tendency to struc-
tural changes more marked.
•
In chronic disease we will frequently find that no im-
provement takes place until the wrong of temperature
is rectified. Getting well may hinge on getting the
feet warm. With cold feet, remedies which seem
adapted to the case, continually fail; warm the feet,
even by sprinkling Capsicum in the stockings, and the
patient improves at once. In some of these cases topi-
cal means will be all-sufficient, but in others we will
have to employ such as give strength to the circulation
and improve innervation.
In acute disease unequal temperature is one of the
most unpleasant symptoms met with, and it is always
looked for in the advanced stages of severe disease.
The experienced physician examines the patient's toes,
his knees, his ears, the tips of his fingers, with as much
interest, as he examines the pulse. If he finds coldness
of these parts, he is at once awake to the necessity of
every means for the conservation of life, whether it
has reference to means to prevent undue expenditure,
or such as will increase the forces of the body. Cold-
ness of parts distant from the heart at once suggests
the idea of alcoholic stimulants as food, to be supple-
T
15
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STUDY OF DIAGNOSIS
1
mented, as soon as may be by such foods as seem best
adapted to the case.
Changes of kind in temperature will not be recog
nized by the thermometer, and hardly by the physiciar
who prides himself on being "scientific." “Kinds of
heat indeed! there is but one heat, and it is nonsense to
try to make a distinction in kind” (?)
This is all very
well, but the practiced physician knows that there are
kinds, at least in so far as his sensations are concerned,
and that these "kinds" tell him of definite lesions,
and point to remedies. We do not know just why we
have varying sensations of kind, but we do even in
warming apparatus. The sensation of heat is not the
same from a coal stove, an open fire, hot water pipes,
or a Dutch earthen-ware oven. And the sensation of
heat by the hand is not the same in simple febricula,
remittent fever, typhoid, typhus, yellow fever, scàrlet
fever, etc. The kind is unmistakable, and becomes
more and more so as the wrong of the blood and of the
nervous system increases.
If one applies the hand upon a surface from which a
sinapism has been recently removed, a peculiar sense
of "pungency" is experienced. Quite as distinct a
sensation comes in severe scarlet fever, in malignant
rubeola, and in diseases characterized by the symptoms
known as typhoid. We get a similar pungent heat
when there is great excitation of the sympathetic and
spinal nervous systems. We may say then, that this
character-pungent heat-which is so readily recog-
nized by most persons, refers us to lesions of the blood—
sepsis, and to lesions of the nerve centres-excitation.
We at once think of antiseptics as appropriate reme-
dies, and select the particular one by symptoms already
STUDY OF DIAGNOSIS.
171
"
named. In so far as the nervous lesion is concerned,
we will be guided in the selection of remedies by the
´acial expression and by the pulse.
It is possible many times, to determine the character
of a local lesion by the sensation given the hand. Thus
one very readily recognizes the peculiar pungent heat
of erysipelas, and sometimes the touch will determine
the advent of this lesion in surgical disease before the
eye would recognize the change of color, or the intu
mescence of tissue. The hand placed upon the abdo
men will feel the advent of puerperal inflammation
before it will be recognized by ordinary symptoms.
There is very much to be learned in this regard, and it
is well to give it thought and experiment.
:
DIAGNOSIS BY THE EAR.
The ear may not be as important in diagnosis as the
eye or touch, yet we purpose employing it to its fullest
capacity. To the routine physician who asks questions
and depends for his knowledge of disease upon what
the patient tells him, it is the organ of greatest impor-
tance. But we have already seen that we do best when
we study disease with our senses, and depend but little
upon what the patient says.
If the reader will refer back to our study of facial
expression, he will notice the statement that wrongs of
life find expression through the usual channels of ex-
pression; where the nerve currents have been most in
the habit of flowing in health, they incline to flow in
disease. Mankind use the facial muscles to express
their feelings or sensations, and hence discase is ex
$
172
STUDY OF DIAGNOSIS.
pressed in the face. For the same reason we should
expect to find wrongs of life expressed in the voice, in
all animals using the voice, and especially in man who
finds it a principal instrument of expression.*
*The character of the human voice, under the influence of
various emotions, has been discussed by Mr. Herbert Spencer in
his interesting essay on Music. He clearly shows that the voice
alters much under different conditions, in loudness and in quality,
that is, in resonance and timbre, in pitch.and intervals. No one
can listen to an eloquent orator or preacher, or to a man calling
angrily to another, or to one expressing astonishment, without
being struck with the truth of Mr. Spencer's remarks. It is
curious how early in life the modulation of the voice becomes ex-
pressive. With one of my children, under the age of two years,
I clearly perceived that his humph of assent was rendered by a
slight modulation strongly emphatic; and that by a peculiar
whine his negative expressed obstinate determination. Mr.
Spencer further shows that emotional speech, in all the above
respects is intimately related to vocal music, and consequently to
instrumental music; and he attempts to explain the character-
istic qualities of both on physiological grounds,—namely, on
"the general law that a feeling is a stimulus to muscular action.”
It may be admitted that the voice is affected through this law;
but the explanation appears to me too general and vague to
throw much light on the various differences, with the exception
of that of loudness, between ordinary speech and emotional
speech, or singing.
That the pitch of the voice bears some relation to certain
states of feeling is tolerably clear. A person gently complaining
of ill-treatment, or slightly suffering, almost always speaks in s
high-pitched voice. Dogs, when a little impatient, often make a
high piping note through their noses, which at once strikes us
as plaintive, but how difficult it is to know whether the sound is
essentially plaintive, or only appears so in this particular case,
from our having learnt by experience what it means! Rengger
states that the monkeys (Cebus azarœ), which he kept in Para-
STUDY OF DIAGNOSIS.
173
As we come into the sick room we give attention to
the voice of the sick person, quite as much as we do to
what he is saying. We find that it expresses strength
and weakness, is free or difficult from local disease, and
shadows forth the condition of the brain in its tone,
which varies from the listlessness of atony to the quer-
ulousness of excited feebleness, and the excitation of
over activity.
In studying the voice as the expression of disease,
we recognize its three-fold bearing as it refers us to a
general impairment of life, a lesion of the brain, and
to lesions of the respiratory asparatus. If we did not
keep these sources of wrong in view we might make
serious mistakes. If, for instance, we have feebleness
of voice, it may be due to general impairment of life,
to impairment of the functions of the brain, to deficient
innervation from the spinal cord, or to a lesion of the
respiratory apparatus.
Whilst strength of voice is usually regarded as evi-
dence of good vital power, and a good respiratory ap-
paratus, it will not do to place too much dependence
guay, expressed astonishment by a half-piping, half-snarling
noise; anger or impatience, by repeating the sound hu hu in a
deeper, grunting voice; and fright or pain, by shrill screams.
On the other hand, with mankind, deep groans and high piercing
screams equally express an agony of pain. Laughter may be
either high or low; so that, with adult men, as Haller long ago
remarked, the sound partakes of the character of the vowels (as
pronounced in German) O and A; whilst with children and
women, it has more of the character of E and I; and these
latter vowel-sounds naturally have, as Helmholz has shown, s
higher pitch than the former; yet both tones of laughter equally
express enjoyment or amusement.-Darwin.
!
1.
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STUDY OF DIAGNOSIS.
5
upon it in these regards. It certainly evidences good
innervation from the brain and spinal cord. But if
these nerve centres are sound, active, and well supplied.
with blood, we may have a strong voice, even though
the body at large is nearly exhausted. Usually it is a
favorable symptom.
Feebleness, on the contrary, evidences a lesion of atony,
either of the body at large, of the brain or mind, of the
spinal cord, or of the respiratory apparatus. Whilst
the probabilities are in favor of its being a nervous
lesion, we will not take it for granted, but make such
examinations as will localize the lesion. Feebleness.
simply, without querulousness, suggests the use of
Phosphorus, the Hypophosphites, Cod Oil, Alcohol as
food, Iron, Arsenic, Quinine. If it is associated with a
marked effort from the will, and a sighing respiration,
we refer it to deficient innervation from the spinal cord,
and think of Strychnia, Ergot, or Suntonine as reme-
dies. In lesion of the respiratory apparatus there will
be change in the voice other than feebleness.
It is difficult to give a name to the peculiar expres-
sion of voice associated with nervous irritation and vas-
cular excitement, yet the reader will learn to recog-
nize it readily, and may frequently be able to deter-
mine these characters of disease by simply hearing the
patient speak. There is a sharpness, and want of
smoothness, representing pretty accurately in degree
the amount of disease.
The halting voice, evidencing a labored action of the
brain, tells the story of congestion, and suggests the
use of Belladonna, or if markedly halting, of Lobelia
The oppressed voice, hollow and unsteady, evidences.
a general impairment of life, and calls for stimulants,
tonics and food.
STUDY OF DIAGNOSIS.
175
The oppressed voice from the upper part of the lungs
suggests deficient innervation to heart and respiratory
apparatus, and causes us to think of stimulant doses of
Lobelia.
Sharpness of voice suggests nervous excitation, and
will sometimes point to the remedy, as in the peculiar
sharp accentuation of the Rhus voice, resembling the
cry encephalique of the child.
The cry of the child will frequently inform the phy-
sician of the location and character of the disease. Of
course we recognize the fact that there may be but
little change in the cry, or that there may be changes
without corresponding disease, but we have other
means of diagnosis to supplement this, and prevent
error. Physicians who have given this subject atten-
tion will recall the peculiar cry of abdominal distress,
the change which marks disease of the respiratory ap-
paratus, the oppressed cry of congestion, the shrill,
metallic cry of inflammation of the brain, etc. It does
not take much observation to distinguish the cry of
disease from the cry of hunger, or anger.
In the preceding paragraph a peculiar cry, encepha-
lique, was noticed, which is so distinctive that it will
never be mistaken. 1ts suddenness and shrillness is
characteristic. In its slighter forms it arises from cerc-
bral irritation and determination of blood, and calls for
Gelseminum as the remedy. When marked and shrill,
I should always think of Rhus Toxicodendron as the
remedy.
A sudden cry, followed by sobbing respiration, is a
prominent indication for Bromide of Ammonium..
The voice is the function of the larynx, and its
changes will point us to disease of this organ. The
}
176
STUDY OF DIAGNOSIS.
croupous cry and voice is quite as distinctive as the
croupous cough. If it evidences moisture, we have
mucous croup; if it is dry and metallic, pseudo-mem-
branous croup; if variable in tone and character, spas-
modic croup.
In chronic disease of the larynx, roughness of the
voice is one of the first symptoms. As the disease pro-
gresses, we have various changes in the voice and dif-
ficult use of it, as characteristic symptoms.
In chronic bronchitis we also find change, but not
similar in kind. It may give the voice shrillness, as
in irritative bronchitis, or dullness, hollowness, or rever-
beration, as in asthenic bronchitis.
COUGH. Whilst cough calls our attention to a prob-
able disease of the respiratory apparatus it does not in-
dicate with any certainty the character of the disease.
But even to this extent it is important, for it is possible.
to overlook local disease, from the prominence of gen-
eral symptoms.
Whilst cough is usually the expression of discaso of
the respiratory apparatus, it may have its origin in
other diseases. Thus we find cough from gastric,
biliary and intestinal lesions, and from disease of
the nerve centres, and our examination is made with
reference to these probable causes in obscure cases.
Cough is the expression of irritation, and comes, from
the sense of an irritant material in the respiratory pas-
sages, which it is intended to remove. But many times
there is nothing to be removed-it is a misconception
of the respiratory nerves, which suffer from irritation,
and we wish to determine whether or not the effort is
to be favored. In the larger number of cases expecto-
r.
#
STUDY OF DIAGNOSIS.
177
ration is undesirable, and if we remove the irritation
of the nerves the cough ceases.
A little attention upon the part of the physician will
determine this point, as it is quite easy to distinguish
the cough necessitated by increased secretion, and at-
tended by expectoration, from the inefficient, rasping
cough of irritation. In either case, but especially in
the last, an effort of the will is of marked benefit in
checking cough.
The character of the cough expresses to some extent
the condition of the respiratory passages.
If dry,
ringing, metallic, we think of irritation, determination
of blood, and arrest of secretion, and the remedies at
once suggested are those which allay irritation, check
determination of blood, and favor normal secretion.
If moist, rattling, gurgling, dull, stimulants to the res-
piratory passages, as well as remedies to relieve irrita-
tion are suggested.
A cough is more or less forcible, and more or less
easily under the control of the patient. If forcible,
not under control, or explosive, we at once suspect a
wrong of the nerve centres, usually of the basilar brain,
and select remedies accordingly. Of course we may
have such uncontrollable cough from local irritation,
especially of the throat, but this will be readily recog-
nized by the expression, as well as from the patient's
sensations.
A cough has more or less evidence of strength, both
of the respiratory apparatus, and of the body at large.
The strong, well sustained cough may be a source of
annoyance, but evidences good vitality and a naturally
good condition of the respiratory organs. A feeble
cough, on the contrary, is the evidence of debility, and
178
STUDY OF DIAGNOSIS.
1
at once suggests the necessity of care in the conserva-
tion of life, and the employment of means which will
give strength, especially the selection of proper foods.
A cough may be feeble from deficient spinal innerva-
tion, and spinal stimulants would prove the best reme-
dies.
Coughs are spoken of as short, hacking, deep, bron-
chial, etc., and these characteristics may suggest the
locality of disease. A short cough may arise from dis-
ease of the upper lobes of the lungs, or it may be due
to disease of the parenchyma of the lung, as in the
first stage of a pneumonia. The hacking cough evi-
dences irritation of the respiratory nerves pointing.
in the throat. The deep or bronchial cough is at once
referred to lesions of the bronchial tubes, though it is
not as good evidence as we would wish.
A cough may have its origin in irritation of any part
of the respiratory apparatus, from the pharynx, larynx,
trachea, bronchial tubes, parenchyma of lungs, to the
pleura. As named above, its character may suggest the
seat of disease, but as a rule, it is not definite. A sin-
gular thing about coughs is, that the irritation points
so that many times the patient can localize the sensa-
tion of irritation for us. Cough very frequently points
in the pharynx, and the irritation of the throat seems
to be its direct cause; such a cough is based to a con-
siderable extent upon irritation of the respiratory
nerves, and remedies directed to relieve this will be the
best cough medicines. In other cases cough points
about the supra-sternal notch, and if very severe and
persistent suggests the use of remedies which influence
the sympathetic nervous system, as Veratrum, Bryonia,
Cactus, Pulsatilla.
STUDY OF DIAGNOSIS.
179
Coughs may be spasmodic and paroxysmal, even in
severe cases, showing distinct, epileptiform symptoms.
Whooping cough is the typical spasmodic cough, but
we have in the cough of measles, and some diseases of
the respiratory apparatus, the same characteristics. It
suggests Drosera, Belladonna, and Bromide of Ammo-
nium.
PHYSICAL DIAGNOSIS.
Diseases of the respiratory organs and the heart are
diagnosed in part by an exploration of the chest with
the ear.
Whilst an examination of the chest with the
eye and the touch will determine something of the
character of disease, and direct our attention to reme-
dies, our reliance will be placed principally upon what
we hear.
In the case of the respiratory organs, a very import-
ant part is to determine the capacity of the lung for
air, or the amount of air contained in the chest, and
this is accomplished by percussion. The walls of the
chest are thin and elastic, whilst the lung which fills it
contains normally four or five times as much air as
there is of solid substance. Any elastic body contain-
ing air will give resonance when struck, and the reso-
nance will be in proportion to the amount of air.
Lessen the amount of air, replacing it with a solid or
fluid, and dullness of sound is the result.
The object of percussion then, in diseases of the re-
spiratory organs, is to determine the condition of the
parenchyma of the lungs with reference to capacity for
air. By examination of the healthy thorax we obtain
a standard of normal resonance for different parts of
{
180
STUDY OF DIAGNOSIS.
:
the chest, and this we use as a basis for comparison.
In many cases, but one side of the thorax being in-
volved in disease, a comparison is instituted between
the sound and the diseased side. In such cases, of
course the information is more accurate, as we have the
normal standard of resonance before us.
Percussion is either direct or mediate, as we strike
directly upon the wall of the chest, or interpose some-
thing between. Direct percussion may sometimes be
employed with advantage, using one or two fingers to
give the blow. The only objection to this method is
the unpleasantness to the patient, and the difficulty of
making percussion of the intercostal spaces. In medi-
ate percussion an ivory or rubber plate (pleximeter) is
sometimes employed, using the finger for the stroke, or
a small mallet of similar materials. The best method,
however, is to apply one or two fingers accurately to
the wall of the chest, and use the middle finger, sup-
ported by the ring finger and thumb to give the stroke.
It is necessary to use care in this, the fingers of the one
hand being accurately applied to the chest, and the
stroke being at right angles, and the muscles of the
hand held firmly so as to give a quick rebound.
As the object to be determined is the capacity of the
lung for air, we make percussion both during full in-
spiration and after expiration. In examining the mar
gin of the lungs over the false ribs and the sternum, it
is necessary to have the patient take a full inspiration
to carry the lung down to the insertion of the diaphragm
in the one case, and to the mesial line in the other. In
making percussion over muscles it is well to put the
body in such position that the muscles will be rendered
tense. In examinations about the shoulder, it is raised
STUDY OF DIAGNOSIS.
181
to allow our examinations to be carried up in the
axillary space, or thrown forward or backward, to
enable us to reach the upper part of the chest.
In making comparison between the two sides, we are
careful that there is the same degree of inflation, and it
is better to have the patient take a full breath, and hold
it as long as he can conveniently, or cease respiration
for a moment, after the air is thrown out.
Normal resonance tells us that the parenchyma of
the lung is free from effusion, it may be the seat of irri-
tation, but the capacity for air is not interfered with.
Increased resonance in slight degree is heard when
the function of one lung being impaired, the other does
an increased work. In greater degree it is the evidence
of emphysema. When very marked, and over a lim-
ited portion, it is the evidence of a cavity.
•
Dullness on percussion evidences that the air is re-
placed by a solid or fluid; as is the degree of dullness,
so is this change in the physical condition of the lung.
We have dullness in acute pneumonia commencing
about the third day, sometimes earlier, and increasing
as deposit takes place in the air cells and intercellular
passages, and in the connective tissue-as is the dull-
ness, so is the intensity of the disease. Resonance returns
when the circulation is restored, and effused materials
are absorbed. Dullness is also an evidence of chronic
inflammation of the lungs, being usually much more
extensive than in phthisis pulmonalis, for which it
might be mistaken. Dullness on percussion is heard
in phthisis, when the tubercle is deposited in consider-
able quantity and near the surface. In the earlier
stages the dullness is so slight that it is not an import-
aut evidence of disease.
182
STUDY OF DIAGNOSIS.
We have dullness on percussion where there is fluid
in the pleural cavities, whether it is simply of water, or
the products of inflammation. In this case the dullness
is of the most dependent part, and unless it is an ex-
treme case, changing the position of patient, will change
the situation of the dullness.
We have dullness on percussion in hydropericardium,
and to a limited extent in bypertrophy of the heart.
The situation of the dullness, and the change in the
sounds from the heart, will determine the condition of
disease.
Occasionally we have dullness on percussion from the
formation of a thoracic aneurism, and still more rarely
from growths in the cavity of the chest. Other symp
toms will determine the character of the wrong.
The reader will notice that in acute disease dullness
on percussion has reference mostly to effusion into, and
solidification of the parenchyma of the lung. The ex-
tent of the dullness determines the amount of tissue
involved, and its intensity determines, to some extent,
the severity of the lesion. In so far as it suggests
treatment, it would say-lessen irritation and determi-
nation of blood to the lungs-give the respiratory appa-
ratus rest-by appropriate food, and in so far as medi-
cines act to sustain the life of the part, and of the body at
large-and by the establishment of secretion, promote
the absorption of the effused material.
Percussion is sometimes employed in other parts than
the thorax to give evidence of disease Thus we find
that some wrongs of the stomach, of the liver, spleen,
bowels, and reproductive apparatus, give rise to
changes in the sounds heard on percussion.
Disease of the stomach with generation of gas, will
3
'
STUDY OF DIAGNOSIS.
183
be evidenced by marked resonance on percussion over
the stomach. In some cases of chronic disease, this
condition is persistent, and the continually distended
stomach is pressed upwards until it occupies consider-
able space, and resonance might lead us to suppose that
a cavity had formed in the inferior lobe of the lung,
had we not symptoms of gastric lesion, and the reso-
nance extending across the epigastrium.
On the right side an enlarged liver pressed upwards.
encroaches upon the cavity of the chest, and gives
marked dullness on percussion over the right false ribs.
The evidences of wrong digestion, and the fullness at
the margin of the ribs will correct the diagnosis.
In distension of the bowels by gas, we get the evi-
dence of resonance on percussion. If of the small in-
testine it occupies the anterior part of the abdomen; if
of the large intestine it is lateral, or in the situation of
the transverse colon.
In ascites the small intestine distended with gas floats
at the top, and though we get the dullness of water
below, and succussion on palpation, there is resonance
at the highest part, if the convolutions are free to
move.
In ovarian dropsy, on the contrary, the sac displaces
the small intestine as it grows, and either crowds it
upward or backward. Intestinal resonance on the
surface, in dropsy, is therefore one of the differential
points in distinguishing between ovarian disease and
ascites. •
We employ palpation to determine the presence of
fluid, whether in the cavities, or formed by the break-
ing down of tissue. In some cases the evidence of
fluctuation is very distinct, the wave of fluid passing
184
STUDY OF DIAGNOSIS.
}
distinctly from the hand on the one side, to the hand
on the other. In other cases, we only obtain a sense
of mobility and the elasticity of fluid.
When parts give rise to sound in the performance of
their functions, the character of this becomes evidence
of disease. This is the case with the respiratory appa-
ratus, the heart, and to a less extent with some other
parts.
Listening to sounds thus produced is called auscultas
tion, and as practiced may be either direct or mediate.
In direct auscultation, the car is applied to the part,
and the sounds heard. In mediate auscultation, an
instrument called a stethoscope is employed as a con-
ductor of sound.
I prefer direct auscultation, as we desire to hear the
exact sounds produced, neither intensified nor modified.
It is quite as easy to apply the ear as a stethoscope,
and except in some rare cases of cutaneous disease
there is nothing objectionable in such examination.
It is claimed that female modesty might be shocked by
this direct examination, both of the chest, and especially
of the lower abdomen to detect the beatings of the
foetal heart. But I confess that in my professional life
I have met with but little of this mock modesty.
The special value of the stethoscope is the impression
it makes upon the public. In the olden time the phy-
sician carried a gold or ivory headed cane, or rather
a staff, to give him an appearance of dignity, and the
professional pose, as shown by Hogarth, with the head
of the cane pressed against the nose or forehead, in
profound thought, is a fair representation of the dig-
nity "that pays." As the physician's cane has gone
out of fashion, the stethoscope, and instruments of
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STUDY OF DIAGNOSIS.
185
similar kind came in to sustain the dignity of the pro-
fession.
Stethoscopes are made in varied forms, from the sim-
ple short wooden cylinder (with a hole through it) to
the double ear-tube instrument of Camman. Some are
so illy adapted to their use, that scarcely anything can
be heard, except the unpleasant roaring from ill adap-
tation to the ear. The best stethoscope is a simple
cylinder of solid wood, with the one end adapted to the
walls of the chest, and the other to the physician's ear.
It may be long or short, or have any shape the taste
of the maker may give it, if it possess the characters
named, it will answer its purpose well.
In the practice of auscultation, whether direct or
with a stethoscope, the physician is careful to avoid
adventitious sounds, and to place his body in a conve-
nient position for listening. The rubbing of clothing,
either upon itself, or against a stethoscope, will fre-
quently mask the sounds we wish to hear. A con-
strained position of body frequently interferes with
listening.
In auscultation of the chest in health two respiratory
sounds are heard-the respiratory murmur, and the
bronchial sound. The first is heard during inspiration.
and expiration over the entire surface of lung; the
second is heard by applying the ear over the spinal
column from the middle cervical region to the sixth
dorsal vertebra-the spinal column being a good con-
ductor of sound. If the normal respiratory murmur
is heard we know this portion of the parenchyma of
lung is healthy; if it is changed in character, or re-
placed by adventitious sounds from the air cells and
small passages, we know that there is disease.
186
STUDY OF DIAGNOSIS.
In studying auscultation, it is well to study in the
language most familiar to us.
If we are original
Romans we may pursue the study in Latin; if French,
we may use French technical terms; but if English is
our mother tongue, we had better employ English, and
use words with especial reference to their meaning. I'
think it is possible to so classify and name the morbid
sounds that the reader can learn them without trouble.
We may say first, that a wrong sound made in the
respiratory apparatus is evidence of disease of this
apparatus. We want then to determine the value of
the sound, and the distinct lesion that produces it.
To this end, the first question is as regards the
medium for the conduction of sound. Solids conduct
sound best, fluids next best. Air stands next as a con-
ductor, and mixed bodies last. The lung, with its
spongy tissue filled with air is a bad conductor of
sound. If it is solidified, it becomes a good conductor,
and sounds will be heard, which otherwise would not
reach the ear. Fluids compressing the lung are also
good conductors of sound. To determine this point,
then, percussion is made-if there is resonance the
sound is referred wholly to a wrong of the part where
it is produced; if there is dullness on percussion, it is
referred in considerable part to the consolidation of
lung, or to the effusion, which gives a better conductor
of sound.
Morbid sounds may be divided first into blowing and
crepitant, having reference to the parts in which they
are produced. Blowing sounds are produced in bron-
chial tubes, and crepitant sounds in the intercellular
passages and air cells.
Blowing sounds are blowing. The idea the listener
1
STUDY OF DIAGNOSIS.
187
gets is of air blown through a tube possessing some
clasticity. In the blowing sounds heard in diseases of
the respiratory apparatus, the listener gets an idea of
obstruction; the air does not pass as freely as in health.
In one case the sense is of constriction-evidently the
calibre of the tube has been diminished-the sound has
the higher tone or shrillness that would be thus pro-
duced. In another case the obstruction is evidently
within the tube, either from fullness of mucous mem-
brane, or from increased secretion, and the sounds are
lower in tone-duller-or show the evidence of mucus in
more or less of gurgling. In a third class of cases, the
obstruction is evidently from want of elasticity and
tone in the tube, which yields before the passage of air,
both in inspiration and expiration-the wavering tone
of the sound determines this condition.
In so far then as we have analyzed the simple char-
acter blowing, we have suggested to us a rational prac-
tice of medicine. Contraction of bronchial tubes is in
the majority of cases from irritation-employ those
remedies which take away the irritation. Fullness of
mucous membrane suggests the use of means to relieve
determination of blood, and to promote absorption
Increased secretion suggests the employment of means
to take away irritation and determination of blood, and
check secretion. Whilst the wavering sound indicating
atony, calls for stimulants, tonics and restoratives.
Blowing sounds are dry and moist, and these common.
words express clearly the idea formed upon hearing the
sounds. They are dry and moist, as they refer to a
condition of dryness or moisture of the mucous lining
of the bronchial tubes.
Dry blowing sounds evidence a condition of bronchial
:
188
STUDY OF DIAGNOSIS.
1
tubes in which there is an impediment to the free
passage of air, and more or less arrest of the normal
mucous secrction. Dryness itself is an impediment to
the passage of air, but in addition there is contraction
of the bronchial tubes. We are in the habit of saying—
as is the blowing, so is the contraction of the tubes-
as is the sound of dryness, so is the arrest of secretion.
Contraction of bronchial tubes results from irritation,
and it suggests that such means be employed as will
relieve irritation. Dryness results from irritation, de-
termination of blood, and the developed inflammatory
process. Given a dry blowing sound, we at once think
of general and local sedatives which lessen determina-
tion of blood, remedics which allay irritation, remedies
which so rectify general lesions of circulation and tem-
perature as to permit secretion, and remedies which
restore secretion, if such be necessary. Thinking in
straight lines, our ear gives us information of the con-
dition of the air passages, we at once think of the
pathological states, and having the factors of disease
before us, we at once think of those remedies which
restore normal functional activities.
Moist blowing sounds tell us of obstruction to the
free passage of air, and to the pressure of fluid in the
air passages. As is the blowing so is the impediment
to the passage of air; as is the moisture, rattling, bub
bling, gurgling, so is the amount of fluid in these pas-
sages.
The ear readily determines from the character of the
sound, whether the blowing is still due to contraction
of the tubes, for in this case the sound is steadier and
more resonant, than if caused by obstruction from accu-
mulated fluids, or from atony. The well-sustained,
:.
STUDY OF DIAGNOSIS.
189
sonorous sound always means contraction-contraction
results from irritation-use remedies to lessen or take
the irritation away.
The impediment from secretion of mucus, muco-pus,
or purulent fluid is clearly expressed in the sounds
heard, and it is well to take the evidence of the ear,
rather than any technical classification of sound. The
presence of just sufficient secretion to lubricate the
passages, of occasional accumulations which need re-
moval by expectoration, of continued accumulation,
giving rise to rattling sounds like the bursting of large
bubbles, or the gurgling which comes from large quan-
tities of fluid, are distinct and unmistakable. The
treatment is clear-take away the causes of determina-
tion of blood, whether due to irritation of the respira-
tory nerves, or some general lesion. Give these tissues
such support as we can, by the use of remedies that
give local or general stimulus and tone. And to a cer-
tain extent favor the removal of these accumulations
by expectoration-usually by giving strength to the
respiratory apparatus.
The evidence of atony of the respiratory passages
is found in the yielding or tremulous character of the
sound. Whilst the evidence of contraction was found
in the well sustained sound, this is found in the feebly
sustained sound. The treatment is clear-to sustain
and increase the strength of the patient, and to stimu-
late and strengthen this enfeebled organism. In some
cases alcoholic stimulants give prompt relief, and their
effect is maintained by Quinine, restoratives, and food.
The local remedy is Lobelia in stimulant doses, and we
always think of this, especially in infancy and child-
hood.
i
190
STUDY OF DIAGNOSIS.
When cavities are formed in the lung, communicating
with a bronchial tube, the ear detects a peculiar blow-
ing sound, as of air blown into a bottle. This may be
dull and more or less gurgling, showing that the pro-
cess of removal is not yet completed, and the walls of
the cavity are of the spongy, partly broken down lung.
Or it may be clear, well sustained. and more or less re-
sonant, showing the removal of deposit, and cicatriza-
tion.
Smali blowing sounds, varying in character, shrill,
whistling, piping, irregular, tortuous, dry, moist, rat-
tling, all combined, in varying proportions, are the best
evidences of phthisis pulmonalis. If the reader will
think for a moment of the structures involved, the
situation of the tubercular deposits, how they must
press upon the smaller bronchial tubes, changing their
position, making them tortuous, changing their calibre,
he will see at once that these are just such sounds as
might be expected.
In addition to these small, queer, blowing sounds, the
ear detects that known as dry crackling. During a full
inspiration three or four distinct crackling sounds are
heard, which seem to the ear very much like the sounds
produced by separating two surfaces attached by a glu-
tinous fluid. And undoubtedly this is the condition,
for if the tubercle is so deposited as by pressure against
a bronchial tube to efface its cavity, the separation of
the glutinous walls of mucous membrane would give
just such sound.
Crepitant sounds take the place of the respiratory
murmur, and are formed in the air-cells, the intercel-
lular passages, and the minute bronchial tubes. When,
therefore, small crepitation is heard, we refer it at once
STUDY OF DIAGNOSIS.
191
to disease of the parenchyma of the lung. If we in-
quire into the condition of the lung-the changes of
structure that will produce such sound-we find it in
irritation, determination of blood, and slight effusion
into these minute air passages. If the effusion goes on,
the lung is rendered impermeable to air, and the crepi-
tant sound ceases.
Crepitance is therefore the evidence of inflammation
of the lung in its first stage, and is associated with re-
sonance on percussion, for the disease has not pro-
gressed to hepatization. Where effusion has taken.
place to the extent of giving dullness on percussion,
the crepitant sounds are replaced by blowing sounds.
from the bronchial tubes, the lung being now a better
conductor of sound. Larger crepitance refers us to
the minute bronchial tubes, and is the evidence of
capillary bronchitis. The smaller crepitance is not
only heard in the first stage of an inflammation of the
lungs, but returns with the absorption of the effused
material, and resolution, and is therefore the evidence.
of the subsidence of the disease.
As crepitance is the evidence of the active stage of
an inflammation, in which irritation and determination
of blood are the prominent factors, the treatment is
plain. In so far as we can take away the irritation,
and stop the determination of blood, our treatment
will be rational. The frequent pulse, the high temper-
ature, and the rapid respiration, are important elements
in the furtherance of the local disease, and means
which will rectify these wrongs, are of first importance.
As the succeeding stage is one of local depression of
life, no means should be employed that will depress
either the life in general, or of the affected part.
192
STUDY OF DIAGNOSIS.
Where solidification of a lung has taken place, it
becomes a better conductor of sound, and if now the
ear is applied and the patient is engaged in conversa-
tion, the voice seems to come out through the chest.
We do not get articulate speech, but simply the modu
lations of the voice. This is called bronchophony
(speaking through the bronchial tubes), but its only
value is to determine solidification of the lung, and per-
cussion is the better evidence.
If there is fluid in the chest, and the ear is applied
over it, the patient conversing, the voice seems to come
out through the chest, but has a tremulous tone. This
has been called ægophony, and is one of the evidences.
of fluid in the pleural cavities.
If the ear is applied over a cavity, which is free and
communicates with a bronchial tube, and the patient is
engaged in conversation, the articulate voice comes to
our ear through the chest. This is called pectoriloquy,
and is additional evidence of the formation of a cavity
in the lungs.
In some cases of structural disease of the pleura, the
result of inflammation, certain friction sounds are
heard, but they are not very common, distinct, or defi-
nite. Once in a while they are said to assume the dis-
tinctness of the "creaking of new leather," but in the
two cases I have seen, the sounds were evidently
from wrong of the parenchyma of the lung, and not
from the change of the pleura.
We employ auscultation in the examination of the
heart with as much advantage as in diseases of the
respiratory apparatus. As the sounds produced by the
heart are much louder, and more distinct or arbitrary,
many persons will succeed better in auscultation of the
heart, than of the lungs.
STUDY OF DIAGNOSIS.
193
sensation.
'The normal sounds of the heart are smooth, uniform
in tone, regular in time, and give the ear an agreeable.
No description in words would give the
reader a sufficient knowledge of them; they must be
heard to be thoroughly known. It is hardly worth
while to call the reader's attention again to the impor-
tance of knowing the phenomena of life for himself,
and especially with regard to things that may so easily
be known by the senses.
If, in examination of the heart, we find that the
sounds are normal, we are quite sure that there is not
structural disease of this organ. If there are general
symptoms of heart disease, the wrong is functional.
If, on the contrary, the sounds of the heart are changed,
or replaced by adventitious sounds, we are just as sure
that there is structural disease of the organ. The two
exceptions to these rules are:-1st, in case of anæmia
or spanæmia, we hear blowing sounds, which are re-
ferred to the wrong of the blood, and not to the heart;
and 2d, in fatty degeneration, no change in the sounds.
of the heart announce the structural lesion.
The morbid sounds of the heart may be divided into
blowing and sawing, and the ideas conveyed by these
words represent exactly the character of the sound.
Whilst blowing sounds may be referred sometimes to
lesions of the walls of the heart, and a wrong in mus
cular contraction, the sawing sounds are referred to
the openings of the heart, and to the valves, and
usually to lesions that obstruct the free flow of blood.
The blowing sounds have been named bellows mur-
murs, and have every range between the simple,
smooth, blowing sound, similar to that heard from the
bronchial tubes, to the roughened, irregular, rattling
17
194
STUDY OF DIAGNOSIS.
sound, similar to that produced by a pair of bellows in
motion. If the sound is dependent upon poor blood, it
may many times be heard over the larger arteries as
well as the heart, and in this case will call for the
proper restoratives and food to make good blood. If
dependent upon enfeebled nutrition, or degeneration
of the walls of the heart, we employ means to give the
heart rest, see that it is not subject to excitement, and
employ means to improve nutrition. The rough,
irregular sound that is attributed to valvular insuffi-
ciency and regurgitation, would demand the same
treatment.
The saw sound has been divided into three varieties,
the saw, rasp and file sounds, but the distinction has
but little reference to conditions of disease, or to the
use of remedies. Possibly the finer sounds may refer
us to a more acute condition of disease, in which plastic
material is yet being deposited. In some cases of val-
vular insufficiency we hear a marked saw sound, but it
has an irregularity and dullness that we do not meet
with in the other cases.
The more common lesions that give rise to contrac-
tion of the openings of the heart, and such disease of
the valves as prevent their free movement, are inflam-
matory, and give fibrinous exudation as the result.
The most of these are rheumatic in character, involving
the tendinous portions of the muscle, and the endo-
cardium. There are rare cases in which the sounds are
due to fibrinous vegetations from the valves, or to
ossific deposit in their structure.
The treatment suggested by these sounds has refer
ence, first to rest, and secondly, to means which will
promote absorption, and give us a better renewal of
STUDY OF DIAGNOSIS.
195
life. Rest is absolutely essential to recovery from
chronic inflammation and the absorption of its pro-
ducts. We want physical rest, and mental rest, and
such relief from irritation of the cardiac nerves as may
be obtained from the use of Cactus, Pulsatilla, and tho
special sedatives. Removal of deposits is facilitated by
the establishment of free secretion, and a better heart
is made by means to obtain good blood, and good
nutrition.
To determine pregnancy after the fifth month the
ear is applied over the lower abdomen to hear the beat-
ings of the fœtal heart. If it is heard the diagnosis is
clear, but if not, we are not yet certain that pregnancy
does not exist, for in many cases, from feebleness of the
movement of the foetal heart, excess of liquor amnii.
thick abdominal walls, or the position of the child, it
can not be heard until late in pregnancy, or not at all.
DIAGNOSIS BY THE SENSE OF SMELL.
as some
The sense of smell has less development in the
majority of men than any other of the senses-
writer has recently remarked-" it is yet in the savage
state." It may not be of much use in diagnosis, and yet
the little it may tell us we want to know. It requires
education, as do the others, and we must learn to dis-
tinguish pleasant odors from stinks, and thus be able to
analyze stinks, and determine their influence upon the
human body. It is possible that some. persons will
never be able to recognize the genus "stink," much
less be able to assort them for our present purpose.
It is well for the physician to commence educating
196
STUDY OF DIAGNOSIS.
his nose at home, and to start with a realization of the
fact that all unpleasant smells are noxious to the human
body. It requires very little exercise of reason to
reach this conclusion, for if the thing was not unplea-
sant or noxious to the economy, the nose would not
give the warning of unpleasantness. What is the evi-
dence of disease to the person suffering? Unpleasantness;
the very expression used, "persons suffering," tells the
story of disease. Is disease ever pleasant? No. Are
causes of disease ever pleasant? No. Do causes of
disease ever pleasantly impress the senses? You
might answer yes, but I say no again.
Commencing at home I put my nose inside your
office door, and-heaven preserve me-what a com-
pound of stinks, from Asafoetida to Jalap, from Castor
Oil to Turpentine. Lesson No. 1, true remedies have
no bad odor, clean up your stinks and put them in the
nearest privy-vault, and have a thorough disinfection.
Reason why-it will be money in your purse--people
that pay good bills don't like stinks, as a rule. Let me
nose your saddle-bags and pocket-case? Faugh! what
a terrible sickly smell!-reminds me of the old country
doctor, who was always announced by a mixed smell
of Asafœtida and Jalap. It won't do in this age; burn
them up, and order a new stock. Now clean up your-
self, and get your nose in good working order, that you
may learn diagnosis with it. Do you know how to eat
onions and go-a-sparking too? Have the maiden taste
them. Reverse the simile-if you carry bad smells
about you, you will not be able to detect them in the
sick room-and it is a most important work, believe me.
When I visit a sick room, my nose commences the
inquiry, (it is a most excellent interrogation point),
STUDY OF DIAGNOSIS.
197
What provisions have you made for fresh air, sunlight,
and cleanliness? It says straightway, the air is bad,
there must be ventilation, and opens a window, builds
an open fire, and does what is necessary. It noses a
stink from under the bed, and suggests half cleaned
chamber utensils, excreta, dirty clothes, dirtied floors,
etc. It says with emphasis there must be a thorougn
cleaning up. The excretions must be removed as soo~
as voided, the utensils thoroughly cleansed and disin
fected, every loose thing removed, the floor cleansed
the bed drawn from the wall, and so arranged that the
air can pass freely under it. It says you have been
trying to feed this. patient upon stale, badly prepared
food, and it detects it remaining in the room hour after
hour, poisoning the atmosphere, and taking away what
little desire the patient may have for nourishment. It
says, the food for the sick must be nicely prepared,
fresh and savory, at such times as he can best take it,
and then promptly removed from sight or sense. It
says—you are dirty-dirty in person, dirty in clothing,
dirty in bed. You must be thoroughly cleaned up,
washed with soap and water, have frequent changes of
clothing and bed linen-"“ cleanliness is next to godli-
ness."
You can't hide dirty sheets from this nose, or a bed
soiled by involuntary discharges, or a bed sore, a badly
dressed wound, however you may try to cover them
up. It recognizes the row of nasty medicine bottles,
and says, "take them out" - your spoiled poultices.
and fomentations, and says, "fresh water." It tells
you of damp walls, of lack of sunshine, of choked
drains, of ground saturated with garbage, of foul
closets, of cellars uncleaned, of decomposing vegetables,
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STUDY OF DIAGNOSIS.
and of the hundred and one noxious agencies which
breed disease and steal away a man's life.
But it not only tells you of dirt, and specifies clean-
liness as the remedy, but it tells of specific agents to
destroy causes of disease. I will warrant that you
have already associated an unpleasant odor of decay
with lime. Lime to freshen the air of cellar, lime to
slush a bad drain or cess-pool, lime to make way for
sunlight, and to get rid of the dead air of a house.
You will recognize a sweetish, mawkish, unpleasant-
odor, similar to that exhaled from smallpox, and it
says Sulphurous Acid, as plainly as it can be expressed.
You burn Sulphur in the room, or in the whole house,
and you are surprised how it changes the air, and how
much the patient is benefited by it. In other like cases
you sprinkle the floors with Sulphurous Acid, wash the
chamber utensils with it, and the dressings in surgical
disease. It is not simply to get rid of a bad smell that
we do this, but it is to remove a cause of disease.
There are other cases in which a peculiar putres-
cence reminds you that Chlorine, Carbolic Acid, or
Iodine are required. You employ Labaraque's disin-
fecting solution, or Chloride of Lime, and you see a
decided improvement. Or you use a solution of Car-
bolic Acid, especially as a wash to things which are
soiled, to wash dressings, or as an application to
wounds, and there is a change for the better. There
is a bad odor that simulates the offensive sputa of
chronic bronchitis, and some cases of phthisis, which
would at once suggest Iodine, and we use it as a disin-
fectant, a dressing, a local application, or as an'inha-
lation. So too there is an unpleasant odor, peculiar to
phlegmonous erysipelas, that says Permanganate of
1
Γ
STUDY OF DIAGNOSIS.
၁ ဝ
199
Potash so plainly that no one can mistake the remedy.
I do not wish to place too much stress upon the evi-
dence of this sense, for as stated in the beginning it is
but rudimentary, yet some things it does tell us with.
certainty.
A sweetish or mawkish odor from the
breath wants Sulphurous Acid, or Sulphite of Soda.
An odor resembling an offensive lochial discharge, is
the best evidence of the want of Chlorate of Potash.
The hot breath, with unpleasant pungence, as of Am-
monia, calls for Muriatic Acid. The fetor resembling
that from cynanche maligna, calls for Baptisia.
But whether we can distinguish one bad smell from
another or not, we know one thing, that they demand
cleanliness, good ventilation, and a restorative treat-
ment. Going one step further, they evidence the con-
dition of sepsis or zymosis, and demand that we select
the proper antiseptic. If we can select it from the
odor, good; if not, and in any case, we have other ex-
pressions of disease that will point out the particular
remedy required.
If we apply the sense of smell to the excreta we find
it of some value, though possibly not of very much.
The cutaneous excretion gives a distinctive odor, and
in disease we sometimes find marked changes in this.
It is not difficult to recognize the pleasant odor from
the healthy skin, kept clean, as it is not to recognize
the odor of the person kept dirty. In treating children
the evidence of our nose is frequently opposed to the
evidence of our eyes. The child seems clean, but the
unpleasant odors tell you to look beneath the surface,
and it is dirty. We find all manner of odors from the
person, running the range of" from grave to gay," and
they tell the story of disease and vitiated secretion.
:
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STUDY OF DIAGNOSIS.
Some of these are so characteristic that they can not
be mistaken, as for instance, the peculiar urinous smell
in tinea capitis.
The urine has a distinctive odor, that may be called
healthy. It may lose odor, or it may have a wide range
of morbid smells, each of which should have a distinct
meaning in the diagnosis of disease. If a Septimius
Pease were to study uriscopy, he would probably trust
his nose in preference to his eyes.
The seminal odor is so distinctive that it can hardly
be mistaken, and as it is very persistent, and may per-
vade the entire person, it will sometimes give impor-
tant information. So too is the odor from the sexual.
organs of both male and female, in certain cases of
disease.
The fetor of the fæces is peculiarly unpleasant, yet
the odors are distinctive, and would suggest health in
one case, and disease in another. I have no penchant
for the olden-time examination of fæces, yet even here
I would about as soon trust my nose as my eyes. Pos-
sibly the characteristic stinks, already named, will be
found here, and the same class of remedies indicated.
INFORMATION FROM PATIENT AND NURSE.
We neglect no source of information with reference
to the origin, condition, or progress of disease, and
whilst careful not to be guided by information from
nurse, friends and patient, we wish to give it its true
value. Attention has already been called to the many
sources of error. To a want of knowledge and care
in observation on the part of nurse and friends, as wel'
STUDY OF DIAGNOSIS.
201
t
as their prejudices and tendency to distortion. To the
want of knowledge upon the part of the patient, want
of language for description, and the impairment of his
powers of sensation and reason from disease.
The elements of uncertainty are thus very great, and
we have to pursue our inquiries with much care.
Questions should never be suggestive, but should be so
put as to let nurse or patient tell what they know, or
to require but the simple and direct answer, yes or no.
Careful attention to these points, and a continued guard
upon the tongue, will soon form a habit of examination,
that will lessen the danger of erroneous information.
We prefer to get information from attendants with
regard to the general condition of the sick, and the
performance of the essential functions of life. From
the patient we desire to know his sensations, as these
are changed by disease.
A first examination may take the following course:
How long sick? What are the seeming causes of the
sickness? How did it commence? What has been
noticed with reference to the progress of disease up to
the present time? How does the patient rest in the
daytime? at night? What food and drink does he take?
How often does he have a motion of the bowels? How
does he pass urine? These questions may seem sug-
gestive, and once in a while they may take a simpler
form as does he sleep? does he eat? does he drink?
It is most absurd for the attendant to attempt a de-
scription of the sensations of the sick, and yet they
almost always volunteer to do it. Many times they
will be continuously making suggestions to the patient,
and lead him into erroneous statements. They will
probably have formed some theory of the disease, and
202.
STUDY OF DIAGNOSIS.
1
will bend everything to the support of their theory.
Physicians are very frequently guilty of this, and
should try to get rid of the bad habit which they con-
demn in nurses.
The question-how do you feel? elicits a loose, wan-
dering description of the patient's sensations, and is
only important, in that it suggests special questions and
examinations. The question-where do you feel bad?
is pertinent, and will elicit valuable information of
local disease. It does not do to take it for granted
that the patient's anatomical or physiological knowl-
edge is perfect, and that his reference to heart, lungs,
stomach, liver, etc., means heart, lungs, stomach, liver.
The direction at once follows-put your hand on the
place. It is a little singular to find after a patient has
located a disease in his own mind, the hand meanders
about with uncertainty, trying to find its location. If
the unpleasantness is marked, and means local disease,
the patient has no difficulty in placing his hand upon
the exact spot.
If there is anything uncertain in the patient's man-
ner or method, and especially if uneducated, we wish
him to describe his sensations, with the hand upon the
affected part In many cases we will find that the de-
scription commences to wander as soon as the hand is
removed. There is a reason for this; with the hand
upon the part, the mind is directed to it and concen-
trated, extraneous ideas are rejected, and the descrip-
tion is of actual sensations.
We want to know the character of the pain, its dura-
tion, exacerbations and remissions, periods of recur.
rence, and its influence on function. In this examina-
tion the physician should show by his questions and
manner that he wants concise and specific answers.
}
STUDY OF DIAGNOSIS.
203
The subject of pain is a study of itself, and much
ess is known of it than we would wish. In some
cases it indicates the special remedy which will cure,
in others it simply points to a pathological condition,
and remedies must be selected by other symptoms.
Thus if we have a pain in the head, heavy, tense,
and sleepy, we give Belladonna; if it is sharp and
restless, Gelseminum; if sharp, limited in location, de-
spondent, Pulsatilla. If of the frontal region and
orbits, with burning, Rhus; if of the right side passing
from before backwards, Bryonia; if of the back of the
head, dull and heavy, Iron.
The pain in right hypochondrium, pointing to the
umbilicus, indeed, all pains pointing at the umbilicus,
Nux Vomica. Pains deep in the ischiatic notches,
Podophyllin. Pains that are tensive and paroxysmal,
Macrotys.
The pain of Macrotys is a singular one.
It feels as
if dependent upon tension, and is decidedly remittent-
a continued succession of tensive pains. We usually
prescribe Macrotys for muscular pain, no matter what
its character, and hit it in a large majority of cases.
For this remittent tensive pain-waves of pain-no
matter where it is, we may prescribe the Macrotys with
certainty, (the pain is not throbbing.) A recent caso
of facial neuralgia was very striking. The gentleman
had suffered for some weeks, and had taken various
remedies without relief; and I had made three failures
myself. Close questioning brought out the character
of the pain, and Macrotys gave prompt relief.
I admit that it is very much easier to prescribe from
the location of the pain, than from its character, for
whilst a patient may be able to locate it correctly, it is
not possible for him to describe its character.
:
204
STUDY OF DIAGNOSIS.
!
-
If we take the pain of Lobelia, we will find its pri
cipal characteristic anguish, of which angina pectoris
and neuralgia of the heart offer the most common ex-
amples. It is that indescribable sensation as if the life
was being forcibly riven from the part-anguish ex-
presses it. Lobelia is specific to it. Give twenty to
forty drops of a good tincture of the seed to a person
suffering from angina, and there is instant relief, which
becomes complete in a short time. I have seen one
case of uterine neuralgia presenting this character, and
from which the patient had suffered beyond conception
—a single dose arrested the paroxysm; and its repeti-
tion when the symptoms were felt, gave a radical cure.
I have seen two cases of abdominal pain presenting this
character to some extent, and both were relieved by
Lobelia. A singular case of hypochondria, in which
the feeling as if a movement of the body would endan
ger life, but without pain, was cured with Lobelia.
The peculiarity of this pain or sensation is so dis-
tinct, that patients may describe it. For many years
(indeed it was one of the first things I learned´in prac-
tice) I have given Lobelia in certain cases of labor
where the pains assumed this character. Every one
will have recognized the two classes of pain, one of
which is well borne, which is really relieved by the
action of the will, and the other which finds no such
antagonism. In the latter class I find the indication
for Lobelia, and it has proven one of the most efficient
agents I have ever used in obstetric practice. Of the
two agents Ergot and Lobelia, I would take the last a
hundred to one.
Let me briefly call attention to the abdominal pain
of Nux Vomica.
;
STUDY OF DIAGNOSIS.
205
I say it is any pain having a tendency to point at the
umbilicus; it is pretty accurately located. It may be a
simple colic, a bilious colic, a derangement of the func-
tion of the liver, a wrong of the spleen, a dysmenor-
rhoea, a disease of the colon, irritation of the bladder-
if the pain shows the constant tendency to the umbili-
cus-I should give Nux. I should fail sometimes, but
the failures would be small in proportion to the suc-
cesses. The definiteness of the symptom, and its easy
recognition, are what please me.
The pain indicating Rhus Toxicodendron is very dis-
tinctive. Frontal pain, especially involving the orbits,
and inclined to be more severe on the left side. Such
pain would lead me to prescribe Rhus, if there were no
other indications. Add the peculiar appearance of the
papillæ at the end of the tongue, and I would have a
positive assurance of success. To any pain add burning
and we would think of Rhus as a possible remedy.
Given, the pains of rheumatism with burning, and Rhus
is the anti-rheumatic, or is alternated with Macrotys.
A case of puerperal fever this Summer in which burning
sensations and pains were pronounced, was cured with
Aconite and Rhus; and arrested so promptly that there
could be no mistake in the action of the remedy.
The pain calling for Bryonia, whilst it may be sharp
or dull, always has with it a sense of oppression, as if
the part were enfeebled, and could not perform its
function. Homœopaths speak of burning as character-
istic of this pain, but I have not been able to see it.
Take a case of pleurisy, or pleuro-pneumonia, or pneu-
monia, with this sense of oppression and feebleness, as
if the part could not and should not do its work, and
Bryonia, with the proper sedatives, will prove curative.
206
STUDY OF DIAGNOSIS.
In the same way a rheumatism giving the same symp-
toms of inability, with increased pain following the
use, will be cured with Bryonia.
The pain calling for Belladonna is dull, heavy, full,
with a sense of functional impairment. It makes but
little difference where you find it, or in what disease;
whether a simple headache, an ague, "bilious fever,"
or inflammation of the lungs, Belladonna will prove
curative.
The pain calling for Stramonium is constrictive, and
when involving muscular structures, is attended with
persistent contraction, and of the outlets of the body
is expulsive. A case of dysentery, with most violent
expulsive movement of the pelvic muscles, was speedily
relieved with Stramonium; as was a case. of broncho-
pneumonia, showing as a symptom a most marked and
unnatural constriction of the chest.
The pain calling for Gelseminum has as a marked
feature exalted sensibility and arterial throbbing. In
some cases, especially in the head, the patient dreads
movement, and the pulsation of the arteries is distinct
and painful. With such pain in any part of the body,
we would prescribe Gelseminum with every assurance
of success.
The pain calling for Chelidonium is dull, heavy, ten-
sive, with occasional twinges, as if the part was being
torn. Situated in the hypochondria or 'epigastrium,
Chelidonium is the "liver" medicine.
The pain calling for Iodide of Ammonium seems to
involve a definite amount of tissue, as in inflammation,
and yet points at some particular place which might
be covered with the tip of the finger.
In thus calling attention to the symptomatology of
STUDY OF DIAGNOSIS
207
pain in therapeutics, I do not wish to be understood a
claiming that it is infallible. Our own senses are suf
ficiently imperfect, even when trained by long obser
vation. The senses of the patient are untrained and
impaired by disease, and his descriptive powers may
be very feeble.
NOSOLOGY.
A distinct department which has for its object the
classification of diseases, is named nosology, and though
we do not propose to make such classification, the sub-
jeet demands a brief study. In so far as the ordinary
classification facilitates study, and the knowledge of
disease, it will prove beneficial, but whenever it is
made the basis of therapeutics, it must work an injury.
Nosology is said to have three objects of considera-
tion 1st. The distinction and definition of particular
diseases. 2d. The nomenclature of the diseases, or the
assignment of the names by which they are to be des-
ignated, so that each disease may be distinguished and
known by an appropriate name. 3d. The arrangement
or classification of diseases in some methodical and con-
venient order by which they may be distributed into
classes, orders, genera, or species."
We employ this method in natural history, and
divide animals and vegetables into "classes, orders,
genera, or species;" why should we not employ it in
the study of disease? If one will think for a moment
the reason will be obvious. The individual, animal, or
vegetable, is a distinct, tangible entity; disease is a
method of life. When we use this classification; we
208
STUDY OF DIAGNOSIS.
}
think of the object as things, not conditions or states.
Thus this method of classifying disease carries to the
mind the idea of disease as an entity, a thing that has
precise form and condition. This idea has been the
foundation of an erroneous practice, and the obstacle
to a successful study of medicine.
The reader will understand me to say that so far as
therapeutics, or the giving of remedies for disease is
concerned, the common nosology is a continued source
of error, though in so far as it may facilitate the study
of pathology it may answer a good purpose. Used to
direct the means of cure, it is wholly insufficient, and
are
many times erroneous. Under single names
grouped the most diverse characters of disease, varying
in different persons and at different times.
If disease is an entity, the doctor thinks of his medi-
cine as
a policeman who takes that entity by the
collar and walks it out of the body. Why not?
"Worms" is a disease, then ascaris lumbricoides, a
variety of this disease-send in Mucuna Pruriens to
tickle the disease to death and make it "vamose the
ranche." Or, we might arrange it as follows: Class-
eccritica; genus-malis; species-pediculis capitis; treat-
ment-crack them.
It does look a little funny when we take this view of
it, and yet you may say that this is an exceptional
case; let us sce. Discase erysipelas, grows by continuity
of structure; treatment-fence it in and keep it from
spreading And so the doctor takes Nitrate of Silver,
Tincture of Iodine, or Tincture of Muriate of Iron,
and makes his dark line on the outside of the disease,
saying, here is an obstruction, I want you to stay on
your own side. If the erysipelas had been a vicious
STUDY OF DIAGNOSIS.
209
1
animal, he could not have built his fence with a more
determined purpose.
If the reader will think for a moment, he will be
surprised how strong a hold this idea of disease as an
entity has upon the profession, and how it is made to
serve as a basis for the most unpleasant medication.
The physician forgets the life of the patient in his effort.
to rid him of his disease-a disease that he has caught,
or one that has caught him. He forgets the impair-
ment of life, the functional wrongs; that disease is a
condition of life—is life, and that it can not be vomited
through the mouth, purged from the bowels, sweated
from the skin, passed with the urine, drawn by a lancet
from the blood vessels, killed with mercury or tartar
emetic, or so afflicted by the class antiphlogistic that in
sheer desperation, it will take itself out of the body.
Our authority says
DISTINCTION AND DEFINITION.
that the first object of nosology is "the distinction and
definition of particular diseases, or of their genera and
species." Here is the common error, of disease as an
entity, for which he wishes a distinction and definition.
He does not desire a definition of pathological life or
groups of unvarying pathological wrongs, but such dis-
tinction as will enable him to affix a name.
Neither are we to understand that this "distinction
and definition" is to have reference to means of cure,
or indeed that they will serve as any guide to reme-
dies Aitken remarks: "In modern times the great
advantages that have arisen from establishing defini-
tions in natural history upon fixed and determinate
principle, not only of its various objects individually,
but also of the groups under which it was found pos-
ì
18
210
STUDY OF DIAGNOSIS.
sible to arrange them, suggested to medical men the
idea that much advantage might also result to the
science of medicine from defining diseases, and such
groups of diseases as might be found expedient to re-
cognize, under general terms or common names, based
upon some fixed and determinate principles.” The
reader will notice in this quotation the tendency to the
error named, and the student finds it impossible to
read medicine without getting the idea, that diseases
thus classified must be something definite, like the
animals and vegetables whose classification is appro-
priated.
NOMENCLATURE.-The second object of nosology is
to name the diseases thus defined, and the medical
world has travailed in labor with names, for many
years. It is very much as recorded in Genesis: "And
out of the ground the Lord God formed every beast of
the field, and every fowl of the air, and brought them
unto Adam, to see what he would call them; and what-
soever Adam called every living creature, that was the
name thereof."
A name should carry to the hearer an accurate idea
of the person or thing in its various attributes, and if
names of diseases did this we could not object. In so
far as names do indicate the wrong of life, names aro
useful as guides to correct practice. In so far as
names direct the mind in pathological inquiry, they
will prove of advantage in medical study. But when-
ever they are recognized as entities, at which remedies
are to be hurled, and which must be forced out of the
human body, then they will prove a source of error.
Plancquet claimed that "the name of each disease
STUDY OF DIAGNOSIS.
211
or species should be so significant that a person slightly
acquainted with the language and the subject, should,
on hearing it, immediately understand what is the
nature of the disease it designates." To such a nomen-
clature we should not object, and if it should go one
step further, that on hearing it we should immediately
understand what remedy would rectify the wrong, or
cure it, then it would be perfect.
If we take the nomenclature of the Royal College
of Physicians, of London, we find 1,146 distinct dis-
eases, and if we would add the named sub-classes or
varieties it would bring the number up to near 2,000.
A man has one right life, and his varied physiological
processes can be studied under one or two score heads,
but his wrong life requires a classification under 1,146
heads, or distinct varieties.
If we examine the therapeutics which go with this
classification, we find that it numbers but about one
hundred remedies in use, and but about twenty in gen-
eral use, and of these five to ten are in common use for
everything. This shows a wonderful discrepancy
between the nosology of disease and its therapeutics.
CLASSIFICATION OF DISEASES. Probably more is
gained in the classification of disease than in its nomen-
clature. The object of classification is to notice the
resemblances rather than the differences, to determine
the pathological wrongs common to a series of diseases,
rather than to determine the special symptomatic dif-
ferences. With regard to classification, Dr. Aitken
remarks:
"It is obvious that any single character, or combina-
tion of characters, in respect of which diseases agree
F
}
212
STUDY OF DIAGNOSIS.
with or differ from each other, may be made the basis
of methodical arrangement, under a larger or smaller
number of divisions, or of higher or lower genera
(language of logicians), or of classes, orders, and genera
(language of naturalists). By ingenious devices of the
mind the physician or the statist may classify and
arrange his knowledge so as to bring it all more readily
within his reach for any special purpose-so as to make
it, in fact, more at his disposal-to facilitate and pave
the way for further investigation. Such are the legiti-
mate objects and the results of all methodical arrange-
ments. Classification, therefore, being only a method
of generalization, there are, of course, several classifi-
cations of disease which may be used with advantage
for special purposes. The physician, the pathologist,
the jurist, the hospital statist, the army or navy medi-
cal officer, may each legitimately classify diseases from
his own point of view, and for his own purposes, in the
way that he thinks the best adapted to facilitate his
inquiries, and to yield him general results. The
medical practitioner may found his main divisions of
diseases on their treatment, as medical or surgical; the
pathologist, on the nature of the morbid action or pro-
duct; the anatomist or the physiologist, on the tissues
and organs involved; the medical jurist on the sud-
denness, slowness, violent or unnatural mode of the
death; the hospital statist, on the kind of diseases
which are treated in its wards; and all of these points
of view may give useful and interesting results, (Farr).
“There is thus no question on which more diversi-
fied opinions are legitimately entertained than on that
of classification. Although it is the aim of all syste
matic writers and observers to arrange the objects of
STUDY OF DIAGNOSIS.
213
study in the most natural order possible, and although
diseases are named as if they were individual entities,
yet they present so great varieties that they will not
admit of that definite and, in many respects, natural
species of classification which can be made with objects
of natural history. Manifest reasons of convenience
and facility for work can therefore be assigned as the
great incentive to classification; and numerous reasons
exist for classifying diseases in various ways: (1.) Men
differ in their estimation of the characters on which
different arrangements may be founded. (2.) The
facts and phenomena of diseases on which classifica-
tions may be made are not all regarded from the same
point of view. Most systems are avowedly artificial,
being arranged with the view to elucidate or support.
a theory, or otherwise to effect a definite end. For ex-
ample, by classifying diseases and recording the causes
of death, the most valuable information is obtained
relative to the health of the people, or of the unwhole-
someness and pestilential agencies which surround
them. We can take this or that disease,' says Dr.
Farr, and measure not only its destructiveness, but
its favorite times of visitation; we can identify its
haunts and classify its victims.' We are able to trace
diseases also as they perceptibly get weaker and weaker,
or otherwise change their type, as some have done from
time to time. We know from the valuable returns of
the Registrar-General, prepared periodically by Dr.
Farr, that certain diseases are decreasing, or growing
less and less destructive; that certain other diseases
have ceased in some measure; while other severe dis-
eases have exhibited a tendency to increase. The ad-
vantages, therefore, of adopting some system of classi-
6
こ
​214
STUDY OF DIAGNOSIS.
fying diseases, which can be put to such useful prac.
tical purposes, must be obvious to every one."
If one can free the mind from the idea that nosology
has a direct relation to therapeutics, these subjects may
be studied to advantage. We want to learn the natural
history of diseased life as we have learned the natural
history of healthy life. If a classification and nomen-
clature will aid in this, even if only as guide boards
and mile posts, we may employ them.
To a certain extent, the common nomenclature of
disease is a necessity. It is quite as necessary to be
able to name a disease for the satisfaction of friends,
as it is to give successful treatment. The name may
not probably have anything to do with the manage-
ment of the case, or the selection of remedies, indeed
should have nothing to do with it, yet we are forced to
give a name. The first question asked of the physician
in the sick room is, "What do you call it?" and we
must be able to "call it" correctly according to the
commonly received nosology.
-
If we can simplify our classification, so as to make it
a good guide for study, we will do well; if we can
make it suggestive of causes of disease which may be
avoided, of right attention to hygiene, and an outline.
of treatment, we will have accomplished all that can
be reasonably anticipated. Let us see how far we can
make such classification..
The first division will have reference to causes of dis-
ease, as well as to pathological conditions. It will be
into epidemic, contagious, endemic and sporadic diseases.
The reader will notice that this is a natural classifica-
tion, referring to causes of disease and their avoidance,
and to a less extent to the conditions of disease and
means of cure.
STUDY OF DIAGNOSIS.
215
The second division will have reference to the general
or local nature of the morbid states, and as will be
noticed occupies the same ground as the preceding,
this having reference to the conditions of disease and
not to its cause. All disease may be classified under
these two heads, though many times it will only have.
reference to the primary lesion, for as the wrong goes
on, a disease which was primarily general becomes
localized, and one which was primarily local will cause
general disease.
A third division has reference to the structure of
parts or to their functional expression, and diseases are
divided into structural and functional. Again, it will be
seen that this classification of disease occupies the
ground of both the first and second, for all disease
must be structural or functional. Here, as before, we
find it especially applicable to the primary disease, for
one may have commenced as a functional wrong, and
grown into a structural disease, as a structural disease
may have first existed, but this being cured, other func-
tional lesions persist.
A fourth division might be called physiological, and
would have reference to the functions of the body.
If, for instance, we make the usual classification in
teaching the principles of medicine:
Formative,
Force. Heat,
Electricity.
Formative,
Cells. Secreting,
Necrological,
Digestion,
tissue making.
does the work of secretion.
pus cells.
Nutrition. Blood making,
Tissue making.
216
STUDY OF DIAGNOSIS.
I
1
"
Secretion.Excrementitious.
Recrementitious,
Circulation. Venous,
{
Arterial,
Capillary.
Brain,
Innervation. Spinal cord,
Sympathetic.
Taking this classification, and assuming that there is
a normal standard of health which may be known, and
that disease is a departure from this standard, all
lesions may be classified as being in excess, defect, or
perversion. This classification is used by Dr. C. J. B.
Williams in his Principles of Medicine, as in the follow-
ing tables:
PRIMARY ELEMENTS OF DISEASE.
STRUCTURAL CONSTITUENT.
ITS FUNCTION.
DISEASE.
STRUCTURAL DISEASE
Tubular (the con-
Contractile fiber.
force.)
Nervous Vesicular (the
ductor of nerve
structure generator and
combiner of nerve
force.)
Secreting structure.
Element-
ary com-
ponents
of blood.
Elementary
changes in
the blood.
Irritability.
Tonicity.
Sensation. :
Voluntary motion.
Involuntary motion,
(excited motor ac-
tion.)
Sympathetic action.
Secretion.
Red corpuscles.
White corpuscles. -
Fibrin.'
Albumen.
Oil, and combus-
tive matters.
Inorganic ingredients,
(saline and mineral)
Water.
[By respiration.
By secretion.
By nutrition.
By foreign matter.
Excessive-Hyper-
trophy.
Deficient-Atro
phy.
Perverted-Degen.
eration.
STUDY OF DIAGNOSIS.
217.
PROXIMATE ELEMENTS OF DISEASE.
Deficient in quan- f General.
Increased-Sthenic.
Dimin'd-Asthenic.
Increased-Determi-
nation of blood.
Dimin'ed-Congest'n.
}
Inflam.
Partly inc.
Partly dim. mation
The circulating blood.
tity-Anemia.
Partial.
General-Plethora.
Excessive in
quantity-Hyper-
æmia.
Partial
Perv'ted in qual-
Local hy-
peræmia.
ity-Cachemia.
With
Circulation
With
Circulation
textures.
Degenerations of tissues.
Deficient-Atrophy.
Nutrition of Excessive-Hypertrophy.
Perverted. Morbid deposits.
Morbid growths.
If now we add to this the ordinary nomenclature of
disease, employed in this country, the reader will have
before him a brief resume of nosology. It will be seen
that these various classifications point the way to certain
necessary studies, having reference to causes of disease,
their general expression, their influence on the func-
tions of life, and lastly the technical language by which
they are designated and known.
It will be recollected that diseases are first divisible
into general and local, and the first may be arranged
according to the classification of Wunderlich as follows:
Tabes.
Chlorosis.
Scorbutis.
*
Dropsy.
General Disease-Dyscrasia. Diabetes.
Rheumatism.
Pyæmia.
Tuberculosis.
Carcinoma.
Lesions induced by {Specific Agents
Vegetable Substances.
19
218
STUDY OF DIAGNOSIS.
K
Periodic.
Intermittent.
Remittent.
Yellow.
Febricula.
Synocha.
Fevers. Continued. Synochus.
Eruptive. Scarlatina.
Typhoid.
Typhus.
Variola.
Contagious.
Rubeola.
Spotted.
Zymotic.
Cerebro-Spinal Meningitis.
Diphtheria.
Erysipelas.
Local diseases are usually arranged in groups accord-
ing to the function of parts. This seems to be the
most natural arrangement, as the expression of disease
is frequently a wrong of function.
Of the Nervous System.
Of the Brain.
Spinal Cord.
Sympathetic.
Structural.
Functional.
Eye-sight.
Ear-hearing.
Of the Organs of Special Sense. Nose-smelling.
Mouth-taste.
Skin-touch.
Nose.
Pharynx.
Larynx.
Of the Respiratory Apparatus. Trachea.
Bronchia.
Lungs.
Pleura.
Heart.
Pericardium.
Arteries.
Of the Circulatory Apparatus. Capillaries.
Veins.
Functional.
Structural.
Functional.
Structural.
Functional.
Structural.
Lymphatic Vessels.
Lymphatic Glands.
STUDY OF DIAGNOSIS. *
219
Functional.
Structural.
Mouth.
Salivary Glands.
Tonsils.
Pharynx.
Esophagus.
Stomach.
Of the Digestive Apparatus. Small Intestine.
Large Intestine.
Liver.
Spleen.
Pancreas.
Peritoneum.
Supra-renal Capsules
Kidneys.
Of the Urinary Apparatus. Ureters.
Bladder.
Urethra.
Functional.
Structural.
Structural.
Functional.
Functional.
Structural.
Of the Reproductive Organs.
Scrotum.
Testes.
Vesiculæ Seminales.
Prostate.
Penis.
Ovaries.
Uterus.
Vagina.
Vulva.
[ Urethra.
Cutis Vera.
Rete Mucosum.
Epidermis.
Of the Skin. Sudoriferous Glands.
Sebaceous Follicles.
Hair.
Nails.
Bones.
1
Of the Organs of Locomotion.
Articulations.
Cartilages.
Muscular Tissue.
Fibrous Tissue,
Connective Tissue.
The reader will notice that whilst this classification
is exceedingly simple, it directs attention to the part
diseased, the function impaired, and in so far as reme-
dies act on particular parts, it suggests appropriate
220
STUDY OF DIAGNOSIS.
remedies. In ordinary professional consultation it
proves sufficient, as it does in writing, and it is quite
sufficient to satisfy the popular demand for names.
GENERAL CLASSIFICATION
We will make a study of disease according to the
four general divisions heretofore named. 1st, with ref-
erence to the cause-epidemic, contagious, endemic, spo-
radic; 2d, as it is general or local; 3d, as it is structural
or functional; and 4th, as it shows a departure from
the physiological standard. In doing this the special
features will be so pointed out, that the reader will be
enabled to recognize the divisions, and classify his
cases according to them.
It is possible that the description will be at times
longer than is really necessary for the purposes of
diagnosis, as we wish as far as possible to study the
natural history of disease, but it will be made as con-
cise as possible.
EPIDEMICS.
A thorough study of epidemic influences has not yet
been made, and we know much less of the subject than
we should, yet what we do know has an important
bearing upon practical medicine.
Many physicians have recognized the fact, that the
conditions of life do change from time to time, and that
as the result of this there are variations in the wrongs
of life diseases-and in their expression. That in
some years and seasons, these changes were so great as
to give that character to disease which is usually known
STUDY OF DIAGNOSIS.
221
as epidemic. The fact has been recognized, that this
epidemic condition might influence but one disease, or
a class of diseases, as those called contagious, those
called zymotic, or it might influence all diseases or
pathological states.
The general epidemic influence is known by some
special character of disease, which is wide-spread, and
is noticed in many localities. In some cases it will be
seen as a condition of asthenia, in others of undue ex-
citation. In some it partakes of the zymotic character,
and this influence upon the blood is noticed in a
majority of cases of acute disease. Physicians will re-
collect it under the name of typhoid, giving a peculiar
character to fevers and inflammations, and even
noticed in minor affections.
·
This epidemic influence is frequently marked by
special symptoms calling for special remedies. Thus
the diseases of the Winter of '72-73 were characterized
by a peculiar frontal pain, frequently localizing itself
in the left orbit; a peculiar appearance of tongue, with
prominence and redness of the papillæ of the tip; the
tendency to erythematous redness and inflammation of
skin and mucous membranes. Epidemic remedy-.
Rhus Toxicodendron. The present year, 1873–74, we
notice the common basilar pain, and the impairment.
of the venous circulation-fullness of veins, a pecu-
liarity of pain, especially of right side, and affection of
serous membranes. Epidemic remedies-Podophyllin,
Bryonia. In 1870-71, we noticed especially the deep
coloration of mucous membranes, the tendency in
severe disease to brown tongue and sordes. Epidemic
remedy-Muriatic Acid.
To diagnose this epidemic influence, one must be a
222
STUDY OF DIAGNOSIS.
}
reader of the periodical literature of the day, so as to
see the expressions of disease in different localities.
It is true that observations are made without reference
to this, and the reporters do not believe in it, but the
evidence is all the more valuable. No one can take a
half dozen of our medical periodicals, and compare
them for a series of years, without being struck with a
certain similarity in the diseases of a year, or a series
of years, which can be accounted for in no other way.
It would be possible from our periodical literature to
tabulate the character of these epidemic influences for
a considerable period of time, and this no doubt will
be done in the future.
The reader will have no doubt observed, that the dis-
eases of some seasons, no matter how diverse in special
characteristics, would have something in common,
which something would be especially manifest in the
treatment. That in some seasons Quinine would cure
everything, in others the sedatives would cure every-
thing, in others a remarkable benefit from Podophyllin,
so that when you had once determined a good treat-
ment, you would persist in it for all affections, with
very little modification.
And this brings prominently before us the fact, for
fact it is, that there is an endemic or epidemic consti-
tution of disease, that should be well studied, and
always regarded in treatment. Success or failure will
very frequently depend upon this knowledge, and it is
something that must be relearned every year.
It was a prominent doctrine of Rademacher and his
followers, and he had remedies for three such constitu-
tions. These were Iron, Copper, and the Nitrate of
Soda. There was some truth in this, how much I don't
- 1
STUDY OF DIAGNOSIS.
223
know, for I have not had the opportunity to experi-
ment, and, indeed, have not had time to give his works
the examination they should have, as I read German
slowly, and they have never been translated.
I believe, however, I have passed through one year,
in which Iron was the remedy for almost everything,
and I think probably some of our old practitioners
may recollect it, if they by chance had used Iron.
The season commenced in December with a large num-
ber of cases of erysipelas, for which Iron was a specific,
and for some fourteen months I prescribed Iron daily
for almost everything, with the most flattering results.
I have experimented with Copper and Nitrate of Soda
to but a limited extent.
Rademacher applied the principle to chronic disease.
Grauvogl says:
"One experience gained by this school is worthy of
special consideration-that, in old chronic diseases, the
previous epidemic constitution always decides, first of
all, upon the present indication of a remedy, hence, in
every case which comes up for treatment, the time of
its first appearance should be learned, as far as possible,
for, by this, frequently, if the then epidemic curative
remedy is known, the primary seat and the primary
kind of the diseased process are known also, and this
very remedy will still effect a cure, if a cure is yet
possible, or, if the disease is not already succeeded by
another disease of the first affected organ or blood, or
if disease of another organ has not ensued. But, even
in this latter case, that knowledge gives the point of
departure for the whole chronic affection.'
"That is in gross, what we see happen on a smaller
scale, after strong or oft-repeated doses of long-acting
:
224
STUDY OF DIAGNOSIS.
remedies. First appear symptoms at the point of
application, then of its reception in the blood, finally,
the affections of the specifically affected organs and
systems in succession, and often, at great intervals, as
we have observed very distinctly with quicksilver, for
instance. The only difference consists in this, that
epidemic injurious influences, often after very many
years, to the surprise of many, bring to view their con-
tinued operation as a token of the presence of their re-
sults under various forms of disease, while the continued
operation of drugs is of proportionally shorter dura-
tion."
If this theory of epidemics is borne out by future
observation, it must have an important bearing upon
therapeutics. If we determine a common element in
the diseases of a season, we will have something common
in the remedies. If we have an underlying influence
of this kind, giving character to disease throughout a
considerable extent of country, it is an influence that
should be known, and have due weight in our estimate
of pathological processes. If we can go still further,
and find certain epidemic remedies opposed to this in-
fluence, whatever it may be, it will greatly aid our
treatment.
I am not only satisfied that we have these epidemic
constitutions of disease, but that we have epidemic.
remedies as well. And going further than this, I
believe with Rademacher, that this epidemic influence
persists in chronic disease, and that the knowledge of
the epidemic influence at the time the disease com
menced, may give us in the epidemic remedy of that
year, the means of cure.
We need not re-discuss the change of type theory,
STUDY OF DIAGNOSIS.
225
and yet I have no doubt but that disease does change
its type; that for a number of years it has the char-
acter of asthenia, and for another period it will be
sthenic. The knowledge of this will be available in
the selection of remedies.
Again we find years in which the peculiar wrongs
known as typhoid are prominent. All acute diseases
seem to partake of this character, and if of consider-
able duration, typhoid symptoms will be developed.
We have "typhoid pneumonia," "typhoid dysentery,"
intermittents and remittents run into typhoid, as well
as other discases. This epidemic influence is readily
recognized, and suggests treatment.
Zymotic diseases are not unfrequently epidemic, or
have underlying them the epidemic character. It is
true they frequently produce a specific contagion, which
serves as a cause of their propagation, and this we wish
to keep distinct from the character we are now studying.
The epidemic influence is that which renders the com-
munity very susceptible to the contagious poison, or
gives it specific characters, or renders it more destruc-
tive to life.
}
Readers will readily recall epidemics of this character.
Seasons in which smallpox, scarlet fever, measles,
whooping cough, were remarkably prevalent, easily
transmitted, difficult to protect against, possessed dis-
tinctive features, and required special treatment. And
they will likewise recall the fact, that in these years
other diseases would show similar peculiarities, and
would require similar remedies. This will have been
noticed in local complications, as well as in the general
features. That in some years there was a remarkable
tendency to disease of the respiratory apparatus, or of
226
STUDY OF DIAGNOSIS.
+
the bowels, or of the kidneys, or of the nerve centres,
and that these local affections were to be met with as
complications of all diseases.
I have already noticed the fact that such epidemic
influences may be discovered in chronic diseases; that
many times the disease will partake to a greater or less
extent, of the epidemic constitution of the year in
which it was contracted, and will require the epidemic
remedies of that year in its treatment. Indeed, in
some cases, we find that determining this, and knowing
the constitution of disease at the time it commenced,
and the remedies that were curative then, we have de
termined the remedies which will prove curative.
It is not only important to thus be constantly on the
alert to determine the presence of epidemic influences,
and carefully note the expressions of disease at such
times, but it is well to keep memoranda for future use.
It is true that all disease has distinct and definite ex-
pression, and that for this we may find distinct and
definite remedies; quite as much for this epidemic con-
stitution of disease as any other.
We are acquainted with quite a number of epidemic
remedies, and find the list continuously enlarging. So
marked is the influence, and so distinct the features,
that we sometimes find a single remedy sufficient for
the entirety of disease. It is possible that we may
make the best study of remedies in such seasons, for I
have noticed that if a remedy has thus proved markedly
curative at such times, the epidemic symptoms indicat-
ing it being pronounced, the remedy would prove cura-
tive in sporadic, endemic, or contagious diseases, wher-
ever the special symptoms were present.
The remedies worthy of special notice in this con-
STUDY OF DIAGNOSIS.
227
1.
nection are Quinine, Muriatic Acid, Soda, the Antisep-
tics, Sulphurous Acid and Sulphite of Soda, Chlorate
of Potash, Baptisia, Aconite, Veratrum, Belladonna.
Gelseminum, Rhus Toxicodendron, Iron, Nitric Acid,
Podophyllum, Lobelia, Bryonia, Nux Vomica.
All of these, and such others as may have attracted
the attention of the reader as being especially useful
in certain years, may be advantageously studied in this
connection.
CONTAGIOUS DISEASES.
In this classification we find that certain diseases are
produced by a specific cause, generated during the pro-
gress of the disease, and propagated from person to
person. In them we find that the contagious element
is continuously reproduced in kind, and the expressions
of disease are alike. As before noticed, it may and
does vary from epidemic influences, and as we will
hereafter see, from endemic influences, but in general
features there will be a remarkable likeness, and in
therapeutics there will be something in common.
The diseases grouped under this head are the crup-
tive fevers-variola, rabcola, scarlatina, varicella; the
contagious cough-pertussis-whooping cough; some
zymotic diseases-erysipelas, puerperal fever, diphthe-
ria, spotted fever, cerebro-spinal meningitis; some
fevers and inflammations, cholera, typhoid, typhus and
yellow fevers, inflammations with typhoid symptoms
The general diagnostic feature is that the disease can
be traced from person to person, and when the fact of
exposure is known, we are justified in giving it the
228
STUDY OF DIAGNOSIS.
care, and using the precautions against the spread of
contagion that may be necessary.
These diseases have certain distinct expressions by
which they may be known, and when we have a first
case, the contagious element will receive due considera-
tion, especially in guarding against its communication
to others, in some cases by the use of appropriate pro-
phylactic means. We also regard the fact, that the
contagion generated during the progress of the disease
may unpleasantly influence the patient, indeed his lifo
may be destroyed by its presence with and around him.
VARIOLA.-The diagnosis of smallpox will be made
by—a, the intense, aching pain in all parts of the body,
deep seated, during the first day of febrile reaction; b,
the appearance of the eruption, as distinct red spots,
which give to the touch the sensation of hardness like
a shot under the skin; c, the regular development of
the pustules in a period of nine days; and d, the flat-
tened and umbilicated form of the pustules.
It suggests protection by vaccination, by avoidance.
of the cause, by the use of proper antiseptics. In the
treatment of the disease, that the contagion be removed,
as far as possible, by the excretory organs, and at
length by the completed stages of the eruption. When
the contagious virus is in large quantity, as shown by
the usual evidences of decomposing animal matter, it
suggests the use of antiseptics, agents that destroy the
material of contagion, great cleanliness, and a sustain-
ing treatment.
RUBEOLA.-The diagnosis of measles will be made
by-a, the catarrhal symptoms, full, suffused and in
jected eyes, which announce the attack; b, the pecu
STUDY OF DIAGNOSIS.
229
liar and constant cough; and c, the irregular form of
the eruption.
It suggests Lobelia and Asclepias to favor the deter-
mination of the eruption upon the skin, and relief of
irritation of mucous membranes, and Drosera as the
special remedy for the cough.
SCARLATINA. The diagnosis of scarlet fever will be
made by-a, the early appearance of a sore throat,
which persists and is a marked feature of the discase;
b, the high range of temperature, and dryness of sur-
face; c, the vivid scarlet redness of the eruption; and
d, the evident impairment of the cutaneous capillaries,
as marked by the persistent white line left as the finger
is drawn over the surface.
It suggests Belladonna in minute doses as a prophy-
lactic, Belladonna and Carbonate of Ammonia as stim-
ulants to the capillary circulation of the skin. And
the use of fatty inunction alone, or with stimulants—
Creosote and Common Salt.
VARICELLA.-The diagnosis of chicken pox will be
made by―a, the irregular appearance of the points of
eruption; b, their speedy development; and c, their
vesicular form.
PERTUSSIS―The diagnosis of whooping cough will
be made by—a, the occurrence of cough without febrile
symptoms; b, its paroxysmal and spasmodic character;
and c, the whoop, the sibilant or whistling sound as the
air is forcibly drawn through the contracted larynx
during or at the close of the paroxysm.
It suggests specific remedies, Drosera, Belladonna,
230
STUDY OF DIAGNOSIS.
1
Nitric Acid, and Trifolium Pratense, as may be indi-
cated in each case by special symptoms.
ZYMOTIC DISEASE. Whilst all contagions may be
classed as zymoti, all zymotic diseases are not conta-
gious. Those named-erysipelas, diphtheria, spotted
fever, and cerebro-spinal meningitis-may be epidemic,
endemic, or contagious, and we study them in each of
these classes. When they prove contagious, it may be
from either of two conditions-the intensity of the dis-
eased action, or the loss of life and breaking down
of the tissues.
If we take the first disease, erysipelas, we will find
that it sometimes develops remarkable virulence in this
direction; so much so that it will attack almost every
surgical case in a hospital, and will be contracted by
nurses and others. This of course will be noticed espe-
cially in certain years (epidemic influence) and in cer-
tain localities (endemic influence), but we can not
neglect to notice the contagious element.
In the one case we notice the intensity of disease, both
as to its local and general symptoms. The part is in-
tensely hot, burning, painful, and is dry and tense, and
its color, whether bright or dark, is vivid. The pulse is
frequent, tense, and unyielding, the temperature has a
high range, and the nervous system shows great exci-
tation. Whenever such symptoms show themselves,
we may fear contagion, and will employ means to pre-
vent the infection of others.
In the second case we have the evidences of sepsis
and deliquescence of tissue. Locally the part is full,
and wants elasticity, the epidermis yields, and presently
the connective tissue The discharge becomes offen-
STUDY OF DIAGNOSIS.
231
sive, the pulse oppressed and feeble, and the tissues at
large softened.
Whilst in the first case remedies would have reference
to the intensity of diseased action, and consist princi-
pally of the five specifics-Iron, Veratrum, Rhus, Apis,
Belladonna; in the second it will consist in the
use of the proper antiseptics, with restoratives and
food.
In the second, puerperal fever, we notice the same two
elements of contagion, quite as marked as in crysipelas.
But there is added a third, an infectious material
thrown off from the reproductive organs. So marked
and virulent is this, that it is readily communicated by
the physician from patient to patient, even through an
interval of days or weeks. It is not only thus infec-
tious, but is intensely poisonous to the patient, and its
re-absorption intensifies disease, and frequently leads
to a fatal result.
Having regard to the means named in erysipelas, the
physician gives especial attention to prevent the spread
of contagion. In some cases this may be avoided by
strict attention to cleanliness, change of clothing, and
the use of antiseptics, as washing with a solution of
Chlorate of Potash, Sulphite of Soda, Labaraque's
Solution, or dilute Sulphurous Acid. To prevent re-
absorption, we use great cleanliness, and the antiseptics
just named.
In diphtheria the contagious property seems to be
developed more by the intensity of disease, than by
devitalization of tissue and putrescence, and it is
always well to use extra precautions when the febrile
action and local inflammation are intense. But here as
in puerperal fever a specific infection is generated at
232
STUDY OF DIAGNOSIS.
the point of local disease, and is readily communicable
to others. This is so marked that the diphtheritic de-
posit is readily inoculable, not only in the throat, but
on almost every abraded surface.
The knowledge of these facts will not only cause us
to guard against the general conditions of contagion,
us in the other cases, but especially against the trans-
mission of the local infection by coming in immediate
contact with the patient and inhaling the breath, the
use of towels, handkerchiefs, before they have been
thoroughly. purified by boiling, and especially the use
of probangs, swabs, or surgical instruments that have
been employed on a diphtheritic patient.
In cerebro-spinal meningitis and spotted fever we have
the double element of contagion first named. The
generation of the infectious material by intensity of
disease, and by loss of life in tissues, and putrescency.
The same means will be employed as in the case of
erysipelas, both to prevent the spread of contagion,
and to protect the patient against the poison generated
in his own body.
CHOLERA.—Asiatic cholera might be studied in the
class of epidemic diseases, as in the seasons of its prev-
alence there is a marked epidemic influence, that shows
´itself in other diseases as well as this. But though we
recognize this, the evidence that it is propagated by a
specific contagion is too well proven to allow us to
neglect it. Cholera advances on lines of travel, and
renews its strength as it goes, going with people, being
propagated by and in people. Gaining strength and
virulence by special combination of circumstances in
its native country India, it takes passage by steamship
STUDY OF DIAGNOSIS.
233
to Europe, from Europe to America, where it is dis
tributed by railroad, steamboat and stage.
It is probable that the infectious poison is found prin-
cipally in the excretions, and mainly in the dejections
from the bowels, and the disease is especially propagated
from them. If so, it points the physician to the neces-
sity of especial care in the removal of the dejections,
and that they be so disposed of as not to endanger
others, either by their exhalations, or by contaminating
the water supply.
We diagnose an attack of cholera by-a, the great
exhaustion that attends the first discharges; b, by the
evidences of imperfect circulation and aeration of the
blood, as seen in the bluish discoloration of the ex-
tremities; c, by the want of color in the fæces, “rice
water"; d, by the marked enfeeblement of the circu-
lation, and lowered temperature; and e, by the exces-
sive thirst, nausea and vomiting, and muscular cramps.
TYPHOID FEVER and acute diseases assuming typhoid
symptoms, usually possess the contagious element in
slight degree. Yet in some cases we observe a remark-
able development of this character which demands the
attention of the physician. Typhoid is generally
thought to mean asthenia, but it is better to think of it
as having reference to sepsis of the blood. With the
condition of sepsis, comes the property of contagion,
and under some circumstances this becomes marked.
think diseases called typhoid will be found to develop
the character of contagion both from intensity of dis-
ease, and from impairment of the life of tissue and
putrescence. The most marked cases I have known
were when there was great nervous excitation, tense
1
234
STUDY OF DIAGNOSIS.
tissues, high temperature, and the sensation of pungent
heat when the hand was applied to the surface. The
other cases are distinguished by a peculiar sweetish
cadaveric odor of breath, dark fetid fæces, and fetor of
urine.
TYPHUS FEVER is markedly contagious, and may be
wholly propagated by a specific contagion generated
during the progress of the disease, and thrown off in
the excretions both from bowels, kidneys, skin and
lungs. It has been noticed that here intensity of dis-
ease, marked by great febrile excitement, was more
likely to develop the contagious element, than the con-
dition commonly known as putrescence.
YELLOW FEVER is undoubtedly contagious in degree,
sometimes very markedly, and at others so as to exert
but little influence. Both conditions of contagion have
been noticed that from great intensity. of disease,
with the symptoms heretofore named, and from putres-
cency appearing in the last stage with the black vomit.
ENDEMIC DISEASES.
If disease showing distinct peculiarities is confined
to a locality, it is said to be endemic, especially if it
prevails to any considerable extent. In such cases the
cause is evidently local, and it is evident that many
times it may be discovered, removed, or avoided.
These diseases have a definite and distinctive expres-
sion, which should and may suggest the means of cure.
In some the endemic influence is so wholly the cause,
and the endemic expression so clearly indicates the
STUDY OF DIAGNOSIS.
235
1
lesion, that remedies will be remarkable for their cura-
tive influence. At other times the endemic influence,
and disease produced, will be but a part of the wrong,
and whilst the endemic remedies are important, they.
are not so certain as before, and have to be aided by
other means.
The diagnosis of endemic disease is usually very
clear: a, There is something distinct and special in the
expression of disease; b, there are a number of cases,
showing these special features; c, the diseases are re-
stricted to definite localities.
First among the diseases included in this classifica-
tion are all those showing periodicity, including inter-
mittent, remittent, and yellow fevers. Following these,
we find that an endemic influence may give rise to the
serics of continued fevers, to all inflammations, and to
many functional and structural diseases. And it is to
be noticed that as a rule the endemic influence intensi-
fies the natural disease in addition to giving it special
features.
I
PERIÓDICITY.—Whatever may be the cause of period-
icity in disease, the fact is sufficiently tangible, easily
recognized by the periodic expression, which indicates
a special pathological condition, and calls for a special
group of remedies, anti-periodics-Quinine. As before
remarked, the periodic element may serve as a basis of
nearly every named disease, which will be cured by the
one remedy, Quinine. Or it may only be a complica-
tion, or part of the disease, and Quinine will only be
one of the remedies called for. But periodicity does
not always mean Quinine, and it is sometimes difficult
to determine whether it does or not. All diseases are
236
STUDY OF DIAGNOSIS.
A
periodic to a certain extent, having periods of increase
and diminution, as may be noticed even in the fevers
called continued. Indeed all the functions of life, both
in health and disease, have something of periodicity in
their performance.
The diagnosis of periodicity will be made by-a, The
marked remission or intermission of the evidence of
disease, and return to the healthy standard of life; b,
the equally marked exacerbation of disease, especially
with reference to the wrongs of innervation, tempera-
ture and circulation; c, the disposition to continue such
functional aberrations without change of structure; and
d, the fact that such disease is endemic in the locality.
INTERMITTENT FEVER.-We diagnose an ague by-a,
the marked cold stage; b, followed by a hot stage; c,
a sweating stage-all occupying a comparatively short
time, usually less than twenty-four hours; and d, a
more or less complete intermission of the disease, and
return of normal functional activity.
If the intermission is complete, with normal temper-
ature, normal circulation, innervation and secretion.
Quinine will be the remedy. If functional wrongs
should persist during the intermission, appropriate
means should be employed for their removal, and the
Quinine given if the disease persists.
Remittent FevER —We diagnose remittent fever by
-a, A forming stage which may be brief or of one or
two weeks duration, and which is frequently attended
by gastric disturbance, and frontal pain; b, a chill, not
nearly so intense as in ague, but well marked; and c, a
hot stage which is distinctly broken up into remissions
STUDY OF DIAGNOSIS.
237
and exacerbations, and continues to the sweating stage,
which is the termination of the disease.
The distinct remissions and exacerbations-periodi-
city-mean's Quinine, and in some cases this remedy
will be sufficient to arrest the entire series of morbid
processes. This condition will be known by-a, The
soft and open pulse; b, the moist and cleaning tongue;
c, the soft and moist skin; and d, return of normal in-
nervation—at the remissions. If these conditions do
not present, we determine the character of the wrongs
and employ the means necessary to remove them.
YELLOW FEVER.-Though there is undoubtedly an
epidemic influence in some seasons, and the disease is
more or less contagious, we find that the endemic con-
ditions are of great importance. Yellow fever can not
prevail in unfavorable situations, (it is said never to
prevail at altitudes of more than four hundred feet
above the ocean), and just in proportion as the local
influences favor it, the disease will be severe and fatal.
Bad drainage and want of cleanliness are especially
noted as likely to favor the propagation of yellow
fever.
The diagnosis of yellow fever is made by—a, The
marked chill, attended by lumbar and frontal pain,
nausea and vomiting; b, the rapid accession of the hot
stage which is very intense, lasting from twenty-four
to seventy-two hours; c, the abatement of febrile ac-
tion, but with marked prostration, and gradually in-
creasing yellowness of skin; and d, the return of nau-
sea and vomiting-the black vomit.
TYPHOID-Next to periodicity the most frequent and
marked endemic influence is that which gives the
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STUDY OF DIAGNOSIS.
1
typhoid character to fever. It may produce typhoid
fever with disease of Peyer's glands, may cause typhoid·
symptoms in remittent fever, and all the inflammations.
A very common manifestation of the influence is in
typhoid dysentery, and typhoid pneumonia. The local cause
is evidently decomposition of vegetable and animal mat-
ter, the products being thrown off into the air and in-
haled, absorbed by food, or infecting the water supply. As
it is possible to remove such causes, the physician should.
always direct attention to them in these cases, that they
may be removed.
Using the word typhoid as an adjective to designate
a condition of disease, it has reference to the condition
of sepsis and putrefaction. The enfeeblement or asthe-
nia is but an incident, and is sometimes not, noticed
until a late stage, though the typhoid symptoms are
marked.
The diagnosis is best made by examining the exuda-
tions or secretions. It is especially marked in the
mouth; on the tongue by dirty coating, or a fur that
assumes a brownish tinge and gradually becomes deeper
until it is almost black; dirty or dark sordes upon the
teeth; unpleasant, dark, and offensive fæces; urine
that is frothy, and gives an unpleasant cadaveric odor.
We also notice it in the sense of pungent heat when
the hand is applied to the surface, and in the low de-
delirium. In surgical diseases, the discharge from
wounds or injuries, or operations, will show it, in a
wrong of the pus, which becomes thin, ichorous, fetid,
and in a tendency to softening of tissues and sloughing...
It suggests the class of antiseptics, especially Sulphite
of Soda, Sulphurous Acid, Muriatic Acid Chiorate of
Potash, and Baptisia, which are selected wcording to
special indications hereafter named.
STUDY OF DIAGNOSIS.
239
We also find special expressions of disease, when
endemic, that indicate special remedies, and these prove
curative. As in the case of epidemic influence, we find
that these symptoms are common to many or nearly all
the diseases of the season or year, and the remedy in-
dicated assumes a very prominent place in treatment.
Thus all the remedies named as being indicated in
epidemics, are found indicated when the cause is
endemic,
Thus we sometimes find an erysipelas, puerperal
fever, or dysentery, that is clearly endemic, and the
special indications for remedies will be distinct.
We
want Iron, Veratrum, Rhus, Podophyllin, etc., and the
indications are so direct and positive that a cure is cer-
tain and speedy.
SPORADIC DISEASE.
In this last class we find no special expression of
disease, or in other words, we find the regular succes-
sion of symptoms as given by authorities. The causes
are in the acts or indiscretions of the individual, in ex-
posure to heat, cold, wet; want of proper clothing or
protection; intemperance in eating and drinking; over-
exertion, physical or mental-and the reverse, a want
of exercise. Or the cause may be found in the general
conditions of life; sudden changes of temperature;
more or less moisture in the atmosphere; and a greater
or less electrical condition.
These causes are temporary, and avoidable, and it is
well to study them in relation to disease. Whilst a man
may not escape an epidemic, contagious, or endemic
240
STUDY OF DIAGNOSIS.
cause, right living will usually prevent the class of dis
eases called sporadic.
It is also well to notice that these diseases are usually
simple in their structure, and very amenable to reme-
dies. If we take the physiological study of disease,
and determine which is the first wrong of function, and
right it, we will have but little trouble in treatment. A
sporadic fever yields readily to the special sedatives--
agents that rectify the wrongs of the circulation; or at
farthest will need but the help of those which increase
secretion. An inflammation readily yields to the gen-
eral sedatives, and those which remove the irritation of
the part. The important points to determine in these
cases are the character of the general disease, and
the remedies which will right it; the situation and
character of the local disease, and the remedies that
will influence the part, and influence it in a right direc-
tion.
GENERAL AND LOCAL DISEASE.
This would seem to be a very simple and profitable
classification, both in determining the character and
gravity of disease, and in selecting remedies. Yet
when we come to the bedside we find it very difficult
to make the diagnosis. Disease may be so uniformly
distributed, that it is impossible to say that one part
suffers more than another, or it may be so localized
and restricted to a part, that its general influence is
hardly noticed. Yet in most cases we will find the two
associated together. It is difficult to find a person so
uniformly constructed that there is not some weaker
part, and in disease which otherwise would be general,
STUDY OF DIAGNOSIS.
241
this weaker part suffers. If it were not so, the happy
man would be like Dr. Holmes' "one horse shay," and
like it would fall to pieces at once, somewhere between
three score and ten and five-score years. And there
is no part so disconnected with the organism as a
whole, that can suffer disease without influencing the
body at large.
Though the body, so varied in function, is one, yet
it is of advantage to think of disease as being general
and local (in principal part), and associate with these
ideas thoughts of general and local remedies. To get
a fair conception of the elements of general disease it
is well to think of those functions which are common
to the entire man, or which are equally necessary in
their results to the entire man. And to get a fair con-
ception of local disease, we study the function of each
part, in so far as it can be dissevered from the life in
its totality.
We might make a group of the elements of general
disease, according to our physiological classification,
somewhat as follows:
Formative-for organization.
Force. Heat.
Electricity.{Conditions of life and motion.
Increased,
In its circulation. Diminished,
Wrong in kind.
The Blood. In its organization.(with reference to nutrition, to degenera-
tions, deposits and growths.
Influenced by
Retained excreta.
Malaria.
Zymctic poisons
Specific poisons.
For the supply of Oxygen.
The Respiratory Function. For the removal of Carbonic Acid.
innervation:
As an aid to the circulation.
From the sympathetic, co-ordinating the vegetative process.
From the spinal cord, as infiuencing the automatic functions.
From the Brain,
Reason.
Emotion.
Volition.
:
Sensation.
21
:
?
1
242
STUDY OF DIAGNOSIS.
It is not necessary to consider each of these in this
place, but having them grouped before the eye, the
mind can analyze each one as a factor of disease, and
combine them in natural groups, as usually seen. The
mind not only recognizes them as general elements of
disease, but will soon learn to recognize the common
expressions of wrong, according to the classification of
excess, defect and perversion. And it will soon go further
than this, recognizing remedies which reach cach in.
dividual element, and do that necessary to be done―
opposing the morbid action and influencing the func-
tion toward the normal standard. If there is an ex-
cess-above, the influence is to bring down to the stand-
ard of health. If there is a defect-below, the influ-
ence is to elevate or bring up to the normal standard.
And if there is a perversion-a departure from, the in-
fluence is to bring back to the normal standard.
We have already noticed that none of these elements
of general disease can exist without producing more
or less of local disease, and we may also say without
influencing the entire series named. With reference
to local disease we find it severe and destructive in
proportion to the severity of the general lesions. So
too we find that the influence of some of these clements
of disease sets up a series of lesions which are severe
in proportion to the severity of the original one. In
both cases general remedies are most important, and in
so far as they rectify wrongs, and restore normal struc-
ture and function, they are most important.
In some
cases the general lesion determines the
character of the local one. This is especially the case
when the general lesion is of the blood, giving caco-
plastic or aplastic deposits. An inflammation may
STUDY OF DIAGNOSIS.
243
spring up, simple in its character, from the common
causes, and if there had been no wrong of the blood, it
would have readily passed away by resolution. Yet,
there being cacoplastic material in the blood, this is
thrown out as an exudation, and breaking down, causes
most serious destruction of tissue. If in such cases as
this the character of the general lesion were recognized
early, and proper means employed to remove the im-
perfect material by way of the excretory organs, and
so improve digestion and blood making as to prevent
its renewal, the local lesion would be less severe and
destructive. In place of a "white swelling," or
CC mor-
bus coxarius," the inflammation would run its regular
course of six to nine days to resolution.
If we take the case of phthisis pulmonalis, we find
another good example. Say there was an original want
of formative force, and in consequence there is continu-
ously produced an imperfect material in the blood.
Its deposit in the lungs comes whenever from any cause
excretion is arrested, preventing its normal removal,
and when an irritation of and determination of blood
to the lungs is set up-the material being carried to
the lungs and there excreted. In this case a rational
practice of medicine looks first to an increase of forma-
tive force, getting thereby a better blood, better tis-
sues, and a stronger life. When the disease has once
developed itself, the treatment will of course look to
the establishment of the processes of combustion and
excretion-removing the material from the blood in
this way-and the arrest of irritation of the lungs,
which is the cause of the deposit there.
If we take the single factor, heat, as the example, we
find the very same state of affairs. If, for instance, we
244
STUDY OF DIAGNOSIS.
have the lesion of the blood known as · typhoid," we
find that its increase is in proportion to the wrong of
the temperature. If we have an inflammation of the
lungs, the local disease is destructive in proportion to
the increase of temperature. If we have a phthisis
pulmonalis, the deposit is rapid in proportion as the
temperature is high, and the destruction of lung tissue
is in the same ratio. We say, therefore, that diagnosis
by the body thermometer, must suggest a class of gen-
eral remedies, which will prove efficient in modifying
and arresting general and local disease.
•
There is no doubt but that lesions of excess and de
fect of electricity, as a condition of life, and as a force,
have a similar influence upon disease. Plus electricity,
and we have increased disease by excitation; minus
electricity, and we have increased disease by want of
excitation. The diagnosis will be formed in most cases
by the degree of excitation as manifested by expres-
sion, and the proper remedies will suggest themselves
to relieve the body of its superabundance, or to employ
means which will add to, or prevent its waste.
When we study the circulation of the blood as a
factor in disease, we see how marked the influence of
one of these general wrongs. Given a lesion of fre-
quency in movement only, and we find that any morbid
process is increased in proportion. Secretion is
arrested, the appetite is lost, blood making and nutri-
tion are impaired, waste is interfered with, and every
cause of disease intensified. Wrongs in the circulation
other than frequency, give the same results. Even an
unequal circulation of the blood may lead to such
serious impairments of function, as to be a cause of
death. Evidently the diagnosis of these general
STUDY OF DIAGNOSIS.
245
wrongs, and the use of remedies to reach them, are of
prime importance.
When we study the influence of lesions of the circu-
lation upon local disease, we find them playing the
same important role. If you have a local disease, in-
flammatory or otherwise, it will be to a considerable
extent severe and destructive in proportion to the
lesion of the circulation. If we have an inflammation
of the lungs, it will be severe in proportion to the fre
quency and wrong in the circulation. With a pulse of
100 beats per minute, and frce, there is little danger;
but with a pulse of 130, small and sharp, there is most
serious danger. If in such case, the lesion of the cir-
culation can be removed, the local disease will be modi-
fied in the same proportion
+
Continuing on with this classification, attention
might be called to the next group-the blood influenced
by certain causes of disease. Take first retained ex-
creta, and we have a most excellent example of the
need of diagnosis by this classification. We are treat-
ing an injury, a wound for instance, and everything
progresses well, until from some cause one or more
secretions are arrested. At once we see a change in
the local disease, the part suffers, its temperature rises,
becomes painful, the process of repair stops, the exuda-
tion is changed in character, the pus is unpleasant, and
finally the repair accomplished is broken down, and it
may be the part sloughs. Surely it is well to be able
to recognize this wrong, and bring such means to bear
as will re-establish waste and excretion.
Or a person from some common cause may have a
simple fever. At first there are no unfavorable symp-
toms, and we reasonably expect a speedy convales-
4
t
246
study of DIAGNOSIS,
;
1
cence, but from some cause there is arrest of secretion,
which is retained in the blood. All the febrile symp-
toms are increased, and in addition we notice in the
brown tongue, sordes, etc., the evidence of sepsis of the
blood. Here it is well to recognize the importance of
this general element of disease, and by early recogni-
tion prevent the unpleasant consequences named.
Malaria has played a most important part in disease
and the reader will at once recognize its importance.
Given a case of disease, most simple in form, seemingly,
and with this element characterized by periodicity, the
disease may go on from bad to worse, until possibly,
death results. It
It does not make much difference
whether it is a fever, an inflammation, or some other
disease. If we take inflammation of the lungs, the re-
cognition or non-recognition of this element of disease
(periodicity), may be that upon which the life of the
patient depends. Without remedies directed to this
special element, the disease goes on to destruction of
the lung tissue. With Quinine properly administered,
it runs a brief course, and terminates in resolution.
The influence of zymosis is well illustrated by ery-
sipelas. You notice the swollen, red, and glistening
spot on the skin, and as the patient complains of the
peculiar burning, you call it erysipelas. If your atten-
tion is not called to the element, zymosis, by the pecu-.
liar tongue, pulse, condition of innervation, etc., and
you prescribe empirically at a local inflammation, you
may lose your patient. Recognizing the zymotic char-
acter of the disease, and uniting it with proper reme-
dies for this, the patient gets along well.
Dysentery is another excellent example of this. In
the minor sporadic cases, Podophyllin to catharsis,
STUDY OF DIAGNOSIS.
247
White Liquid Physic, or Castor Oil and Turpentine,
may serve the purpose, and the sufferer gets well after
a time. But do not trust zymotic dysentery to this
treatment. Here the wrong of the blood, working
typhoid symptoms, is the principal factor of the disease
and the element of danger. It is to be met by specific
epidemic remedies, or those which we class as anti-
zymotic or antiseptic.
The influence of specific poisons well illustrates the
truth of what has just been said, though the illustra-
tion is outside of ordinary practice. The hunter in the
Carolina mountains feels something prick his leg, and
getting through the brush he pulls up his pants, and
finds but a slight wound, and the smarting has already
ceased. It amounts to but little as a wound, but if he
has heard the rattle of a serpent, or has seen it in the
act of striking him, he is at once awake to danger.
He has made specific diagnosis, and by sucking the
wound, the use of Ammonia, or the free use of Whisky,
he provides against the specific poison.
We get a practical example of these lesions in the
case of syphilis. A man finds a small sore on his penis,
which as yet has given him no annoyance, and if he
had no experience with such things, he would expect it
to disappear as rapidly as it came. But as days go by.
it gets larger, and seems more prominent, and after a
time comes skin disease, sore throat, falling of the hair,
iritis, nodes, etc. Surely there is something more than
a simple abrasion here-from a strain. Supposing the
physician should only recognize it as a sore, ignoring
the specific poison of syphilis, what would be the suc-
cess of treatment? And yet he could do this with
quite as much credit, as to fail in recognizing the
淼
​248
STUDY OF DIAGNOSIS.
specific wrongs in zymotic dysentery, in typhoid fever,
in smallpox, in scarlet fever, or in measles.
/
If we study the function of respiration in its influ-
ence upon processes of disease, we reach the same re-
suits. With wrong respiration, every other wrong is
intensified; with right respiration ameliorated. There
is such a thing as too much oxygen, and consequently
increased burning and excitement, just as there is such
a thing as blood loaded with carbonic acid gas, and so
burdened that the varied functions of the body can not
be properly performed. Surely it is worth our while
to endeavor to diagnose these conditions, and to em-
ploy remedies which directly reach the wrongs and re-
move them.
When we study the lesions of innervation, we are
impressed with their influence upon all parts of the
body, and the necessity of directing the mind to them
in all forms of disease for the purpose of diagnosis.
Whether our senses will detect a lesion, frequently de-
pends upon our method of thinking. If the mind.
directs the necessary examination, the evidences of dis-
case may be quite clear, when otherwise they would
scarcely be noticed, and would not make the necessary
impression.
If we study thoroughly the physiology of the sympa-
thetic nervous system, and get correct ideas of its con-
trolling influence over all the functions of vegetative
lite, we will always direct our observation to those ex-
pressions of disease which give information with re-
gard to this. Remedies influencing disease through the
sympathetic are among our most important therapeu-
tic agents, and fortunately the expressions of disease
are quite clear. If we commence with the lesions of
STUDY OF DIAGNOSIS.
249
the circulation-frequency of pulse, change in its char-
acter-lesions of temperature, change in the condition
of the skin, some changes in muscular expression,
change in the respiratory function, we will find a group
of symptoms that are distinct and expressive, and so
closely associated with individual remedies, that the
remedy is at once suggested by the symptoms.
The influence of lesions of spinal innervation is well
shown in many cases of chronic disease, where "spinal
irritation" is a complication. A disease of the diges-
tive or urinary apparatus may seem quite clear and
simple-one that remedies will readily reach, and yet
when we prescribe them, there is continued failure.
We have failed to recognize a "spinal irritation," but
from this wrong of innervation, the local disease is
continuously kept up. If the special wrong is diag-
nosed, and proper means used for its relief, the reme-
dies which had before failed with the local disease, are
more speedily successful.
We get another good example of this in some cases
of continued fever, and other low forms of diseasc. A
patient is doing well enough, other than he can not
sleep from difficulty of respiration. When awake the
respiratory function is carried on by the influence of
the will, but when this is in abeyance, the automatic ·
function of the spinal cord is not sufficient. Unless
this wrong is recognized, and means employed to rectify
the wrong of spinal innervation, the patient will prob
ably die. We may get evidence of similar wrong, in
one case in retention of urine, in another case in incon-
tinence, in a third in convulsions or muscular wrongs,
and in all we are impressed with the importance of
remedies that influence the spinal cord, and influence
250
STUDY OF DIAGNOSIS.
it in the direction of health. It would be most absurd
to omit from our diagnosis the evidence of a convulsive
tendency, and it would be quite as absurd to omit to
look after and recognize any evidence of spinal lesion.
When we study the functions of the brain, we find
them exerting similar influences over the body at large,
both in health and disease. It will not do to under-
value a right action of the mind, as an element in the
recovery of the sick, as it will not do to undervalue a
wrong action of the mind in perpetuating disease.
Given a mind at ease and restful, and a patient may
recover from disease or injury, which under other cir-
cumstances would most certainly be fatal. So true is
this that we are always on the watch for symptoms
shadowing forth the condition of the brain. The quer-
ulous voice, the hopeless voice and expression, the
unstable voice, the tone of excitation, the tone of pros-
tration, all convey valuable information, which must
not be neglected.
We find cases in which an emotional wrong may
originate or so intensify processes of disease as to en-
danger life. A very familiar example of this is found
in nostalgia, or "home-sickness." In the late war, it
was found that this so influenced disease in the hospi-
tals, at times, as to double the mortality; indeed, many
times a furlough to go home was the only reprieve from
death. In the recent Franco-German war, many cases
were noticed. Fernand Papillon writes: "During the
last war nostalgia carried off many sufferers among our
unhappy prisoners dispersed throughout Germany. It
attacked the soldiers and mobiles during the seige of
Paris, especially toward the close of it, when privations
and successive defeats began to reduce the most robust
study of dIAGNOSIS.
251
organizations." I have seen just such cases in private
practice, and the hope and promise of a return to home,
was the strongest remedy toward recovery.
"Hope is an anchor." for many wearied and suffering
souls, binding them to this world, lightening their suf-
fering, and giving increased strength for recovery.
The want of hope is one of the most serious things we
have to contend with in disease. To give hope to the
sick, is one of the many duties of the physician.
It is possible that some may give little credence to
the statements regarding the influence of the emotions
in disease. And yet every one practicing medicine for
some years will have seen the influence of love, fear,
anger, grief, etc., so clearly manifested, that there can
be no mistake in the matter. I have seen grief so pro-
found, that every function of life was seriously im-
paired, and unless the current of thought could be
changed, there was danger to reason or life. A free
outburst of tears might give relief to the overburdened
heart (brain.)
Every physician in active practice has realized the
influence of the will upon disease, and every one will
wish to know the condition of this function in serious
or protracted disease. The evidence of a strong will,
and intention to get well, is a real encouragement to
the physician, as the want of will in this direction is a
great discouragement. If we recognize a want of voli-
tion in severe or protracted disease, we do all we can
to call it out and strengthen it, and in so far as we do
this our patient is benefited. Even in the treatment
of a cough we find this is important. If the patient
can be impressed with the importance of controlling
the cough by the will, we will find it much easier to
check it.
252
STUDY OF DIAGNOSIS.
Physicians are always awake to wrongs of sensation
though frequently the only idea that follows is, the use
of means to obtund the sensibility of the brain. It is
true that unpleasant sensations or pain intensify pro-
cesses of disease, and wrong the entire body by depriv-
ing it of necessary rest, yet many times far less harm
comes from this than we would suppose. Indeed, in
the larger number of cases it is better that the patients
suffer pain, than that they be relieved by the ordinary
narcotics. If by the study of pain we can select a
remedy for disease, then it becomes a valuable evidence.
A remedy in this case looks not so much to the removal
of the pain, as to the arrest of the disease of which
pain is a symptom.
The study of local disease becomes important in that
it directs the mind to limited parts and functions, and
thus specializes the wrong. We group the most im-
portant functions of the body, as of digestion, circula-
tion, respiration, excretion, etc., and then study each
particular organ or part. If we take digestion, we
study the function in the mouth, the stomach, the large
and small intestine, and as influenced by liver, pancreas,
etc. If a certain group of organs or parts do a par-
ticular work, we will find diseases of it announced by
wrongs of that work. Thus the wrongs of function
point us to the locality of the lesion, and a closer ex-
amination determines the particular part or organ in-
volved.
Knowing the lesion of function we readily determine
its influence upon the life in its totality, and upon
other parts and functions. It is possible in some cases
to provide against these influences, by calling into ac-
tion other functions which may be supplementary or
}
STUDY OF DIAGNOSIS.
253
vicarious. As for example, if the digestive organs are
in such condition that they can not appropriate calori-
facient food, we may for the time being use alcoholic
liquors, which require no act of digestion to furnish
heat, until food can be taken. Or in similar cascs, re-
quiring histogenetic food or the stimulus of beef-essence,
we employ it per rectum.
We have similar examples in the relation between
the excretory organs-kidneys, skin and bowels. If
the function of one is impaired, or there are special
reasons why one organ should have rest, we call upon
one or both the others, to do additional work. In some
of these cases, the vicarious action will free the blood
from noxious materials, and thus give a chance for re-
covery. In others, the relief of the part from work,
gives an organ opportunity to recover its normal con-
dition by improved nutrition.
In the study of local disease we not only have in
mind the influence of changed function, but also that
which may arise from a change in the circulation, in-
nervation, and nutrition of a part. We can not have
an excess of blood in a part, without depriving some
other part of blood. We can not have a too rapid cir-
culation in a part, without influencing the circulation
at large.
We can not have an arrest of circulation in
a part, without impairment of that blood, and a wrong
to the whole of this fluid. We can not have a wrong
of innervation of a part, without suffering of the nerve
centres and a reaction upon the body at large; as we
can not have a wrong of nutrition, or waste, without
general suffering from it.
As the mind grasps these varied factors of disease, it
is better able to appreciate the present condition, and
254
STUDY OF DIAGNOSIS.
provide against other phases of disease. We not only
want to know the condition of discase at the present
time, but we also wish to know, from this, what will be
the probable condition to-morrow, or some subsequent
time. If to-day we can arrest the wrongs of life now
present, and turn the tide toward the standard of
health, well. If not, we wish to make provision, so far
as we can, against the wrongs of to-morrow or next
weck.
Further along, we will give the diagnostic features
of the general lesions here named, as well as the more
important evidences of local disease. The object in
this chapter being specially to direct the mind to the
advantages of this classification, in determining the
real nature of disease, and as being suggestive of cer-
tain classes of remedies. As before stated, there are
many lines of thought in diagnosis, and we do not wish
to get them tangled. We wish to do our thinking
methodically, and in so far as we can, we take one at a
time.
1
PHYSIOLOGICAL DIAGNOSIS.
Some may think the heading of this chapter a mis-
nomer, as they can not harmonize the name physio-
logical, which means right life, with disease, which is
wrong life. But if we explain that in diagnosis we
must have a standard to measure from-that is, health.
-then the term, "physiological diagnosis," is most
appropriate. The most important element here is the
point to measure from; without this, diagnosis would
be the merest guess work.
It might be asked, how we can harmonize this method
STUDY OF DIAGNOSIS.
255
with the diagnosis by, and prescription for special
symptoms, as described in the first part of this work?
If remedies are indicated by special expressions of dis-
ease-symptoms-which may be common to many and
different pathological conditions-why not employ this,
to the exclusion of all other methods? If it is true to
any considerable extent, should it not be true in all
cases, and furnish the only sure basis for therapeutics?
These are pertinent questions, and I doubt not many
readers have asked them time and again. If a certain
pain in the left orbit, a certain appearance of the
papilla of the tongue, and a certain sharp stroke of the
pulse, says to us that Rhus Toxicodendron is the
remedy, whether the discase be fever, inflammation of
the lungs, conjunctivitis, diarrhoea, or erysipelas, what
do we want of a physiological standard? True, in
such cases we do not want it as a basis for prescription,
and if we know enough of the relation between reme-
dies and disease, we should not make this a study, at
least not as a basis for prescription. But, unfortunately,
we do not know enough of this. As far as we know
it, we base our therapeutics upon it; when it fails, we
must supplement it with other methods. Practical
medicine is in its infancy, and until it attains the firm
step of adult years, we must second it with all the aids
that can give it support.
If the reader will refer back to page 216, he will find
a table which will serve as the ground-work for this
study. We purpose examining the various functions
of the body, setting up a physiological standard-health
—and measuring from it. We find that all lesions
can be grouped under the three heads of-excess, defect
and perversion-above, below, from. If once we are
256
STUDY OF DIAGNOSIS.
$
able to recognize these departures, and have a know!-
edge of the action of remedies upon function, we may
make a rational selection. If the condition of disease
is "above" the normal standard, we employ those
means which will bring it down. If the condition of
disease is "below" the normal standard. we employ
those means which will bring it up. If the condition
of disease is a departure "" from the normal standard,
we employ those means which will bring it back.
The reader will notice that it makes no diffèrence
what "school" of remedies is prescribed from, as it is
quite as well adapted to the one as another. Take the
gross dose of regular medicine, and the physician using
it should know the locality of its action, and the quality
of its action. And even when the action is secondary
or indirect, this method of prescribing is still good, for
the mind associates the secondary influence upon a part
or function with what needs be done to restore health.
If the modern Eclectic prescribes the usual dose of
specific medicine, he has clearly in view its direct ac-
tion upon a part or function, and he associates the
action of the drug with that which needs be done to
oppose disease, and restore health Our Homœopathie
brother, with his minute doses or infinitesimals, fre-
quently prescribes on the same basis. He knows where
the disease is, and he prescribes a remedy which spe-
cially influences that part; he knows the character of
the disease, and he prescribes remedies which his expe-
rience has shown opposes the disease, and favors the
return of health.
Having thus shown the advantage of this study, as
being applicable to all systems of therapeutics, and
even adapting itself to each individual expression,
:
STUDY OF DIAGNOSIS.
257
desire to call attention to its value as a training for the
mind, and a study of the phenomena of life. "Think-
ing in straight lines" has been our motto, and most
certainly this is such method of thought. As we edu-
cate the mind, so it will do our work, and this I think
one of the best studies. This is a study of life in all
its phases. It is a study of normal life, for without
this it has no basis. And it is also a critical study of
wrong life in all its phases, for this is its end.
It may be well to call attention again to the too com-
monly received methods of examination and diagnosis
-direct and by exclusion. In direct diagnosis the
symptoms are marked and point directly to the locality
and character of the wrong. But in some cases there
are no such direct symptoms, and we proceed to make
an analysis of the life before us, questioning each par-
ticular part or function, until we have found the seat
and the quality of the lesion. This is diagnosis by ex-
clusion.
FORMATIVE FORCE.-The force of organization is re-
ceived by inheritance, and the rule reads-as is this
force in the parents, so will be its manifestation in the
children. Thus it is sometimes an important element
in diagnosis, to know the parentage, and in so far as
we can, their physical history. From feeble parents
we usually expect feeble children. From parents who
have had an imperfect organization, and wrongs of
blood, degenerations, deposits and growths, we expect
children with like imperfect organization, and with the
same tendency to disease. If we know that parents
have died of phthisis pulmonalis, or other tubercular
disease, a cough or articular irritation has a deeper
+
22
258
STUDY OF DIAGNOSIS.
signification, and we are wide awake to the necessity
of early means for protection.
If parents or near relations have had cancer, we view
with suspicion any growth that may make its appear-
ance. If they have suffered with Bright's disease,
diabetes, epilepsy, insanity, or other similar disease, we
are advantaged by knowing the facts.
The force of organization is very rarely in excess,
probably never, as regards the whole man. Once in a
while we notice examples. of it as affecting parts. Thus
we may have hypertrophy of the adipose tissue; hyper-
trophy of bone; of the epithelium; of cellular tissue,
taking the form of growths. All of these will be read-
ily recognized, though it is not so easy to find reme-
dies which will arrest or modify the condition. Still
bearing in mind the distinction between the unknown
and the unknowable, we may expect to find remedies
for even such wrongs as these.
The wrong of defect is very common, and met with
in many cases of disease. We recognize it in defective
or feeble nutrition, parts being small, wanting normal
solidity, and lacking the usual capacity of our standard
man. The functional activity is usually the measure
of the force of organization; for though the organism
in such case may for a limited time give a large amount
of work, it is rapidly exhausted, and requires much
more than the usual time for recovery.
We may learn that such defect is inherited; that it is
the result of bad conditions of life; that it results from
over-work, or is caused by disease. Whilst we can not
rectify the present wrong of inheritance, we can pro-
vide to a certain extent against this in the children of
the future. But in the other cases the treatment is
STUDY OF DIAGNOSIS.
259
quite plain-we rectify the conditions of life and make
them healthful; we prevent over-work, and remove
such diseases as influence nutrition. Following this we
observe the great law of development-" as a part or
function is rightly used, it gains size and capacity.'
As we exert the force of organization, we call into
right action that which the person has, and as it is thus
normally used, it grows.
HEAT. The normal temperature of the human body
is 98° and a fraction, say 98.4°. To have healthy life
this must be maintained, with but very slight varia-
tion; even the change of one degree producing disease.
The temperature is accurately determined by the body
thermometer, applied in the axillæ, or under the tongue,
though it may be recognized less definitely by the
touch.
Excess of temperature is met with in fevers, inflam-
matory diseases, and most diseases accompanied with
change of structure. As a rule the excess of tempera-
ture is associated with corresponding frequency of pulse,
frequent respiration, arrest of excretion, digestion and
nutrition. In proportion to the excess of temperature
is the activity of causes of disease, of wrongs of the
blood, and the tendency to destruction in local disease.
Thus to a certain extent, the excess of temperature
which we can measure so accurately, becomes a means
of diagnosing all the wrongs of life.
As heretofore named, when studying the changes of
temperature as an element of disease, the saving fea-
ture is the diurnal variations in the range. Though
in protracted disease it may reach the height of 105°
to 107°, at some period of the day, it falls to 103° tc
1
}
}
260
STUDY OF DIAGNOSIS.
102°, at others, and in this fall of temperature the per
son has a promise for the maintenance of life. Whon
the high temperature is maintained throughout the
twenty-four hours, the disease is necessarily of short
duration, either in a fall of temperature and return to
health, or in death.
Excess of temperature calls for remedies which
lessen the processes of combustion, and provide for the
better removal of heat. The relation between the cir-
culation and the temperature is very suggestive-as is
the circulation, so is the temperature-lessen the fre-
quency of the pulse, and you reduce the temperature.
Thus the special sedatives are suggested, as among the
most prominent remedies. Wrongs of sympathetic in-
nervation (excitement) are associated with excess of
temperature, and those special remedies, Rhus, Bryonia,
Gelseminum, Lobelia, etc., become remedies. Excita-
tion of the brain and spinal cord are associated with
excess of temperature, and when noticed, call for rem
edies which relieve such excitation. Lesions of the
blood, especially those of a septic or zymotic character,
are associated with excess of temperature, and anti-
zymotic remedies are suggested in these cases.
The skin is the regulator of the temperature of the
body. In the continued evaporation from the surface,
excess of heat is removed. With a high range of tem-
perature the function of the skin is impaired, and
transpiration more or less arrested. Among the ser-
viccable means to remove the excess of heat, are those
that put the skin in better condition, favoring transpi-
ration. Among these means, baths hold a prominent
place, and should not be neglected.
Excess of temperature is quite as important a factor
STUDY OF DIAGNOSIS.
261
in chronic, as in acute disease, and its recognition is an
important element in diagnosis. Whatever may be the
wrong, a range of temperature of 100° and over, means
a continuation of the disease, and eventually a destruc-
tion of life. On the contrary, amendment is always
preceded or associated with a fall of temperature, and
if this is maintained at the standard of 98°, we may ex-
pect recovery. Thus in phthisis pulmonalis the range
of temperature is over 100°, even in the first stage, and
if maintained at this, recovery is impossible. If it can
be reduced. and held permanently at or near the nor-
mal standard, the patient may get well.
There seem to be three factors in this high range of
temperature, which require study the frequency of
circulation, a wrong in combustion, and a defect in the
means for regulating the temperature. In some cases
remedies directed to the wrong of circulation is most
efficient, as when we employ Veratrum, Digitalis, Cac-
tus, Lycopus, etc. In others the wrong is of combus-
tion, either in a deficiency of some element of the
blood, or in an undue excitation of the nerves govern-
ing the respiratory function. For the first we think of
Cod Oil, the Hypophosphites, Sulphur, and appropriate
foods. For the second, Arsenic, Phosphorus, Rhus,
Bryonia, Belladonna, Lobelia, etc. In the third the
lesion of the skin is prominent, and calls for such
means as will restore normal functional activity. It
may be the use of baths-alkaline, acid, stimulant,
tonic, astringent, inunction, electricity by Faradization,
or the use of internal remedies that specially influence
this organ.
Deficiency in temperature is less frequently met with,
and not so easily diagnosed. If the thermometer in
i
by
262
STUDY OF DIAGNOSIS.
i
axillæ or under the tongue, shows 98°, but there is
coldness of the extremities and surface, showing in
some places not more than 90°, we have determined
our case. Or possibly we may find that the normal
condition of heat, 98°, can be maintained in a state of
rest, but there is little surplus for motion-we have
heat as a condition of life, but not as a force. In the.
last class of cases, the want of power, with exhaustion
and lowered temperature after exertion, tells the
story.
The
Deficiency of heat may be dependent upon want of
calorifacient food, upon wrongs of digestion, upon the
want of some special material in the blood to facilitate
combustion, upon deficient innervation, upon a wrong
of the skin permitting heat to be wasted, and upon an
impairment of the respiratory function. In our ex-
amination of the sick, the mind at once determines a
comprehensive plan of examination, and our inquiries
proceed in this regular order—with regard to food,
with regard to digestion, with regard to the need of
special material for the blood, with regard to innerva-
tion, with regard to the condition of the skin, and with
regard to the respiratory function. Finding the princi-
pal wrong, the mind at once turns to the remedies that
influence the part and fanction, and selects from them
the special agent or agents that do that which is needed
to bring the part or function back to its normal condi-
tion.
Unequal distribution of heat is not quite as important
an element of disease as excess or defect, but in some
cases plays a not unimportant part. If in long-con
tinued and severe chronic disease, we have this unequal
temperature-the trunk being too hot, the extremities
STUDY OF DIAGNOSIS.
263
1
cold- -no means will prove curative until the tempera-
ture is equalized. Physicians may laugh about “equal-
izing the circulation," "equalizing the temperature,'
but these inequalities are very common elements of
disease, and recovery can not take place until they are
rectified. Hence sometimes means to restore heat to
the part which is too cold, are among the most impor-
tant to the cure. Take a protracted case of chronic
gastritis or dyspepsia, with continued cold feet, and
Capsicum in the stockings may be the remedy, or at
least it will put the patient in the way of being bene-
fited by others.
*
There are some peculiarities in the temperature that
the thermometer will not recognize. For instance, in
some cases of zymotic disease, typhoid and typhus
fever, protracted disease showing "typhoid" symp-
toms, the hand placed upon the skin gets a sensation
of pungent heat, very like that when it is placed upon a
surface reddened with mustard, or cantharides. The
sensation is very distinctive to most persons, and gives
the idea of sepsis, and unnatural irritation of the vege-
tative nerve centres. There is nothing more certain
than this evidence, whenever it is presented, and we
are at once awake to the danger to life, and the neces-
sity of means to overcome the morbid process going on
in the blood, and to relieve the over-excited nervous
system. At once we examine our patient with refer-
ence to the indications for the special antiseptic-
Muriatic Acid-the Alkaline Sulphite, Sulphurous Acid,
Chlorate of Potash, or Baptisia, and with reference to
the remedies which influence the nerve centres-Aco-
uite, Veratrum, Rhus, Gelseminum, etc.
1
264
STUDY OF DIAGNOSIS.
1
ELECTRICITY, like heat, is both a condition of life and a
force for carrying on the various activities of the body.
Like heat, it may be in excess or defective, or have an
unequal distribution. The diagnosis, however, is diffi-
cult, for we have no instrument to measure its varia-
tions, as we have in the body thermometer.
Excess is determined in part by the unnatural state -.
of excitation, there being no wrong of the nerve cen-
tres to account for it, and by a peculiar dry and con-
stricted condition of the skin. In some rare cases the
excess is so marked, that sparks may be elicited by
rubbing the head or the surface in a dark room. When
the evidence is closely examined we will find that the
conditions of life have been such as to produce this
condition. The patient has been a hard brain-worker,
has lived or worked much in a confined room, heated
by a stove, causing dryness of the atmosphere, and at
the same time has worn clothing that was a bad con.
ductor. Taking, therefore, the symptoms of excitation,
the constriction of the skin, and the previous history,
the diagnosis is pretty accurate; and if we add to this
the evidence of exclusion-no other lesion being found
that would account for the symptoms-we are certain
of the lesion.
The treatment will look to a change in the conditions
of life. Less work, good ventilation, a moist atmo-
sphere, and cotton under clothing. Then will come the
use of appropriate baths to rectify the wrong of the
skin.
And finally, the use of non-stimulating foods,
and appropriate remedies to lessen nervous excitement.
Defect in electricity is indicated by opposite symptoms.
There is a want of energy, and of capacity for con-
tinued effort, that can not be accounted for by any
STUDY OF DIAGNOSIS.
265
lesion of digestion, blood-making or nutrition, or by
local diseases. The skin is relaxed and atonic, the
temperature is inclined to be low, and all the processes
of life are performed with less than usual vigor. These
symptoms will sometimes be supplemented by a his-
tory of the conditions of life. A low situation of
house, dampness of living rooms or shops, trades that
give a superabundance of moisture in the air, the wear-
ing of cotton, the use of non-stimulating foods, exces-
sive drains upon the system in the shape of sweating,
urination, or seminal secretion, etc.
Having thus determined the condition of disease, we
at once think of changing the patient's surroundings.
He is to have a dry atmosphere, an elevated position if
possible, air directly influenced by sunshine, sometimes
sun baths, and that kind of exercise which will call
into action the respiratory function. This is supple-
mented by non-conducting clothing of woolen or silk,
by the use of stimulating inunction, or dry friction
with the hand, or flannel or silk. The selection of
proper food is sometimes quite important, animal foods
taking precedence. Some of the restoratives arc use-
ful, especially the preparations containing Phosphorus,
sometimes Iron, and occasionally the Bitter Tonics.
These may be supplemented by nerve stimulants, Qui-
pine, Nux Vomica, and agents of like character.
CELLULAR PATHOLOGY.-During the past twenty-five
years we have heard much of cellular pathology, and
it has been proposed to refer us back to these primary
forms for the history of all disease. According to
some enthusiasts in the study of cell life, we not only
need to study disease as manifested in cell life, but our
i
23
266
STUDY OF DIAGNOSIS.
1
diagnosis should go back to reach these primary organ-
isms. Taking the truism, that all wrongs of life mus
be based upon change of structure, and all manifesta
tions of life flow from, or are the aggregate of cell life
the theory becomes very plausible.
But there is this difficulty: Cells are organisms so
minute that they are beyond the ken of our grosser
senses. True we can bring them into view with the
microscope, and to a limited extent we can determine
changes of shape, but even this is somewhat difficult.
The best microscopist will fail to detect differences in
cells, when the expressions of disease may have been
of the most marked character.
It is possible to determine degenerations, some de-
posits, and to a limited extent growths, but many times
the diagnosis would be post-mortem, rather than at
such period of life as would give any practical advan-
tage from it. Even in the case of growths, the micro-
scope fails to detect the difference between those which
are benign, and those that are malignant. True there
are distinctive cancer cells, but then there are malig-
nant growths without such cells, as there are benign
growths with those which so closely resemble them,
that the best observer may be mistaken.
The microscope will enable us to recognize some
changes in the blood-globules, the presence of white
globules, some changes in secretion and excretion, and
in the formation of pus, and in so far as it does this,
it is a valuable aid. Yet in the main, we find it better
to rely upon the more common and gross expressions
of disease, especially as these are suggestive of reme-
dies.
If by conceding that life is from cells, and that as are
STUDY OF DIAGNOSIS.
267
these cells, so is its expression, we must be referred to
cells in the study of disease, we may go one step further
back and say that all life is from molecules, and as are
the molecules so is the life, and refer you to the com-
pound molecules. Failing in this to get beyond the
Iruman senses, we might go a step backward, and en-
deavor to fix the life of health and the life of disease
in the ultimate atom, when surely we will be lost.
Molecular pathology is quite as rational as cellular
pathology, quite as easy in diagnosis, and furnishing
just as good a basis for therapeutics.
NUTRITION.-In studying the diagnosis of lesions of
nutrition, we observe the same order. Having clearly
before us the factors-food, digestion in mouth, stomach,
intestine, the process of blood-making, the circulation,
the condition of the tissues with reference to appropri-
ation, and even the adverse side, retrograde metamor-
phosis. Any one or more of these factors may be
wrong, and we desire to so localize it, that we can
select our remedy with certainty. It would be most
absurd, to give "Bitter Tonics and Iron," when the
wrong was a want of proper food; quite as absurd to
employ a stereotyped tonic when the patient failed to
properly masticate and insalivate his food, or when the
lesion was one of the intestinal canal, or a wrong of
the circulation. We must know the exact location and
character of the lesion, if we are to prescribe with cer-
tainty.
Many wrongs of nutrition are dependent upon a
want of proper food. In this country where food is
abundant, it is not usually the want of foods in gross,
as it is a want of proper selection and preparation.
268
STUDY OF DIAGNOSIS.
*1
As the attention is directed to this matter, inquiry soon
elicits the facts of wrong food, or bad cooking in which
good food is spoiled, and we are able to set our patient.
right.
We not unfrequently find that food is wrong in kind,
though it may be good in quality, and well prepared.
If a man wants animal food, vegetables containing a
large proportion of starch will not answer well; if he
wants calorifacient food, it does not do to feed him upon
beef-tea. Again we must have regard for the power
of appropriation by the individual, who may be able to
digest certain varieties of food, when he can not others.
(:
Wrongs of buccal digestion are easily diagnosed in the
majority of cases by the history given. The patient
eats rapidly, bolting his food," which is not properly
chewed or insalivated. Or he may be an habitual
tobacco chewer or smoker, and thus by continued abuse
of the salivary glands have so changed the character
of this secretion that it can not do its work.
The treatment of such cases is very plain. The
patient must be instructed as to the uses of the mouth,
and the necessity of amending his bad habits. Abun-
dant time is to be given to each meal, and the food
thoroughly masticated. If tobacco has been the cause
of trouble it is to be dispensed with in all forms Fre-
quently this, without medicine, is sufficient for the cure
of severe cases.
The wrongs of stomachic digestion are frequently an-
nounced by unpleasant sensations which the patient
refers to the stomach, and points you directly to the
seat of the trouble. We have the evidences of indi-
gestion, and a wrong of blood-making and possibly of
nutrition, in addition to the localization of unpleasant
STUDY OF DIAGNOSIS.
OF DIA
269
sensations. Of course the unpleasantness varies in
different cases, and has the entire range between sen-
sations of fullness, weight, heaviness, to the most ex-
quisite pain.
But having thus localized the lesion, we have only
made a commencement, for it is necessary to know its
character, and this may be determined in part by the
sensations of the patient, and examination of the
tongue and the epigastrium, and by the discharges from
the stomach. It is possible first to arrange these lesions
in two classes-irritative and atonic-and even to make
these classes embrace structural lesions. Probably
this is the simplest, as it is certainly the best classifica-
tion, because it points out the remedies required. Rem-
edies influencing the stomach are readily divided into
sedative and excitant-the one removing irritation, and
the other giving stimulation.
The evidence of irritative lesions is found in uneasi-
ness or pain of a somewhat acute character, tenderness
on pressure over the epigastrium, and in many cases
by injection of the papillæ of the tongue, especially of
the tip and edges, giving the characteristic redness.
We have every degree in the intensity of these symp-
toms, from the slight irritation with determination of
blood, to the well developed inflammation.
With these evidences of disease, the mind at once
turns to those remedies which allay irritation-Hydro-
cyanic Acid, Peach Bark, minute doses of Aconite,
Ipecac, Rhubarb, Bismuth, Oxide of Zinc, and some of
the simpler stomachic bitters, as the Hydrastis. If we
have the general indications for a group of medicines,
we will find it much easier to select the special one
which will be most efficient. The reader will notice
270
STUDY OF DIAGNOSIS.
that these remedies are alike applicable in all cases
characterized by irritation and determination of blood,
even in cases of severe structural disease.
The evidences of atony are impaired circulation and
innervation, and want or perversion of function from.
this, is found in sensations of weight and fullness in
the epigastric region, a sense of oppression referred-
by the patient to the epigastric region. When we ex-
amine the patient we find that the expression of the
face is dull, the movements listless and show a want
of energy. If we examine the tongue we find it full,
and expressionless, in some cases pitting where it comes
in contact with the teeth. As a rule there is increased
secretion of mucus, and the bowels are constipated.
The symptoms above named point the physician to
that class of remedies which are topical excitants to the
stomach, and that stimulate a better circulation and
innervation. Nux Vomica and Strychnine may be
taken as the type of such stimulants, and are fre-
quently employed when the impairment is temporary.
The bitter tonics-stomachic tonics-are the remedies
usually selected when the impairment is of longer dura-
tion; Hydrastis Canadensis, Gentian, Columbo, etc.,
may be taken as examples of this class. With atony
there may be irritability, and in such cases the remedies
might be Amygdalus Persica, or Matricaria Chamo-
milla. If the atony is very marked we may employ
topical stimulants, as White Mustard, the peppers, or
combine with the stomachic bitter small portions of
Podophyllin.
-
Atony with increased mucous secretion will be marked
by the coated tongue, yellowish or gray, especially
toward the base, full and expressionless features, dull
eyes, and evidence of oppression.
STUDY OF DIAGNOSIS.
271
I
In acute disease it may call for an emetic, may be
relieved by a cathartic carefully given, by the use of
saline diuretics, or by the use of the Alkaline Sul-
phites.
Excess of gastric juice will usually be known by its
eructation, the sense of acidity of stomach, elongated
papillæ of the tongue tipped with white, and mal-
digestion.
For it we think of remedies that allay irritation, or
that remove diseases of which this is sympathetic, as
of Bismuth, powdered Charcoal, the Alkalies, or the
Acids, as may be indicated by other symptoms.
Deficiency of gastric juice is shown by mal-digestion
and eructations of undigested food for some hours after
eating.
It may require stimulants, tonics, acids, alkalies,
Podophyllin, etc. Recognizing the deficiency, the
mind is directed to the cause, and when determined.
the treatment will be very direct and certain.
Excess of acid is determined by the eructations, and
the sense of acidity, but if of the blood as well it will
be shown in pallor of mucous membranes.
Whilst the alkalies would seem to be the direct rem-
edies in the treatment of these cases, they are really
curative only where there is evidence of this lesion of
the blood. In other cases the cause must be determined.
Many times it is a wrong of innervation, and wher
this is removed, the acidity ceases. In some cases, in-
deed, acids have a more direct influence in effecting a
cure than the use of alkalies.
Deficiency of acid may be known by the unpleasant
fluid eructations, greasy if fatty matter is taken as
food. The general defect will be shown in the deep
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}
redness of mucous membranes, and wherever blood
comes to the surface.
This is sometimes the cause of serious functional
wrong, and until the acid is restored digestion will not
be well performed. In these cases we usually think of
Muriatic Acid as the remedy, though in many Lactic
Acid will give the best resuits.
The symptoms pointing to Pepsin as a remedy are
not very direct. Indeed if we should say there was
an entire absence of symptoms it would be a better
guide to the physician. Given a case in which there.
is indigestion or enfeebled digestion, and there are
neither evidences of irritation nor atony, acidity nor
alkalinity, or wrongs of innervation, or disease of
which this may be sympathetic, and we would say, give
Pepsin.
The wrongs of intestinal digestion require care in diag-
nosis, as many of the symptoms are obsure and indirect.
The lesions may be classified as in case of the stomach,
into irritative and atonic, and the sensations of the
patient, if they are described, will usually lead to a
correct conclusion.
The pinched expression of facé,
the loss of adipose tissue, giving a shrunken appear-
ance of body, the contracted tongue, slick, seemingly
divested of papillæ, tell the story of irritation. The
atony will be indicated by fullness of the abdomen,
with a sense of atony as the hand is passed over it; the
full, doughy tongue, inclined to be coated, and the gen-
eral oppression of the nervous system, give very clear
intimations of the character of the lesion.
The irritative condition cails for Aconite, Ipecac,
Matricaria, Amygdalus, Bismuth, the stomachic bitters,
Epilobium, etc., and they may usually be selected with
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273
considerable certainty. The atony calls for Nux
Vomica, Chelidonium, Podophyllin, etc. In many of
these cases the combination of Podophyllin in minute
doses with one of the simpler bitters, answers an ex-
cellent purpose.
As a rule good blood-making follows good digestion
and having secured the one we are not troubled to
look after the other, yet sometimes we have the fault
here and must rectify it. Good blood-making is de-
pendent upon the conditions already named. There
must be a normal temperature, a normal circulation,
normal activity in use, normal waste and normal ex
cretion. If there is a wrong of either factor we may
expect some degree of wrong in the making of blood,
and in nutrition. If at any time we suspect this
lesion we examine our patient thoroughly with refer-
ence to these important functions, and finding the
wrong, whatever it may be, we right it.
There may be a want of some particular material in
order to make good blood and good tissue. This has
been recognized by physicians, and is the basis of that
called restorative medication. We have already scen
that the physician must select the proper food for his
patients, and that more may depend upon giving his-
togenetic or calorifacient food, than upon medicine.
"Restorative medication" is an indefinite term, as
used, and may mean remedies that stimulate an appe-
tite, increase digestion, giving of proper food, as well
as the use of those agents which add a needed constitu-
ent to the blood. It would be better to restrict the
term to the use of agents that enter into the formation
of the blood and the tissues. We may sum these up as
Iron, Phosphorus, Soda, Lime, Potash, Sulphur, Silica,
F
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Copper, and the bitter principle. These may not be
all, but if we can get a clear conception of their use,
the wrongs that follow their defect, and the symptoms
that point them out, we will do well.
As Iron is the coloring material of the blood, want
of color is generally regarded as indicating the use of
this remedy as a restorative. In some cases the evi-
dence is sufficiently clear, and when Iron is given the
effect is direct and positive. If taking the symptoms,
“want of color from blood,” we are careful in our ex-
amination to exclude those cases where other and pri-
mary lesions exist, the certainty would be almost abso-
lute. But there is another indication quite as certain
as "want of color," when tissues, especially the tongue,
show a solid but not deep blue. In these the action
of Iron is specific. Again we find certain lesions of
the blood, more noticeably those which give an erythe-
matous eruption (erysipelas), in which the redness is
dirty or dulled, in which Iron is specific.
When the diagnosis is carefully made, the action of
Iron will give great satisfaction. A recent case of
uterinc disease of long standing with greatly impaired
nutrition, presented as a prominent feature frequent
erythematous eruptions of this dirty, though somewhat
vivid redness, and the cervix uteri and vaginal tissues
presented the same color. One grain of Iron by
Hydrogen three times a day, was sufficient to effect a
cure in a month. In another, where there was im-
paired nutrition of many years' standing, and no direct
symptoms but the solid blue tongue, the patient made
a quick and good recovery on Iron alone.
The best indication for Phosphorus in its varied
forms, will probably be found in the want of expression,
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275
·
both in the face and in movement, an enfeebled respi-
ration and unequal temperature. The sensations of
the patient may point to impaired nutrition of the
nerve centres, or simply to a general failure of life.
The indications for Phosphorus in the ordinary dose,
are invariably of atony-impairment of the circulation
and innervation. In a minute dose it may be used
where there are evidences of vascular and nervous ex-
citement with enfeebled tissue-as instanced in low
grades of inflammation of the lungs.
Soda is a true restorative in some conditions of dis-
easc. If deficient in quantity every function of life is
impaired, and without its restoration recovery can not
take place. In some cases want of Soda is the basic
lesion, and its administration all that is necessary for a
cure. In others this deficiency is but one of many
lesions, and the giving of Soda will be but one of the
means employed.
The indication for the use of Soda is clear and un-
mistakable--want of color in mucous membranes
which are usually full. Usually we are guided by the
tongue, and the expression would be full and pallid—
Soda.
The indications for Lime are not so distinct, but yet
quite definite. We are in the habit of saying that
Lime is indicated in all idiopathic cases of suppurative
disease of cellular tissue. The very fact of inflamma-
tion with a low euplastic or cacoplastic deposit, not the
result of injury, evidences a peculiar wrong, and for
this Lime is the remedy. Furuncular disease in all its
forms, finds a remedy in Lime. In the majority of
cases, there will be pallor of mucous membranes, though
in some cases they will be purplish or blue. Lime is
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STUDY OF DIAGNOSIS.
1
employed in chronic disease of the lungs, with caco
plastic deposit, determined by a low grade of inflamma
tion.
The indications for Potash will be found in pallor of
mucous membranes, calling for an alkali, and impair-
ment of muscular power. In most cases a dull, leaden
hue of mucous membrane with pallor, will point espe
cially to the Salts of Potash. A marked example will
be found in syphilis, in which this coloration is the in-
dication for Iodide of Potassium. In some cases a Salt
of Potash may be needed, even though the deep color-
ation calls for an acid; this is sometimes seen in scurvy.
Here the Soda is excess, Potash is defect, and the
patient is cured by the administration of Lemon juice
and vegetables containing Potash in large quantity.
The best indication for Sulphur as a restorative is a
change in or want of the pigment of the skin and hair.
In some cases the dull, dirty color may call for Sulphur,
in others the blanched surface. Rapid loss of color in
the hair will sometimes be an indication. Sulphur is
also indicated by a peculiar blue or leaden color of
urine and fæces. It would be designated by some,
"want of color," and so there is a marked lack of the
natural coloring material of these excretions. If I
were picking a case to obtain the most marked curative
action of this drug, I would take the dirty or tawny
skin with bluish urine.
The indication for Silica is not very well known.
I have used it with most advantage when the epithe-
lium had a lifeless appearance, and there was continued
tendency to desquamation. In some cases these symp-
toms are followed by severe ulceration of the skin.
Hahnemanr. claimed that it was a valuable remedy in
STUDY OF DIAGNOSIS.
277
rachitis of children, and named sweating of the head,
as one of its most prominent indications.
Copper is not usually regarded as a constituent of
the body, yet I think it is clearly proven that it is
present in small quantity. The indication for its use is
the unpleasant greenish pallor of skin met with in
some diseases of women, and a very similar coloration
of tongue. In some cases the patient has not lost
flesh, and nutrition seems to be quite as good as usual,
but there is a want of energy and power of endurance.
The Bitter Tonics are in such common use, that it
would seem hardly necessary to point out the indica-
tions for their use. But one would find it a little diffi-
cult to point out clearly the cases in which the bitters
are direct remedies. One might say "want of appe-
tite," and as by their topical action they are appetizers,
he would guess his case off right with the majority.
Or we may say "impaired digestion," and by their
topical action they do improve digestion, and we would
be right in the majority. Or we might say "enfeebled
nutrition," and as they do improve nutrition, we would
make a right diagnosis in a great many cases. The
blood requires a bitter principle, and its want is the
cause of most serious disease, yet I can not point the
reader to any better evidence of it than impaired
appetite, digestion and nutrition.
Further along, we will see that a right circulation is
essential to carry the blood, thus well made, to the tis-
sues where it is to be used. Wrongs of the circulation
impair the quality of the blood, and the power of the
tissues to withdraw from it the materials for nutrition.
Thus in all cases of lesion of nutrition a right circula-
tion must be maintained. In this connection attention
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STUDY OF DIAGNOSIS.
may also be called to the necessity of having the
normal temperature of 98°, which, as we have already
seen, is a condition of healthy life.
A patient may have good food, good digestion, and
good blood-making, and yet there will be a failure in
nutrition. If the tissues are not in a condition to ap-
propriate the material and weave it into organic forms,
the patient would be better not to take it as food. We
have already referred briefly to the properties of form-
ative cells, and have seen that we have no means of
determining their condition, except by the physical
properties of the tissues en masse. If they have normal
hardness, elasticity, form, and activity, we have reason
to conclude that nutrition is good, in so far as the
power of appropriation is concerned. Conversely we
may say, if they want hardness, elasticity, form, and
activity, there is a want of power to organize new
tissue. Diagnosis is here made by the tactile and
visual senses, and will be valuable just in proportion
as these have been trained to use.
Concluding from these evidences that the tissues
lack the power of appropriation, what will be the
remedies? In so far as internal remedies are con-
cerned, we have but few that influence the furction of
the formative cells. To a limited extent, some of the
bitters may do this. Yet when we subtract their topi-
cal influence upon the digestive apparatus in increasing
the appetite and improving digestion, and the slight
stimulant influence upon the circulation and innerva-
tion, there is but a small fraction to be accounted for.
Want of hardness, elasticity and activity will show
a want of nutrition, whilst the change in form, want
of expression-dull and lifeless-may be taken as evi-
STUDY OF DIAGNOSIS.
279
1
dences of a want of retrograde metamorphosis. We
have already made reference to the great law of animal
life-as an organism is used it gains the power of re-
production and increased use; as it is disused it loses
this power. But it is well not to forget that over-use
will impair reproduction, the forces of life being thus
exhausted. In many cases, after providing for good
food, good digestion, and good blood-making, a good
circulation, normal temperature, and good innervation,
we stimulate the appropriation of material by the tis-
sues by well regulated exercise. Or if the patient is
over-worked, and thus exhausts his powers of repro
duction, by recommending rest.
In some cases the patient requires exercise under
the influence of the will, innervation in this way being
of as much importance as the activity of tissue. In
other cases it requires passive movement, with as little
expenditure of nervous power as is possible. In some
cases the stimulus of electricity becomes an important
means, and by its general use normal nutrition of tis-
sues may be obtained.
The character of deposits may usually be determined
by the symptoms indicating the condition of the gen-
cral health, and by the local appearance of the part
when near the surface. Bearing in mind that good
blood will give euplastic deposits, an inferior blood
cacoplastic deposits, and a very poor blood aplastic
deposits, we will be in a pretty good position to judge.
The means of determining this have already been
pointed out.
As regards the local symptoms we may say that the
inflammatory process, regular in its course, is the best
evidence of euplastic deposit. All irregularities,
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STUDY OF DIAGNOSIS.
whether of time, intensity, or of the common symptoms
-heat, pain, redness or swelling-point to a deposit of
lower character. So certain is this that the physician
will very rarely make a mistake if irregularities cause
him to employ greater vigilance. If for instance, in
local disease, there is too much or too little heat, too
much or too little pain, too much or too little swelling,
too much or too little redness, or if the color is changed,
we are sure the deposit, if there is one, will be low in
character. So if the disease runs its course too rapidly,
or progresses too slowly, we conclude that the deposit
will be of lower grade. So true is this, that we look
with suspicion on all alterations of the inflammatory
process, and use extreme care in the treatment of such
cases.
Degeneration is not easily recognized, and in a major-
ity of cases it progresses until the destruction is beyond
remedy. Of course I exclude granular degenerations
of the kidneys (known by albumen in the urine), and
degeneration of the liver (known by jaundice), which
present characteristic functional disturbance. The
gradually decreasing power of continued exertion is an
important point in the diagnosis. Persons having de-
generation will find themselves incapable of prolonged
exertion. There is a want of expression in every part,
and the soft tissues sit upon the bones like an ill-fitting
suit of clothes. A want of sharpness and strength in
the wave of blood as it passes under the finger is an
additional element.
In the treatment of degenerations we wish to re-
establish this" renewal of life." Whilst we want good
food, good digestion and blood-making, adding any
agents of the class restorative that may be needed, and
STUDY OF DIAGNOSIS.
281
an active condition of the formative cells, we also want
increased retrograde metamorphosis to remove the old
and degenerated tissue. In so far as the tissue is de-
generated it can never be replaced, but it is possible to
so improve the function of nutrition, that what yet re-
mains may serve the purpose of the organism.
The diagnosis of growths belongs to the province of
surgery, and requires but a brief notice here. They
are classified as benign and malignant, and to deter-
mine to which of these two classes a growth belongs is
the first object. As a general rule we may say a benign
is a growth from the tissues, whilst a malignant is a
growth in. A benign growth is distinctly separate
from the tissues, and though it may be deeply seated it
obtains room for its enlargement by separating them,
and occupying the place of the connective tissue. It
may interfere with the nutrition and use of tissue by
pressure and weight, and in rare cases when inflamma-
tory action is set up may form adhesions to them, other-
wise it maintains a distinct and separate existence.
On the contrary, a malignant growth takes possession
of the tissues of the body, and grows in them, trans-
ferring the structure into its own lowered forms. It is
no respecter of tissue, and occupies one quite as readily
as another, taking possession alike of skin, connective
cellular tissue, muscle and bones, using the fibrous
tissue as its skeleton, and the blood-vessels, lymphatics
and nerves, for its supply, waste and innervation.
The reader will notice that if in any case it be pos
sible to determine the condition of a growth-from or
in—the diagnosis is readily made. A growth that does
not interfere with or take possession of tissue, is of
necessity benign, whilst a growth that does appropriate
24
282
STUDY OF DIAGNOSIS.
the normal tissues is as surely malignant. In a major-
ity of cases careful inspection of the part will deter-
mine this.
A benign growth is generally of uniform consistence,
smooth, and of equal elasticity as the hand is passed
over it. The reader will readily see why this should
be the case, as it has a single point of origin and
supply, and consequently a uniform development. But
in the case of a malignant growth, its consistence and
elasticity will depend to a considerable extent upon the.
tissues it appropriates, and hence it will be of unequal
hardness and elasticity-nodulated.
There is a marked difference in the sensations of the
part. The benign growth has no nerves, and any sen-
sation experienced will be from its pressure or drag-
ging upon adjacent parts. The malignant growth
appropriates the nerves of the part, and hence inter-
stitial pain of a peculiar character is usually found in
these cases.
A benign growth has no lymphatics, and does not
influence the blood other than by withdrawing the
materials for its supply. On the contrary, the malig-
nant growth appropriates the lymphatics as it does
other tissue, and furnishes through them a cancerous
lymph which eventually produces the constitutional
impairment so generally noticed.
SECRETION.
Among the important functions changed by disease.
secretion holds a first place, and in the practice of
medicine remedies influencing the secretions have held
STUDY OF DIAGNOSIS.
283.
a first place. But very crude ideas of the function of
secretion have been held, and of course the medication
based upon these was equally crude and empirical
Whilst physiologists have been pretty clear in their
teaching that (in the main) secretion was purely a vital
function performed through certain cells, called secre-
tory, physicians have acted as though they believed it
a purely physical process, like the osmose that occurs
through an animal membrane. If secretion is a vital
process, life is an essential, and the conditions of life
necessary; if it is a physical process of straining, then
a dead tissue may secrete as well as a living one.
There is little use to talk of diagnosis here, unless
we have first a clear idea of the apparatus of, and the
conditions for secretion. If we can clearly appreciate
that in the case of all the secretions-recrementitious
and excrementitious-there must be a membrane con-
tinuously giving birth to secreting cells, and that these
grow to the normal stature of cells, withdraw from
the current of blood the special material of their secre-
tion, and then discharge themselves with it in the com-
mon duct, we will have a basis for correct diagnosis
and therapeutics.
Taking one step further, we find that function not
only depends upon life, but upon the normal conditions
of life. This is true of every part and every function
of the body. Studying the life of cells, and secreting
cells bear a very close relationship to formative, we find
that a certain temperature, circulation and innervation
are necessary. Probably the life of the secreting cell.
*These conditions are. as necessary to the entire organism as
to the individual cell, otherwise we would not be benefited by
284
STUDY OF DIAGNOSIS.
is not so much affected by changes of these, as the life
of the formative cell, but in a certain range it is so de-
pendent; whilst the range is greater the effect beyond
certain points is just the same.
The cause of lesions of secretion may be general or
local, and the diagnosis is made by an analysis of gen-
eral symptoms influencing secretion at large, and
symptoms pointing to local lesion of the secreting
organs. When secretion in general is affected, we have
good reason to think that the lesion is general; when
but a single secretion is affected we have good reason
to believe that the lesion is of the organ furnishing the
secretion.
When all the secretions are involved, the cause, as a
rule, will be found in changes of temperature, circula-
tion, innervation, digestion, blood-making and waste.
knowing them. We have constant cognizance of the gross form,
while the minute structure is beyond our vision only as we bring
the microscope to bear upon it. Let us now see how they are
applicable to the body as a whole.
First.-An original viability is seen to be an imperative condi-
tion. A want of this gives us hereditary diseases and early
death. A want of it also gives us an enfeebled life and a want
of resisting power to the ordinary causes of disease; while a
strong viability gives great resisting power to disease, and long
life. This has already had a partial consideration.
Second.-A proper supply of nutrient material is also an abso-
lute condition, as man only lives by a constant renewal of his
body. The material for this renewal being furnished, and the
cells possessing a normal formative power, life continues in a
regular manner.
Third.-The circumstances favorible for normal development
in man are a normal circulation, innervation, temperature, and
excretion.—Principles of Medicine.
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285
If now secretion is to be restored to its normal condi-
tion, we want normal temperature, normal circulation,
innervation and waste, especially the first three. In a
large majority of cases, secretion is re-established so
soon as the conditions of life permit, without the use
of special means to this end. Thus in acute disease, if
means are employed to rectify the wrongs of circula-
tion, the temperature and innervation, we find that the
tendency is to a re establishment of secretion as the
conditions of health are approached.
Local lesions of the secretory apparatus are best
classified as irritative and atonic, as it points out the
classes from which our remedies are to be drawn.
When a part is involved there will be in nearly all
cases such unpleasantness of it as will call the attention.
of patient and physician to the wrong.
It may be
pain, or something less pronounced than pain, but i.
gives the special part a distinctive character separate -
from the general life. In health the body is a unit,
and all sensations are pleasurable, in local disease there
is a feeling of separateness between the part and the
life, and the severer the disease (as a rule) the more
distinct this feeling which regards the suffering part as
distinct from the life-a foreign body, which it would
be well to get rid of.
It is true these subjective sensations are not always
pronounced, and in some cases the suffering is so mani-
fested that it seems of some other and distant part.
Yet if the patient's attention is excited, he readily de-
termines the wrong sensation, and our knowledge of
nervous distribution and sympathies will soon translate
the character and situation of pain.
The reader will already have been impressed with
286
STUDY OF DIAGNOSIS.
|
1
1
the character of pain as determining the condition of
a part as regards excitation and atony. Excluding
neuralgia, acute sharp pain is the evidence of undue
excitation and an active condition, whilst dull pain and `
sensations of weight and fullness, indicate atony, with
impaired circulation and innervation. It may be said
that this method of diagnosis is too gross and arbi-
trary, but I think in the majority of cases it will serve
as a good basis for the selection of remedies.
With this method, we should say the absence of local
symptoms points to general disease, and we carefully
examine our patient with reference to the conditions
of normal secretion. Finding the wrong in tempera-
ture, circulation, or innervation, we select from those
remedies that influence the particular function, and
take that one which in its action is opposed to the dis-
ease, and in its influence brings the functional wrong
toward the standard of health. Determining a local
wrong, we at once think of those remedies that espe-
cially influence the organ or part, and take that one
which in its action will do that which favors the healthy
life of the part. Nothing can be simpler than this în
theory, as nothing, I am sure, will furnish a better
basis for a successful practice of medicine.
Secretion is divided into two classes, recrementitious
and excrementitious, and it is well for the reader to
have a good knowledge of these distinct from each
other, learning the uses of each. We want to know
the simple facts, with regard to the use of saliva, gas-
tric juice, bile, pancreatic fluid, and the small glandulæ
of the intestine in digestion, that we may weigh the
wrongs which may arise from changes in these secre-
tions.
We want to know the value of mucus as a
STUDY OF DIAGNOSIS.
287
lubricant and protector of mucous membranes, and of
the sebaceous secretions as a lubricant and protector
of the skin. And we want to know the value of excre-
tion from the lungs, the kidneys, skin, and bowels, as a
means of removing worn out and effete material from
the body. It is direct thought that we want, for when
the mind is directed to a single object it readily grasps.
it, but when it is made to embrace a multitude of
objects, they become indefinite and indistinct.
If, for example, we are called to a case of increased
secretion of saliva the diagnosis is easily made, for the
senses can not fail to be impressed by the increased
amount of fluid in the mouth. But the questions that
follow are not so easily answered-is it mercurial
from local disease of the salivary glands? from disease
of parts contiguous? from diseases of the digestive
apparatus below? from disease of the brain? or from a
lesion of the sympathetic system of nerves? It seems
difficult at first to make such diagnosis, and yet as the
mind considers one after the other of these, with such
light as additional symptoms may throw on it, the
problem is soon solved, and in its solution we are
directed to the particular class from which the remedy
is to be selected, and possibly the special remedy which
will cure.
The example given above is one of the most com-
plex, and we will find the others simpler. If we take
the secretion of gastric juice we might make a different
study. First, is the disease general, local, or sympa-
thetic? If the examination is carefully conducted, the
absence of evidence of local disease, and of parts with
which the stomach is in special sympathy, and the evi-
dences of general lesions which might affect the
1
288
STUDY OF DIAGNOSIS.
stomach, will determine the first classification. But if
the local symptoms were pronounced, and there was
wanting the evidences of general or sympathetic dis-
ease we would have determined the second classifica-
tion. Whilst if we had pronounced disease of parts.
with which the stomach sympathizes, as of the uterus
or brain, but without marked symptoms of local or
general disease, we would have determined the third
classification. It may be that we will find two, or pos-
sibly three of those causes in some cases, but we reach
our conclusions by these methods of examination and
thought.
If we take the liver as the next example, we will
find it necessary to employ a different method. The
first questions we ask are with reference to local disease.
Has the patient unusual sensations in the right hypo-
chondrium, of pain, weight, distension, pressure up-
wards on lungs, toward the mesial line on the stomach?
is there tenderness on pressure, sense of fullness when
the hand is passed over the part, or can the organ be
felt below the margin of the ribs? Is there expression
of disease from adjacent parts, as from the bowels,
stomach, lungs? Is there a wrong in the uses for
which the bile is secreted?
It is always well to get rid of old-time errors, and in
these methods of diagnosis we wish to start with a
right physiology. What is the use of bile? Your
physiologist will tell you, possibly, that he does not
know, but he is sure that it is not, as was formerly
thought, an excretion, but that it is elaborated to serve
uses in digestion and blood-making. As you read on,
and think of what you are reading, you see the absur
dity of the old practice of medicine, which was con-
STUDY OF DIAGNOSIS.
289
tinuously looking after the liver and the secretion of
bile, and talked glibly of liver complaint, liver disease,
"your liver is affected," and about liver pills, chola-
gogues, "touching the liver," etc. It requires but
little study to get rid of this old rubbish, and reach
the conclusion that the liver does its work very kindly
and well, and is an organ that aids nutrition, and not
waste. If, therefore, we find a wrong of intestinal
digestion, in which the liver is very surely concerned,
we may look after the condition of this organ.
The secretion is peculiar in color, and sometimes
wrongs of the liver may be determined by this. Thus
fæcal matter is to some extent colored with biliverdin,
and if the color is dark we say, excess of bile—if it is
light we say deficiency of bile. This method of diag
nosis is a little crude, for there are many sources of
error. Thus Lehman showed that the peculiar green
stools following the administration of Calomel were
not due to any action of that drug upon the liver, but
to the presence of Sulphate of Mercury in the fæces.
An excess of acid may also produce green stools, as a de-
ficiency may render them lighter in color.
The cutaneous pigment will prove a better guide
than the color of the fæces. The yellowness of jaun-
dice will be called to mind as an instance, and many
will recollect brownish spots-liver macula-that are
very clearly traceable to the liver and its associate
organs. But a change in the pigment less marked than
this has a very definite meaning. I allude to a taumy
coloration of the skin, giving it a dull, dirty appear-
ance. I believe this always points to a wrong of the
chylopoietic viscera, especially to innervation from the
25
290
STUDY OF DIAGNOSIS.
!
solar plexus, and indicates the class of remedies that
have been regarded as "liver medicines."
But the really important point to determine in these
cases is, the condition of the organ with regard to ex-
cess or defect, in its circulation and innervation-is
there excitation or atony? The symptoms are usually
distinct so far as this is concerned, and the remedies.
will be clearly pointed out. And yet there is nothing
in which mistakes are so frequently made. Take, for in-
stance, a case of jaundice, and the teaching of the books,
is to give hepatic stimulants-Podophyllin, Leptandrin,
Blue Pill, Calomel, etc., without reference to the condi-
tion of the liver. But in one-half the cases, there are
evidences of excitation in pain, tenderness on pressure,
and accelerated circulation, increased temperature, dry
skin and scanty urine. Surely hepatic stimulants are
not remedies here, and they usually do much barm in-
stead of good. In such case the patient requires the
special sedatives, Gelseminum, Acetate of Potash, the
bath, and possibly the cold-pack or fomentations to the
right hypochondrium. In the opposite class of cases,
with sensations of weight, fullness, oppression, unequal
temperature, etc., such remedies as will stimulate the
liver and associate organs will prove remedies.
Again we wish to know in this connection that the
bile pigment when once deposited in the cutaneous
tissues is never removed by way of the liver, but is
always excreted in principal part by the kidneys. In
so far then as getting rid of the unpleasant coloration
of skin in jaundice is concerned, we might just as well
give a remedy to act upon the salivary glands as the
liver.
There are scores of these olden-time errors in
STUDY OF DIAGNOSIS.
291
practice that can only be gotten rid of by a carefu'
study of physiology.
The pancreas does a most important work in secretion,
one which the physiologist clearly understands, and yet
we hear nothing about "pancreatic complaint," "pan-
creatic disease," or "touching the pancreas." Indeed
there are no pancreatic remedies in our Materia Medica.
Why is this? There is nothing like getting these sub-
jects fairly in view, that we may think of them. Leh-
man remarks" The function of the pancreatic fluid in
digestion, may be two-fold, according to the above men-
tioned properties, namely: to change starch into sugar,
and to decompose the fats, so as to render them absorb-
able. That it actually performs the former in diges-
tion, has been placed beyond doubt by numerous ex-
periments. The pancreatic fluid possesses this property
in a much higher degree than the saliva; it is opera-
tive at even a low temperature; neither bile, nor gas-
tric juice, nor free acids, interfere with the function of
the fluid."
What then would be symptoms of disease of the pan-
creatic secretion? Most surely they would be func-
tional, and we would find them in imperfect digestion
of calorifacient foods, a deficient supply of burning
material, and a more or less rapid consumption of the
fat stowed in the body. We would naturally expect te
find unchanged starch and fat globules in the fæces,
and examination shows that this is the case.
Just so
soon as we begin to reason rightly, we reach definite
results.
But if we have no "pancreatic medicines," how will
we rectify these wrongs, after we have found them?
This is also easy enough. There are in almost all cases
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STUDY OF DIAGNOSIS.
•
certain general lesions of the circulation, temperature,
innervation, excretion, etc., easily recognized, and
which must be relieved in all cases preparatory to a
successful local treatment. As local remedies we may
think of Veratrum, Cactus, Chelidonium, Oxide of
Zinc, Nux Vomica, Podophyllum, Iodine in minute
doses, Panax, etc. They all act "there or thereabouts,"
and we can choose from the list those that act in the
right direction.
To the doctor in ordinary, the intestinal canal is a
place to put pills, powders and potions, for purgation.
Bowels were made to be moved, and it is the doctor's
business to move them, and sometimes, it seems, it is
almost his whole business. He never thinks that the
intestinal canal is a digestive apparatus, and if he has
ever learned this in his physiology he has forgotten it.
And yet this function of the intestinal canal is really
the most important element in digestion.
""
In addition to the bile and pancreatic fluid, we have
an intestinal fluid secreted by the "bottle-shaped
glands of the alimentary canal. With regard to this
· Lehman remarks-" The intestinal fluid serves, as re-
gards its function, as a complement to the digestive
fluids, the gastric and pancreatic fluids, which become
inoperative toward the middle of the small intestine;
it possesses not only, as the latter of these does, the
power of rapidly changing starch into grape sugar,
but also of dissolving and rendering absorbable flesh
and other protein bodies. In tied knuckles of intes-
tine, into which starch or paste has been introduced,
all the starch is transformed into sugar at the end of
three hours, and in a great measure absorbed. Pieces
of meat or coagulated albumen disappear from such
knuckles after six to fourteen hours."
STUDY OF DIAGNOSIS.
293
This is good reading, my friend of many cathartics,
and it is well to give it a prayerful consideration. Here
is a fluid that will do the entire work of digestion, and
here is an apparatus that really does do a considerable
part of it. When you have occasion to use the old-
fashioned harsh remedies, think twice, and possibly
you may see that the wrong done to this important
function may outweigh, many times, the good that
comes from counter-irritation.
The remedies named above, for wrongs of the pan-
creatic secretion, may be employed here, with some
additional ones. What we want to know, as a basis for
a rational prescription is-do we want sedation or
stimulation-do we want it of the circulation, or the
innervation, though these are usually associated. It is
hardly worth while to point out now the special indi-
cations for Amygdalus, Bismuth, Nux, Chelidonium.
Aconite, Ipecac, Nitric Acid, Podophyllin, etc., for their
uses will have been learned elsewhere.
Mucus is secreted to lubricate and protect mucous
surfaces, and in normal amount it favors the perform-
ance of function. Wrongs of the secretion are usually
easily determined. If of the outlets of the body, the
condition may be seen and felt. Thus it is easy to re-
cognize increased secretion from the nose, throat, and
genito-urinary passages, from the abundant discharge.
Increased secretion from the bronchial mucous mem-
branes is known by its discharge, and also by the blow-
ing and rattling sounds heard during cough and on
auscultation. Increased secretion of mucus in the
stomach is usually shown by the heavily loaded tongue
at its base. Whilst increased secretion of mucus in the
intestinal canal will be shown by the uniformly dirty
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STUDY OF DIAGNOSIS.
tongue, and by the tumid abdomen. Scanty secretion
gives rise to irritation, and this is one of the prominent.
signs, and taken together with the absence of discharge
is very good evidence.
With a wrong of mucous secretion we ask the ques-
tions-what are the general wrongs, operative in this
case? what is the condition of the mucous membrane,
as regards its circulation and innervation?
It is a
rule in practice, to rectify any general lesions, prepara-
tory to the cure of local disease, and many times with
this the local disease will disappear. Thus in a given
case of acute disease, we have a frequent pulse, high
temperature, and excited innervation, with dry mucous
membranes; the use of the appropriate general reme-
dies will establish secretion. And on the contrary, if
secretion is too free, the use of appropriate general
remedies will lessen it.
When we think of local remedies we want to group,
a, those which act upon mucous membranes; b, those
that act upon the special organ, part, or function in-
volved. Having the classes of remedies before us, we
now select a stimulant, sedative, or one which by its
action tends to change the character of the secretion
or function. It is not difficult to select a local remedy
if we know exactly what needs be done, and we have
a clear knowledge of the value of remedies.
A change in the sebaceous secretion frequently gives
rise to cutaneous disease. If our attention is directed
to the function of this secretion, as a lubricant of the
skin, its lesions will readily be detected. The treat-
ment here will have reference to the condition of exci-
tation or atony of the circulation and innervation, and
to changes in the nutrition of the organ. Sedatives in
STUDY OF DIAGNOSIS.
295
i
the one case, stimulants and tonics in another, and
remedies that alter morbid action in others, will be
selected to meet the different cases.
A wrong in the secretion of tears, or the meibomian
secretion, may occasion serious trouble with the eye.
Profuse lachrymal secretion is sometimes a source of
irritation, always a source of feebleness to the tissues.
Scanty secretion on the contrary, by leaving the eye
dry, and without the protection given by this fluid, is
a cause of irritation. The secretion of the meibomian
glands serve an important purpose, and when in excess
or defect, the function of the eye is impaired, and un-
pleasant disease may be grown.
Just so soon as the mind is directed to the parts
which may be diseased, it is pretty certain by direct
symptoms or by exclusion, to determine the exact loca
tion and kind of disease. Then knowing the action of
remedies, local and general, these may be selected with
reasonable certainty.
A wrong in the secretion of cerumen is a very fre-
quent cause of partial deafness, and many aural un-
pleasantnesses. It is surely well to know this, and by
a careful examination determine the character of the
disease-whether in excess, defect or perversion-and
also the condition of the secreting structures as it re-
gards increased excitation or atony. With such knowl-
edge as may be readily obtained by any one, the treat
ment of these diseases becomes successful.
The principal object in the consideration of these
secretions is to call attention to the necessity of con-
stantly keeping our physiological knowledge well in
hand, and directing attention first to the use, that
we may be able to understand the disease. If at any
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STUDY OF DIAGNOSIS.
time we forget this, and take the ordinary writers on
pathology and therapeutics as authority, we are quite
sure to go astray.
The excrementitious secretions are four in number—the
lungs, the skin, the kidneys and the bowels-and these
remove the waste of the body. The due performance
of the function of excretion is essential to health, and
in disease we invariably find a lesion of one or more.
If the excretions are in excess, debility is the result,
and becomes a prominent symptom. If they are in
defect, materials which should be removed, are re-
tained within the body; the result being irritation or
oppression, according to the character of the material,
and the amount retained.
Excretion by the lungs is but little studied, and yet
this is one of the most important of the excretions,
being to the extent of 517 grains of carbonic acid per
hour. In a rough estimate the value of these excretions
may be written-lungs eight, kidneys two, skin and
bowels each one. True it is carbon which is thus ex-
creted by the lungs, (this being regarded in the olden-
time as the special province of the liver), but a simple
experiment in closing the mouth and nose of an animal
will show that it will kill in a very few moments.
Excretion by the lungs may be in excess, and this
will be seen by the vivid redness of the blood where it
reaches the surface, by the frequent full respirations,
an exalted circulation, an excited nervous system, a
high range of temperature, and rapid waste of tissues.
We find these evidences of excess both in acute and
chronic disease, and it must be evident to the reader
that means to check it will be of value in both cases.
Such a remedy as Veratrum, and to a less extent
STUDY OF DIAGNOSIS.
297
}
Lycopus, Cactus, Sticta, must prove of great value in
such cases, associated with such local and topical ap-
plications as relieve irritation and give rest. The
reader will see very clearly that in the early stage of
pneumonia with such symptoms, Veratrum and a mush-
jacket may prove speedily curative, and that in some
cases of phthisis, Veratrum becomes a prominent
remedy.
Defect in excretion from the lungs will be known by
the darker color of the blood where it comes to the
surface, the evident defect in the movements of the
chest, fullness of superficial veins, and the oppression
of all the functions from retention of carbonic acid gas.
At once our attention is directed to such remedies as
prove excitant to this function, as Nux, if there is de-
ficient spinal innervation, Phosphorus, Arsenic, Lobelia,
Bryonia, Drosera, Apocynum, etc. If by these means,
excretion of carbonic acid can be increased, the various
functions of life are relieved from oppression.
Even if this knowledge did not point us to special
remedies, it would be valuable as suggesting a proper
hygiene. The patient suffering from excess wants
quiet and rest, a moist atmosphere, and one not stimu-
lant. The patient suffering from defect requires such
exertion as will call into action the respiratory appa-
ratus, a dry atmosphere, and one which is stimulating.
Proper direction in these regards may be the one thing.
necessary to recovery, and we can only give such ad-
vice when we thoroughly understand our case.
The attention of physicians has been specially
directed to the skin, kidneys and the bowels, as the
apparatus of excretion, the importance of this function
to health, and as a cause of disease. Indeed they have
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STUDY OF DIAGNOSIS.
received too much attention (such as is) for three-
fourths of the Materia Medica has for its object an ac-
tion on these emunctories. If we should take away
from the regular physician his cathartics, diaphoretics
and diuretics, he would be poor (for harm) indeed.
Whilst I do not wish to depreciate these functions,
either in health or disease, I think a much more care-
ful study should be made of them, and that their thera-
peutics should be improved.
This fact should be especially learned-that in a
large majority of cases wrongs of excretion are depen-
dent upon changes in general conditions of life-the
circulation, temperature and innervation-and that
when these are corrected, the excretions resume their
normal condition. Even when the function is not re-
stored, very simple means are usually all that is required.
Excess in secretion from the skin is readily deter-
mined by its moisture to the touch, dampness of the
clothing, as well as by the patient's sensations. The
questions that follow are-is it from excitation, or is it
a result of debility? It rarely results from excitation
in disease, though once in a while from increased circu-
lation to the skia, as in some cases of rheumatism, and
in the so-called sweating fever, and some other anoma-
lous cases, this will be found to be the case. Here the
diagnosis is quite clear-the skin has an active circula-
tion, is deepened in color, and the temperature is in-
creased. The increased perspiration of debility is not
secretion, but an exudation of water, washing away a
small quantity of albuminoid materials. The condi-
tion is determined by the evident relaxation and loss
of tone to the touch, the pallor, and usually the want
of sensitiveness.
STUDY OF DIAGNOSIS.
299
cases.
Evidently the treatment will be different in the two
The one of excitation requires the special seda-
tives, Aconite, Veratrum. Gelseminum, or special reme-
dies influencing the sympathetic nervous system as the
Rhus, Lycopus, etc. We want to relieve the undue ex-
citation of the skin, and this accomplished the sweating
ceases. In the other case an opposite treatment is re-
quired. Here we select such remedies as stimulate the
the skin-stimulant diaphoretics-Serpentaria, Senega,
Erigeron, Erecthites, Polygonum, etc. Or stimulants
to the circulation and innervation, as Belladonna,
Lobelia, Ipecac, Bryonia, etc. Local means will vary
just as much, in the one case being sedative, in the
other stimulant.
Defect in secretion may usually be known by exam-
ining the skin, which in one class of cases gives the
hand a sense of dryness and constriction, and in another
dryness with want of elasticity and life. The symp-
toms produced by retention of this excretion, are first
of oppression, terminating in chill, and second of exci-
tation, giving the phenomena of fever. As will be seen,
the general symptoms are somewhat indefinite, for both
the oppression and stimulation may be the result of
other causes. It is well to give due weight to this
lesion, though we may not rest our entire practice
upon it.
If the defect in secretion is due to an increased cir-
culation and temperature, means to rectify these wrongs
will stand first. In a majority of cases of fever and in-
flammation, a right use of the special sedatives and
proper baths will place the skin in such condition that
it will resume its function; or that it can be called into
action by very simple remedies. In other cases, where
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STUDY OF DIAGNOSIS.
$
the wrong of circulation, temperature and innervation
is based upon other special lesions, the use of the special
remedy for this, is followed by a return of normal cir-
culation, temperature and secretion. A marked ex
ample of this will have been seen in the administration
of Tincture of Muriate of Iron in some cases of erysip-
elas, as well as in the use of Rhus, when specially
indicated.
If the defect is due to a want of excitation in the
cutaneous nerves and circulation, remedies are employed
which exert a stimulant influence upon the skin. Many
diaphoretics owe their power to influence this secretion
to their stimulant influence, and of course they can be
beneficial only when a correct diagnosis is made, and
they are rightly used.
Perversions of this secretion are not uncommon, but
owing to our imperfect means of diagnosis are rarely
recognized. "This fluid, (sweat), as it collects in drops
on the skin of one perspiring, is colorless, tastes salty,
has a peculiar odor, is poor in solid constituents, and,
when recent, always reddens litmus." Yet we find in
disease that it has color, sometimes to the extent of
coloring the clothing, varying in shade and intensity;
has a variety of tastes, sweet, sour, acrid; is rich in
albuminoid elements; and is sometimes neutral to test
paper, and in other cases will change red litmus blue.
Evidently here is a field that will repay investigation.
Authorities upon skin diseases have recognized the fact,
that perversion of the secretion may be a cause of
some of these, and may perpetuate the most intract-
able.
In so far as we know now treatment will be directed
to the physical condition of this organ, as shown by
STUDY OF DIAGNOSIS.
301
examination, and to lesions of the blood. The last are
sometimes very important, for so long as there is in
this fluid morbid material that is excreted by the skin,
so long will the skin suffer.
Before leaving this subject, I wish to call the reader's
attention to the character of normal cutaneous secre-
tion, and to the fact, that in so far as it is a secretion it
is effected by secreting cells. In its normal state the
skin has a uniform temperature slightly below that of
the blood, gives to the hand a pleasant sensation of
softness and elasticity, is not damp and moist, indeed
rarely shows moisture upon the surface except on in-
crease of temperature and exertion. As this is the
condition in which it does the best work, it is the con-
dition we wish to obtain in disease. Many act as if
they supposed secretion from the skin necessitated the
pouring out of an increased quantity of fluids upon the
surface, as from the old class of sudorifics. Yet in
practice we find that the soft and but slightly moist
skin is the best evidence of secretion.
We have already studied the urine as an index to
disease and a means of diagnosis, and it will only be
necessary here to notice a few of the more salient fea-
tures connected with this study. Whilst the physician
is aware that the secretion of urine is indispensable to
life, in that it removes the largest portion of the nitro-
genized waste, he finds the common means of diag-
nosis so defective, that he takes it for granted that the
kidneys are doing their work right, because in a very
large percentage of cases, they do their work right.
As a matter of form he will ask-"how is your urine?"
and in the olden time he might examine a mixture of
urine and fæces in the chamber utensil. If the patient
302
STUDY OF DIAGNOSIS.
complained of scanty urine, it might mean something,
if there was uneasiness in voiding it, there was prob-
ably something wrong, and if there was arrest, very
surely something must be done. But just what that
something should be, was not so definite, only that it
must be drawn from the class diuretics, and was usually
the favorite prescription.
in
In this study it would be well for us first, to see why
any case the urine should receive a special examina-
tion, and then how this examination should be con-
ducted. We take it for granted that in ordinary prac-
tice examinations of urine will not be made.
In acute disease retention of the elements of the
urine are so clearly shown by the nervous system, that
there can hardly be a failure to have our attention
directed to them. The first influence is that of excita-
tion-the patient becomes restless and irritable and suf-
fers more than the condition of disease will account for.
The second influence is of oppression-the patient be-
comes dull and lethargic, and finally sinks into coma.
Of course we may have cerebral excitation and coma,
without any wrong of the urinary secretion, but we
never fail in these cases to make diligent inquiry, and
satisfy ourselves as to the source of the nervous
lesions.
Now scanty urine has a definite meaning, as has un-
pleasant sensations in its passage, or a failure to pass
it, or going further, we may make a critical exainina-
tion of it, as heretofore named. I do not wish to be
understood as saying that inquiries with regard to the
urine need not be made unless there is nervous dis-
turbance, for there can be no harm in thorough exami-
nations in all directions - but I desire to impress it
STUDY OF DIAGNOSIS.
303
upon the mind of the reader that these are the cases
where such examination is imperative.
But finding a failure upon the part of the kidneys to
do their work, we are not yet ready to say-give “ diu-
retics." We want to know the condition of the kid-
neys as regards their circulation and innervation. Such
arrest may result from irritation and determination of
blood, and any excitant may so increase this as to en-
tirely suppress the secretion and cause death. Or it
may result from capillary congestion, which the ordi-
nary diuretics would increase, and thus death might
result from the use of remedies which in ordinary cases
would increase secretion.
The condition of the kidneys may be determined in
part from the patient's sensations, and in part from a
personal examination. In irritation with determina-
tion of blood (active condition) the patient will have a
sense of constriction in the loins with tensive or draw-
ing pain, sometimes seeming to be in the spine. Some-
times the sense of irritation extends to the bladder, the
urethra, the testes, and even to the rectum. In irrita-
tion the patient is restless, quick in his movements, the
eyes are bright, the tissues around them seemingly con-
tracted, the tongue small and pointed, and the pulse
small, wiry, or vibratile. In congestion the patient.
complains of a sense of fullness and weight in the loins,
and sometimes the same sense of fullness and weight
in the pelvis. The patient is dull and apathetic, the
eye dull, the face expressionless, the tongue somewhat
full, and the pulse lacks sharpness in the wave-op-
pressed.
Such diagnosis is of especial value, because it en-
ables the practitioner to select his remedies with cer-
304
STUDY OF DIAGNOSIS.
tainty. If we have the condition of irritation, we give
Gelseminum, with or without the sedatives, as may be.
indicated. If there is the condition of congestion we
give Belladonna, Ergot, or Solanum, with or without
Aconite as the sedative. Diuretics are not given until
there is marked relief, and secretion has become more
free; indeed, sometimes they will not be required at all.
When we do give them, they are selected with refer-
ence to the condition of the kidneys-sedative diure-
tics for the condition of irritation, stimulant diuretics
for that of congestion.
Excess in this secretion is not of frequent occurrence,
and is usually recognized without trouble. The large
amount of urine in diabetes, insipidus and mellitus, at-
tracts the patient's attention, and is evidence to the
physician of the nature of the wrong. But there are
a few other cases in which the excess is not marked in
this way-the patient passing but the usual amount of
urine, or possibly it is less in volume than usual. It is
only when tested with the urinometer that it is found
continuously of high specific gravity, and that the
solids are increased from one-tenth to possibly one-
fourth more, and still it does not contain sugar or albu-
men. Such excess will be marked by loss of flesh and
strength, and by feelings of weight and dragging in
loins or pelvis.
The wrong may be wholly due to a lesion of the
kidneys, or principally to an excess in retrograde me-
tamorphosis. This of course must be determined to
give us a rational treatment.
Attention is rarely called to lesions of perversion by
the common examinations of the urine.
Of course
there are exceptional cases, as the excess of urine in
STUDY Y OF
305
OF DIAGNOSIS.
diabetus mellitus, and urinary irritation in some cases
of deposit, in which the direct symptoms are sufficient
to excite attention. In the majority, the diagnosis is
made by exclusion There is an impairment of the
health; object-to locate and determine the character
of the lesion. And thus we give the patient a thor-
ough examination, with reference to the more import-
ant functions and organs. Is it of the circulation,
digestion, respiration, innervation, nutrition, secretion
of skin, bowels, kidneys? Thus excluding one after
the other, as we find them free from disease, we at last
reach the affected part. Even now we do not know
the character of the lesion, and proceed by the same
method to determine it Is there sugar in the urine,
albumen, blood, the phosphates, or some of the rarer
morbid materials? The general symptoms may point.
us to the special examination, or we may be obliged to
make test after test, until we determine what the real
trouble is.
But having learned the character of the perversion,
we are not yet ready for treatment. It will not do to
say, here is a remedy for all cases of diabetus mellitus,
albumien blood, deposit of the triple phosphates.
The examination must go a step further-to what extent
is it a lesion of the kidneys, or of some other part, the
blood, nervous system, or the associate secretions from
lungs, skin and bowels? and still a step further, we want
to know the physical condition of the kidneys, and the
special character of any other wrong.
The reader may say these methods are very com-
plex, and it will be difficult for one to follow them
out (?) I admit it, and whenever possible, should rather
prescribe from a single characteristic symptom, but
26
E.
1
306
STUDY OF DIAGNOSIS.
there are cases that require just such thorough analysis
to give succeesful treatment.
When we study excretion from the bowels, we want
first to correct our physiological ideas of the value of
the secretion. Physicians have made a hobby of the
bowels and have ridden millions of them to untimely
graves. We want to know if bowels were made to be
continuously physicked? and whether good or harm is
most likely to result from the common use of purga-
tives? If we consult Lehman again, (a most excellent
authority), we find that "The contents of the intes-
tines, even after the use of tolerably simple articles of
diet, consist of a mixture of undigested, indigestible,
and already changed or decomposed substances, with
which are mingled constituents, partly undecomposed,
partly already metamorphosed, of the digestive fluids."
But of a real secretion eliminated by the glandulæ of
the intestine the fæces contain but a small proportion-
probably less than the excretion from the skin.
Excess is usually associated with frequent fluid evac-
uations-diarrhoea-yet we must not take it for granted
that in all cases of diarrhoea there is excess. Excessive
discharges of fæces produce debility, first by the re-
moval of some portions of the food, and secondly by
withdrawing some of the albuminoid materials of the
blood.
Constipation is not to be regarded as positive evi-
dence of defect in secretion from the bowels, as it is
possible, and not uncommon, for constipation to exist
for days, and yet excretion goes on into the bowels as
before. But even constipation may be a cause of dis-
ease, either from irritation produced by the debris of
digestion, or by the decomposition of some of the
STUDY OF DIAGNOSIS.
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1
material, or by the generation of offensive gases, or the
absorption of some of the decomposed matters. Evi-
dences of irritation, or of oppression, when they can.
be referred directly to inaction of the bowels, may be
regarded as an indication for the simpler cathartics.
The more harsh remedies of this class have usually
been used for their derivative effect, and the saline
hydragogue cathartics to deplete the blood-vessels of
fluid.
Small doses of some of the cathartics, as Podophyl-
lum, Apocynum, etc., do increase the secernent function
of the intestine, and at the same time improve its func-
tion of digestion. The dose is less than that required.
for catharsis, and the indications are sensations of full-
ness, weight and atony.
Perversions of the secretions of the bowels and acces-
sory glands are recognized principally by changes in
color and in odor, but these are not as certain as would
be thought at first sight. The reasons are clear-there
is so much and varied coloring material taken with the
ingesta, and the odor naturally intense and foul is so
readily changed by decomposition of fæcal material.
Still it is well to make the fæces yield all the informa-
tion possible.
A few examples may be given in illustration. The
vivid green discharges of childhood, acrid and irritat-
ing, give information of excess of acid, and suggest the
use of alkalies. The extreme yellow (chrome) of in-
fantile discharges, evidence an insufficient digestion of
the food, both of albuminoid material and fat, and sug-
gest more care in diet, and the use of remedies that give
tone to the digestive apparatus. The clay-colored evac-
uations of disease tell of want of secretion from all
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STUDY OF DIAGNOSIS
the intestinal glands (liver included), of impaired
power of digestion, and suggest the use of stimulants to
the upper intestinal canal and associate viscera. The
yellow rye-mush fæces of typhoid fever is characteristic,
and calls our attention to commencing disease of Peyer's
glands. The deep brown or black fæces, with greenish
tinge, sometimes yeasty, is one of the most marked in-
dications of the typhoid condition, and calls attention
to the necessity of antiseptics. The color and physical
properties of mucus, pus and blood, are readily recog
nized, and either by their quantity, condition, or some
local symptoms, their source may be readily detected.
THE BLOOD.
The study of the blood is one of much interest to
the physician, for in changes of its structure and circa-
lation we find a principal element in many diseases.
The old Hebrew poet well remarked that—" the blood
is the life of the man," at least we find by experience
that wrongs of the blood are manifested by impairment
of the life. We study both the lesions of the blood
and the lesions of its circulation, and it is well to keep
them separate in the mind.
Excess in the amount of blood is of very rare occur-
rence as a cause of disease, and yet occasionally we
meet with cases in which, from local disease, the high
stimulus of a large amount of rich blood is injurious.
We find such cases in local disease of the kidneys, the
lungs, the heart, the brain, in which these organs, en-
feebled by disease, can not bear the strain of such vig
orous life.
This has been named sthenic plethora
:
STUDY OF DIAGNOSIS.
309
!
There is another condition in which a large amount of
blood is continuously made, but owing to exhaustion of
the circulatory apparatus and nervous system by ex-
cesses, its circulation is sluggish.
Excess of blood is readily recognized by the fullness
of the blood vessels, especially of the capillary system
of the surface, which shows the deep tint of abundant
red globules, by the full firm tissues, and the vigorous
performance of function. Asthenic plethora will be
recognized by fullness of blood vessels, oppression in
the stroke of the pulse, and a turgid venous circulation,
giving the surface the peculiar color of venous blood.
The color is so characteristic, that when associated with
the full animalized tissues, and the full blood vessels,
there can be no mistake in the diagnosis.
When high stimulus is likely to be a source of danger,
we take measures to lessen the quantity of the blood.
The safest means is to diminish the supply of food to a
minimum, and select such vegetables and fruits as yield
small proportions of nitrogenized material. In some
cases the saline purgatives and diuretics may be em-
ployed to a limited extent with advantage, which, with
well regulated exercise, will remove the source of
danger. Many a man has lost his life because his
digestive and blood-making organs were so much
better than the remainder of his body, that they have
furnished the material for a too active life. In asthenic
plethora the important remedy is right living. Cut off
the supply of stimulant drinks and food, establish good
excretion, and have the patient take such exercise as
will promote a more rapid combustion and waste of
effete material, and in a few months the patient will be
on safe ground.
}
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STUDY OF DIAGNOSIS.
髀
​7
Defect in the quantity of the blood-anaemia-is
readily recognized by the want of color of surface, and
the loss of that hardness and elasticity of tissue that
we call tone, and a loss of size and functional activity
of the soft structures of the body. "As the life of the
man is his blood," we have a loss of life in proportion
to the condition of anæmia.
But we may have gone so far in our diagnosis as to
determine absolutely that there is a want of blood, and
yet not be ready to make a prescription. It will not
do to say, give Iron, or give " Bitter Tonics and Iron.”
We want to know why a sufficient amount of blood is
not made, or why, if made, it is not applied to its proper
use-nutrition. In one case it will be a want of proper
food, or of some special element of the blood, in another
a want of buccal, gastric or intestinal digestion, in
another a wrong in the blood-making organs, in an-
other a lesion of the circulation, in another a lesion of
innervation, in another a lesion of retrograde meta-
morphosis or excretion. Is it too much to ask that
each of these receive due consideration, and that our
prescription should be directed to the special fault?
It requires a little time to pass all this in review, but
the mind works very rapidly, and taught to work
right, it will do all of this automatically.
Of course the treatment of anæmia must vary in
different cases, as the cause of it varies so much. In
one case good food, well prepared, is all sufficient; in
another some special element of blood needs to be
added as Iron, Phosphorus, Soda, Potash, etc.; in an-
other the digestive apparatus requires stimulation; in
another special stimulants are required to increase sym-
pathetic innervation; in another special means to give
I
STUDY OF DIAGNOSIS.
311
{
a right circulation and temperature; in another stimu-
lants to the formative cells by remedies and exercise;
and in others still the cure comes from stimulating the
processes of waste and excretion, thus getting rid of
old and feeble forms.
The consideration of spanhemia, or poor blood, is
hardly necessary here, because it is included in the
general term anæmia. Whilst it is possible to have a
normal amount of blood, yet poor in some of its ele-
ments, this is a rather rare condition. It will be known
by the full, limp, inactive tissues, the full, blue veins,
the full pulse without power in its stroke, and the ten-
dency to dropsical effusions. It is really a worse con-
dition than a simple anæmia, and requires more care in
its treatment. As we employ means to increase the
formation of blood, and add those elements necessary
to its proper structure, we at the same time wish to get
rid of the old stock, and the safest way to do this is by
well regulated exercise and gentle stimulation of the
apparatus of excretion.
As remarked under the head of anæmia, special con-
sideration is always given to a want of some of the cle-
ments of blood, and to the means which will restore
them. This is the basis of the treatment called restora
tive. If the blood requires Phosphorus, it will not do
to give it Iron, as when it requires Iron it will not do
to give it Sulphur or a bitter. The special symptoms
heretofore named, showing these defects, should be
closely studied.
But the blood may be bad, or changes may be going
on within it which will work its destruction. You may
say that "bad blood" is a popular myth, and does
well enough to base a nostrum advertisement upon, but
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STUDY OF DIAGNOSIS.
it will hardly do for specific medication (?) There you
are wrong, for "bad blood" is a real, tangible entity,
with definite expressions, and a definite therapeutics.
How will we recognize it? Assuredly in the ordinary
way, by an inspection of it where it shows at the sur-
face, by any material (secretion) that is drawn from it,
and by wrongs in the nutritive function which is based
upon it. When you think of these methods for a
moment you will see that they have a physiological
basis, are plain, and eminently practical.
In acute disease we are more interested in those
changes going on in the blood which we call septic,
than in any special material contained within it, and
these changes are more readily recognized by exuda-
tions than other means. Attention has already been
called to the secretions and deposits upon the tongue,
as evidencing the condition of the blood. We find that
all exudations that might be called dirty, and all changes
in color toward brown and black, might be regarded
as certain evidence of sepsis, and of the impairment of
the blood. We put the proposition in this form-" as
are the secretions of the mouth (notably the coating
of the tongue) dirty or of deep color, so is the intensity
of sepsis, and the death of the blood." In so far as the
term typhoid is applicable to sepsis, these symptoms are
among the most prominent in typhoid diseases.
Any exudation will serve to show the character of
the blood as well as the coating upon the tongue. The
discharges from the bowels and of urine, the sputa in
disease of the respiratory apparatus, the lochia in puer--
peral disease, the "washings-of-meat" discharges in
dysentery, the secretions of an ulcer, the sanies of an
injury or surgical operation, all tell the story explicitly.
STUDY OF DIAGNOSIS.
313
It is not possible to get a good secretion or exudation
from septic blood, and the character of the one will
show the condition of the other
In some forms of chronic disease there is effete or
imperfectly elaborated albuminoid material in the blood
in considerable quantity. It serves to lower the char-
acter of this fluid, and to impair all vital activities, and
by influencing the nutrition of structures it gives rise.
to local disease. This bad blood has been a basis for
the administration of the various compounds called alte-
rative, so extensively employed by the profession, and
also for nostrum venders, and no doubt the treatment
adopted, by increasing waste and nutrition, has cured
many cases.
The evidence of bad blood is best found in wrongs of
excretion and of nutrition. There can not be a wrong
of this character without an effort upon the part of the
skin, kidneys and bowels to remove the unpleasant
material, and we will usually find that all three of these
emunctories show a lesion caused by the effort, though
one may suffer more than another. In the case of the
skin it manifests itself in cutaneous disease, taking the
forms of the exanthemata in the simpler cases, and the
graver forms of the pustulæ, squamæ and tuberculæ,
when the lesion is more persistent and severe. This
fact has long been recognized, in so far as the treat-
ment of skin diseases has embraced means for remov-
ing effete and unpleasant materials from the blood.
We frequently hear it remarked, "I know my blood
is bad, because my flesh does not heal easily, and
wounds and scratches inflame and suppurate." True
there is something wrong here, and it may be "bad
blood," according to our definition above. At least in
27
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STUDY OF DIAGNOSIS.
a large number of cases, a treatment that looks to the
increase of excretion, and better digestion and blood-
making, removes all the unpleasantness. In the re-
maining cases some special material of the blood is
wanting, frequently Lime, sometimes Soda, Potash,
Phosphorus, etc.
In some cases the urinary apparatus is the special
seat of suffering. The entire apparatus is irritable, and
the urine contains an abundance of ammoniacal com-
pounds, and gives characteristic deposits. The effort at
removal may be continued by these organs, until severe
disease is induced, as seen in some cases of chronic in-
flammation, and an occasional case of degeneration.
The bowels always suffer more or less, indeed I hardly
think it possible that this condition should continue
long, without a loss of regularity in defecation, and a
change in the character of the stools.
The lesions of nutrition may take the form of de-
generation, or of deposits. In the one case we have
the symptoms heretofore described, of enfeebled func-
tion, and a want of expression in the soft tissues. In
the other comes the evidence of local disease, enlarge-
ment preceding inflammatory action, which runs a very
irregular course. The last is so important an evidence
that it is well to read it over. Whenever swelling
and change in the form and functions of a part precede
inflammatory action, there is a wrong of the blood, and
means must be employed to remove the unpleasant
material by excretion, and to provide for better blood-
making.
In place of thinking of certain remedies called "alte.
rative," which act in "an insensible and inexplicable
manner," it is
process of cure.
•
STUDY OF DIAGNOSIS.
315
The bad material is to be removed, and good material is
to be introduced in its place. We wish to know
whether it is necessary to employ means to stimulate
retrograde metamorphosis, by exercise or medicines,
to increase the processes of combustion, to employ
remedies that modify and arrest the septic processes,
or to use such as increase excretion It is possible that
the habits and surroundings of the patient must be
changed before a cure is effected, or that he should
have better food, better digestion, or better blood-
making. In thus getting a better blood, there is less
tendency to depravation.
THE CIRCULATION OF THE BLOOD.
Among the most common lesions in disease are
wrongs of the circulation of the blood. We may state
it as an axiom that the condition of health requires a
circulation normal in time and character, and just in
proportion as we have a change from this normal
standard we have severity of disease. The time of the
pulse varies greatly in different individuals in a state
of health, in the adult having a range of from 50 to 90
beats per minute, yet in its other characteristics it is
pretty uniform, and can hardly be mistaken. The
finger on the pulse is trained to determine lesions of
the circulation, and should rarely make any mistake.
The wrongs of the circulation may be general or
local, and classified under the three heads. excess, de-
fect and perversion. The first has reference to rapidity,
the second to an impairment or checking of the circu-
lation, and the third may embrace cases in which the
circulation is not uniform, or is irregular.
}
1
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STUDY OF DIAGNOSIS.
Increased frequency of pulse is one of the character-
istic symptoms of fever, and is usually associated with
a proportionate increase of temperature. As a rule we
estimate that ten pulsations represent 1° of tempera-
ture—that is for each degree of increased temperature
we may expect to find an increase of ten pulsations per
minute. There are many exceptions to this rule, the
increased frequency of pulse being sometimes more,
sometimes less, and indeed sometimes showing but
little relation. As a rule, increased frequency of pulse
represents gravity of disease, and we are accustomed
to think of it as an unpleasant symptom. As is the
frequency of the pulse, so is the arrest of secretion, the
increase of heat, the impairment of digestion and blood-
making, the arrest of nutrition, the development and
progress of sepsis, the progress of inflammatory dis-
éase, and the danger to life, local and general. Hence
the importance of means which influence the circula-
tion, reducing its frequency without impairing its free-
dom.
FREQUENCY OF PULSE may be the basis of fever or
inflammation, and when the pulse is brought down to
a normal standard all the other phenomena of disease
may disappear. Thus we often observe under the in-
fluence of the special sedatives, that as the frequency
of pulse is reduced, the temperature falls, the nervous.
system is relieved, the skin softens and becomes moist,
the urine is increased, the bowels move of themselves,"
and the appetite returns. Or, in case of inflammation,
the pain ceases, there is less heat, redness and swelling,
and resolution rapidly progresses to complete restora-
tion. These results are so common, that we are sur-
prised in some seasons and in some cases to find that
the sedatives do not seem to produce sedation.
STUDY OF DIAGNOSIS.
317
等
​This brings up the important point in the study of
disease that there is a first and predominant wrong
upon which the entire morbid process rests. In some
cases, as in the instances given, this is so markedly the
case that when we have removed this, the whole disease
rapidly fades away. But in others this simply paves
the way for the doing of something else, and this again
for the restoration of other functions, and thus a suc-
cession of means may be required in a single case.
It will not do to say here, I have frequency of pulse,
and my patient requires a sedative, taking any one of
this class at random. The ten or a dozen remedies
grouped under this head are not alike, and can not be
used one for the other. It is true that we may so sub-
stitute Veratrum and Aconite in many cases, but even
these had better be given according to the special indi-
cations heretofore named-Veratrum when the pulse is
full, Aconite when it is small. Then we have Digitalis
when the impulse is feeble, Lobelia when it is op-
pressed and the artery is turgid with blood, Gelsemi-
num when it is full and. vibratile, Belladonna when it is
full, soft, and without strength, etc. For these indica-
tions and others, the reader is referred to a former con-
sideration of the pulse as an element of diagnosis.
SLOWNESS OF PULSE is not a common symptom in
disease, but is occasionally met with in chronic disease.
It indicates a want of innervation, or excitability of
parts supplied from the sympathetic. The wrong may
be found in degeneration of tissue, or simply a want of
waste and nutrition, the tissues becoming old and in-
active. In some cases the pulse will be slow when the
patient has remained quiet for some time, but is in.
creased in frequency upon exertion.
1
318
STUDY OF DIAGNOSIS.
These cases will be benefited by the use of small
doses of Lobelia, Digitalis, or Ergot, with the use of
means to stimulate increased waste and nutrition.
Changes in the character of the pulse are of very fre-
quent occurrence, and many of them have already been
named in connection with special remedies. In most
severe diseases change in the character of the pulse
will be found associated with frequency, and will prob-
ably point out the sedative which will be found most
useful. As heretofore stated, our examination of the
pulse has reference to size, the movement of the mass
of the blood, the impulse of the wave, its length, gen-
eral character and termination, and the inter wave-
current. A reference to any sphygmographic illustra-
tions will show that there is very great variation in all
of these, and that they do represent definite pathologi-
cal conditions.
+
Irregular distribution of blood is frequently met with
in disease, and a popular expression in treatment is,
"equalize the circulation." Some have laughed at the
expression as being indefinite, unscientific, and partak-
ing of the character of "old women's" medicine. But
there is no plainer pathological fact than that the cir-
culation of blood is unequal in many instances-here
too much blood, there too little-a want of circulation
to the extremities and surface, too much blood in the
cavities of the body. That such inequality is the cause
of disease is very easily shown by many examples
Every one will recollect the cold feet and chilled sur-
face that attends an ordinary bad cold, and will recall
the local and general wrong that comes from a similar
condition at the period of the menstrual flow, very
greatly increased by the local stasis of blood in the
STUDY OF DIAGNOSIS319
DIAG
.
uterus if the flow should be stopped. Many can recall
cases of chronic disease, associated with cold feet and
a tendency to chilliness of the surface from imperfect
circulation, and they will recollect that such cases were
very intractable. Some will recall cases of pneumonia
or of typhoid fever, in which an irregularity of the cir-
culation, and a tendency to accumulation of blood in
the cavities, and a want of blood to extremities and
surface were prominent features, and they will recall
the gravity of such cases.
If
As the mind recalls these well-known facts, the im-
portance of equalizing the circulation will be seen.
If in the commencement of a cold, means are employed
to give an equally vigorous circulation to surface and
extremities, the mucous membranes cease to suffer
in chronic disease we so improve the circulation that all
parts receive an equal quantity of blood, we have ac-
complished one of the essential things necessary to re-
covery. If in severe local disease, or the graver acute
affections called typhoid, we find an irregular distribu-
tion of blood and heat, getting well will probably de-
pend upon our ability to rectify this wrong.
THE LOCAL LESIONS OF THE CIRCULATION that interest
us most are embraced under the head of hyperæmia, or
an excess of blood in a part. This has special reference
to the capillary circulation, though arteries and veins.
are involved to a limited extent. The condition of
local hyperemia is easily understood and recognized.
In health the mass of capillaries are not full, indeed it
is impossible that they should be full at once. If there
is an increased amount of blood in a part, with its
motion unchanged, there will be increase of size-swell-
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STUDY OF DIAGNOSIS.
ing-redness, if the part is superficial, and increase of
temperature and sensitiveness.
Whilst it is possible to have the condition above
named, it is uncommon. As a rule there is a change in
the rapidity of the circulation as well. Thus we divide
hyperemia into two varieties, active and passive-in
the one there is excess of blood in a part with its move-
.ment increased, and in the other excess of blood in a
part with its movement diminished. We call the first
determination of blood, and the second congestion. It
will not do to mistake these pathological conditions, as
the treatment of one is almost the opposite of that of
the other.
The cause of determination of blood is one-irrita-
tion-ubi irritatio ibi fluxus; and the condition of the
part is one of excitation. The symptoms are very
clear-there is swelling, heat, increased sensitiveness,
and redness. In minor degree the functional activity
of organs and parts is increased; but when in excess,
though the part is excited, the function is diminished.
If now we compare with this the condition of the
capillary circulation in congestion, we will see that
there is much difference. In this the capillaries are
filled with blood, but the movement of the blood is
sluggish, or entirely arrested in some vessels. The
active life of the part is impaired to the extent of the
impairment in the circulation, and all the expressions
show dullness and want of functional activity.
Whilst there was but one cause for determination of
blood, in congestion we may have three. The principal
one of these is an impairment of the life of the part-
the structures being enfeebled the capillaries yield to
the visa tergo of the blood. In some cases an irritation
STUDY OF DIAGNOSIS.
321
#
of the part is a first cause, determining a greater amount
of blood to it than its weakened vessels can withstand.
In other cases an obstruction to the return current by
way of the veins, is a principal cause.
As before named, the symptoms are all of impaired
function and oppression, and when we compare this
with the excitation of the active state of determination
of blood, the distinction will be clear. We say that
the sensations are of fullness, weight, dullness, and if
there is pain it will partake of these characters. The
objective symptoms when near the surface are of swell-
ing, and an increased redness that has not the bright-
ness of the active circulation; the temperature may or
may not be increased.
If we take some examples of the two conditions, the
subject may be clearer. In determination to the brain,
there is a flushed face (bright), bright eyes, contracted
pupils, increased temperature, and excitation of func-
tion-the patient being excited, restless and sleepless.
In congestion the face is usually flushed (dusky, pur-
plish or livid), the eyes are dull, pupils dilated or im-
mobile, the mind is sluggish and the patient inclined
to coma. If we take the lungs, we find in determina-
tion a rapid, uneasy respiration, characterized by quick
movements of the walls of the chest, and the patient
shows the excitation in the sharp, forcible cough, and
frequent change of position to get relief. The func-
tional activity of the lungs being increased, the color
of the blood when it reaches the surface is brighter than
usual, and the surface is therefore flushed. In conges-
tion, the movement of the chest is sluggish, labored and
oppressed, and the cough has a like dull and oppressed
character. The function of the lungs being diminished
322
STUDY OF DIAGNOSIS.
the surface is inclined to be dull, dusky, or livid. If
we take a diarrhoea as an example, the symptoms are
quite as clear. With determination of blood, there is
marked uneasiness, and the evacuations are unpleasant
or possibly painful, and attended with some tenesmus.
From congestion, the bowels are tumid, have a sensa-
tion of weight and fullness, and the discharges are free
and without uneasiness.
Whenever we find these two conditions, the symp-
toms will have the same character, and will be shown
by the sensations, and by the function of the part. In
determination there is the feeling of increased activity,
and in congestion the feeling of impaired activity; in
determination there is excited function, in congestion.
impairment of function.
As the cause of determination is irritation of the part,
any agent which will remove this irritation becomes a
remedy. As the circulation in its entirety is controlled
by a system of nerves, a lesion of a part may some-
times be best relieved by an action upon the whole
through the sympathetic. Determination of blood to
any part may be relieved by the use of Veratrum,
Aconite and Gelseminum. Other than these general
remedies, we select those that influence the special part
affected, and that remove irritation. In determination
to the brain we use Gelseminum; to the lungs Vera-
trum or Ipecac; to the kidneys Gelseminum; to the
bladder Eryngium; to the bowels Aconite and Ipecac;
to the uterus Aconite and Macrotys. In so far as we
use local applications they are selected in the same
way wet packs, poultices, fomentations, enemata, in-
halations, etc., are selected with reference to their seda-
tive character.
STUDY OF DIAGNOSIS
323
t
In congestion the part requires stimulation, especially
stimulation through the sympathetic. It may also be
influenced to a greater or less extent by remedies
stimulating the circulation at large. Thus Belladonna,
Lobelia, and to some extent Aconite, are of value in all
cases of congestion. Other remedies are selected with
reference to their action upon the part, as stimulants
or excitants. In congestion of the brain we use Bella-
donna; in congestion of the lungs or of the heart,
Lobelia; in congestion of the abdominal viscera, Nux
Vomica; in congestion of the kidneys, Belladonna, etc.
In selecting local applications we observe the same.
rule; whatever their form, they should be excitant to
the part. In studying the action of remedies, we first
wish to know where they act, and second the kind of
action. If a part is diseased, we wish a remedy that
acts upon that part particularly, and which does that
which is necessary to restore it to health. In the case
of determination of blood-the active circulation-we
want a remedy that will remove irritation, and the un-
due excitation of its circulation; in congestion we want
a remedy that will increase the life of a part, or that
will give the necessary stimulus to the capillary vessels.
According to Dr. Williams, inflammation is a local
hyperemia, with the movement of the blood partly in-
creased and partly diminished. We study this process
of disease, with reference to its cause, the lesion of the
circulation, the exudation, and the result or termina-
tion. The cause is one, irritation with such impairment
of vegetative life. From the irritation comes an in-
creased circulation to the part, the capillaries are filled
with blood, which in some moves slower and slower,
until the circulation through them is arrested; and yet
324
STUDY OF DIAGNOSIS.
But
in others the movement of the blood still continues
rapid. As the capillaries lose their strength and be
come thus filled, the fluid portion of the blood is exuded
into the intercapillary spaces, or upon free surfaces.
This completes the pathological process, and we next
study its result upon the life of the part. If the origi-
nal lesion has not impaired the vegetative life too much,
or the lesion of the circulation has not been too great,
we find that after a time these minute vessels regain
their tone, and the circulation is re-established in them.
As the current of blood commences to flow through
them, the material exuded is drawn into the current
and carried away, thus leaving the part in its original
condition. This termination is called "resolution,"
and is the result most to be desired in all cases.
if the life of the part be so impaired by the cause, that
it can not renew itself; or if the impairment of the cir-
culation be so great as prevent its receiving the
necessary amount of oxygen, and the removal of car-
bonic acid gas, then it must die and be removed. This
death and removal takes place in two ways-by sup-
puration, and by gangrene or mortification. In sup:
puration the process of death is modified by a lower
form of life-the production of pus-cells, from the
formative cells of the part, and thus the remainder of
the body is protected in part, and repair facilitated.
But if the impairment of life is greater than this, the
part dies, and is removed en masse, by the suppurative
process when the tissues still retain sufficient life.
The symptoms of inflammation, according to the old
authorities, are pain, heat, swelling and redness, and
for superficial parts these are characteristic and definite,
but for internal and concealed parts we are obliged to
STUDY OF DIAGNOSIS.
325
rely upon the first, and the evidences of impaired func-
tion, and the influence upon the general health.
Pain is a very constant expression of inflammation,
though it is very common from other causes. It varies
from simple uneasiness from over-excitation, to the
sharpest and most severe suffering, and its intensity is
not to be taken as the measure of inflammatory action
in any case. It becomes symptomatic of inflammation
only when there is evidence of a wrong circulation, and
increase of temperature, general or local.
Heat is a constant symptom, and much more reliable
than pain. It may be but local in superficial inflam-
mation, or when but a small and unimportant part is
affected, but is general when an important part or much
tissue is involved. In some cases the patient's sense of
heat may be taken as evidence, though this is very
liable to error. As a rule the temperature of an in-
flamed part will not rise higher than 102°, unless there
is a corresponding elevation in the temperature of the
body, and there is rarely more than one or two degrees
difference between the general and local temperature.
The sense of heat, when the hand is placed upon a
superficial inflammation, is due in part to arrest of
secretion from the skin, which is also the cause of any
difference there may be in temperatuře.
Swelling is also a constant symptom, thougn not so
marked when free surfaces are involved, or very dense
tissues. It is not a reliable symptom, however, for it
may be due to changes in the nutrition of a part, to
growths, deposits and exudations. To be of any im-
portance in diagnosis it must be associated with evi-
dences of derangement of the circulation, and with in-
creased heat.
326
STUDY OF DIAGNOSIS.
Redness is only an evidence in superficial inflamma
tion, and is due to the presence of a large number of
red globules. It is deeper than in determination of
blood, though it may be simulated by some rarer con-
ditions of the skin.
Among the prominent and most valuable symptoms
of inflammation are wrongs of function; these are con-
stant and characteristic. In the early stage of excite-
ment the functional activity of some parts will be in-
creased; but in a majority it simply shows excitement
and is really impaired. As the capillary stasis in-
creases, and exudation occurs, the function becomes
more and more impaired, until in some cases it is com-
pletely arrested. Thus in inflammation of the brain,
we have at first great mental excitement, then delirium,
then probably incoherent (muttering) delirium, and
finally from exudation-coma. In this case the symp-
toms of the first and second stages are almost opposite-
active delirium and coma. In inflammation of the
lungs we find at first increased activity and a rapid oxi-
dation of the blood; but in the second stage there is
oppression, and an imperfect aeration of the blood. In
inflammation of the liver, there may be at first stage an
increase of biliary secretion, whilst in the second there
is complete arrest: So in inflammation of the kidneys,
the first excitement produces increased secretion of
urine, whilst the second may arrest it entirely.
The different phases of the inflammatory process and
its results, require care in diagnosis. Recognizing the
presence of an inflammation, we want to know the
danger to the life of the part, and to the life as a whole.
In this respect it may be said, that those cases of but
moderate excitement are most favorable. When the
STUDY OF DIAGNOSIS.
327
vascular and nervous excitement are extreme we may
anticipate an unfavorable result, as well as when we
have marked swelling and redness, with impaired sen-
sibility and arrest of function. The sensation given to
the touch will be most reliable in external inflamma
tions; the greater the departure from the normal stand
ard, the greater the danger to the tissues.
Suppuration is announced by an increased fullness of
the tissues, a sense of increased tension, and a change
in the character of the pain, which becomes throbbing.
If but a moderate amount of tissue is involved in an
unimportant part, suppuration is followed by relief of
the general symptoms, but when considerable tissue is
broken down, or important organs are involved, it is
frequently ushered in with a chill, and attended by a
fever having somewhat the character of hectic.
Gangrene of external parts is announced by the
change in color-purplish or black-by coldness, and a
want of sensibility. Internally it is announced by
great prostration, the subsidence of pain, loss of sensi-
bility, and a soft, feeble pulse.
The general symptoms are those of fever. The cause
of inflammation is depressing to the life of the indi-
vidual as well as to the life of the part, and when con-
siderable`structures are involved the expressions are
very distinct. The first influence gives the listlessness,
languor and loss of function; this culminates in a chill
or rigcr; and this is followed by the symptoms of
febrile reaction-frequent pulse, increased temperature,
arrest of secretion, and derangement of the nervous
system.
In the severer cases of inflammation these general
symptoms are as pronounced as in fever, and it is some-
328
STUDY OF DIAGNOSIS.
times difficult to determine a local lesion, except by
close examination and attention to special symptoms.
If care is used, however, a special wrong of function
will attract attention to a part or organ, and symptoms
of inflammation will be detected.
The close relationship between fever and inflamma-
tion should not be forgotten, and indeed it is well in
practice to recognize them as requiring the same treat-
ment; an inflammation is fever of a part. The reme-
dies for fever are remedies for inflammation, and in
many cases they are the best and most direct we have,
If, in the majority of cases, the pulse is brought down
to a normal standard, the temperature reduced, inner-
vation normal, and the secretions restored, the inflam-
matory process will cease, and if the life of the part
has not been too much impaired, resolution will be
rapidly effected.
In studying the treatment of inflammation it is well
to bear in mind the different phases of the morbid pro-
cess. First, irritation and determination of blood;
second, impairment of capillary circulation until its
final arrest, and lastly, the impairment of the life of
the tissues from this and the exudation. The irritation
may continue through the entire progress of the in-
flammation, and thus will continuously attract the blood
to the part, whilst from the commencement there are
marked evidences of impairment of tissue life.
Anything that will lessen or remove irritation will
prove a remedy in inflammation. Take away the irri-
ation, and you take away the cause of an excited cir-
culation of blood to and in a part. The general means
have been already referred to, but some of them are
local as well. The sedatives, Veratrum and Aconite,
1
STUDY OF DIAGNOSIS.
329
1
influence the inflammatory process directly, wherever
it may be located. So do the indirect sedatives of the
olden time—the nauseant emetics, and the more power-
ful diaphoretics.
In the selection of local means, we must closely
value the inflammatory process, and determine the
kind of influence most desirable. It may be directly
sedative, removing irritation, and in some instances
may be depressant. In others, whilst an object is to
remove irritation, we also keep in view the greater ne-
cessity of stimulation to the capillary circulation. And
in many we keep in view, as a principal object, such
treatment as will increase the life of the tissues.
When we have determined by an examination that
the inflammation must terminate in suppuration, we
should not forget that resolution goes on at the same
time, and that it is our business to confine the suppu-
rative process to as small a proportion as possible, and
to obtain resolution as far as is practicable. The treat-
ment is just the same as in mortification; we wish to
restrict the death to as small a portion as possible, and
we do it by strengthening the life of the tissues.
The means named are those which might be em-
braced under the head of physiological medicine, and
give us an excellent basis of treatment in many cases.
In some we have special means, the action of which
can not be explained in this way. These remedies are
indicated by some special expression of disease, and as
we have already seen, they prove curative in very
diverse (seemingly) conditions of disease. I need but
instance the action of Tincture of Muriate of Iron in
erysipelas; the action of Rhus, Bryonia and Macrotys
and some other agents in the arrest of special inflam-
330
STUDY OF DIAGNOSIS.
mations, or the special action on individual parts or
associate functions, as Phytolacca in mammary inflam-
mation, or in disease arising from nursing.
INNERVATION,
We divide the nervous system into three parts, for
study-the brain, the spinal cord, and sympathetic.
The first is the organ of conscious life, the second of
automatic movement, and the third governs and asso-
ciates the functions of vegetative life. The functions
of the brain are reason, emotion, volition and sensation ;
of the spinal cord, the co-ordination of muscular action,
and the functions of respiration, defecation and urina-
tion, and expulsion of the uterine contents; and of the
sympathetic, digestion, circulation, nutrition, and secre-
tion and excretion.
Lesions of innervation may be due to a change in the
condition or structure of the nerve centres, or to some
lesion external to these. The more common lesions are
of the circulation, and we have them from the two
opposite conditions of an excited circulation—too much
blood in a part, or an enfeebled circulation—too little
blood in a part. Whenever we find these lesions, this.
is the first question we ask, and usually the symptoms
of hyperæmia or anæmia will be distinctly marked.
A physiological treatment will be based upon this, to a
considerable extent. If we have hyperemia we use
remedies which lessen excitation, if it is anæmia we
employ such agents as stimulate and give a more vig-
orous circulation. In the first cases the treatment may
be temporarily depressant, in the second it is always
restorative and tonic.
STUDY OF DIAGNOSIS.
331
We
DELIRIUM in acute disease is readily recognized.
The inability to reason rightly, and the illogical and
unreasonable expressions tell the story clearly.
say delirium is active, it is passive, it is coherent, it s in-
coherent-taking the entire range of that active con-
tinued expression, in which it is almost impossible to
control the patient, to the dreamy delirium of typhoid
fever, in which the patient is calm and still, or the mut
tering delirium that soon passes into coma.
But we are not so much interested in the expression
of delirium as we are in the symptoms indicating the
physical condition of the brain. We want to know
whether there is an active circulation, or an enfeebled
one; whether the patient can bear temporary depres-
sants, or requires stimulants and restoratives.
The
practitioner will recognize the pertinence of this in-
'quiry, as it points the way to the selection of direct
remedies. In the first case we use the sedatives and
associate means that relieve excitement, and the special
remedy, Gelseminum. In the second we use Quinine,
stimulants, restoratives, tonics and food.
It may be remarked here, that in addition to the
means selected in this way, any remedy which may be
indicated by special symptoms, is a remedy for delirium.
Thus we see a delirium rapidly disappear under the use
of an acid, an alkali, one of the antiseptics, Rhus, and
other agents heretofore spoken of. The two methods.
may be sometimes combined; though, if the symptoms
indicating a single remedy are pronounced it should be
first given.
In delirium tremens, we also find two conditions of the
brain as a basis for the wrong reason. A want of re-
cognition of this fact has given us some queer medical
332
STUDY OF DIAGNOSIS.
literature. For a time we will find our medical peri-
odicals teeming with recommendations of stimulants,
tonics and food as the means of cure; then for a time
they will recommend a sedative and depressant treat-
ment. It never seems to have impressed the profession
that delirium tremens might arise from two opposite
conditions of the brain-one in which the circulation
of the organ is depressed, and the other in which it is
too active-and yet this is very certainly the case.
If we find our patient with sunken eyes, blanched or
livid lips, cold extremities, and a small and feeble pulse,
we know that he requires stimulants, and especially
food. In the early stage of such a case we would ex-
pect to arrest its progress by the stimulant action of
Nux, Iodine and Hydrastis, and the use of beef-tea.
We can see how it is that Capsicum in large doses
should prove curative, and how small doses of Quinine,
Opium and Camphor exert a beneficial influence.
But if we find him with a florid face, full, bright eyes,
increased temperature, and a full, hard pulse, we recog-
nize a condition of undue excitement, and would hardly
use the treatment just named, though it has proven
successful in cases of delirium tremens. On the con-
trary, we propose to select remedies which will remove
the undue excitement of the circulation, and give rest
to the brain. Thus we give full doses of Veratrum and
Gelseminum, saline cathartics and diaphoretics, and
possibly follow with Bromide of Potash and Chloral.
If we study puerperal mania, or acute insanity, we
find two classes of cases, as in delirium tremens. In
one from exhaustive discharges, lactation, and starva-
tion (the regulation toast and tea), we have a condition
of anæmia. We find the face pallid, the eyes dull, the
STUDY OF DIAGNOSIS.
333
tongue broad and pallid, the pulse small and feeble, and
the extremities cool. We at once recognize that this
patient wants proper stimulants, tonics, restoratives,
and food, and as we give them we find that there is a
steady improvement. If we had employed the olden.
stereotyped treatment of purgatives and depletives, we
would have had a funeral, or a case for the lunatic
asylum.
But in other cases we do find a flushed face, full,
bright eyes, contracted tongue, increased temperature,
a full, hard pulse, and partial arrest of secretion. The
case is just as clear as the first one, and we cure it by
the use of the proper sedative, Gelseminum, and means
which will restore secretion and excretion. In this
case temporary depressants may sometimes be employed
with good results.
In chronic mania, the diagnosis of the physical condi-
tions of brain and body will be made in the usual way.
All wrongs of function and structure are to be removed
as far as possible, and the patient placed in the best
possible health. Thus if there are special indications
for any single remedy, this should be given. In some
cases the action of such agents is very speedy and per-
manent.
With regard to the psychological treatment, but little
need be said. It must be based upon this law of
nature" that in proportion as an organ or function is
used it gains strength; and as it is disused it loses
strength." In so far as the morbid mind has material
to feed upon, and has exercise, the insanity will be in
creased; and in so far as the normal functions of the
mind are disused, they become enfeebled. The object,
therefore, is, to call out the mind in orderly channels as
334
STUDY OF DIAGNOS18.
?
much as possible, and to give as little cause for the i
sane manifestations as possible, that the one may gain
strength and the other lose it.
What has been said with reference to reason is appli-
cable to the emotions, in so far as the necessity of re-
cognizing the physical lesions are concerned. Emo-
tional wrongs have a physical basis, and if perfect
health can be restored, they will pass away. Indeed,
permanent cures can only be effected in this way.
The wrongs of the emotions may be in either of the
three ways—excess, defect and perversion—but the first
and last associated, are usually met with. The expres-
sion is so distinct that it can hardly be mistaken; too
great a manifestation and rapid alternation of grief,
joy, hope, fear, exaltation, depression, etc., without
sufficient or corresponding cause, tells the story. Hys-
teria is the type of this class of diseases, though it in-
volves other than the emotions.
A defect in volition is often noticed as an element of
mental disease, and as an attendant upon some other
diseases. It is often remarked that the strong will is
an important means of recovery-" that when one wills
to get well, he will get well "-and every practitioner
will have noticed the difficulty of managing those cases
in which there was an indifference, or want of volition.
The expression of the face will frequently give this in-
formation before a word is spoken. The firm expres-
sion of the muscles of the mouth and closure of the
jaws is characteristic of strong will; whilst the relaxed
muscles of the mouth, and the general want of expres
sion, tells of enfeebled will.
Recovery will frequently depend as much, or more,
upon strengthening the will, as upon the use of reme-
1
STUDY OF DIAGNOSIS.
335
}
dies. If we can call it into action, by presenting addi-
tional motives for its exercise, or by a judicious stimu-
lation from attendants and friends, we find that it will
grow by exercise, and that which was difficult to the
patient at first soon becomes easy and natural.
The brain receives impressions from the world with-
out, and from the various parts of the body, through
the apparatus and nerves of special and general sense—
and this we call sensation. In the healthy body all
sensations from it are pleasurable, and the use of the
special senses is a source of pleasure. But in disease
sensation is unpleasant, and a source of discomfort, and
we designate it as pain. It is well to become thor-
oughly conscious of this, by passing the various sensa-
tions in review. To the sound eye, use is a pleasure,
and we only know the organ through the pleasurable
sense of vision; the impulse of sound waves upon the
ear is pleasurable; so is the use of the sense of taste,
and of smell. When we direct the mind to the appa-
ratus of digestion, we find that it gives pleasurable sen-
sations, in so far as it gives sensation at all; the func-
tion of respiration is pleasurable, and so is defecation.
and urination.
If
When this sense of pleasure is lost, we may know
that an organ or part is diseased, though the discomfort.
may not tell us the quality or amount of disease.
the use of the eye becomes a source of discomfort, our
attention is called to that organ as the seat of disease, ·
and we at once make a proper examination to deter-
mine its character. If the use of the ear is a source of
discomfort, we at once conclude that it is the seat of
disease, and we make the necessary examinations to
determine its exact character. If there be discomfort
}
336
STUDY OF DIAGNOSIS.
in the sense of taste, we know there is a wrong in the
mouth where these nerves are distributed, or of the
digestive apparatus to which these nerves stand sen-
tinel. If there be discomfort in the sense of smell, we
at once conclude there is disease of the nasal cavities.
So when there is discomfort from any apparatus or
function-the throat, larynx, lungs, stomach, bowels,
defæcation, urination, etc., we know there is disease,
and having our attention directed to its seat, we pro-
ceed with the proper examinations to determine its
character.
Persons will sometimes have their first knowledge of
organs or functions through discomfort and pain. The
dyspeptic realizes that he has a stomach through pain;
the minister realizes that he has a larynx, when it has
become irritable and painful by abuse; the location of
lungs, liver, spleen, bowels, kidneys, bladder, uterus,
etc., is first realized by many through the suffering of
disease.
It is well to bear in mind that pain may have two
causes-it may be due in principal part or in whole from
disease of the part that suffers, or of the brain that re-
ceives the impression. To determine this is an impor-
tant part of the diagnosis of pain. A little care in
noting the expression of the face, the eyes, and the
other functions of the brain will determine this in most
cases, and this may be supplemented by a careful ex-
amination of the part.
The diagnosis between the pain of structural disease
and neuralgia is usually made with ease. The absence
of heat, redness and swelling, in any considerable de-
gree, is usually sufficient, but in obscure cases it is well
to carry the examination further to determine lesions
of the blood, of nutrition, waste and excretion.
STUDY OF DIAGNOSIS.
337
:
General disease will give rise to the conditions of
pain, and to a considerable extent may be considered
its cause.
Thus, the vascular excitement and increased
temperature of fever render the brain more sensitive
to impressions, and the nerves more active purveyors.
The symptomatic fever that attends inflammation has
the same influence in increasing pain. Thus, in those
cases where pain is very severe, the means that lessen
the frequency of the pulse, diminish the temperature,
and establish secretion, are the most effective to cure
pain.
When we study the condition of the brain as a cause
of pain, we find that it is not one, as generally sup-
posed, but two, possibly three. In one case we have
evidence of vascular excitement in the flushed face,
bright eyes, contracted pupils, and increased tempera-
ture. And we meet this condition with Gelseminum,
the sedatives, and possibly the saline diuretics and
cathartics. In the second case we find the evidence of
an enfeebled circulation in the pallid, expressionless
lips, the dull eyes, dilated or immobile pupils, and pos-
sibly the coolness of nose, ears and forehead-the gen-
eral expression is of want of stimulus. In these cases
we think of nerve stimulants, of Belladonna, Quinine,
Nux, Ammonia, etc. The feeling of dullness and in-
clination to sleep attending some forms of pain is met
especially by Belladonna and Ergot. The wrongs of
perversion are not so easily determined, but with care
we may find the indications for special remedies, some-
times in the expression of the face, sometimes in the
appearance of the tongue, and sometimes in the changes
of the pulse.
There is no doubt that many times the character of
も
​29
338
STUDY OF DIAGNOSIS.
1
the pain may point out the special remedy for the cure
of the disease, though it is not as certain as other
means of diagnosis. If we could feel the pain, as we
feel the pulse, it would be different, but trusting to the
patient's uneducated senses, and his imperfect power of
analysis and expression, we find it uncertain. If per
sons are trained to close observation, analysis and ex-
pression in this regard, as in some Homœopathic fami-
lies, it may become very reliable.
Lesions of spinal innervation are diagnosed from
wrongs of function controlled by this nerve-center.
Thus impairment of muscular motion may be referred
to an enfeebled spinal cord, an exalted sensibility of
muscles, to increased spinal innervation, whilst all
forms of convulsion may be attributed to perverted
spinal innervation. Among the important functions
controlled from the spinal cord is that of respiration.
We will sometimes find deficient respiration, that phy-
sical examination will determine is not from structural
disease, and we reach the conclusion that it is want of
innervation. In acute disease we sometimes find this
so marked, that respiration can not be carried on except
through the influence of the will and the external re-
spiratory muscles. We notice that so soon as the
patient sleeps, respiration becomes more and more dif-
ficult, until at last he is suddenly aroused by a feeling
of asphyxia; thus rest is prevented, and death may re-
sult. In all these cases we think of spinal stimulants
as remedies, Nux Vomica and Strychnine being the
type-and increasing spinal innervation, we find our
patient breathes better, and gets necessary rest.
The lesions of excess are rather rare, but still they
deserve close study. We will find it marked in some
STUDY OF DIAGNOSIS.
339
cases by excessive muscular irritability, so that the
patient exhausts himself by over-exertion, or more fre-
quently by that uneasiness which might be called mus-
cular fret. In others the lesion is principally manifested
in the respiratory muscular apparatus, giving frequent
or irregular respiratory movements-respiratory fret-
or sometimes severe and intractable cough from very
slight internal irritation. In other cases we find the
evidence in defecation and urination, giving frequency
and some tenesmus, without corresponding internal
disease.
In these cases there is usually hyperemia of the cord,
marked by a full, hard pulse, tense skin and muscular
structures, and rigidity or contraction in all the expres
sions of the body. The remedies will be Veratrum,
Gelseminum, Sulphur in free doses, the saline cathartics
and diuretics, the cold wet-sheet pack, alkaline bath,
étc.
In some rare cases, there is a condition of anæmia,
and the patient requires Nux, Strychnine, Quinine,
Iron, Arsenic, stimulant baths, with restoratives and
animal foods.
The lesion of perversion gives us the entire series of
convulsive affections, so frequently met with in the
practice of medicine. In this case the spinal cord takes
complete control of the body, and sets it into disorderly
movement. How the wrong is produced, or what is
its exact character, is not known, but when once it has
obtained, the tendency is to its repetition. There is no
difficulty in its recognition; the complete arrest of the
function of the brain, and the disorderly activity of the
muscles is so marked that it can not be mistaken.
Two causes of convulsions are recognized: the one
340
STUDY OF DIAGNOSIS.
disease of the spinal cord itself-intrinsic, the other a
lesion of some other part-extrinsic. The exact condi-
tions of the spinal cord are not well known, but we
may recognize one of vascular excitement, and one of
atony and impaired circulation. In the first the surface
and face is flushed, the eyes bright and pupils con-
tracted, the pulse somewhat full and hard, and the tem-
perature usually increased. In the other the face is
pallid or livid, the eyes dull, the pupils dilated in the
intervals of spasm, the extremities cold, and the pulse
small and frequent. There is a third case in which
there is very evident congestion of the cord, and the
face will be full and dusky, the eyes protruding, and
the pulse full and oppressed.
These cases are usually so well marked that the diag-
nosis is not difficult, and a correct treatment is at once
suggested. In the first case we use Gelseminum or
Veratrum, or both. In the second case we use Lobelia,
Chloroform, Bromide of Ammonium, or the fœtid gum
resins. In the third case, Belladonna, Ergot, and pos-
sibly Aconite; Bromide of Ammonium is sometimes an
excellent remedy here..
It is most absurd to think of treating all cases of
convulsions with one prescription. Specific Medication
never goes that far, it treats conditions of disease, and
not names. The instance of convulsions furnishes a
very good example of the necessity of accurate diag-
nosis.
It is well to note here that the spinal cord having
formed a habit of convulsive action, has a tendency to
repeat this at varying intervals, even though no change
of structure, or disease of other parts can be found to
account for it. In addition to the treatment for the
STUDY OF DIAGNOSIS.
341
convulsions, this habit, or tendency to recurrence is to
be broken up, and we find in many cases that the
longer the convulsive action can be postponed, the less
disposition there is to its recurrence. In the treatment
of some cases of epilepsy, this is a principal object, and
any means which will even temporarily ward off an
attack, becomes a part of the cure.
The extrinsic causes deserve consideration, though
many times they have ceased before we are called to
treat the cases. If in infancy we find the gums swollen
and purplish, a free incision over the coming tooth may
relieve the convulsion at once. If green fruit or other
irritant ingesta has proven a cause of convulsions
through irritation of the stomach, an emetic will give
the speediest relief. If it has come from irritation of
the solar plexus, attended by pain-colic-Nux Vomica
will give relief. If from irritating materials in the
intestine, cathartic enemata may be of great service.
If from partial suppression of urine, the hot packs over
the loins, with Gelseminum, will be the treatment.
Worms may be a cause of convulsions, and yet I do
not think it advisable to give worm medicines, until all
symptoms of nervous irritation and convulsions have
been removed. Otherwise the additional irritation from
the worm medicine may prove fatal.
In epilepsy the original cause may pass away in a
few hours, or it may persist for years. Thus in some
cases an epilepsy will arise from a temporary irritation
of the stomach, the intestinal canal, or the reproductive
apparatus, and no traces of the lesion will be found
when we are called to treat the patient. But in other
cases the lesions will persist, and their occasional or
periodical increase will determine the convulsion. Thus,
342
STUDY OF DIAGNOSIS.
menstrual derangement may prove a continuous cause,
as will disease of kidneys, stomach, bowels, and some
other parts. In all cases the examination is carefully
made to detect local lesions, and when found, means are
employed to remove them as part of the cure.
The study of paralysis might follow the consideration
of the lesions of the brain and spinal cord, as it may
embrace either or both.. When the lesion is of one of
the hemispheres of the brain, the paralysis is of one-
half of the body, divided vertically, and is called hemi-
plegia. When it is of the spinal cord, it is of the lower
portion of the body, the division being horizontal, and
involves all parts below the seat of disease; this is
called paraplegia. When of but limited extent, we call
it local paralysis, and we trace it, to a lesion in the
course of the nerves, or to a limited disease of the cen
tre from which the nerve has its origin. Ha
1.
:
We must not suppose that when we have diagnosed
a paralysis by the impairment or total loss of motion
or sensation, or both, that we are ready to make a pre:
scription, and that all that is necessary to be done is
to stimulate the nerve centres or the affected parts, by
Strychnia, or electricity. We want to know the char-
acter of the wrong, both of the nerve centres and of
the general health, and when we have determined this
we can prescribe intelligently...
..!
In hemiplegia we will find two conditions of the
brain. In one case we will have a flushed face, bright
eyes, contracted pupils, increased temperature, im-
paired excretion, and a pulse characterized by fullness
and hardness. Surely no sane person would treat this
case with Nux or Strychnine? On the contrary, we
use the proper sedative, Gelseminum, means to establish
STUDY OF DIAGNOSIS.
343
1
secretion, and possibly suppurative counter-irritation.
In a second case the face is swollen and dusky, the lips
livid or purple, the eye dull, pupils dilated or immobile,
and the pulse full and oppressed. This patient wants
Belladonna, Ergot, Bromide of Ammonium, and wet-
cups to the spine, with, possibly, stimulating cathartics.
In a third case the head is cool, the face lacks expres-
sion, and the pulse is nearly normal, but wants force.
Every symptom points to anæmia of the brain, and to
the want of restoratives. Here we give Nux or Strych-
nine as nerve stimulants, the bitter tonics, good food,
and use electricity for its stimulant influence.
The diagnosis will take the same course in acute
paraplegia, and the same means will be used in its treat-
ment When it has been preceded by an injury, or by
inflammation, we wish to determine as nearly as pos-
sible the condition of the part, and whether or not the
lesion has destroyed the nerve structures. Even here
the treatment may be rational.
needs doing, whether it be to promote the removal of
effusion of organized lymph, or of water, or by an in-
crease of waste and nutrition gradually renew the dis-
eased structures until they are capable of doing their
work.
We do that which
Wrongs of the sympathetic nervous system are so in-
timately associated with lesion of the vegetative fanc-
tions that we find difficulty in separating them. Pos-
sibly it is only where an important part or the whole
of this system is involved, that it requires special study.
We e may classify these lesions as an excess, defect, or
perversion, though the excess is more an undue excita-
tion than an increase of power.
We will find this excess marked in an unnatural and
344
STUDY OF DIAGNOSIS.
}
•
unaccountable frequency or hardness of pulse, and an
unpleasant irritability of the organs of digestion and
secretion. There can be no improvement until we can
have better innervation. In such cases Veratrum has
a most excellent action, and followed by Arsenic, will
frequently effect cures in very stubborn cases.
Defect is marked by a feeble circulation, the artery
giving the sensation of a want of tone or elasticity,
and all the vegetative functions are feebly and imper-
fectly performed. That it is not due to a wrong of the
organs themselves is readily determined by other symp-
toms. In these cases, Phosphorus, Sulphur, Iron, Cod
Liver Oil, Pulsatilla, Digitalis, Aconite, are especially
indicated, the particular remedy being selected by spe-
cial symptoms.
Perversion of sympathetic innervation is shown by
irregularity in the performance of the vegetative func-
tions, and by changes in the character of the pulse,
other than frequency, strength, or feebleness, The
remedies will be selected, as named in the first part of
the work.
The association of the sympathetic with the spinal
nervous system gives us that condition of disease known
as spinal irritation. It is of frequent occurrence in
chronic disease, and when marked is sufficient to pre-
vent a cure by the ordinary means, being a continued
source of wrong innervation. It is a little singular
that the source of this lesion of the spinal cord should
always be an organ supplied from the sympathetic, and
that irritation should be so readily propagated back-
ward along these nerves. Yet it is a fact that a dis-
ease of irritation can not exist long in an organ with-
out some disturbance of the great sympathetic, and the
1
STUDY OF DIAGNOSIS.
345
"
spinal cord immediately behind the ganglion, that fur-
nish the nervous supply.
Spinal irritation is usually marked by tenderness on
pressure over the bodies of the vertebræ, and when
such tenderness is found, it is taken as evidence of this
lesion. But once in a while we will find the evidence
at some distance from the spine, but always in the
course or termination of the posterior spinal nerves.
It has been proposed by Prof. John King, to deter-
mine the locality of chronic visceral disease, by an ex-
amination of the spine, and this can be done where
there is spinal irritation. If the reader will refer to a
text-book on anatomy, he will see that the distribution
of sympathetic nerves, and connection with the spinal
cord is very simple. The sympathetic ganglia send off
large nerves, which before their distribution form a net-
work, called a plexus, and from this the nerves are dis-
tributed upon the nearest arteries. Thus if we know
the source of nerve supply to a plexus, and the distri-
bution of the arteries nearest to this, we will readily
make the association between a particular part of the
spinal-cord, and a special organ or organs. It might
be remarked that the connection between the cord and
the ganglia which lie upon the bodies of the vertebræ
in front, is immediately backward and forward by fila-
ments of communication, and that a limited portion of
the gray substance of the cord is thus associated in
action with a ganglion.
The first cervical ganglion sends its branches upwards.
on the carotids, to supply the brain and the organs of
special sense; and a nerve downward, which through the
cardiac plexus is distributed to the heart; thus to a
certain extent associating the brain and heart in action.
f
$
1
346
STUDY OF DIAGNOSIS.
The other cervical ganglia send nerves downward to
the cardiac plexus, which supplies the heart, and to
some extent the lungs. The upper dorsal ganglia
send off the great splanchnic, which passing through the
diaphragm form the solar plexus, and from this the
nerves are distributed upon the cœliac axis to the
stomach, liver and spleen, and upon the superior me-
senteric to the small intestine and pancreas. Branches
from this pass downwards upon the spermatic artery to
the testes in the male and the ovaries and uterus in the
female. The lower dorsal ganglia furnish the lesser
splanchnic nerves, which form above the renal arteries
the renal plexus, and furnish nervous supply to the
kidneys, ureters and bladder. The dorsal ganglia fur-
nish nerves for the formation of the hypogastric plexus,
which gives nervous supply to the pelvic viscera. The
sacral ganglia furnish nerves for the sacral plexus,
which supplies some parts at the outlets of the pelvis,
and the lower extremities.
The above is but a brief synopsis of this subject, and
the reader will do well to give it a thorough study, and
trace out the distribution of these nerves on an anatom-
'cal plate. It will be found that there is a free inter-
communication between different parts, some more
especially than others, and thus many sympathies ob-
served in health and disease can be accounted for.
•
In the olden time we were in the habit of recom-
mending the irritating plaster for all these cases, and
though unpleasant, it may be employed with advantage
in a great many. It is better, however, to determine
more exactly the condition of the cord, as quite surely
it is not always the same. Possibly our old division
will serve our purpose here, classifying them with refer-
STUDY OF DIAGNOSIS.
347
nce to the circulation-a, with vascular excitement;
b, with enfeebled circulation, or spinal anemia.
The case of vascular excitement will be shown in the
bright eyes and contracted pupils, slight increase of
temperature, and a pulse that has hardness and undue
vibration as an element. It is especially the case for
suppurative counter-irritation over the site of tender-
ness, though I prefer, as being much pleasanter, the use
of the wet-pack, of water, vinegar, or water acidulated
with Sulphurous Acid. The internal remedies will em-
brace Veratrum, Gelseminum, Bromide of Potash, and
these may be aided by means to establish secretion.
The case of anæmia of the cord will be recognized.
by the dull, sunken eye, feeble circulation to the sur-
face and extremities, and a pulse that wants strength.
In many of these cases the skin is relaxed, and there is
undue exudation. These cases may have the irritating
plaster used to rubefaction, stimulant frictions, rubbing
of the spine with salt water, the use of electricity
(Faradization) and means of a similar character. In-
ternally the remedies will embrace Nux, Ergot, stimu-
lant doses of Iodine, Pulsatilla, Bromide of Ammonium,
and if the pulse is small and vibratile, Rhus.
There are a few cases, marked by a full, sluggish,
and oppressed pulse, dull eye and dilated pupil, in
which Belladonna and Ergot will prove very efficient.
internal remedies, and in which a Belladonna plaster is
the best local application.
348
STUDY OF DIAGNOSIS.
NOSOLOGICAL CLASSIFICATION.
The study of this is beyond the scope of this little
volume, and the reader is referred to works on the
"Practice of Medicine," or special treatises on diag
nosis, in which this classification is the basis. Our
study has been wholly with reference to the selection
of remedies, and the ordinary nomenclature interests
us only as it points us to groups of remedies.
The study of nosology is of some importance in
"enabling one to give appropriate names, in writing or
conversing of disease, and especially as satisfying the
friends of a patient, who are always desirous of having
a disease named. If the reader will take the classifica-
tion given, and apply the methods of examination
named through this work, he will find but little diffi-
culty. We will pass it in brief review, pointing out the
method of study, and giving the most pronounced
symptoms.
CHLOROSIS.-In the early menstrual period, usually
before the age of twenty; is characterized by want of
blood, impaired nutrition, loss of flesh and strength, and
differs from anæmia only in a greenish coloration of
the otherwise blanched and bloodless skin. The name
has no meaning in selecting remedies, unless in some
cases, the peculiar shade of green would indicate Cop-
per, and in others Sulphate of Alumina and Iron.
SCORBUTIS-IS caused by a want of vegetable food,
and is especially marked by softened and spongy gums,
usually of a deeper color than natural; and, finally, by
a tendency to deliquescence in all tissues of low organi.
1
STUDY OF DIAGNOSIS.
349
+
zation, especially cicatrical tissue. The name indicates
a special pathological condition, and calls for vegetable
acids (Citric Acid or lemon juice), and for vegetables,
especially those containing a considerable amount of
Potash.
DROPSY-Has different causes, which require special
study. It is characterized by exudations of water into
the cellular tissues—œdema, anasarca; or into the
serous cavities ascites, hydrothorax, hydropericardium,
hydrocephalus, hydrocele, and hydrops articuli. The
diagnosis is made by the touch, which gives a different
sensation from growths, deposits, or accumulations of
pus, blood, or gases. It refers us to special remedies,
Apocynum, Aralia, and the hydragogue cathartics and
diuretics for the removal of the accumulated fluid.
DIABETES MELLITUS.-Increased flow of urine, with
loss of flesh and strength, and impairment of every
function. Examination of the urine, as named under
that head, determines the presence of sugar. The name
does not point to remedies, which must be selected with
reference to the symptoms in each individual case.
PYÆMIA-A condition of blood simulating suppura-
tion in solids, usually having its origin in injuries or
wounds of loose, non-vital tissues, though it may arise.
from wounds of any part in which putrescency develops.
The condition may be known by the extreme restless-
ness, and fear of a fatal result, a small, tremulous pulse,
(sometimes the pulse has its usual inflammatory condi-
tion until a short time before death), a peculiar con-
striction of tissue about the base of the brain, pinched
nose, and a general expression of irritability. It points
35C
STUDY OF DIAGNOSIS.
us to antiseptics and good food, as the means of cure.
Opiates should not be used to relieve pain, if it is pos-
sible to get along without them.
TUBERCULOSIS.-The impairment of the blood that
gives rise to aplastic and cacoplastic deposits, has
already been described. There is impairment of diges-
tion, blood-making and nutrition, with loss of flesh
and strength, local symptoms indicating the situation
of the deposit. The treatment is suggested by the
above description-increase retrograde metamorpho-
sis and excretion, and remove the low albuminoid mate-
rials, and improve nutrition.
FEVER.-The different forms of fever have been de-
scribed in a preceding classification, and it is only
necessary here to call attention to the principal phe-
nomena, and the treatment. A fever is a disease of
four stages forming, cold, hot and sweating. The
symptoms of the first are of prostration-there is an
impairment of life. In the second this impairment is
still greater, especially of innervation and circulation,
and the patient feels cold. In the third vascular and
nervous excitement are marked, the pulse is frequent,
the temperature increased, the secretions partially
arrested, and the vegetative functions impaired in pro-
portion to the severity of the disease. In the fourth
stage, the various functions are restored, and excretion
estäblished-it is convalescence. Whether a fever lasts
a day or a month, it has these symptoms, with addi-
tional ones showing a wrong of the blood.
+
The treatment suggested is very plain. In the form-
ing and cold stages means to increase the life, and espe-
cially to stimulate the nervous and vascular systems
1
STUDY OF DIAGNOSIS.
351
In the hot stage, to reduce the frequency of the pulse,
the temperature and excitation of the nervous system,
and to increase excretion and the vegetative functions,
employ such means as will check destruction of the
blood, or that will neutralize any morbid element in it.
LOCAL DISEASE.-Local disease is determined by the
unpleasant sensations in the part, experienced by the
patient; by change in its functional expression; and
by an examination with our senses. and the application
of any instrumentality that medicine affords.
The distinction between functional and structural
disease is determined by the careful examination of the
physician. In functional disease we expect to find
little or no change in the physical properties of the
part; in structural disease such changes will be de-
tected
THE BRAIN,—Disease of the brain is shown by un-
pleasant and painful sensations experienced in the
organ, a change in the expression of the face and body,
and changes in its functional expression. The charac-
ter of the disease will be diagnosed by symptoms
already pointed out.
It suggests the use of brain remedies, in addition to a
right general treatment. As examples we may name
Gelseminum, Belladonna, Pulsatilla, Opium, Bromides.
of Potash and Ammonium, Phosphorus, Cypripedium,
Camphor, Nux, Quinia, Rhus.
THE SPINAL CORD.-Disease of the spinal cord is
shown by unpleasant sensations experienced in the
spine by the patient, by wrongs of muscular movement,
respiration, etc. The same remedies are employed as
for the brain,
352
STUDY OF DIAGNOSIS.
OF THE NOSE.-Unpleasant sensations in and change
in secretion of the nasal mucous membrane. Remedies
that influence mucous membranes.
PHARYNX.-Sore throat, with unpleasant sensations
in deglutition and respiration. The throat can be in-
spected and changes of structure noted.
LARYNX.-Unpleasant sensations in the part; change
in the voice; difficulty of respiration; cough; sputa;
and change in the sounds on auscultation. Special
remedies, Aconite, Spongia, Antimony, Collinsonia.
BRONCHIA. Unpleasant sensations in the thorax;
difficult respiration; cough; sputa; and change in the
sounds heard on auscultation-blowing. Treatment
will be general, and remedies that influence mucous
membranes.
LUNGS.-Unpleasant sensations in the thorax; diffi-
cult respiration; cough; sputa; sounds heard in aus-
cultation-crepitant; percussion gives dullness when
consolidation has taken place from any cause.
Reme-
dies, Aconite, Ipecac, Lobelia, Drosera, Agrimonia,
Phosphorus.
HEART.-Unpleasant sensations in the præcordia;
sense of oppression and impending danger; change in
the pulse; and impairment of the circulation. Special-
remedies, Veratrum, Aconite, Digitalis, Cactus, Pulsa-
tilla, Rhus, Bryonia.
PLEURA.-Pains of a sharp, lancinating character
difficulty in inspiration; cough; no change upon aus
cultation except in rare cases; dullness on percussion
from effusion. Remedies are all general, unless we ex
cept Bryonia and Asclepias.
STUDY OF DIAGNOSIS.
353
MOUTH AND SALIVARY GLANDS.—Unpleasant sensa-
tions, especially on taking food; on exposure structural
lesions can be seen and felt. Special remedies, Mer-
cury, Iris, Podophyllin, Phytolacca, Collinsonia.
ESOPHAGUS.-Difficult deglutition. Remedies gen-
eral, except for nervous dysphagia, Pulsatilla.
TONSILS.-Uneasy sensations in the throat; difficult
deglutition and respiration; can be inspected and
changes in size and form noted. Remedies, Aconite,
Nitrate of Potash.
STOMACH.-Unpleasant sensations in the region of
the stomach, and impairment of function. Special
remedies, Hydrocyanic Acid, Bismuth, Muriatic Acid,
Lactic Acid, Pepsin, Hydrastis, Podophyllin, Leptan-
drin, Nux, the class of emetics.
SMALL INTESTINE.-Uneasiness in the abdomen; im-
pairment of digestion; diarrhoea. Special remedies,
Bismuth, Podophyllin, Nitric Acid, Hydrastis, Nux,
Agrimonia, Epilobium, Aconite, Ipecac, a part of the
class of cathartics.
LARGE INTESTINE. Uneasiness in the abdomen;
tormina; tenesmus; and small, non-fæcal evacuations.
Special remedies, Aconite, Ipecac, Aloes, Colocynth,
Hamamelis, Collinsonia.
LIVER.-Unpleasant sensations in right hypochon-
drium, with occasional slight change in form and size;
impairment of digestion; and changes in the color of
the skin. Special remedies, Leptandra, Nux, Nitric
Acid, Sulphur.
30
354
STUDY OF DIAGNOSIS.
SPLEEN.-Unpleasant sensations in left hypochon-
drium; change in form and position of the organ de-
termined by the touch; and impairment of blood-mak-
ing and nutrition. No special remedy unless it be the
Uvedalia.
PERITONEUM.-Sharp, lancinating pain in the abdo-
men, increased by pressure, motion or respiration, with
small, wiry pulse, if inflammatory. No special reme-
dies.
1
SUPRA-RENAL CAPSULES.-But one disease known-
Addison's characterized by bronzed discoloration of
the skin, gradually increasing, and associated with im-
pairment of the vegetative functions. No remedies
known.
KIDNEYS.-Unpleasant sensations in the lumbar re-
gion near spine, in the urinary apparatus below, and in
micturition; changes in the urine determined by ex-
amination; and an influence upon the nervous system
by retained urea-excitation at first, coma following.
Special remedies, Gelseminum, Belladonna, and the
class of diuretics.
5
BLADDER.-Unpleasant sensations behind the pubes;
perineal pressure; difficult and painful micturition; and
the presence of its secretion, mucus or pus, in tho
urine. Special remedies, Eryngium, Apis, Phosphorus,
Hydrangea, Agrimonia, Staphysagria.
PROSTATE GLAND.-Unpleasant sensations in the peri-
neum; difficult and painful micturition; and an ex-
amination externally and by rectum determines change
in size and sensibility. Special remedies, Staphysagria
Hamamelis, Phosphorus, Pulsatilla.
STUDY OF DIAGNOSIS.
355
URETHRA.-Unpleasant sensations in passing water,
discharges. Special remedies, Cannabis Indica, Copai-
ba, Cubebs, Macrotys, Sandal Wood.
*
TESTES.-Unpleasant sensations in; changes in size
and form. Special remedies, Phytolacca, the Bromides,
Pulsatilla, Staphysagria, Phosphorus, Iodine.
:
OVARIES.-Unpleasant sensations in the iliac regions;
change of size and sensibility to the touch; and wronge
of the reproductive function. Special remedies, Ma-
crotys, Actea, Caulophyllum, Pulsatilla.
1
UTERUS.-Unpleasant sensations in the pelvis ; change
of size and form; change of position; change in the
menstrual and reproductive functions by the discharges;
change in the tissues determined by the touch and by
sight Special remedies, Ergot, Macrotys, Caulophyl-
lum..
VAGINA AND VULVA.-Unpleasant sensations; by the
discharges; and by an examination by the touch and
speculum. Special remedies, those which influence the
reproductive function; other remedies such as influence
mucous membranes, and the general health.
ARTERIES.-Changes in the sensation given to the
touch, and impairment of the circulation. Special
remedies, the same that influence the heart.
VEINS.-Change in size, form, course, and in their
color. Special remedies, Hamamelis, Ergot, Iron.
LYMPHATIC GLANDS. Changes in size, in tempera-
ture and in sensibility; with special impairment of the
356
STUDY OF DIAGNOSIS.
blood, and of nutrition in some cases. Special reme-
dies, Phytolacca, Iris, Stillingia, Alnus, Scrophularia,
Iodine, Bromine, Phosphorus, Arsenic.
SKIN.-Unpleasant sensations; charges in structure
determined by examination. Special remedies, diapho-
retics, Arsenic, Phosphorus, Sulphur.
EYE.---Unpleasant sensations; wrongs of function.
Special remedies, Belladonna, Calabar Bean, Gelsemi-
num, Opium, Rhus, Macrotys, Cannabis Indica, Arsenic.
EAR.-Unpleasant sensations; wrongs of function.
No special remedies.
BONES.-Unpleasant sensations; change of form, size,
sensibility, and impaired use. No special remedies.
MUSCULAR TISSUES.-Unpleasant sensations in move-
ment; changes in size, form and sensibility. Special
remedies, Macrotys, Apocynum, Bryonia, Sticta, Phyto-
lacca, Colchicum, Potasseæ.
ARTICULATIONS.-Unpleasant sensations; changes in
form, size and sensibility. No special remedies, except
possibly Bryonia and Macrotys.
CELLULAR TISSUE.-Symptoms of inflammation, sup-
puration. Special remedy, Lime.
We have passed most of the organs and tissues in
review, in order to impress the fact that remedies do
act on special parts. Only a few remedies have been
named as examples, but the reader is advised to make
notes of remedies under the various heads as they come
to his notice by reading or experiment. It must prove
·
****
"
STUDY OF DIAGNOSIS.
357
of value in therapeutics, to be able to at once associate a
group of remedies with special parts and functions, as hav-
ing them thus clearly before us we can better choose the
individual remedy applicable to the case in hand.
Much more might have been written on this subject, and
I doubt not the reader will feel that a more minute exam-
ination of local disease would have been profitable. Yet
there are many authorities who give this information, and
as said before, it is beyond the scope of our work to make
this study.
Something must be left for each reader to think out for
himself, (and this is really the most profitable study), and
I have endeavored to point out the way, and give subjects
for such thought. The physician who does his own think-
ing will always have the largest measure of success, and
the greatest pleasure in and from his work.
1
1
INDEX OF REMEDIES.
In appending an index of remedies, I desire to point out the
prominent indications for their use, whilst reference is made tc
the pages where the agents are noticed. With some of the agents
this index will be quite a complete study, and as the reader has
all the special indications before him, he will be better able to
group them together. So in the study of individual remedies,
I thought it would be better to so arrange the index that the
reader might do his reading with reference to the one agent; or
when using it as a work of reference, he would be pointed to the
special feature he desired to study.
Acids, Indicated by deep redness of tongue and other parts
1
freely supplied with blood,..…………………….
Slick tongue……………..
…………………..80, 81, 102
103
In stomachic digestion.........
Acid Acetic, Indicated by deep redness, zymosis..............81,
Lactic, Indicated by deep redness...
Tissues pinched and stringy.
Eructations from stomach…………………..
Sepsis......
Gastric digestion
271
81, 102
81
143
112
111
272
In diseases of the stomach......
353
Muriatic, Contraction of tissues..
65
Deep redness of mucous membranes..
81
((
and condition of stomach……………………..
102
Slick tongue.......
103
360
STUDY OF DIAGNOSIS.
$
Acid, Muriatic, Sepsis..........
111
Eructations from stomach.........
112
Hot breath, pungent.……………….
199
"
As an epidemic remedy.
Typhoid symptoms
Pungent heat
Gastric digestion..
In diseases of the stomach…………...
Nitric, Irritation of sympathetic.......
Violet color..........
To influence the temperature...
As an epidemic remedy...
Whooping cough......
To influence the pancreas
Sulphurous, Color muddy or dirty
Erysipelatous redness, blanched
Dirty tongue...
Increased secretion of saliva.......
Large pulse, empty.....
Mawkish odor from excreta......
As an epidemic remedy...
………………..221, 227
238
263
272
....
353
65
.82, 103
166
229
་
...........
- 230
293
83
90
....
104
111
153
198
breathi
199
227
Zymosis.....
Typhoid symptoms.....
231
238
Pungent heat……………………..
Aconite, Illustrating the certainty of medicine....... ……………. ..
273
15
Inflammation of brain......
62
Effusion, with bright eyes
...63
Constriction about temples...
65
Shrunken face........
66
Simple increase of color...
78
Vascular excitement....
79
Constriction and thinning of structures...
84
Elongated and pointed tongue...
95
Contraction of tongue...
106
Eructations from stomach………………………………….
112
Contraction and irritability of muscular tissue..........
142
Small pulse......
153
INDEX.
361
Aconite, Epidemic remedy....
To influence the nerve centers
Tongue, redness of tip and edges.
Contracted slick tongue.....……….
To infinence the pancreas..
To influence secretion.......
To influence the kidneys.
Frequency of pulse..........
Determination of blood..........
Congestion....
In inflammation………….
To influence sympathetic innervation
227
26.
269
272
293
299
304
31'
322
323
328
344
In diseases of the larynx, lungs and heart…………..
352
In diseases of the stomach and intestinal canal
353
Acetate of Potash, Sensation of fullness without elasticity... 143
To remove bile pigment.....
290
Alkaline Salts, Pallid tongue......
101
211
102
Acidity of stomach..
Potash, Muscular wrongs
Alcoholic Stimulants, Oppressed voice, hollow and unsteady, 174
Small, soft pulse......
Asclepias, Rubeola, measles.....
Apis, Surface hot, burning, painful, dry……..
In disease of the bladder.
Aralia, A remedy for dropsy.
Ammonia, Enfeebled capillary circulation.......
Scarlatina......
As an antidote.........
As a cerebral stimulant
Actea, Pinkish color..........
153
229
231
354
349
79
229
...
247
337
86
355
In the treatment of disease of the ovaries........
Arsenic, White line around mouth, dragging down of corners, 85
Tongue large, thick in center, incurved edges.....
Dull and opaque skin....
Increased secretion of saliva..
Pinched, contracted tissues.
Open, tremulous pulse........
Feebleness of voice......
103
93
111
...
....
144
154
174
31
362
STUDY OF DIAGNOSIS.
Arsenic, Influence upon the temperature.....………….
Defect in excretion from the lungs.....
Anemia of the spinal cord....………………
In the treatment of diseases of the skin...
Alnus, In disease of the lymphatic glands....
Apocynum, Fullness of eyes, fullness of face, drawing down
of corners of mouth......
Duli eyes and relaxation of face..
:
Full eyelids..
261
297
339
356
356
62
63
..66, 84
Full pulse, doughy, accompanied by muscular pain... 153
Edema of cellular tissue.………….
Defect in excretion from the lungs.........
To increase excretion from bowels......
A remedy for dropsy.
....
In diseases of muscular tissue....
Asclepias, In disease of the pleura........
Agrimonia, In diseases of the respiratory apparatus……....
In diseases of the gastro-intestinal canal…………..
In diseases of the kidneys......
Aloes, To influence the large intestine.......
Baptisia, Deep color, purplish, brown, black.…………………….
แ
sepsis......
Saliva, viscosity of......
Full pulse, oppressed..
Pungent heat.....
Fetor of cynanche.
An epidemic remedy.
Typhoid symptoms.....
155
297
307
...... 349
356
352
352
353
354
353
82
103
111
153
165
199
....
227
238
263
62
......
63
66
79
87
106
153
....
.166, 261
Pungent heat, sepsis.
Dull, sodden expression of face.
Belladonna, Dull eyes, dilated pupils.....
Expressionless eyes.........
Slow return of capillary circulation when pressure is
made upon the skin.........
Fullness of tongue.....
Dull, colorless eye….………..
Full, oppressed pulse…………..
To influence the temperature...
INDEX.
363
J
Feebleness of voice
174
Spasmodic cough....
179
Pain in head, heavy, dull, sleepy
203
......
Pain dull, heavy, full, with sense of functional im-
pairment..
206
An epidemic remedy....
227
Scarlatina......
In convulsions.....
229
231
To infiuence the skin.
299
To influence the kidneys.......
To influence the circulation.
A remedy for congestion.......
Feeble cerebral circulation...
In the treatment of paralysis.
In disease of the brain.......
In disease of the kidneys...
In disease of the eye...
Bismuth, Dragging down of corners of mouth........
Elongated and pointed tongue.…………………….
Eructations, pyrosis.......
304
317
.... .....
323
•
337
.343
351
354
356
85
95
112
}
Irritation of stomach
269
Excess of gastric juice......
271
Intestinal dyspepsia.......
272
To influence the pancreas......
293
In diseases of the stomach and small intestine............ 353
.
Bitter Tonics, Relaxation of tissue.........
143
Defect in electricity……..
265
Want of expression.......
Absurdity in prescription......
Intestinal atony.
267
270
273
Want of appetite.
277
Bryonia, Constricted tissues.
65
Right eyebrow drawn down, flushed right cheek.......
66
Pain, excited circulation......
69
Deep flush of right cheek......
86
Venous obstruction.......
7S
Sharp stroke of pulse, even vibratile current......
To lessen the temperature…………….
154
168
"
364
STUDY OF DIAGNOSIS.
Bryonia, Cough points at supra-sternal notch...
.....
Pain in right side of head, passing from before back-
ward........
....
Pain, with sense of oppression.....
An epidemic remedy....
Excess of temperature……….
Wrong in combustion......
To influence excretion from the lungs
To influence excretion from the skin..........
In the treatment of inflammation
In diseases of the respiratory apparatus......
In diseases of the articulations........
Beeberina, Brownish discoloration of skin....
Bromides, Scanty secretion of saliva.....
In diseases of the testes......
....
To influence the lymphatic glands......
178
203
205
221, 227
260
261
297
299
...
329
....
352
356
92
.... 110
355
...
Bromide of Ammonium, Sudden cry, with sobbing respira-
tion......
Spasmodic cough...
In disease of the spinal cord.
In the treatment of paralysis.......
In the treatment of spinal irritation.......
In diseases of the brain......
Bromide of Potash, A remedy in delirium tremens…..
Carbolic Acid, Blanched appearance in inflammation
In spinal irritation………..
In disease of the brain.
Dark coating of tongue....
Fetor of putrescence…………………………...
Camphor, In disease of the brain........
In delirium tremens....
Caulophyllum, In disease of the ovaries
Cactus, Præcordial oppression…………….
Irregularity of pulse, wrong of stroke.......
Cough pointing at supra-sternal notch......
Morbid sounds from the heart.........……. …………………….
To influence the temperature...
To influence the pancreas…..
356
175
179
...... 340
343
347
351
332
347
351
90
104
198
351
332
355
82
154
178
195
261
291
INDEX.
366
Cactus, To influence the skin.………….. ……….
In diseases of the heart.......
Canabis Indica, In diseases of the urethra.…………….
In diseases of the eye......
Calabar Bean, To influence the eyes.
Cold feet...
Capsicum, Want of power in pulse.
In the treatment of delirium tremens...
Chloroform, to relieve irritation of the sympathetic nervous
system.........
Præcordial oppression....
Elongated, pointed tongue.
In the treatment of convulsions.....
Chloral, In the treatment of delirium tremens...
Cathartics, Stimulant, Congestion of brain.........
Hydragogue, Effusion into brain……………...
Full, broad tongue......
Heavily loaded tongue.
Creasote, In scarlet fever.....
Chloride of Sodium, Blueness with pallor ......
Increased secretion of saliva.....
In scarlet fever…………………….
Colocynth, To influence the large intestine....
297
352
355
356
356
153
169, 263
332
65
82
106
340
332
62
63
95
99
229
82
111
229
353
Chlorate of Potash, Appearance of tongue
Increased secretion of saliva....
104
111
Sepsis.........
165
Odor resembling lochial discharge.......
199
An epidemic remedy......
227
In puerperal fever.............
231
Typhoid symptoms......
238
Pungent heat.........
263
Chlorine, Odor of putrescence
195
Chlorinated Soda, In puerperal fever.
231
Cod-liver Oil, Pinched, stringy tissues.....
Want of calorifacient food.......
144
169
Feebleness of voice........
174
To influence the temperature…………………
261
In defective sympathetic innervation....
344
:
366
STUDY OF DIAGNOSIS.
Chloride of Lime, As a disinfociant……………………
198
Cider, Deep red tongue, dry, contracted, with dark sordes... 102
Collinsonia, In diseases of the larynx
Influences the large intestine and rectum
...
I
Chelidonium, Color dull and opaque......
352
353
-92
1
Dull, heavy, tensive pain, with occasional twinges, as
if the part was being toru..………. ……………. ……….
Dull, leaden, yellow fur......
Intestinal dyspepsia....
A pancreatic medicine......
Chamomilla, Gastric indigestion
Intestinal indigestion...
Charcoal, Excess of gastric juice…......
Columbo, Atony of stomach.……………………
Copper, Sallowness with a tinge of green.......
Dull, cheesy-looking fur with tinge of green
An epidemic remedy........
As a restorative…........
Greenish pallor of skin....
In Chlorosis.....
10€
100
273
...
292
270
272
271
270
92
101
.222, 223
274
277
348
Colchicum, In disease of muscular and fibrous tissue......... 356
Cupping, Congestion of brain……………….
Effusion into brain……………...
Cypripedium, In the treatment of diseases of the brain
Digitalis, Fullness of the tissues of the face.....
Dull, leaden color.........
Pulse, want of power in impulse.....
To influence the temperature..
Frequent pulse…………………...
62
63
351
65.
82
153
261
317
318
... 344
179
22
229
297
352
……………………..99, 271
299
Change in the character of the pulse...........
To influence the sympathetic nervous system…………………….
Drosera, Spasmodic cough.........
Whooping cough.....
Measles,
་་
To influence excretion from the lungs.....
In diseases of the respiratory apparatus...
Emetics, Heavily loaded tongue at base……………………..
Erecthites, In excessive secretion from skin......
INDEX.
367
Erigeron, Passive hemorrhage………..
To influence secretion from the skin......
Ergot, Fullness of eyes, face, prominent veins...
Passive hemorrhage…………………………….
115
299
62
115
Feeble voice, sighing respiration......
A remedy for congestion………..
Slowness of pulse..........
In the treatment of paralysis........
174
304
318
343
In disease of the spinal cord.........
To influence the uterus....
Electricity, To influence the temperature...
347
355
261
Epilobium, Intestinal irritation........
272
In disease of the gastro-intestinal canal..
353
Eryngium, Irritation of the bladder.....
322
In disease of the bladder........
354
Gentian, Loss of appetite,...........
270
Inflammation of brain....……….
Gelseminum, Bright eyes, contracted pupils, flushed face..... 61
Pain, with evidence of excitation.........
Restlessness, with determination of blood.....
62
69
71
Vascular excitement....
Elongated and pointed tongue.………….
Pinched, contracted tissues.....
Full pulse, vibratile…………………………….
79
106
142
153
To influence the temperature….....
Sudden, shrill, sharp cry..
Pain, sharp, restless.......
Exalted sensibility, arterial throbbing.
An epidemic remedy.
To influence the skin.............
In jaundice...……………….
In irritation of the kidneys..
Frequent pulse…………………….
In the treatment of delirium......
..166, 260
175
203
206
227
299
290
....
...304
317
331
mania
333
convulsions
340
paralysis..........
342
44
delirium tremens......
332
ย
368
STUDY OF DIAGNOSIS.
Gelseminum, Determination of blood...
In hyperemia of the spinal cord....
In suppression of urine........
To influence the sympathetic........
Gallic Acid, Passive hemorrhage.......
Helonias, Pinkish color of surface....
Hydrastis, Yellow coating of tongue........
Intestinal dyspepsia.......
Eructations feebly acid......
Indigestion.......
Tongue full and expressionless...
In disease of the stomach......
In delirium tremens..........
Hamamelis, Swollen, relaxed eyelids……………
Color purplish from venous stasis
In diseases of the large intestine.....
urinary apparatus.....
venous system....
Hydrangea, In diseases of the bladder.
...
Hypophosphites, Pinkish color of surface.......
Dull, leaden color of tongue...……………..
Tissues loose and flaccid….....
Feebleness of voice.......
To influence the temperature………….
322
339
341
347
1:5
86
100
..... 111
112
269
270
353
332
84
89
353
...
354
...... 355
344
86
103
143
174
261
Hydrocyanic Acid, Elongated and pointed tongue, reddened
tip and edges..………………….
Acid eructations.....
Gastro-intestinal irritation.......
In diseases of the gatro-intestinal canal....
Iodides, Scanty secretion of saliva.........
...
95
112
269
353
110
Iodide of Ammonium, Tissues pinched and contracted...... 144
Localized pain........
Iodide of Potassium, Fullness without elasticity.
Not when tissues are pinched or stringy.......
Iodine, As a disinfectant......
શ
To influence the pancreas.
In the treatment of delirium tremens……………………………..
A stimulant to the sympathetic......
206
143
144
...
198
292
....
332
347
INDEX.
369
1
Iodine, To influence the lymphatic systein....
Iron, Muriate of, To influence the skin
In the treatment of inflammation....
Solid blue color….………………………..
Eyelids full, swollen...
356
300
329
82
84
Blueness of veins........
87
Tissues loose and flaccid..
Feebleness of voice......
143
174
•
Pain in the back of head, dull, heavy....
203
...
Deficient sympathetic innervation..
An epidemic remedy.
In zymotic disease......
An endemic remedy
Defect in electricity
As a restorative.....
Want of color.
Anæmia......
...
Anæmia of the spinal cord..….……..
In chlorosis.......
In wrongs of the venous circulation.......
Muriated Tincture, Blueness with deep color of tongue 87
แ
Iris, Scanty secretion of Saliva......
90
110
222, 223
231
239
265
273
274
310
339
344
348
...
355
Deep erysipelatous redness
Enlarged thyroid gland
In, disease of the lymphatic system.......
356
Ipecac, Excess of color........
79
White line around mouth with thinning of tissue....... 84
Elongated and pointed tongue...
95
Acid eructations....
112
Opaque mucus……......
114
Active hemorrhage……………….
115
To relieve irritation of stomach……………………………….
269
Pinched face..........
272
To influence the pancreas..
293
To influence the skin.....
299
Irritation of the bowels……………….
In disease of the respiratory apparatus......
In disease of the gastro-intestinal canal....
322
352
353
370
STUDY OF DIAGNOSIS.
Lobelia, General bluish or purplish color from venous ob-
struction.......
Fullness of eyes and face..........
Want of sympathetic innervation....
Capillary stasis from venous obstruction.......
Præcordial oppression and constriction of the chest...
Fullness of tongue............
Full and doughy tissues.....
89898
62
65
79
82
106
142
Pulse full and doughy....
Halting voice…………………..
Oppressed voice.........
153, 155
174
175
Yielding or tremulous character of sounds from the
chest.......
189
Anguish, fear of impending danger..
204
An epidemic remedy....
227
In measles......
229
To influence the temperature…………..
260
Defective excretion from the lungs..
297
To influence the skin
299
To influence the circulation.........
317
(
"L
((
Slowness of pulse......
Congestion..........
In disease of the respiratory apparatus...
In the treatment of convulsions......
Lime, As a restorative.............
In disease of cellular tissue....
In lesions of nutrition.
Lycopus, To influence the temperature....
respiratory function.....
skin.....
Macrotys, Pain from an excited circulation..
Deep color under the eyes..
Contraction and irritability with pain....
Steady vibratile pulse without wave.....
With Rhus...………. ………………….
Continued succession of tensive pains......
In determination of blood to the uterus.
In the treatment of inflammation.........
318
323
352
340
273
275, 356
314
261
297
299
69
84
142
154
205
203
....
322
329
INDEX.
371
1
Macrotys, In diseases of the reproductive apparatus..
Nux Vomica, Illustrating the action of medicine.
Full, expressionless eyes and face......
Expressionless mouth..............
Pain with enfeebled circulation….....
Unsteady movement, anxious countenance.....
Brownish-yellow coloration.......
355
In diseases of muscular and fibrous tissues………………………… ………………
356
15
65
67
69
72
92
Yellow coating of tongue...
Fullness of tongue,..
Influences the temperature....
100
106
....
Increased secretion of saliva....
Pain pointing at umbilicus.........
An epidemic remedy
Defect of electricity……
111
166
203, 205
227
265
Atony of stomach....
270
Atony of intestine......
273
To influence the pancreas....
292
To influence excretion from the lungs......
297
In congestion..........
323
In the treatment of delirium tremens..
332
To influence the brain.........
To influence the spinal cord......
In anæmia of the spinal cord……………………………….
In the treatment of convulsions..
In the treatment of paralysis.
In diseases of the brain.....
In diseases of the gastro-intestinal canal
Nitric Acid, (See Acids,) Violet color...........
Nitrate of Soda, An epidemic remedy...
Opium, Pain with evidence of atony
Moisture of tongue………..
Small pulse, open, square wave.......……………………… ……………………………………. 153
Pulse soft and open
In delirium tremens.....…………………….
To influence the brain..........
Oxide of zinc, Gastric irritation........
A pancreatic remedy......
154
332
351
269
292
337
338
339, 347
341
343
351
353
....
....
82, 103
222, 223
69
105
372
STUDY OF DIAGNOSIS.
To influence the pancreas ..
Panax, Scanty secretion of saliva...........
Peach bark, Amygdalus, elongated and pointed tongue, red-
110
292
dened tip and edges.
Irritation of stomach.........
Intestinal irritation.....
To improve digestion.....
95
269, 270
272
293
Permanganate of Potash, Erysipelatous redness, blanched... 90
Cadaverous fetor.............
Phosphorus, Full, pallid face, waving alæ nasi.….…………………….
198
65
*
Unsteady movement....
Eyelids full, swollen, expressionless.......
Pinkish color.........
Dull and opaque skin
Dull, leaden color of tongue......
Moist mouth
Feebleness of voice.........
To influence the temperature......
Deficient electricity
As a restorative.......
71
84
86
93
103
111
174
261
265
273
Want of expression.....
274
To influence excretion from the lungs......
297
Anæmia.......
310
Bad blood....…………………………… …………….
In disease of the brain..........
314
To influence sympathetic innervation.......
344
351
In disease of the respiratory apparatus…………….
..
352
In disease of the urinary and reproductive organs...... 354
In diseases of the skin.....
356
Phosphate of Soda, Secretions of the mouth neutral or acid.. 112
Phosphoric Acid, Tissues pinched and stringy........
143
Potash, As a restorative.........
273
Pallor of mucous membranes, impairment of muscular
power
276.
In anæmia......
310
Bad blood....
314
In the treatment of scorbutis...
349
In disease of muscular tissue…………………………………………………………….
356
INDEX.
373
Polygonum, To influence excretion by the skin………………… ……………… …………….
Phytolacca, Scanty saliva......
Pulse, dull stroke with tremulous wave..
299
110
154
Mammary inflammation......
330
In diseases of the mouth and salivary glands...
353
In disease of the testes...
355
In disease of muscular tissue........
356
Pepsine, Enfeebled digestion...
272
In disease of the stomach........
353
Podophyllin, Illustrating the action of medicine......
Fullness of the tissues of the face......
15
65
Cellular tissue full, veins prominent...
Full upper lip, pallor
Venous obstruction...
66
67
79
Fullness of tissue......
84
Change in pigment, liver spots..
92
Yellow coat of tongue.
100
Fullness of tongue..
Moist mouth.....
Full, open pulse.......
Contra-indicated when pulse is small and wiry.......... 154
Pain in ischiatic notches....
An epidemic remedy..
An endemic remedy
Dull, expressionless face
106
111
153
203
221, 227
.... 239.
270
Deficiency of gastric juice…………………..
Intestinal atony...
271
273
To influence the pancreas.........
To increase intestinal secretion….….……..
292
293
To increase excretion by the bowels..
307
In diseases of the gastro-intestinal canal.
353
Pulsatilla, Color dull purple….....
.....
82
Eyes sunken, contracted.............
84
Sudden dropping of wave of blood as it passes the
finger…………………..
154
•
Cough points at supra-sternal notch......
178
Mental rest....
195
Pain, sharp, limited in location, despondent......
.......... 203
374
STUDY OF DIAGNOSIS.
Pulsatilla, To influence the sympathetic nervous systerm
To influence the brain....
To influence the heart.....……………………………………
In dysphagia....
To influence the reproductive organs..
Quinine, Full, expressionless face..........
Drooping tissues, expression sad............
Unsteady movement, relaxation of muscles......
Causes dryness of tongue.....
344
•
351
352
353
354, 355
65
69
72
105
Moist mouth.........
Tissues loose and flaccid....
111
143
Soft pulse.........
Contra-indicated by hard and wiry pulse........
Feebleness of voice........
Tremulous sounds from chest.
153
....
154
174
189
An epidemic remedy
227
Periodicity..
Malaria......
A nervous stimulant
To influence the brain........
In delirium tremens.......
.235, 236, 237
246
265
.....331,
.331, 351
332
As a remedy for pain
337
Acid eructations........
To increase the blood....
To influence the spinal cord......
Rhubarb, Elongated and pointed tongue, gastric irritation...
Irritation of gastro-intestinal canal.....
Restoratives, Want of expression......
Rest, Expression of......
Rhus, Constriction about temples and eyes....
Pinched eyes.....
339
...
95
112
269
54
273
54
65
66
Pain with excitement of circulation........
69
Bright flush of left cheek.
85
Bright redness of surface........
90
Eroded appearance of anterior papillæ of the tongue, 107
To influence the temperature….....
166
Sharp cry, cry encephalique...
175
Frontal pain, pain in left orbit…………..
203
INDEX.
375
Rhus, Burning pain.....
An epidemic remedy……...
Zymosis......
An endemic remedy....
Illustrating prescription from single symptoms……………….
To influence the temperature..
Pungent heat......
205
221
231
239-
255
...... 260, 261
a
......
263
...
300
329
delirium.....
spinal irritation....
331
347
351
•
352
eye....
356
To influence the skin......
In the treatment of inflammation..
แ
แ
To influence the brain...
In diseases of the heart....
Santonine, White line around the mouth with fullness of
tissues...
Sighing respiration.......
Full upper lip, picking at the nose........
Staphysagria, Full, swollen eyelids.......
In disease of the reproductive apparatus.....
Senega, To influence excretion by the skin...
Strychnia, Sighing respiration......
Fullness of tongue.....
....
Atony of gastro-intestinal canal...
To influence the spinal cord……………..
....
Serpentaria, to influence excretion by the skin …………………………………………..
Stramonium, Constrictive pain, muscular contraction.......
Sticta, To influence excretion by the lungs......
84
174
67
84
354
299
174
106
270
.338, 339
299
206
297
356
93
111
198
261
276
In hyperemia of the spinal cord......
339
To influence sympathetic innervation
344
In disease of the liver......
353
"
skin...........
356
In diseases of muscular and fibrous tissues
Sulphur, Want of pigment, change of color…………..
Moist, dirty tongue............
As an antiseptic or disinfectant
To influence the temperature………..
Change of pigment........
376
STUDY OF DIAGNOSIS.
Solanum, Congestion of the kidneys....
Sinapis Alba, Atony of stomach........
Sulphite of Soda, Erysipelatous redness.......
Pallor of tongue, with dirty coat....
Dirty tongue.………….
Viscidity of saliva....
Large, empty pulse...........
To influence the temperature.....
Mawkish or sweetish odor..
An epidemic remedy.....
Zymosis
...
Typhoid symptoms.....
Heavily coated tongue
.....
304
270
90
83
104
111
...
153
165
199
227
231
238
271
Sulphurous Acid, (see Acid Sulphurous.)
Sulphite of Magnesia, Dirty tongue, redness natural.......... 104
Sedatives, Dryness of tongue
Silica, Dullness of epithelium, desquamation.......
Soda, An epidemic remedy…...
As a restorative......
Anæmia.....
Bad blood.........
.... 105
276
227
275
310
314
230
......
62
65
78
79
90
Trifolium: Pratense, Paroxysmal, spasmodic cough......
Veratrum, Inflammation of brain.....
In disease of atony.....
Color, simple excess of...........
In disease of thoracic organs………………………
Bright redness, arterial throbbing....
Elongated and pointed tongue, evidencing vascular
excitement in the brain
Glairy, tenacious mucus......
Active hemorrhage.....
Or Aconite....………………………. ……… ……
Tissues pinched and stringy
Full pulse, with strength.....
Influence of large dose.....
Cough.......
An epidemic remedy....
Zymosis.
106
113
....... 115
142
144
152
163
178
227
231
INDEX.
377
Veratrum, An endemic remedy.......
To influence the temperature.
A pancreatic medicine......
To increase excretion from the lungs....
To influence excretion by the skin...
Frequency of pulse........
In determination of blood...
A remedy for inflammation
In the treatment of delirium tremens.
Hyperæmia of the spinal cord..
In the treatment of convulsions....
spinal irritation......
In diseases of the respiratory apparatus...
ī
239
261
292
296, 297
299
317
322
328
.....
332
339
340
347
...
352
...
Wet Sheet Pack, In simple increase of temperature…........... 167
32
:
INDEX.
19
50
310
19
•
Apoplectic condition of brain 62
Abdomen, pain in....
Acids as remedies...
Adventitious sounds..
Egophony...
Anatomy applied..
Animals, Study of.
Anæmia.
.....
Applied anatomy.........
...
81
69 Bath in temperature..........167
Basis for all schools............256
Blood, condition of the....... 66
193
192
Color from the......... 77
Blueness of..... 82, 115, 308
Pulse waves....
Wave, length of.....
149
150
Circulation of the....
......244
Condition of the...........244
Appearance sickly…………..
76
Making......
....273
Arteries.....
355
Excess of
308
Articulations.….………….
356
Defect.....
....310
Areola.........
83
Bad.......
.311
Atrophic irritation...
63
Evidences of.
313
Auscultation.......
184
Sepsis of.........
312
....
Stethoscope...
...184
Exudates from
312
...
Healthy sounds in chest.185
Circulation of..
315
Study in English......
186
Physics of.......
186
Morbid sounds.
186
Blowing sounds.....
187
•
Plowing and moist.
188
Tremulous sound.....
Irregular distribution of318
Determination of.........320
Evidences of determina-
tion of......
Examination of...
189 Black vomit......
Sounds from cavities………..190 | Blowing sounds....
...
190 Bladder.........
Small.........
Dry....
...
190 Boquet
Crepitant sounds.....
...
Broncophony.
Egophony.......
Pectoriloquy
...
191 Books, advantage of…………..
...192 Bowels....
....
321
....
112
113
187
.354
45
...
23
135
156
192 Body thermometer.
192 Bowels, liver, percussion of..183
Excretion from the.......306
Of the heart....
Adventitious sounds......193 Bones.....
193
...356
Of the fœtal heart.........195 Brain, condition of the.
61
....
....
INDEX.
379
Brain, Congestion........
61 | Classification, nosological....348
Determination of blood. 61 Condition of the sympa-
Apoplectic condition..... 62
Inflammation………………….
Effusion
Nutrition....
62
thetics..
65
Condition of the blood......... 66
63 Convulsions, symptoms of….. 74
63 Color of the surface...
Softening...
63
......
From the blood...
Atrophic irritation..
63
Of health……………….
64
75
77
77
Functional activity..
Innervation from.. 250, 330
Pain, condition of...337, 351
Brown color.....
91
Broad and full tongue......... 95
Broad and pallid tongue………….. 101
Brown and black fur... .104
Broncophony......
.192
.....138
Cadaverous fæces.........
Capsules, Supra-renal......... 354
Cardiac wrongs, Color from. 89
Cavities, Sounds from......... 190
Certainty
Cerebro-spinal meningitis...232
Cells, Secreting....
Cerumen...
Cellular tissues.........
Of mucous membranes.. 77
Pigment of health........ 77
Transparency and clear-
ness........
Excess of
...
78
78
Capillary circulation.... 79
Effacement of.............. 79
Venous obstruction....... 79
Defect of.....
80
Deepening of......
80
Dark red.....
80
Typhoid......
80
Unyielding...
81
24
An evidence of sepsis... 80
Deep redness…...
81
..283
Acids as remedies……......
81
295
Dull purple
81
356
Blueness
82
Violet......
82
30
Deep purplish brown... 82
Muddy
82
Local
83
83
83
87
87
Children, Better diagnosis
with.
..
Childbirth, Expression in..... 59
Change of form of tongue 94
Cheesy sputa............... ..114
Changes of kind of tempera-
ture.......
Chest, Healthy sounds from..185
Chronic disease, Epidemic
..
.170
influence in...............223
Change of type in disease.....224
Chicken-pox, Varicella.......229
Cholera......
Character of normal secre-
232
tion from skin.... ..301
Changes in the character of
the pulse..........
Of the areola of the
nipple.....
Under the eyes..
Of conjunctiva..
Of bright red.....
Of deep red................. 88
Of purplish..........
88
From cardiac wrong..... 89
Erysipelatous redness... 89
Pigment..
90
แ
Excess............ 90
Transparent.... 90
....318
....348
((
Local excess.... 91
((
Deep........
91
แ
Brown
91
tr
Greenish yellow$2
Dull & opaque. @2
"
Chlorosis.......
Clay-colored fæces.............137
Clinical examination urine...130
Cleanliness.....………………………………………………. 197
Classification, general... 217, 220
Bright yellow.. 92
380
STUDY OF DIAGNOSIS.
"
Color, pigment, greenish..... 92 | Dessicated mucus….............,114
Tallow-like...... 92 Deposits, urinary.....
Dirty......
Table of urinary..........134
(L
93
แ Want of......... 93 Deficient fæces..
Of fæces......
Coatings of tongue..
...
Yellow.....
Dark...
Contraction of tongue.
..137 Deposits.........
.129
..136
.........279
..280
...... 97 Degeneration..............
|
.....100
100 Defect in secretion..............299
...104 In excretion from lungs, 297
106
Of the blood................310
.176 Determination of blood......320
Cough....
Expresses irritation
176
Delirium
.331
Dry, ringing...
.177
Forcible.......
.177
Delirium tremens..........
Diagnosis, study of………….....
.331
9
Strength.
....177
Short, sharp, hacking...178
Anatomy necessary in... 20
Methods of.
28
Points....
.178
Spasmodic.........
179
Contagious diseases.
..227
Better with children..... 30
Use of the senses in...... 48
By the eye......
49
Condition of the blood.
...245
By the touch………….
..139
Of the tissues....
....278
By the ear..
...171
Congestion.....
Of the kidneys.
Evidence of…………..
303
Physical.....
...179
Constipation...…….. …………………..137, 306
Disease not an entity........
12
61, 320
...321
Convulsions.......
339
Intrinsic..…………
340
Extrinsic....
.341
Cord, spinal.......
......351
Cry of pain........
43
Encephalique………………………….
.......175
Cu'tivation of the senses...... 38
Dark red color..
Dark coatings..
Dark brown fæces...
Dead, awake, asleep.
use.....
80
!
104
Development of senses by
Expressions of…………......... 14
Relation between reme-
dies and....…….
Varieties of color in...... 42
Evidence of local......... 58
Local...........
Temperature in chronic 160
Voice expresses.
Laryngeal, voice changed
by..........
137 Diseases, classification of......211
25
34
53
Decumbence…………………..
Depression or excitation..... 55
Determination, expression of 69
Degeneration, expression of.. 70
Defect of color....
80
Deepening of color.
Deep redness, associated with
asthenia................... 81
Deep purplish-brown.......... 82
Deep color.
91
80
|
Change of type in......... 224
Disuse, senses lost by.......... 35
Dirty color…………………..
Dirty fur....
93
.103
Discharges, examination of..108
Disinfection...... .......... 198
Distinction and definition of
disease........ ........209
Digestion, intestinal:.......... 272
Distribution of blood irreg-
ular.....
Diabetes………...
318
349
15
...... 66
Range of temperature in 159
Cause of.......
.........165
.173
..176
Contagious....
.227
INDEX.
381
Doctrine of Rademacher......222 | Examination of blood....
Dryness of tongue.........
Dry, ringing cough.
Dropsy..
Dull purple color
Dull and opaque color
.105 Eructations
...
..177
.349
81
92
Dull, elastic stroke of pulse..150
Dullness on percussion........181
Ear.........
...356
Vomiting...
Black Vomit.......
·
Of discharges from res-
piratory tract.......
Mucus, thin, glairy.
Mucus opaque.....
Globular sputa........
Cheesy sputa……………..
Dessicated mucus..
.....
112
......112
112
113
.113
.......113
113
114
...114
14
Pus.......
114
63
Blood......
.115
71
Mucus streaked with
blood.......
115
Exudative material….....116
Of the urine......
Objects of.
116
...
.118
130
132
..135
.202
.301
304
Education of the senses....... 32
Educated nose…..……. …………………….
..45, 196
Effusion......
Effort for rest.
Effacement of color............ 79
Elongated & pointed tongue
95, 106
Elements of disease, first...... 13
Empty pulse.....
Emotion
.151
334
.186
9
Entity, disease not an......... 12
Encephalique cry…………………………………..175
English, study of ausculta-
tion in......
Equalizing the circulation...319
Errors from nosology.....
Eructations, examination of.112
Expression of the mouth...... 67
Provokes function........ 68
Of disease.........
14
In the Horse......
Law of.......
In Childbirth......
In the face....
Facial........
Of determination......
In motion..........
Clinical of urine...
Of the sediment..
Of the fæces..
Care in.......
Of the urine.....
...
Excess of the urine.....
Of the excretions from
the bowels......... ..306
Of blood.....
29
..308
Of color pigment......... 90
Of color pigment local.. 91
In secretion from skin...298
51 Exaggeration by the sick.... 29
57 By the nurse………....
58 Excitation or depression...... 55
58 Extension, flexion....
60 Excretions, odor of.............199
From lungs, defect in...297
From the bowels..........306
From bowels, excess of..306
Perversion of the......
... 69
70
Of degeneration............ 70
Of the voice.....
voice………………………………………… 172
73
.307
Expresses disease............... 173 Exudates from blood..... .312
Examination of tongue....... 93 Extrinsic convulsions..
110
Of the discharges.........108
Discharges from nose....109
Discharges from mouth..110
Saliva increased......
Saliva, reaction of......111
Of discharges from the
stomach........ ......112
...341
Evidence of local disease..... 58
Determination of blood.321
Of congestion.......
....321
.313
Eye........
356
Diagnosis by the.......... 49
Color under the…………..
Of bad blood…..
83
382
STUDY OF DIAGNOSIS.
Facial expression
60 | Health, color of pigmer 71
Favoring the affected part... 72 Hemorrhage
Fæces, examination of
Increase of
Fluid.......
Deficient.....
Color of.....
Dark brown.
Greenish....
Clay-colored.
Fetor of....………
Cadaverous...
Odor of........
Feebleness of voice
...
...
....
.....127
135 Healthy standard of temper-
ature.........
136
136 Health, range of tempera-
136
137
ture in.....
155
...158
137 Healthy sounds in chest......185
137 Heart, auscultation of the.... 193
Foetal, auscultation of...195
137 Heat from inflammation
138 Hemiplegia....
138 Heart........
325
...342
.........352
200 Huxley, method of......
22
.174
30
63
...322
Foetal heart, auscultation of.195
First elements of disease... 13
Five senses
..
Imagination ……..
Irritation, atrophic..........
36 Irritation.
182
147
161
163
95 Indications for quinine...…….. 154
73 Inflammation and fever,tem-
perature in.....
Influence of sedatives.
Increased frequency of pulse3! S
Inter-wave current-pulse....151
Inflammation..……………….
62, 323
Symptoms of......... 324
Resolution of..
Fissured tongue...
Flexion, extension.....
Fluid, dullness from.
Forcible cough…………………….
Form, recognition of......... 42
Frequency of pulse…….... 146
Increased.
......316
Functional activity of brain. 64
Function, expression pro-
vokes......
Full and broad tongue........ 95
Fur, dirty tongue....
Fullness of tongue........
68
Pain from.
Heat from.
Swelling from
103
....106
Full, systolic wave of pulse.151
324
.325
..325
325
Redness from..............326
Wrong of function from326
Full pulse....
Gangrene.......
Glairy, thin mucus
Globular sputa.
....
Glands, intestinal.....
...151
Danger to the life from.326
Innervation …………….
..330
.327
From the brain...
..330
•
113
Insanity...
333
114 Intrinsic convulsions..
340
292
353
137
Large...
• •
119
Intestinal digestion..
281
Irregular temperature......
.353
272
292
.169
Greenish yellow color......... 92
Grayish or yellowish fur......107
Gravity, specific........
Greenish fæces.....
Growths.
..
Innervation, sympathetic....343
Intestine, small.....
Glands....
Distribution of blood....318
151 Irritation, spinal................344
151
174
Hardness of pulse.....
Hard, small pulse...
Halting voice.....
Hacking, short, sharp cough.178
Hearing...
42
Kidneys, condition of...303, 354
Knowledge, source of.......... 17
Senses the source of...... 32
INDEX.
383
Law of expression.....
Larynx.......
Large intestine...
Lesions of nutrition.
Life, one......
Wrong.....
Study of......
57 | Names, prescribing at……........ 10
352 Nausea……………………..
353 Names necessary.
67
..... 214
314 Nipple, areola color of the... 83
Nosology.
207
Errors from.............9, 208
Distinction & definition.209
Useless......
12
12
13, 16, 17
18
40
Nose.....
Living man, study of.........
Light......
Lines, white around mouth... 84
Lip, pallid upper...
84
Liver, percussion of. 183, 289,353
Local disease, evidence of.... 58
Diseases...
Color
Bright red color...
Excess of color..
Disease
Lungs, the...
15
Nosological classification.. 348
Educated....……………….
352
....
196
Examination of dis-
charges from the.......109
66 Nomenclature....
Defect in excretion from 297
Lymphatic glands……..
.....210
Nutrition, lesions of...........314
83
87
91
51
Objects of the examination... 118
Odor of the excretions....
199
•
352
Of the urine
200
....~
Seminal.....
200
353
Of fæces......
200
Esophagus.......
353
332
One body, one life.
Opaque mucus.....
12
.113
22 Ovaries....
...355
56, 68, 203, 336
Cry of......
43
Man, study of the living... 18
Mania, puerperal........
Method of Huxley.
Measurement,
24
Methods of diagnosis... 28
Mediate or direct percussion 180
Medical stinks......
.196
Medication, restorative....... 273
Metamorphosis, retrograde..279
Mouth, expression of........... 67
... ....
...
71
71
White lines around the. 4
Bluish tint around the... 85
Salivary glands............ 353
Movement, rapid....
Unsteady
Moistening tongue......
Movements of tongue....
Morbid sounds……………..
Moist, blowing sounds.....
Muscles.....
Pain
From inflammation...... 325
The result of two condi-
......
6.9
tions.......
In the abdomen........... 69
Pallid upper lip............ 84
Pallid and broad tongue..... 101
Palpation......
....183
Patient, information from...200
Pancreas
96 Paralysis...
291
342
.107 Paraplegia
..343
.186 Percussion...
.179
.188
Direct or mediate
180
74
Rules for.....
..180
Object of.....
Mucous membranes, color of 77
Muddy color of blood......... 82
Mucus, thin, glairy, opaque..113
Dessicated...
Streaked with blood,115,293 |
Muscular tissue......
356
•
114
...
180
Standard of comparison.181
Normal resonance........ 181
Increased resonance.....181
Dullness.....
Dullness from fluid......182
....
181
1
INDEX.
383
Law of expression...
Larynx.........
Large intestine...
Lesions of nutrition
....
Life, one...
Wrong...
57 | Names, prescribing at......... 10
352 Nausea..
....
67
214
353 Names necessary.
314 Nipple, areola color of the... 83
Nosology.
12
12
..13, 16, 17
207
Errors from.............9, 208
Distinction & definition.209
Useless......
15
348
352
....
196
40
Nosological classification..
Nose....
Study of......
Living man, study of.......... 18
Light......
Lines, white around mouth... 84
Lip, pallid upper.....
Liver, percussion of. 183, 289,353
Local disease, evidence of.... 58
84
....
Educated...……………….
Examination of dis-
charges from the.......109
Diseases...
66
Nomenclature.
210
Color ...
83
Nutrition, lesions of ...........314
Bright red color.........
87
Excess of color..
91
Disease
51
Objects of the examination...118
Odor of the excretions..
.199
Lungs, the...
...352
Of the urine
Seminal.....
.200
.200
353
Of fæces...
Esophagus......
332
200
....
353
12
113
...355
Defect in excretion from 297
Lymphatic glands........
Man, study of the living... 18
Mania, puerperal.......
Method of Huxley
Measurement.
One body, one life.
Opaque mucus......
22 Ovaries.....
24
Methods of diagnosis.... 28
Mediate or direct percussion 180
Medical stinks......
…..196
Medication, restorative....... 273
Metamorphosis, retrograde..279
Mouth, expression of........... 67
White lines around the. 84
Bluish tint around the... 85
Salivary glands.......
Movement, rapid......
Unsteady
...
Moistening tongue....
Movements of tongue.
Morbid sounds......
Moist, blowing sounds....
Muscles....
353
Pain....
Cry of......
56, 68, 203, 336
43
From inflammation .. 325
The result of two condi-
tions.......
......
6.9
In the abdomen........... 69
Pallid upper lip............. 84
Pallid and broad tongue..... 101
Palpation......
.......183
71 Patient, information from...200
71 Pancreas
....
96 Paralysis.....
107 Paraplegia
...186 Percussion..
291
342
343
..179
188
Direct or mediate ........ 180
....
74
Rules for..………………
...180
Object of.....
Mucous membranes, color of 77
Muddy color of blood......... 82
Mucus, thin, glairy, opaque..113
..114
Dessicated...
Streaked with blood,115,293 |
..356
Muscular tissue......
...
180
Standard of comparison.181
Normal resonance........ 181
Increased resonance.....181
Dullness.....
Dullness from fluid......182
....
181
INDEX.
385
......
.348 Sounds, tremulous
Scorbutis....
Senses, education of....... 32
The source of knowledge, 32
Acquired.
33
Developed by use......... 34
Lost by disuse....
From cavities.......
Small, blowing......
Crepitant
Adventitious
189
190
..190
35
Sputa, globular......
...
Conscious life thro' the... 36
Cheesy.
191
.193
114
...114
Five..........
36
Specific gravity
Cultivation of the
38
Spasmodic cough
..132
Use of in diagnosis...... 48
Sediment of urine, examina-
tion of............
Spinal innervation......338, 344
Spanæmia.
..119
.179
311
Cord........
351
Seminal odor.....
Secretion.
Secreting cells.......
200
Spleen....
354
282
Study of diagnosis.
9
.283
Of life.....
13, 16, 17
18
,294
50
52
Secretions, recrementitious. .286
Sebaceous
... 296
299
Excrementitious..
Defect in...........
Perversion of...............300
From the skin, excess in,298
Sepsis of blood.....
Sensibility........
Of the living man………………………
Of animals....
Objects of...
Standard, physiological ... 24
Stomach, examination of
discharges from ........ 112
Stroke, dull, elastic of pulse.150
Strength of voice...
312
335
173
Of cough
...
...177
150
150
Standard of comparison
Stethoscope..
.181
184
186
........196
353
Shrunken, pinched tongue... 95
Sharp pulse.........
Shock wave…………..
Sharpness of voice... .....175
Shrillness of voice............ 175
Short. sharp. hacking cough, 177
Sick, exaggeration by the.... 29
Sickly appearance…………………………….. 76
Skin, regulating temperature
by.
Slick tongue.
•
Study of auscultation in
English.
Stinks, medical
Stomach
Surgeon, education of......... 17
Surface, color of.......
Of pulse wave……………….
.166, 356
103
Suppuration
...
75
...150
327
Slowness of pulse ...............317 Swelling from inflammation,325
Smell.......
44
Sympathetic, condition of... 65
centre, 106 Symptoms of convulsions... 74
151 Systolic wave, pulse full...... 151
151 Symptoms of inflammation..323
195 Sympathetic innervation....343
Small tongue, full in
Hard pulse
Soft pulse......
Smell, diagnosis by......
Small intestines.......
Source of knowledge………...
Softening of the brain
Sobbing respiration......
353
17 Taste
63
.175
Sounds, healthy in chest..... 185
Morbid.....
Blowing
186
..187
....
46
215
Tallow-like color of pigment, 92
Table of urinary deposits....134
Physiological.......
Of Dr. Williams......... 216
Temperature......
.155
Blowing and moist…………….. 188 Healthy standard of... .155
386
STUDY OF DIAGNOSIS.
}
}
Temperature, range of in
health.....
Range of in disease.
Relation to pulse......
..158
159
160
In chronic diseases 160
In fever and inflamma-
tion......
Treatment for
....
...
161
162
Influence of sedatives on 163
Relation to functional
disease......
...
164
Tongue, dark coatings......104
Dryness of
Contraction of
Fullness of......
105
...106
..106
Elongated and pointed..106
Small, full in centre......106
Grayish or yellowish fur, 107
Movements of............107
Touch, the.........
21, 39
Diagnosis by the .........139
In obstetrics.............. 141
Relation of pulse to….....155
A cause of disease......165
Regulation of the skin... 166 | Tonsils......
Baths in
167 Transparency and clearness
of color.....
Waste of tissue............ 167
Depression of........
Irregular.
Changes of kind...
Tears......
Testes......
Thermometer, body
Registering..
Use of......
Tissues, condition of......
Muscular......
...
353
78
168 Transparent color of pigment,90
169 Track respiratory, examina-
170 tion of discharges from..113
295 Tremulous sounds on auscul-
353
tation.
156 Typhoid color....
157
..158 Unrest
.189
80
54
..278 Unyielding color......
..356 Uncertainty of information
81
94
94
from patient and nurse..201
Upper lip pallid ...
Urine, examination of the...
84
116,301
T'ongue, examination of the, 93
Indications from...
Change of form………....
Elongated and pointed.. 95
Full and broad...
95
Pinched, shrunken.
95
Fissured......
95
Dryness, moisture......... 96
Coatings of ....
97
Coatings, whiteness of... 98
Odor of
Heavily loaded....
Coatings yellow.
....100
Coatings, transparent... 98
...
99 Urinary deposits, table of...134
Wrongs, symptoms of...302
Redness of tip and edges101 | Urethra......
Represents the blood...101 Uroscopy...
355
117
Broad and pallid......... 101
Useless nosology..
15
Deep red.....
102
Violet colored'……..
.103
Use of the senses in diagno-
sis......
48
Scanty.......
Deposits from............129
Clinical examination of, 130
Without visible deposit, 130
Examination of the sed-
iment.........
...132
200
..302
Thick and large.........103 Uterus............……………………… ……………………… 355
Leaden.....……….
Slick.
.....
Dirty fur......
……..103
103 Variations of color in disease, 42
103 Vagina and vulva............355
Brown and black fur...104 Venous obstruction....
79
INDEX.
387
Veins.......
Blueness of.....
of…………………………….
Violet color.........
..355 | Wave of blood.....
86
82
•
Colored tongue..........103
Vibratile pulse….....
Vomiting....
Vomit, black.....
Volume of pulse.
......149
Blood, length of.........150
Surface of....……………………………………….150
Shock......
...150
Full, systolic........ .151
Intercurrent………………….. ......151
.........167
....151
112
113 Waste of tissue
•
....
334
173
149 White lines around mou:h 84
Whiteness of tongue... 98
Will, volition.......
.........334
Williams Dr., table of ……………….. 216
Wrong life.........
..
Volition, will....
Voice, expression of the......172
Expresses disease.....
Strength of...... ... .....173
12
Feebleness of......... 174 Cardiac, color from...... 89
Of nervous irritation....174 | Wrongs of function from in-
Halting...
Oppressed.....
Sharpness of...
Encephalique…..
Shrillness of......
Sobbing respiration.
Want of color.........
174
..174
flammation........... 326
175 Yellow, greenish color of
..175
.175
.175
pigment..........………………….. 92.
Bright color of pigment 92
Coatings of tongue....... 100
93 Yellowish fur on tongue......107
Specific MEDICATION
SPECIFIC
AND
SPECIFIC MEDICINES.
FOURTH REVISION,
WITH AN APPENDIX CONTAINING THE ARTICLES PUBLISHED ON THE
SUBJECT SINCE THE FIRST EDITION,
AND A
REPORT OF CASES ILLUSTRATING SPECIFIC MEDICATION.
BY
JOHN M. SCUDDER, M. D.,
Professor of the Principles and Practice of Medicine in the Eclectic Medi
cal Institute; author of "The Principles of Medicine,
"The
Eclectic Practice of Medicine," "The Eclectic Materia
Medica and Therapeutics." "A Practical Trea-
tise on the Diseases of Women," etc.
SIXTEENTH EDITION.
Reprinted by request, not revised since 1890.

ἐκλέψω
CINCINNATI, O.:
JOHN. K. SCUDDER
1913.
DorM
Entered according to Act of Congress, in the years 1870, 1873,
and 1880,
BY JOHN M. SCUDDER,
In the office of the Librarian of Congress.
Copyright, 1898, by
THE SCUDDER BROS. CO.
PREFACE TO THE TENTH EDITION.
In this edition the part on Materia Medica has been re-
vised, and about one hundred and fifty additional remedies
added. We have medicines enough and to spare, and what
we need most now is, a thorough study of them to determine
their specific indications. The best way for a student, the
young practitioner, or any one making a first study of Spe-
cific Medication is, to take the remedies marked "My Pocket
Case," and learn their use, being guided by single indications.
After this one can add to his materia medica as he has need
for other remedies, and as he has opportunity to study them.
It is very difficult in looking over a Medica Medica like
this, to determine the remedies of greatest value, and to
distinguish the important from the unimportant symptoms.
Each practitioner must make his own materia medica, and
the greater the amount of care he gives it the better will it
serve his purposes. What I have tried to do in this work,
and in the companion volume, "Specific Diagnosis," is to
point out the way for these studies, and give such definite
knowledge of a number of remedies as will suffice for suc-
cessful treatment of the more common diseases of our
country.
The favor with which these volumes have been received is
a proof that the profession has been looking in this direction
for a better practice of medicine.
CINCINNATI, March 30th, 1880.
PREFACE.
For some hundred years or more, there has been a pretty
uniform agreement in the statement, so frequently repeated—
"there are no specifics in medicine." To have a good reputa-
tion for professional acquirements and standing, this was a fun-
damental article of belief. Whatever might be the certainty
in Anatomy, Physiology, Chemistry, and the arts of the Ob-
stetrician and Surgeon, it was essential to believe that the
practice of medicine was a great uncertainty.
That it was a great uncertainty, as commonly followed, we
are well assured. The records of disease, the mortality
tables, and the resultant lesions from the mal-administration
of medicines, abundantly testify to this.
This stands confessed in the writings of the most prominent
men in the medical profession to-day, who unite in deprecating
the use of the older treatment of disease, and the greater
safety of the expectant plan-which is really diet and rest.
Must we give up medicine entirely? Are there no agencies
opposed to processes of disease, that we can employ with cer-
tainty? These are the questions of the day, and in answering
them, we will decide either for no medicine, or for specific
medication.
To determine which of these shall be chosen, the reader
will have to refer to his own experience of the action of medi-
vi
PREFACE.
cines, and be guided by it. All will admit the uncertainty of
medicine, as now used, but no one will be willing to confess
that he really knows nothing in therapeutics. I think it will
be safe to assert that every practitioner will have the knowl-
edge of some antagonism of medicine to disease, that is clear,
definite and uniform. If he has but one such, it is positive
proof there are others, and the evidence that direct or specific
medication is a possibility.
Specific medication requires specific diagnosis. We do not
propose to teach that single remedies are opposed to diseases
according to our present nosology. These consist of an asso-
ciation of functional and structural lesions, varying in degree
and combination at different times, very rarely the same in any
two cases. To prescribe remedies rationally, we are required
to analyze the disease and separate it into its component ele-
ments, and for these we select the appropriate remedy.
The writer has had a sufficiently extended experience in
the treatment of disease, to say that he knows absolutely that
remedies have this direct antagonistic action to disease, and
in many instances he is able to define it so that the reader can
readily determine its truth. Still the field of investigation is
a broad one, it has been but little cultivated, and there are
few careful observers, so that much of the work remains for
future investigation.
The tendency of medicine in all schools, however, is in the
one direction. The giving up of the old uncertainty is the
first step, then follows the careful study of individual reme-
dies, and their use to accomplish certain well defined objects.
One need not be a prophet to forecast the future in this
respect. The medicine of the future will very certainly be
direct, or as we have chosen to term it, "Specific Medication."
PREFACE.
vii
The object of the author has been to make the subject as
plain as possible, and not to obscure it with useless verbiage.
The first intention was to tell only what he knew-then this
small volume would have been but a pamphlet. But on fur-
ther consideration it was deemed best, to point out the lines
of investigation with the larger number of our indigenous medi-
cines, that they might be thoroughly tested.
No apology is offered for its shortcomings. It has been
compiled in considerable part, from monthly articles in the
Eclectic Medical Journal, and is presented to the profession
as a guide in part, but especially as an incentive to the re-
study of the Materia Medica.
SPECIFIC MEDICATION
AND
SPECIFIC MEDICINES.
THE THEORY OF SPECIFIC MEDICATION.
I take it for granted that the reader will concede
that all agents employed as medicines act either
upon function or structure, and that this action to
be curative must be opposed to the processes of
disease. This proposition seems so plain that it re-
quires no presentation of facts in proof, yet it is
well to give it careful consideration, and arrange
such facts as may have come under the reader's ob-
servation in its support.
If the action of a remedy is to oppose a process
of disease, evidently its selection will depend-first,
upon a correct knowledge of the disease, and
second, upon a correct knowledge of this opposition
of remedies to it.
It is a law of the universe, "that like causes
always produce like effects," or to reverse it," that
like effects always flow from like causes." There-
fore, if we can determine the opposition of a remedy
19
SPECIFIC MEDICATION.
1
to a process of disease in any given case, we have
determined it in all like cases. And, to make use
of this knowledge subsequently it is only necessary
that we be able to determine the exact condition of
disease, when we very certainly expect to obtain
the same curative (opposing) action from the
remedy.
In describing this action to another, it is neces-
sary-first, that we so observe and group the signs
and symptoms of disease, that he may get the exact
idea of the pathological condition to be opposed.
The skill required is in diagnosis, and necessitates
a very thorough re-study of pathology, ignoring to
a great extent, our present nosology. To facilitate
this study, the author has published a work--“ The
Principles of Medicine "—which embodies his views,
and will serve as a basis for specific or direct medi-
cation. Much that might be deemed necessary in
this monograph, will there be found in its proper
connection, and we have not deemed it desirable to
separate it and reproduce it here.
Many persons are in error in regard to our use of
the term specific. They think of a specific medicine,
as one that will cure all cases of a certain disease,
according to our present nosology, as pneumonitis,
dysentery, diarrhoea, albuminuria, phthisis, etc.; and
a person looking at the subject in this light, and
guided by his experience in the use of remedies,
would at once say there are no specifics.
We use the term specific with relation to definite
pathological conditions, and propose to say, that
SPECIFIC MEDICATION.
11
certain well determined deviations from the healthy
state, will always be corrected by certain specific
medicines.
A disease, according to our present nosology, may
be formed of one, or of a half-dozen or more distinct
pathological changes, bearing a determinate relation
to one another. We do not propose to reach all of
these by one remedy, except in those cases in which
one lesion is primary, and the others result from it.
But on the contrary, we propose a remedy for each
pathological feature, using the remedy for that first
which is first in the chain of morbid action, and
that second which stands second, and so on.
As an example, we analyze a case of fever, and
find it to consist of a lesion of the circulation, a
lesion of innervation, a lesion of secretion, a lesion
of the blood, and a lesion of nutrition; each of
these is regarded as a distinct element of the dis-
ease, but in the order named,—the one depending
upon the other to a certain extent. A remedy that
will rectify the lesion of circulation, will sometimes
be sufficient to arrest the entire chain of morbid
phenomena as we notice in the simple fevers. Or
a remedy that will correct the lesion of the blood-
this being primary and the cause of the various
morbid processes,-will be a specific for all, as when
quinine arrests an intermittent or remittent fever.
But in the severer types of disease, we find it
necessary to use a remedy or remedies for each path-
ological feature. Thus, we employ one to correct
the lesion of circulation, one to correct the lesion
12
SPECIFIC MEDICATION.
of innervation, special remedies to increase secre-
tion, to correct the lesion of the blood, etc. Instead
of one remedy to arrest the disease, according to
the ordinary use of the term specific, we employ a
number of different agents, which are none the less
specific, for they meet distinct features of the dis-
eased action.
To employ remedies in this way, it is requisite
that we analyze the disease according to what we
know of pathology, determining definitely the ele-
ments that go to form it, and their relation to one
another.
And secondly, that we know the direct influence
of remedies upon the human body, both in healtu
and disease; that we use them singly or in simple
combinations; that we do one thing at a time:
that first which is first, that second which holds the
second place, and so on.
If one expects to obtain the advantages of specific
medication, he must not associate it with indirect
medication. The direct sedatives, with free podo-
phyllin catharsis veratrum in pneumonia, with
nauseants, blisters, etc., are incompatible. Success
comes from one or the other alone. If I use direct
medication I use it alone, and if I use indirect medi-
cation I use it alone. If we propose to treat a case
of croup with Aconite, we do not use nauseants;
if we propose to cure a case of cholera infantum
with Ipecac and Nux Vomica, we do not want as-
tringents.
But we go further into the analysis of diseased
SPECIFIC MEDICATION.
18
action as expressed by symptoms, than many sup-
pose. The success of direct medication comes from
the definiteness of diagnosis-determining the exact
condition of a function or part.
:
•
To illustrate, it is not sufficient in selecting a
sedative to know that the pulse is frequent, using
alike Veratrum, Aconite, Digitalis, Gelseminum, or
Lobelia. Frequency is but one element of the
lesion and we have to determine in addition the
strength or weakness of the circulation, the degree
of obstruction of the capillary circulation, and the
condition of the nervous system that controls this
function. Thus, where there is strength with fre-
quency we employ Veratrum; feebleness with fre-
quency, Aconite; excitation of the nervous system
with strength and frequency, Gelseminum; atony
of the nervous system and tendency to stasis of
blood, Aconite and Belladonna; feeble impulse from
the heart, without capillary obstruction, Digitalis,
etc.
1
It is not sufficient to know that the tongue is
coated, indicating an impairment or arrest of diges-
tion. We make this secretion give us the history
of blood lesions, as well as of gastric and intestinal
derangements. We learn that pallid mucous mem-
branes with white coat demand alkalies; that deep
red mucous membranes and brown coat call for
acids; that a dirty-white, pasty coat requires the
alkaline sulphites, etc. It is not necessary to con-
tinue this illustration further, for the reader will see
by the above that the specific medication requires spe-
14
SPECIFIC MEDICATION.
cific diagnosis, and that it will be successful just in
proportion as we become skilled in this.
It is true that almost any one can use Veratrum
and Aconite successfully, for the conditions are so
prominent that they can not be mistaken; or any
one may successfully prescribe Aconite in sporadic
dysentery from cold; Ipecac in the diarrhoea of chil-
dren; Collinsonia or Hamamelis for hemorrhoids;
Collinsonia for ministers' sore throat; Cactus for
heart disease; Pulsatilla for nervousness; Staphy-
sagria for prostatorrhea; Eryngium Aquaticum for
cystic or urethral irritation; Apocynum Canabinum
for dropsy, etc., etc.
These remedies have an extra
value attached to them, because the conditions in-
dicating them are so easily determined.
Yet the reader will learn with surprise that ten
years since, with but one exception, not one of these
agents were used for the purpose named. In 1860,
10 lbs. of the crude root of Collinsonia supplied the
market for a year; now one house gets in 10,000
lbs. for the year's supply.
SPECIFIC DIAGNOSIS.
We have a eady insisted upon the necessity of
specific diagnosis if we are to expect definite cura-
tive action from medicines. This is a very impor-
tant element of specific or direct medication that
many physicians do not seem to understand. When
we speak of specific medication they get the idea
of an absolute cure for disease according to our
SPECIFIC DIAGNOSIS.
18
present nosology, and say there is no such thing as
a specific medicine. They expect to guess at the
name of a disease, and find a remedy that will fit
their guess-work. To suit such, a medicine must
be like a blunderbuss, scattering its shot all over the
field, giving a probability that some will reach the
mark.
Direct medication, on the contrary, requires spe-
cific diagnosis. We must know exactly what the de-
parture from health is, and knowing this we may
select a remedy which will correct it. As was re-
marked before, the physician must have first a thor-
ough knowledge of healthy life, and be able to re-
cognize it, or any departure from it. Thus Anat-
omy and Physiology are the true basis of direct
medication, for if we do not know the healthy
structure and function, it is not possible that we can
know the diseased structure and function.
We have a very simple rule for measuring the
departure from health, and it is easily applied. It
is in one of three directions-excess, defect, or perver-
sion—above, below, or from. If we can measure
disease in this way, the desired remedial action is at
once suggested-if in excess it is to be diminished,
if defective it is to be increased, if perverted it is to
be brought back to the normal standard. In a
majority of acute diseases, we will find these de-
partures so clearly marked that the diagnosis and
treatment are very easy.
But as there are many elements that go to make
healthy life in man, so there are many that go to
16
SPECIFIC MEDICATION.
make the sum of disease. These will be found in
varying combination, yet in most cases there are
certain prominent lesions which may be regarded
as standing first in the chain of morbid phenomena
and upon which the others rest. If we can find
remedies which will reach and correct these, the
disease is at an end, and the natural restorative
power of the body soon gives health.
The most simple form of specific medication is
where a single remedy is sufficient to arrest the pro-
cess of disease. As when we prescribe Collinsonia
for ministers' sore throat, Drosera for the cough of
measles, Belladonna for congestive headache, Ma-
crotys for muscular pains, Hamamelis for hemor
rhoids, Phytolacca for mammary irritation, Cactus
for functional heart disease, Staphysagria for pros-
tatorrhoea, etc. This use of remedies gives great
satisfaction in the treatment of many diseases, and
we are led to wish that the practice of medicine
could be resolved into the giving of such specifics.
A
Not quite so simple, but yet very plain is the
second form of direct medication, illustrated by the
following examples. A heavily loaded tongue at
base, with a bad taste in the mouth and fullness in
the epigastric region, demanding an emetic.
uniformly yellowish coated tongue from base to tip,
relieved by Podophyllin or Leptandrin. A pallid
tongue, coated white, calling for a salt of soda. A
pallid large tongue, with a moist pasty coat, de-
manding the alkaline sulphites, say sulphite of soda.
The deep red tongue and mucous membranes with
SPECIFIC DIAGNOSIS.
17
brownish coatings, demanding the use of acids, say
muriatic acid.
Quite as plain, but not so easily and directly
reached by medicine, is the need of a good condi-
tion of the intestinal canal for digestion and blood
making, and associated with it the recognition of
the need of certain restoratives that may be neces-
sary to normal nutrition and functional activity.
These are essentials in the treatment of every form
of disease. In acute cases, it is required first to rid
our patient of functional disease before we can fully
establish digestion and nutrition, but in chronic dis-
ease it will many times stand first, and must always
be associated with treatment for local lesions.
The complement of this is, treatment to increase
the removal of old and worn-out tissues, and thus
relieve the solids and fluids of material that must
necessarily depress functional activity. Probably
we have as little positive knowledge of remedies
that increase retrograde metamorphosis, as of any
other class, still they are being studied, and in time
we will be enabled to use them directly. Remedies
that increase excretion are in common use, and
form a very important part of our practice. From
the earliest periods of medicine, the fact that dis-
ease is destructive has been recognized. Destruc-
tion of the material of our bodies, necessarily leaves
the debris either in solids or fluids, and experience
has shown that it can not remain in the body with
safety. Hence the common use of those agents
2
18
SPECIFIC MEDICATION.
that stimulate excretion from skin, kidneys and
bowels.
But there has been a failure to appreciate the
true nature of these processes, and from this has
flowed a very great deal of bad practice. These
processes are strictly vital processes, carried on by
delicate organisms under the control of the nervous
system. As they are the basis of life, we may well
suppose that nature has guarded them on all sides,
and that they are the true centre of life. The doc-
tor of the olden time has looked upon them as
mechanisms to be powerfully influenced by reme-
dies. He powerfully excites the stomach and intes-
tinal canal as a means of derivation, and works
upon the skin and kidneys as if secretion from them
were a purely physical process. Thousands of lives
have been and are being destroyed in this way.
Any one who will take up Huxley's Physiology,
and read the clear and simple description of this
apparatus for digestion and waste, upon which our
lives rest, can not but be satisfied that the common
practice of medicine is a very great wrong. A man
lives, because he has the power of renewing his life
day by day. Take away this power and he will die
in a brief time; take it away in part, and you have
lessened his power to that extent; take it away for
an hour, for a day, or for a week, and his power to
live is weakened to that extent.
When we regard these processes as strictly vital
processes, in highly developed organs, under the
control of a most delicately adjusted nervous system,
SPECIFIC DIAGNOSIS.
19
we will be in a position to use remedies to aid vital
action. Studying the condition of the stomach and
intestinal canal in this light, we will see how a
direct stimulant, or tonic, an alkali, an acid, a rem-
edy that will relieve nervous irritation, or one that
will give increased innervation, will in different
cases be an aid to digestion. Looking farther, we
will see the necessity, in one case of histogenetic
food, in another of calorifacient, in one of iron, in
another of phosphorus, etc. It is just as much
specific medication to be able to select the proper food
for the sick as it is the proper medicine.
One or two examples of this may not be out of
place. The past winter I was called in consultation,
in a case of continued fever in the third week.
The treatment, so far as medicine was concerned,
had been very judicious, but the food had been
starchy, and for a week the patient had been able
to take very little. He was failing fast, and stimu
lants and tonics were used without advantage. The
most striking features of the disease to me were:
the feebleness of the heart's action, the want of
respiratory power, and the evidences of a general
failure of muscular power-in all other respects the
patient was in good condition. I advised enemata
of beef-essence, and its internal administration in
small quantities frequently repeated, and a suspen-
sion of all medicine. The effect was marked in
twenty-four hours, and the patient speedily recov-
ered. In the early part of my practice I had occa-
sion to call Dr. William Judkins in consultation, in
1
20
SPECIFIC MEDICATION.
酱
​the case of a lady who had incipient phthisis de
veloped from menstrual irregularity. She was very
feeble, and I had been giving her freely of the bit-
ter tonics, stimulants and animal food. The old
Quaker remarked, if thee will stop the medicine
and stimulants, and give her fatty matter she will
recover-and the result justified the old doctor's
skill in diagnosis. I have had to take this advice
twice in the past eighteen months, from other par-
ties, when I should have recognized it myself; in
both it was the one thing necessary to success.
With regard to excretion, we must be thoroughly
impressed with the fact that it is wholly a vital pro-
cess, and not a process of straining. When we
come to understand that a secreting organ is con-
tinually growing secreting cells, and that these
withdraw from the blood the worn-out materials of
our bodies, we will be in a position to use remedies
with better success. Evidently it is possible to so
over-stimulate or over-work an excretory organ,
that this function of cell-production will be very
much diminished or altogether arrested. Just in
this proportion must secretion be impaired or wholly
arrested. The best remedies to increase secretion are
those that act mildly and stimulate vital function.
Thus far direct medication is very plain sailing.
All can succeed with it, yet successes will be in pro-
portion to the physician's acuteness of observation,
and to some extent upon his knowledge of remedies.
But beyond this we have a field that requires a very
thorough knowledge of vital processes, accurate ob
DIFFERENCE FROM HOMEOPATHY.
21
servation, and an extended knowledge of remedies.
We study not so much the grosser manifestations
of disease, but the more delicate shadings and com-
binations, and our therapeutics requires that we
have a most intimate knowledge of the influence of
remedies upon the human body. In this field of
study the physician will find a beauty and certainty
in the practice of medicine that will give zest to in-
vestigation, and as it is pursued he will find greater
and greater success.
DIFFERENCE FROM HOMEOPATHY.
The question has been asked, "In what does your
theory of specific medication differ from Homœop-
athy?" The question is a pertinent one, and I
will endeavor to answer it briefly.
The law, similia similibus, upon which the Ho-
mœopathic practice is based, is defined in two ways.
One contends that the drug, used for cure. "pro-
duces the essential morbid condition" when proven
in health. The other, "that it produces similar
symptoms," but not the exact pathological condi-
tion.
The truth in this law of similia similibus, 18, that
certain agents, called medicines, act on particular
organs, parts, and functions of the human body in a
uniform manner. They act equally on the organ,
part, or function, in health and disease; and thus
acting in health, they produce such change in the
phenomena of life as to render the action sensible
22
SPECIFIC MEDICATION.
to the person-symptoms. If an agent directly and
uniformly produces an influence upon a particular
part, it is more likely to be used as a remedy in dis-
ease of that part than another which does not influ-
ence the part at all.
Remedies are, therefore, those agents which
directly and uniformly influence an organ, part, or
function. The question then comes up, are they
remedies because "they will produce a similar state
of disease," or because they are opposed to diseased
action?
The Homœopaths will not admit any explanation
of their law of similia. The remedy is a remedy
because it will produce the exact diseased condition,
or at least the exact symptoms of such condition.
I contend that a drug is a specific remedy: first,
because it influences uniformly and directly the
part or function diseased; and second, because it
opposes such diseased action. I would, therefore,
write the law of cure, contraria contrariis opponenda,
instead of similia similibus.
I find a late authority in Homœopathy agrees
with me in this. Dr. v. Grauvogl, in his "Lehr-
buch Der Homoeopathy," says:-"The conception
of a specific remedy expresses the mutual relation
existing between it and parts of the organism,
which has to be ascertained empirically by physio-
logical provings of drugs. For some part of the
organism is in a relation of immunity, for other
parts of attraction, for others again one of repulsion
and always vice versa. For instance, there is a spe-
DIFFERENCE FROM HOMEOPATHY.
28
ific form of fever and ague which, for these very
reasons, is cured by Quinine, a dose or quantity of
Quinine being given which corresponds to the in-
tensity of the attack."
*
*
Again with reference to the dose of medicines:
"All we have to do is to determine, independently
of all subjective persuasions and incomprehensibili-
ties, what quantity of a substance is necessary in
order to produce in any morbidly affected part of
the organism a chemical or physical counter-move-
ment of equal intensity, and in an opposite direction
to the movement originated by the morbific cause,
with a view of arresting, or at least, retarding this
latter, and finally discontinuing it altogether by re-
peating the dose.
* The problem
is simply to determine what remedial movement
quantities will antagonize as their equivalent the
movements that had been excited by the morbific
agent; for the measure of the force is the effect,
nothing else. To solve this problem we have the
natural law according to which quantity contains
the measure of the movement and counter-move-
ment; consequently for therapeutic purposes, the
correct dose consists in a quantity of force of the
indicated quality which is equal to the quantity of
force of the morbific agent, and in its movements
runs in a contrary direction to the quality of the
latter."
In ordinary practice, whether it be Old School or
Eclectic, there is no principle or law of cure. Rem-
edies are not given because they are opposed to or
24
SPECIFIC MEDICATION.
agree with diseased action, but simply because they
have been previously used with reputed good suc-
cess. It is, in fact, pure empiricism. The old dog-
ma of phlogosis and antiphlogistics, and the new
doctrine of impaired vitality and restorative medi-
cation, guides the empirical use of remedies in the
one or other direction.
THE ADMINISTRATION OF MEDICINES.
We may lay it down as an axiom, from which it
is never safe to depart, that-No medicine should be
given, unless the pathological condition and the indica-
tions for its use are clearly defined. It is much better
to employ a placebo, than run the risk of doing harm
by medication.
Good nursing is an essential element in the suc-
cessful practice of medicine, and always requires
direction by the physician; keeping the stomach in
good condition for the reception of food and medi-
cine, is of first importance, and requires attention.
Following this is the selection of proper food, its
preparation, and the time for its administration
These alone very well repay the careful attention
and thought of the physician, even if he can not
see an indication for the employment of remedies.
When we recollect that the cause of disease is
always depressing, and a source of constant renewal,
we will see that the removal of the cause from the
patient or the patient from the cause, or the antag-
onism of remedies to remove the cause, is` a proper
ADMINISTRATION OF MEDICINES.
25
field for our efforts. If we can see clearly that the
condition of disease is one of depression-that in
proportion as a man is sick, his vitality is lessened,
such means as will increase the power to live, or
the resistance of the body to death, will be sug-
gested.
As we have stated before, we make an analysis
of the disease and divide it into its component
parts, before making a prescription of medicine.
There are certain basic functions or conditions upon
which all others rest, and which are essential to life.
These demand our first consideration. Thus the
circulation of the blood, the temperature, the condition
of the nervous system, waste, excretion, the condition of
the blood, blood-making and nutrition, are examined
separately. Determining the lesion of these, we
prescribe such remedy as antagonizes it, and brings
the function toward the healthy standard. Some
one of them will stand first in the series of patho-
logical changes, and will serve as a basis for others,
and this will receive first attention. Thus we pre
scribe at the other lesions, in the order in which
they seem to be arranged.
We
As a rule, it is best to do one thing at a time.
prescribe first for that lesion which is first in the
chain of morbid action. Then maintaining the in-
fluence obtained by a continuation of the remedy,
we do that second which is second, and that third
which is third, and so on.
In the cure of disease time is an important ele-
ment, and it is never best to be in a hurry. Here,
3
26
SPECIFIC MEDICATION.
the old proverb "haste makes waste," is a very
true one. As a rule, the severer the disease, the
slower its development; the slower the departure
from health the greater the impairment of function
and structure, and necessarily the slower its restora-
tion.
The manifestations of life in man are from a
highly developed organism, the perfection of which
is a work of time. Every manifestation of life ne-
cessitates a continued renewal of structure, requir-
ing an expenditure of that force we know as vital.
Therefore, when the manifestations of life are ab-
normal (disease), we must necessarily allow time for
the development of the organism, increased because
the vital force is impaired.
As a rule, it is best to change the manifestations of
diseased life slowly, giving sufficient time for the or-
ganism to adapt itself to the change, and gain in-
creased strength as it returns to the condition of
health. It will never do to suppress a process of
disease at the risk of suppressing the organism upon
which natural function depends.
As a rule, it is best to effect these changes insensibly,
or without shock to an organ or to the entire body. In
this, as in all other things, it is the slow but con-
tinued application of an opposing force, that ac-
complishes the greatest results. Many thousands
of sick have been hurried to their graves by the
sudden and forcible efforts of the physician to re-
move disease. This is one of the most prominent
THE FORM OF MEDICINE.
27
errors of the old practice, and will require consid-
erable effort to avoid.
As a rule, it is best to employ remedies singly, or in
simple combination of remedies acting in the same way.
The reasons for this rule are obvious. It prevents
random or scattering prescriptions. We either
know a single remedy that will accomplish the ob-
ject, or we know nothing and have no right to
make a prescription. There can not be anything in
a combination that is not in the individual articles
composing it, and in some one of them par excellence:
this is the remedy to use. In direct medication we
want no modifying influences; we want the plain
and constant action of a simple remedy.
THE FORM OF MEDICINE.
The common action of many medicines obtained
in the old practice is the poisonons action. The
agent is given in such large doses and is so nauseous,
that the human body in self-preservation is forced
to act upon and expel it. Thus, an emetic forces.
the stomach to an act of expulsion, and we have
emesis; a cathartic influences the intestinal canal
in like manner and we have catharsis; and. with
diaphoretics and diuretics. A different class, which
may be represented by mercury, antimony, and
arsenic, obtain entrance to the blood, and depressing
this, they depress every manifestation of life until
they are finally slowly removed.
If we desire to obtain these grave influences of
1
28
SPECIFIC MEDICATION.
medicine, the form is not particular, neither is the
size of the dose-if the patient can stand it. But
if we desire that slow, insensible, but direct action
that I have spoken of, we want our remedies in such
form that they will be kindly received and have a
kindly action upon the organism.
We have also to take into consideration the pre-
servation of the article, uniformity of action, pleas-
antness to the sick, portability, and ease of pre-
scription. These hold a secondary place, yet are
very important.
A class of remedies may be regarded as chemicals,
and these we desire in greatest purity, and only
purchase such as bear the names of the best manu
facturers. Such are Quinia, Morphia, Sulphite of
Soda, Phosphate of Soda, the Bromides, etc.
The largest class is obtained from the vegetable
world, and are products of nature's laboratory.
These we wish unchanged by art, as nature has
prepared them, simply reducing the bulk, and using
a vehicle to preserve them.
Very certainly the best menstruum for all vege-
table remedies is alcohol and water in varying pro-
portion. There is no vegetable product that does
not yield its medicinal properties to these, in a very
concentrated form, the alcohol being in sufficient
proportion for preservation. Not only so, but with
modern apparatus for percolation, the fluid may
easily represent the strength of ounce for ounce,
giving sufficient concentration to make it portable.
The tincture thus prepared is miscible with water,
THE FORM OF MEDICINE.
29
which is undoubtedly the best vehicle for the intro-
duction of a remedy into the blood. In using a
hypodermic injection, we employ water as a vehicle
for the medicine, and not simple syrup, syrup of
lemon or ginger, an extract of quassia or other
nasty substance, and so in introducing remedies
into the circulation, through the stomach, we will
find water decidedly the best vehicle.
Remedies in pura naturalibus are not offensive, it
is the covering them up, and mixing them that
makes them unpleasant. Doctors' potions are pro-
verbially nasty, and the public mind has been culti-
vated to believe that a mixture in a bottle must be
an offence to smell, taste and stomach. The
thoughts of such medicines are enough to make
some sick.
My prescriptions are uniformly made with water
as a vehicle, the tincture being added to it in such
proportion that the dose will be a teaspoonful. If
the tinctures are carried in the pocket case, we add
them to a glass of water in proper proportion, and
renew the medicine at each visit that it may be
fresh.
In the treatment of diseases of children this ex-
temporaneous dispensing is especially desirable.
Children are naturally adverse to anything un-
pleasant, and one ordinary drugging is sufficient to
"put them agains. medicine." It is very unpleasant
to be required to for, e medicine upon a child against
ts wishes, still more to throw it down, hold it for-
cibly, and grasping its nose make it swallow the
;
80
SPECIFIC MEDICATION.
mixture. No wonder parents turn from such prac
tice to Homœopathy.
It has been my practice to have the little patient
see all the operations of preparing the medicine.
It sees the pocket case, inspects the bottles, and is
convinced that everything is clean and there is
nothing objectionable. The glass of water is placed
before it, and the few drops of medicine added, and
to the request, "My dear, taste this and see if the
medicine is not good," it offers no objection, is sat-
isfied, and you have obtained the little patient's
confidence, and will never lose it until you abuse it.
THE DOSE OF MEDICINE.
As a rule, the dose of medicine should be the smallest
quantity that will produce the desired result. The
proper dose, or that which gives the best result, is
very much smaller than one who has been used to
the large doses of indirect medicine would suppose
possible. Yet it is not infinitesimal, as our Homœo-
pathic friends would have us believe. It is difficult
to state what the dose should be as yet, but I be
lieve those named in connection with the remedies
are the maximum.
A few examples may serve to illustrate this. In
the olden time we thought the dose of a strong
tincture of Macrotys was from half to one teaspoon-
ful, repeated every two or three hours, until "the
head felt like bursting." I now find the remedy
much more certain in the proportion of 3j. of the
1 REPARATION OF REMEDIES.
81
tinsture lʊ water 3iv. a teaspoonful every two hours.
The common directions for using Veratrum (Nor-
wood's Tincture) were to commence with a dose of
three drops every three hours, increasing one drop
each dose, until its full effect was produced. Now
the dose is always less than one drop. Aconite was
formerly given in doses of drops, now in fractions
of drops.
The dose will vary in different cases, and with
different practitioners. If it falls below the gross
or poisonous action of the drug, it will have specific
influence, and the diagnosis being right, will accom-
plish the object of the prescriber. I am satisfied
that the size of the dose does not make such differ-
ence as has been thought, and that the essential
element of success is to get the right remedy.
THE PREPARATION OF REMEDIES.
The majority of physicians will prepare but few
remedies themselves, yet it is just as essential that
they know how they should be prepared, as if they
made them all. With an intelligent understanding
of the simpler processes of pharmacy, he will have
a much better knowledge of the physical properties
of medicines, and be enabled to judge somewhat of
their purity and efficiency when purchasing.
The general drug trade has been a miserable
fraud upon the profession. Whether selling crude
or manufactured articles, the chances were ten to
one that they were adulterated, and not what they
82
SPECIFIC MEDICATION.
were represented, (Morphia, Quinia, and some of
the common chemicals, have been exceptions.)
So far has this sophistication been carried that
all certainty in medicine, even in gross drugging
for indirect effect, has been lost. Solid or fluid ex-
tracts are found of all degrees of strength, from
the highest named in the pharmacopoeia to nothing.
In many cases they are prepared from old and
worthless crude material, that has partly or wholly
lost its medicinal properties, yet it is sold in the
same packages and at the same prices, as if good.
There is but one safe plan for the physician in
procuring remedies, and that is by personal experi-
ment to satisfy himself that a good remedy can be
readily prepared, and learn to know it when he
sees it. Deal with houses that claim to prepare
remedies from recent crude material, of full
strength, without heat, and return every package
that does not come up to the full standard of
strength and excellence.
It is well to adopt a simple nomenclature for fluid
medicines. Let them be called tinctures, as they are
prepared with alcohol, and specify the strength ounce
for ounce, of crude material to fluid preparation.
I insist that all vegetable remedies should be pre-
pared from the recent crude material obtained at its
proper season. In some cases the remedy does not
materially deteriorate within the year, and may be
kept in stock until the next season for gathering.
But in all cases it is better if prepared at once after
gathering, and in many the preparation should be
PREPARATION OF REMEDIES.
88
from the fresh article before any dessication. The
reasons are obvious-the medicinal properties are
found in the juices of the plant, or stored in its
cells, principally of the bark. In both cases drying
removes the medicinal principle, to a greater or less
extent. The medicinal principles of plants are to
a considerable extent complex and unstable organic
bodies, and time, with its constant processes of
change and decay, changes, deteriorates, and finally
destroys them.
STRENGTH OF FLUID REMEDIES. As before re-
marked, a remedy is desirable in proportion as it is
easily carried and dispensed, (leaving out of the
question its medicinal action), hence concentration
becomes an important element of pharmacy. A
skilled manufacturer who has the proper appliances,
has no difficulty in removing all the medicinal prop-
erties from vegetable products, so that one Troy
ounce of crude material will be contained in one
fluid-ounce of the tincture.
This may be accomplished by the simple process
of percolation, in most cases. In some pharmacies
this is supplemented by powerful pressure; in other
cases, the hydraulic press being employed with ad
vantage. In other establishments, the new process
of percolation under atmospheric pressure, has been
adopted with great advantage. Either of these
methods if carefully and honestly conducted will
give reliable and uniform remedies.
If we can
make up our minds that it is quality, rather than
quantity, that we should look after, slight variations
34
SPECIFIC MEDICATION.
1
of strength will make but little difference. I do
not wish to be understood, however, as admit-
ting that there can be any great variation of
medicinal strength, if recent crude material is used,
and the product represents ounce for ounce, and
the pharmaceutical processes have been skillfully
conducted.
PHYSICAL PROPERTIES OF FLUID REMEDIES.-The
fluid preparations should possess the exact physical
properties (intensified), as regards odor and taste,
of the fresh crude material. It will have the color
of the chlorophyll of the article, but should be
clear and transparent, and give no sediment, or
muddiness when shaken. These may seem like
minor matters, yet we will find it profitable to give
them attention. Skilled pharmacy gives fine look-
ing remedies, and they are likely to be good. Un-
skilled pharmacy gives dirty-looking preparations,
and they are likely to be inferior.
We may judge to a considerable extent of the
goodness of chemicals in the same way. If we find
our Sulphate of Quinia and Morphia presenting the
clear white silky or feathered crystals, we are satis-
fied that we have good remedies. But if it is dull,
discolored, crystals faint, broken, or amorphous, we
want none of it. So in the purchase of the Bro-
mides, Iodides, Salts of Potash and Soda, Iron, etc.,
we expect to find the highest physical qualities,
associated with purity and efficiency. If a salt is
discolored, or in any wise deficient in its appear-
ance, we want none of it.
OFFICE PHARMACY.
85
OFFICE PHARMACY.
There are good reasons why every physician
should have such knowledge of pharmacy, that he
can perform or direct all the simpler operations for
preparing medicines. Without this knowledge, his
education is deficient, in that he has not that know-
ledge of his tools which is so essential to good work.
He is in a condition to be imposed upon by imper-
fect and worthless remedies, and must surely lose
confidence in medicine, except given in large doses,
for its gross effects.
In country practice, a knowledge and practice of
office pharmacy is an important element of success.
The preparation of a remedy gives an interest in it
that leads to thorough study and careful use.
We
learn what a good preparation is, and its advantages
over the common stock in the drug trade, and we
will afterward use more care in making our pur-
chases. It economizes time, saves money, and cul-
tivates habits of thrift, all of which are deficient in
the medical profession.
It is not only an excellent school for the physi-
cian himself, but is also an admirable school for the
student. It is a study of the Materia Medica, that
gives a practical knowledge of remedies, and im-
presses the mind through the organs of sense, leav-
ing lasting impressions.
I do not wish to be understood as advising the
preparation of all medicines; or keeping the office
86
SPECIFIC MEDICATION.
dirty and unsightly with the refuse of roots, barks,
and herbs. This is the opposite of what we desire;
skill is associated with neatness and cleanliness. I
know some pharmacists that are so slovenly and
dirty in person and surroundings, that I should not
like to take their medicines. (The only one who
ever offered an objection to office pharmacy, had
these faults in excess.)
A half dozen neat tin percolators of the capacity
of two to ten pounds, hung in a closet or cupboard,
with a large mortar, comprises the apparatus. The
alcohol is kept in stock, and the crude material is
procured at proper seasons and used fresh, or in
some cases is ordered of the wholesale druggist
when obtaining other medicines.
The process of percolation is a very simple one.
The crude material requires to be as finely commi-
nuted and as closely packed in the percolator as
possible. It is then covered with alcohol, and
allowed to stand for forty-eight hours, when the
tincture is drawn off. Filter it through paper, and
you have a fine looking remedy, that will give sat-
isfaction whenever used.
In office pharmacy I have advised the strength
to be viij. of the crude material to the pint of
alcohol, because it is more easily manipulated by
one who is not expert. All the formula in this
work are of this strength, for every remedy named
may be prepared in the office.
The physician in the country will probably pre-
pare only those remedies that are indigenous, and
CLASSIFICATION OF REMEDIES.
87
at the proper season the year's supply. It is not
very difficult to find some one to gather the crude
material, and the preparation comes at that season
when there is least to do.
CLASSIFICATION OF REMEDIES.
I have been in doubt in regard to the best plan
of arranging the remedies in this study. Evidently
the old classification will not serve our purpose, for
it deals with indirect action; and the influence of
remedies in poisonous doses. We have not ad-
vanced far enough to make a new classification; at
least, to make one that would facilitate our study.
I have, therefore, concluded to take up the different
articles in alphabetical order, and so far as possible
make a brief review of our entire Materia Medica.
When a remedy has no especial value, it will be
named so; and when it seems to have a specific ac-
tion, not fully determined, this will be pointed out
for future experiment. Self-deception is a very un-
profitable pursuit, and great care will therefore be
employed to insure accuracy, and no statement
made unless pretty thoroughly proven.
The best preparations, and the best process for
office manufacture will be given, also the form in
which we deem it desirable to use them.
When we have thus given the Materia Medica a
review, we will be better able to make a classifica-
tion.
Some suggestions, however, as to the general in-
88
SPECIFIC MEDICATION.
dications for treatment, and use of remedies, may
not be out of place, and will serve as a further illus-
tration of our idea of specific medication.
In all acute, and most chronic diseases, our exam-
ination of the patient and our therapeutics will take
this order: 1. With reference to the condition of
the stomach and intestinal canal-bringing them to
as nearly a normal condition as possible, that reme-
dies may be kindly received and appropriated, and
that sufficient food may be taken and digested. 2.
With reference to the circulation of the blood, and
the temperature-obtaining a normal circulation as
regards frequency and freedom, and a temperature
as near 98° as possible. 3. With reference to the
presence of a zymotic poison, or other cause of dis-
ease—which may be neutralized, antagonized or re-
moved. 4. With reference to the condition of
the nervous system-giving good innervation.
With reference to the processes of waste and excre-
tion-that the worn-out or enfeebled material may
be broken down and speedily removed from the
body. 6. With reference to blood-making and
repair-that proper material be furnished for the
building of tissue, and that the processes of nutri-
tion are normally conducted.
5
These are general outlines for the study of dis-
ease, and the action of remedies in antagonizing it,
and may aid in giving direction to our study, and
enable each one to make a classification of remedies
for himself. A brief consideration of each one,
with examples of the application of remedies,
CLASSIFICATION OF REMEDIES.
89
though it will be a repetition, may be of advantage
to the student.
•
1. The condition of the stomach is of first im-
portance in the treatment of disease. It must be
in such condition that it will receive remedies
kindly, and permit their speedy absorption, in order
that they give us the desired results. Surely, it is
not difficult to see the necessity of this, if we take
no further view than to obtain the curative ac-
tion of remedies. If the stomach does not receive
a remedy kindly, is irritated by it, we can not ex-
pect ready absorption, or the complete curative
action. If the stomach throws out its juices, which
digest or decompose a remedy, we can not expect
its curative action. If the stomach is secreting
mucus in large quantity, if it is in that condition in
which it is but a receptacle or retainer, then we can
not expect the ready absorption of remedies, and
will not get their curative action.
We are accustomed to specify two conditions of
the stomach, which may be tolerably easily deter-
mined by constant symptoms, and which should
always be corrected. These are:—
Irritation of the stomach, marked by a reddened
(bright) tongue, elongated and pointed, with some-
times reddened and erect papillæ. It is accom-
panied with unpleasant sensations of constriction,
and tenderness on pressure over the epigastrium.
There may be nausea, retching, or vomiting; and
in the severer cases, when prolonged, an irritation
40
SPECIFIC MEDICATION.
of the sympathetic, and finally of the spinal and
cerebral nervous systems.
Its treatment takes precedence of everything
else, for until removed we can not expect the kindly
or definite action of remedies.
The remedies employed for its removal are:
minute doses of Aconite; small doses of Ipecac or
Lobelia; Hydrocyanic Acid, or better, a prepara-
tion of the bark of the Peach tree; Rhubarb;
Bismuth. These may be aided by the external use
of the cold pack, hot fomentations, or rubefacient
application, and sometimes an enema to remove the
torpor of the lower bowel. From twelve to forty-
eight hours, is usually the time required to effect it.
But, the reader may ask, why if remedies are
specific, name so many for the relief of so simple a
pathological condition as gastric irritation? The
question is pertinent, and we will endeavor to
answer it. Each of these remedies has a direct ac-
tion in this condition, and each may be relied upon
as a remedy. We choose the remedy, however,
with reference to the association of diseased action,
and in some cases one will be found best, in others
another.
b. The atonic stomach, with increased secretion
of mucus, and sometimes with considerable accu-
mulations. It is marked by the broad tongue,
heavily coated at its base, bad taste in the mouth,
and feeling of weight and heaviness in the epigas-
trium. The symptoms are distinct, and can not be
mistaken.
CLASSIFICATION OF REMEDIES.
41
When the condition is pronounced, in severer
forms of disease, there is no means which will reach
it so directly and speedily as an emetic. It needs
to be prompt and thorough in action, not producing
debility or leaving the organ irritable. If not re-
quiring this, we may accomplish the same object
by the use of the Alkaline Sulphites, followed by
Nux Vomica.
We have many minor lesions that can not be
classified under these, to which we will find single
remedies specific. Thus in simple nausea and vom-
iting, without irritation, we prescribe Nux Vomica.
In typhoid disease, with tumid mucous tissues, the
Baptisia. Increased mucous secretion with irrita-
bility, Oxide of Zinc. Imperfect gastric secretion,
Hydrastis. Increased mucous secretion with im-
paired functional activity, minute doses of Podo-
phyllin, etc.*
2. We recognize the fact, that just in proportion to
the variation of the circulation and temperature from the
normal standard is the severity and activity of disease.
The more frequent the pulse, and the higher the
temperature, the more active a zymotic poison, the
more rapid the progress of local or general disease,
and the less able the body to protect itself, or expel
the cause of disease. The rule here is absolute, and
there is no variation from it.
In therapeutics we find--that just in proportion as
the circulation and temperature can be brought to, and
*See Practice of Medicine, page 27.
4
42
SPECIFIC MEDICATION.
maintained at the normal standard, just in that propor·
tion are the processes of disease arrested, and vital pro-
cesses re-established.
These facts must surely have been noticed by ob-
servers, and we can only wonder that they have
never been clearly stated, and practiced upon.
If we take as an example a case of fever, we will
find that remedies that will reduce the pulse to a
normal frequency, giving freedom to the circula-
tion, will reduce the temperature, and that just in
proportion as this is accomplished, the febrile symp
toms disappear, and the various vital functions are
re-established. If we maintain the circulation and
temperature at this point, the fever must certainly
cease.
In acute inflammation, the rapidity of the local
disease and destruction of tissue, is in the ratio of
frequency of pulse and increase of temperature.
Just in proportion as we get a normal circulation
with reference to frequency and freedom, and
diminished temperature, just in that proportion the
inflammatory process is arrested.
In asthenic inflammation we find another element
in the pathology of the disease--a want of vital
power, either in the whole or in the part. This
must be antagonized by appropriate remedies. In
others there is a zymotic or animal poison, which
must be antagonized, destroyed, or removed.
In chronic disease the law is just as absolute as
in the acute. Given, any disease of function or
structure, with a pulse maintained constantly shove
CLASSIFICATION OF REMEDIES.
43
100 beats per minute, and a temperature above 100°,
and the patient must die. The disease, as a general
rule, will run its course rapidly to a fatal termina-
tion just in proportion to the extent of this devia-
tion.
Recovery from chronic disease never takes place
until the circulation and temperature approximate
a normal standard. In any given case, the proba-
bilities of cure are as the possibility of bringing and
maintaining the circulation and temperature at the
standard of health. The first evidences of amend-
ment are announced by a diminution of frequency
of pulse and a better circulation of blood, and by
an equal temperature of the body, approximating
98°. These seem like dogmatic statements, and
many will be inclined to dispute them, because op-
posed or not named by the common authorities on
medicine, but it only requires observation without
prejudice to prove each position.
We may claim then, that remedies influencing the
circulation and temperature, toward the normal
standard, are the most important of the Materia
Medica.
In very many cases the lesion of the circulation
is a basic lesion, upon which others arise and are
continued. When this is the case, the remedy that
gives us normal circulation removes all the diseased
processes which rest upon it. Thus we will find
that arrest of secretion and excretion, lesions of in-
nervation, of waste and nutrition, as well as the in-
tensity of zymotic causes, are in proportion to the
*
44
SPECIFIC MEDICATION.
rapidity of the circulation. Conversely, as the
pulse comes down to the normal standard, and the
blood circulates freely, just in that proportion we
have a restoration of the secretions and excretions,
better innervation, better digestion and blood-mak-
ing, and a more active waste and repair.
Have we remedies that influence the circulation
directly, giving a free and equal circulation, with
diminution of frequency? Many of our readers
will have asked this question before this, and an-
swered it in the negative. Certain remedies will
have been recommended to them as special sedatives,
which they have used without the good results
named and expected. How is this? It is a com-
mon failing with physicians to expect a desired re-
sult too soon, and endeavor to force it by large doses
of medicine. This has been a common cause of
failure in the use of Veratrum and Aconite. Others
have purchased worthless medicines, which will
readily account for the failure. Taking the article
of Veratrum alone, and excepting Norwood's Tinc-
ture, nine-tenths that has been sold was wholly
worthless as a medicine.
The theory with regard to the action of the class
of special sedatives was erroneous. They were re-
garded as depressants, and diminished frequency of
pulse was supposed to depend upon their depressing
influence upon the heart. It was the common error
of large doses and poisonous action. All of these
remedies are active poisons in large doses, and
death occurs in all by cardiac syncope. In the cases
CLASSIFICATION OF REMEDIES.
of Veratrum, Digitalis, Lobelia and Gelseminum,
slowness of pulse is a prominent symptom of the
poisonous action. In the case of Aconite, extreme
frequency of pulse is produced by the poisonous
action.
In medicinal doses (small), the influence of these
remedies is that of a cardiac stimulant, and is un-
doubtedly through the sympathetic system of
nerves, which controls the entire circulation of the
blood-not only the action of the heart, but of all
the blood-vessels to the most minute capillary. I
contend that this influence removes obstruction to
the free circulation of the blood, as well as gives
power to heart and muscular fibre of arteries. As
obstruction to free circulation is removed, it requires
less effort to move the blood; as the power of mov-
ing the blood is increased there is less necessity of
frequency of contraction upon the part of the heart.
As a rule, the time required to effect sedation
will bear a distinct relation to the time required for
the development of disease, and its average dura-
tion. Thus in an acute fever or inflammation from
cold, the influence of the sedative may be promptly
obtained, and the disease speedily arrested. In
continued fever, the accession of the disease (in
most cases), is slow in proportion to its duration and
severity. Here there are grave lesions of function,
possibly of structure, and we expect to obtain the
influence of the sedative slowly.*
*See Principles of Medicine, pp. 219, 264. The Eclectic Prac
tice of Medicine, page 94.
46
SPECIFIC MEDICATION.
Whilst each of the remedies named as arterial
sedatives, Aconite, Veratrum, Digitalis, Gelsemi-
num, Lobelia, exert a direct influence in this direc-
tion, they are not equally valuable in all cases.
The two first are pre-eminently the sedatives, their
action being more definite and stronger, and adapted
to a larger number of cases. The special adapta-
tion of each to special forms of diseased action is
named in the description of the remedy.
The temperature bears such a constant relation
to the frequency of pulse, and general condition of
the circulation, that a remedy which will correct
the one will also correct the other. Thus we find
in practice that just as we bring the pulse to the
normal standard by the use of an arterial sedative,
in the same degree we reduce the temperature.
This is the case in chronic as well as in acute dis-
case. For instance, in a case of phthisis we find a
temperature of 101° associated with a pulse above
100 beats per minute; if it is possible to bring the
pulse down to 80 the temperature comes down to
98° and a fraction. If this can be maintained we
find a cessation of tubercular deposit, and a repara-
tive process set up in the lungs.
We have some special means to influence the
temperature, outside of the remedies acting upon
the circulation. A full description of them would
be out of place here, but may be found in my Prin-
ciples of Medicine, p. 40.
3. The field of therapeutics embraced in our third
proposition is very large, and will well repay careful
CLASSIFICATION OF REMEDIES.
47
study. Whilst zymotic causes have been recog-
nized in many of the severe acute diseases, but little
has been done to determine their character, or the
means to antidote them. Possibly the observations
of Prof. Polli, with regard to the influence of the
Alkaline Sulphites, was the first important step in
this direction.
The presence of such blood poison is readily de-
tected, and we have advanced so far in our knowl-
edge of remedies, that in many cases we can select
the antidote with much certainty. I do not wish
to be understood as claiming that we have any
remedies that will immediately unite with all of a
zymotic poison in the blood, destroy it, and at once
restore health. Such an influence could not reason-
ably be expected. But we have remedies which,
introduced into the blood, will antagonize the zy-
motic poison, as it comes in contact with it, arrest-
ing its septic influence, or wholly destroying it. In
some cases they act rapidly, in others slowly, but
in all, if properly selected, with great certainty.
The principal remedies of this class are the Alka-
line Sulphites, (Sulphite of Soda being in most
common use) and the mineral acids. The rules for
the selection of the one or the other of these are
quite simple, and very definite :
In any given case presenting a pallid tongue,
with white, or dirty-white, pasty coating, use the
Alkaline Sulphites.
In any given case presenting a deep-red tongue
with brownish coatings, or deep-red glossy tongue,
48
SPECIFIC MEDICATION.
and dark sordes, use mineral acids. In some cases
we employ Sulphurous Acid, but in the majority,
Muriatic Acid.
Of our indigenous Materia Medica we have but
one remedy that markedly possesses these proper-
ties, and it possesses it in high degree. This rem-
edy is the Baptisia Tinctoria, which may be used in
either of the cases named, but is especially valued
in the last.
The reader will bear in mind that the activity of
a zymotic poison is in exact proportion to the de-
parture from normal function. With a rapid pulse,
high temperature, and arrest of secretion, its devel-
opment is rapid and its devitalizing influence
marked. Or in the rare opposite case of congestive
intermittent and cholera, as the circulation is en-
feebled, and the temperature lowered, its progress
is rapid.
Hence, in order to antagonize a zymotic process,
it is necessary, so far as possible, to obtain a normal
circulation and temperature. This proposition can
not be too strongly insisted upon. In a given case,
the circulation and temperature being favorably in-
fluenced by Aconite and Veratrum, Sulphite of
Soda exerts an immediate and marked controlling
influence over the fever poison. Whilst if it had
been given without such preparation it would have
had no influence at all, or but slight influence.
Some causes of disease are destroyed and removed
by remedies that increase waste and excretion. Pre-
parations of Potash and Soda, especially the alka-
CLASSIFICATION OF REMEDIES.
49
line diuretics act in this way. There are some
organic remedies that exert a direct influence upon
causes of disease, modifying or destroying them, as
may be instanced in the action of Phytolacca in
diphtheria. This action, however, in the majority
of cases, is feeble.
Causes of disease acting in and from the blood,
are frequently removed by stimulating the excretory
organs. Some are removed principally by the skin,
others by the bowels, others by the kidneys.
The cause of periodic disease, whatever it may
be, plays a very important part in the diseases of
some localities. Antagonize this cause, and the
disease ceases, or at least is very much modified.
Hence in the treatment of the diseases of the West,
antiperiodics become the most important remedies.
Quinia is a true specific, and may be taken as the
type of these remedies. It fails frequently, possibly
it is administered nine times where its specific action
is obtained once. But it is not the fault of the
remedy, but of the doctor. If the diagnosis is cor-
rectly made, and the system is prepared for its ad-
ministration, it will rarely fail, even when given in
a single sufficient dose.
I am satisfied that the study of the direct antag
onism of remedies to causes of disease, must ad-
vance the progress of rational medicine. It is pos-
sible, and I deem it probable, that such research
will give us remedies controlling all zymotic disease
in its early stage.
4. The human body is a complex structure, united
5
50
SPECIFIC MEDICATION.
in functional activity by a nervous system. As thir
exerts a controlling influence, we should expect that
its lesions would form a very important element of
the study of pathology. This has not been the case,
however, and we find pathologists and therapeutists
giving it but very little attention. It is a wide field
for study, and its cultivation will greatly advance
medical science.
A few suggestions may not be out of place here:
Those functions which we have been accustomed
to speak of as vegetative, are associated together, and
to some extent governed by the ganglionic or sym-
pathetic nervous system. It comprises digestion,
blood-making, the circulation of the blood, nutri-
tion, and secretion and excretion-these are the es-
sentially vital functions, in the performance of
which man has life. If they are properly performed,
he has healthy life, if there is an aberration in
either of them, one or more, he has diseased life.
Is it possible to have disease, without a lesion of one
of these? I think the reader will say it is not.
If this be so, then this ganglionic system of nerves
must play an important part in every disease.*
Control and association of these vital processes
being in the ganglionic system of nerves, we would
naturally expect it to furnish the readiest means of
reaching them and correcting their lesions. If
there are remedies then that influence the gangli-
ɔnic nerves directly, and through them the vital
*See Principles of Medicine, page 306.
CLASSIFICATION OF REMEDIES.
51.
processes of the body, they must become our most
direct and important therapeutic means. It is in
this way that a large number of specific remedies
act, as I believe. The sedatives, Aconite, Veratrum,
Gelseminum, Lobelia, and others, as Cactus, Bella-
donna, Eryngium, Phytolacca, Hamamelis, Pulsa-
tilla, etc., very certainly produce their effects
through it.
The association of the spinal-cord with the sym.
pathetic brings vital functions in relation with our
conscious life, and through its superior expansion
the brain, adds suffering from disease. Conversely,
mal-conditions of conscious life are reflected through
this association and influence vital processes.
Whilst, therefore, it is very important to reach
lesions of vegetative life directly through the gan-
glionic system of nerves, it is no less important to
control any disease producing influence that might
be extended from the cerebro-spinal centres.
5. Lesions of waste and excretion are elements of
every disease. In some they form a principal part,
in others in less degree, but in all they require to
be estimated in diagnosis and therapeutics. They
range themselves under the common classification
of excess, defect, and perversion, and usually it is
not difficult to determine their character, and select
means that exert a direct influence.
Constant waste is a necessity of life, as is constant
removal of this waste. If the materials of the body
are not broken down and removed as they have
served their purpose, the body is old, imperfect, and
SPECIFIC MEDICATION.
has lost functional power to this extent. If the
material is broken down and removed to the blood,
but not carried out by the excretions, we will have
an impairment of life from its presence in the
blood. I have given this subject full consideration
in my Principles of Medicine, pp. 116 to 185, to
which the reader is referred.
Too rapid waste of tissue is sometimes an impor-
tant element of disease, requiring care in diagnosis
and the application of remedies.
A perversion in waste and excretion is a common
element of disease. In the breaking down of a
protean body, it passes through many phases, and
in its metamorphosis, it assumes forms that are
noxious to life, if they have any degree of perma-
nency, or are in any considerable quantity. Lesions
in retrograde metamorphosis are therefore to be esti-
mated, and remedies which influence it become im-
portant.
We have already noticed that many causes of
disease act in and from the blood. They are zy-
motic poisons, or animal matter undergoing change,
and influence the blood and life in different degree,
in proportion to their quantity, and especially in
proportion to their activity in setting up the septic
process. These may be antagonized or destroyed
in many cases; in others the natural process of re-
trograde metamorphosis is stimulated, and they are
transformed into urea and other innocuous bodies
fitted for excretion by kidneys, skin and bowels.
Means that increase the activity of these excretions
CLASSIFICATION OF REMEDIES.
58
are frequently sufficient for the removal of such
causes of disease.
6. The necessity of regarding the nutritive pro-
cesses during the progress of disease, is now admit-
ted by all advanced physicians, and insisted upon
by such writers as Chambers, Anstie, Bennett and
others. Experience has conclusively proven that
proper food with good condition of the digestive
apparatus, without medicine, give a success in the
treatment of the graver acute diseases, that was
never obtained by any other method of treatment.
As we have already seen, the condition of the
stomach and digestive apparatus is of first impor-
tance in all forms of disease, and its lesions demand
first attention in our therapeutics. We have shown
that this was essential to the successful administra-
tion of remedies, it is no less necessary that the
patient may take and appropriate proper food.
The administration of remedies that increase
functional activity of the digestive apparatus, or aid
in the digestive process, are sometimes important
means. The selection of appropriate food, and the
use of restoratives is supplemental to this. The
object is to place the digestive organs in good con-
dition to receive and prepare food for admission tc
the blood; to furnish such material to the blood
as may be necessary for its perfect organization,
and for the renewal of tissue.
REMEDIES.
ABIES CANADENSIS.
(HEMLOCK.)
This agent has been employed in medicine for a long time;
the bark in decoction as an astringent, the foliage in hot
infusion as a diuretic and diaphoretic, and the oil as a stim-
ulant local application. It undoubtedly possesses valuable
properties. The following properties and uses are suggested
to those who live where it may readily be obtained:
1st. A tincture of the recent inner bark in diluted alcohol;
use in general asthenia, with pallid mucous membranes and
feeble digestion; also, in diseases of the respiratory mucous
membranes.
2d. A tincture of the foliage in dilute alcohol; use in irri-
tation of the urinary organs, and in disease of the skin.
3d. A sack of wheat bran flattened, and sprinkled with oil
of hemlock, is an excellent application to the loins in chronic
disease of the kidneys and reproductive apparatus. It may
be worn for weeks.
ACHILLEA MILLEFOLIUM.
(YARROW.)
Preparation -Prepare a tincture of the recent herb, 3viij.
to alcohol 50° Oj. Dose, gtt. v. to 3ss.
This agent, though feeble in its action, is much better than
many in common use. It acts directly on the urinary appa-
ratus, and the reproductive organs of the female. I have
used it to allay irritation of the kidneys, and vesical and
urethral irritation. In these cases its influence is somewhat
similar to that of Buchu and Uva Ursi. It is employed with
advantage in atonic amenorrhoea, menorrhagia, and vaginal
leucorrhoea.
ACONITUM NAPELLUS.
55
ACIDS.
There is a specific use for acids in the treatment of disease,
which we wish to study carefully. In any form of disease
we may have an excess of the alkaline salts of the blood.
This may be the basis of diseased action, or but a complica-
tion rendering it more intense, but whether the one or the
other, it needs to be recognized and have direct treatment.
The indications of excessive alkalinity are very plain, and
need not be mistaken by the youngest practitioner. The
color of the mucous membranes is deep red, especially of
mouth and tongue; the coating of tongue, sordes, or any ex-
udative material, has a dark color, usually brownish. It
makes no difference what the diseased action is, in its total-
ity, or what it is called, the deep red, somewhat dusky color,
always demands the administration of acids.
There is but one exception to this, and that is a rare one,
in which the excess is of soda, but with a defect of potash.
In this case the administration of a salt of potash will an-
swer a better purpose than the acid, or may be combined
with it.
Muriatic acid is preferable in most acute cases, and
should be used so diluted, and in such quantity, as to be
pleasant to the patient, and until the indication for its use
is removed. Lactic acid is sometimes preferable with child-
ren, and in some cases of chronic disease, especially when
associated with indigestion. The vegetable acids may be
used in acute disease, but are not so good as those named.
ACONITUM NAPELLUS.
(ACONITE.)
Preparation.-A tincture of the root (imported from Ger-
many) is the stronger and more uniform preparation. It
should be prepared by percolation; the strength being ounce.
for ounce; though, if constantly made in the office, it will
be easier to make it 3viij, to the pint, the dose being propor-
tionately increased.
56
SPECIFIC MEDICINES.
The medium dose one-third of a drop, and the form
of administration: R Tincture of Aconite root, gtt. v. to x.;
water, 3iv.; a teaspoonful every hour in acute disease, every
two or three hours in chronic disease. To a child two years
old the proportion is gtt. ii. to v. to water iv.
Aconite is a stimulant to the sympathetic system of nerves,
and increases the power of the heart to move the blood, at
the same time that it places the blood-vessels in better con-
dition for its passage. It will be recollected that the same
system of nerves governs the movements of the heart and of
the entire system of blood-vessels. What influences one
will, therefore, influence the other in the same manner.
But Aconite is said to be a sedative; and by a sedative we
are to understand a remedy that diminishes the frequency of
the pulse. How can Aconite, therefore, be a stimulant and
a sedative?
There is no doubt but that Aconite is one of the most cer-
tain remedies we have to reduce the frequency of the pulse
in certain conditions of disease. And the condition is that
in which there is a want of power on the part of the heart,
and a like want of innervation to the capillary system of
blood-vessels. Aconite in small doses lessens the frequency
of the pulse, because it removes obstruction to the flow of
blood in the vessels, and gives greater cardiac power.
We employ it in all forms of fever, to control the circula-
tion, and diminish the temperature. Used in the doses named,
it gives greater freedom to the circulation, at the same time
that it diminishes the frequency of the pulse. It seems to
remove obstruction to the free circulation of the blood, at
the same time that it removes irritation of the cardiac nerves,.
and gives increased power to the heart.
Its action in inflammation is as pronounced as in fever.
It directly antagonizes inflammatory action, and in the early
stage will arrest it speedily-if this is the sedative in-
dicated.
There are some diseases of an inflammatory character to
which Aconite is specific, that deserve mention. The first of
ACONITUM NAPELLUS.
57
these is tonsillitis, in which we employ it by internal ad-
ministration, or better by the use of the steam atomizing ap-
paratus. In some forms of mucous croup, with enfeebled
circulation, in muco-enteritis, and in simple colitis or dysen-
tery from cold, I never think of making any other prescription.
As the notice of the action of Aconite in croup may not
impress the reader sufficiently, I desire to say that I regard
it as the most certain internal remedy in all forms of this dis-
ease, and if one cannot find a specific indication for another
remedy, let him give this. I prefer g t. ij. to water živ., a
teaspoonful every fifteen to thirty minutes. Stillingia lini-
ment is the external application.
To point out the special indications for the use of Aconite
I can not do better than reproduce the editorial in Septem-
ber Journal of 1868 on the "Differential Therapeutics of Ve-
ratrum and Aconite:"
To determine which of a class of remedies is applicable in
a given case, is the most difficult task of the physician, and
any information in this respect is of much value. I doubt
whether any one using the two remedies named, would be
willing to risk giving this estimate. Many may have an em-
pirical intuition in regard to it, but most could venture noth-
ing but a guess.
Veratrum is the remedy where there is a frequent but free
circulation. It is also the remedy where there is an active
capillary circulation, both in fever and inflammation. A full
and bounding pulse, a full and hard pulse, and a corded or
wiry pulse, if associated with inflammation of serous tissues,
call for this remedy.
Aconite is the remedy when there is difficulty in the capil-
lary circulation, a dilatation and want of tonicity of these
vessels, both in fever and inflammation.
In general terms, Veratrum is the remedy in sthenia, Aco-
nite in asthenia; but there are too many exceptions to this
to make it a safe rule for our guidance.
It is the remedy for the frequent, small pulse, the hard
and wiry pulse (except in the cases above named), the fre-
58
SPECIFIC MEDICINES.
quent, open and easily compressed pulse, the rebounding
pulse, the irregular pulse, and indeed wherever there is the
evidence of marked enfeeblement of the circulation.
It is the sedative I associate with Belladonna in congestion,
especially of the nerve centers, and to relieve coma. Whilst
I would use Veratrum with Gelseminum in determination of
blood to the brain, and in active delirium.
Veratrum acts more efficiently upon the excretory organs;
indeed I believe it to be one of the most certain remedies we
have to increase excretion. Hence it is employed with great
advantage for those purposes usually called alterative.
Aconite controls excessive activity of the excretory organs,
whether of the bowels, kidneys, or skin. Thus it is our most
certain remedy in the summer complaint of children, associ-
ated with Belladonna in diabetes insipidus, with the bitter
tonics and Strychnia in phosphuria and oxaluria, and with
the mineral acids in night sweats.
ACTEA ALBA.
(WHITE COHOSH.)
Preparation.-Two preparations may be used: first, a tinc-
ture of the recent root, 3 viij. to alcohol 98 per cent. Oj.; sec-
ond, a tincture of the dried root in the same proportion, but
using alcohol 76 per cent. Let the dose range from gtt. j. to xx.
The white cohosh has had but a limited use in medicine,
yet it possesses such properties that it will undoubtedly prove
useful when studied. The direction of experiment will be
to determine its influence on the functions of waste and nu-
trition, and its special action on the reproductive organs of
the female.
BLOOMINGTON, ILL., Sept. 30.
DR. SCUDDER: I intended to have written to you in regard
to one specific property of the Actæa Alba. As you have
reached it in your order, you can do as you wish in regard to
inserting this. It is specific in controlling after-pains. There
is probably no remedy known that equals it. Make a tea of
it, and drink freely. This power in controlling after-pains
suggests that it will prove valuable in congestion and neu-
ralgia of the womb.
W. FULTON, M, D.
·
:
ESCULUS GLABRA.
ACTEA SPICATA,
(BANEBERRY.)
59
Prepare a tincture from the root gathered in the fall, using
strong alcohol.
In large doses it is a violent purgative, and may produce
inflammation of the bowels. It causes tormina and tenes-
mus, and seems to extend its influence to all the abdominal
viscera, the urinary apparatus included. Its action is at-
tended with unpleasant sensations in the head, and some
times it produces severe headache.
In small doses (gtt. ij. to water 3iv.) it may be used in diar
rhoea and dysentery, some forms of colic, and in disease of
the urinary apparatus when the passage of urine is attended
with tenesmus.
ADANSONIA DIGITATA.
(BAOBAB.)
The bark of this tree was employed with great success by
Dr. Duchassaing, of Guadaloupe, in intermittent fevers. It
is also a very good diaphoretic. One ounce of the bark was
boiled in a pint and a half of water to one pint, and the
whole taken in the course of a day.
A tincture may be prepared in the usual way from the
bark, and used in doses of from one to thirty drops, as a sed-
ative, diaphoretic and antiperiodic, in the treatment of ma-
larial and other fevers.
ÆSCULUS GLABRA.
(BUCKEYE.)
Preparation.-Whilst the bark possesses medicinal proper-
ties in considerable degree, and may be used, a tincture of the
nuts will probably be the best preparation.
Take of the recent nuts, fully ripened, four ounces; bruise
them thoroughly, and cover with alcohol 76 one pint; let it
stand for two weeks; strain and filter.
Of this tincture add from one to two drachms to four
ounces of water-the dose being one teaspoonful.
60
SPECIFIC MEDICINES.
The buckeye has been used to but a limited extent in med-
icine, yet its activity is such (as a poison), that it will proba-
bly prove very valuable when thoroughly studied. In my
boyhood, I well remember persons carrying "buckeyes" in
their pockets as a sovereign cure for "piles," and at a later
period as a remedy for rheumatism. Doubtless this sugges-
ted the first use of the Esculus in medicine.
It has been used in the treatment of hemorrhoids with
much success, and I am satisfied that in some forms of the
disease it is the most certain remedy we possess. I have also
given it in a few cases of diseased uterus with good results
cases in which the entire organ was enlarged, the cervix
tumid, with too frequent recurrence of the menstrual flow.
The marked influence of the Esculus on the nervous sys-
tem would suggest a line of experiment likely to lead to the
development of valuable properties. It has already been em-
ployed as a stimulant to the nervous system in some cases of
paralysis.
We may reason in this way: a remedy that cures hemor-
rhoids must exert a powerful influence upon the circulation;
whilst its poisonous action, often witnessed-vertigo, dimin-
ished sight, wry neck, fixed eyes, paralysis, convulsions, etc.,
show its influence upon the nervous system.
ÆSCULUS HIPPOCASTANUM.
(HORSE CHESTNUT.)
Preparation.—Take of the recent nut, fully ripe, four ounces,
bruise it thoroughly, and cover with alcohol 76° one pint: let
it stand fourteen days and filter.
Dose, two to four drops, in water.
The bark of this variety has been employed to a limited
extent as a tonic, and possesses feeble antiperiodic powers.
Quinine being employed to break the chill, this agent was
sufficient to prevent its recurrence. The pulverized kernel
has been used as a sternutatory for the relief of headache and
facial neuralgia. The nuts were also thought to possess some
special influence over hemorrhoids and rheumatism.
AGARIC.
61
The influence upon the nervous system is similar in kind
to the buckeye, though not so active. This probably will be
its best field of action, standing midway between Belladonna
on the one hand and Nux Vomica on the other.
It exerts the same influence upon the circulation as the
Æsculus Glabra, and has been successfully employed in the
treatment of hemorrhoids. It will doubtless be found to
improve the circulation generally, and may be employed
whenever there is want of power in the heart, capillary stasis,
or tendency to congestion.
ETHUSA CYNAPIUM.
(FOOL'S PARSLEY.)
A tincture is prepared from the flowering plant, using
strong alcohol.
This remedy has had but a limited use, and must be em-
ployed with care. It may be recommended in active delir-
ium, when patients become excited from slight causes, and
are liable to transports of rage. There is also confusion of
intellect, dizziness, as if intoxicated. Violent headache with
dizziness.
To water iv. add gtt. ij. of the tincture, and give a tea-
spoonful every two or three hours.
AGARIC.*
History. This is obtained from various fungus plants of
the mushroom tribe. They absorb a great amount of oxygen
with evolution of hydrogen and carbonic acid gas, and con-
tain considerable proportions of nitrogen. They are destruc-
tive to nearly all organic matter upon which they grow. Ac-
cording to Dr. M. A. Curtis, of N. C., the genus boletus, as
now constituted, includes only fleshy species, with a hymeni-
um composed of sporable tubes. Those species formerly in-
cluded in Boletus, and whose hymenium is composed of pores,
now form the genus Polyporus.
*The following is taken from the new edition of King's American Dis
pensatory.
62
SPECIFIC MEDICINES.
The Polyporus Officinalis (Boletus Laricis), known by the
name of White Agaric, Purging Agaric, etc., is procured from
Asia, Corinthia, Russia, Central America, and the Rocky
Mountains, where it is found growing upon the Larch. It is
in masses, varying from the size of an ordinary apple to that
of a large nutmeg-melon; its shape somewhat resembles a
horse's hoof; it is reddish-gray or yellow externally, whitish
internally, and of a spongy, friable consistence; hymenium
concrete; substance of the pileus consisting of subrotund pores,
with their simple dissepiments; pileus corky-fleshy, ungulate,
zoned, smooth; pores yellowish; it has a feeble odor, and a
bitter, acid, somewhat sweetish taste. Braconnot found in it
72 parts resinous matter, 2 bitter extractive, 26 of a nutri-
tious animalized principle, which he termed fungin. Ben-
zoic acid and several salts have likewise been found in it.
It is collected in August and September, deprived of its outer
covering, and then dried and placed in the sun.
Polyporus (Boletus) Ignarius, Agaric of the. Oak, is a fungus
found on the oak, cherry, willow, plum, and other trees; when
young it is soft, but gradually becomes hard and woody. In
shape it somewhat resembles the preceding; its upper smooth
surface is marked with dark circular ridges, and its under is
very porous, and of a yellowish-white color It is tasteless
and inodorous. The Polyporus (Boletus) Fomentarius, growing
on similar trees with the P. Ignarius, when cut in slices,
beaten, soaked in a solution of nitre, and dried, forms an in-
flammable substance, known as Spunk, Amadou, or German
Tinder. The Polyporus Pinicola grows upon the pine, birch,
tamarac, fir, and similar trees; with absolute alcohol the fresh
fungus forms a dark-red, intensely bitter tincture. A white
amorphous powder, called laricin, is obtained from some of
these plants. It has a bitter taste, is soluble in alcohol and
oil of turpentine, forms a paste with boiling water, and has
the formula C14H12O4.
Properties and Uses.-The dust of the Larch Agaric is irri-
tating to mucous surfaces, causing tears when it enters the
eyes, and sneezing, cough, and nausea, when the nostrils are
exposed to it. It has been used in half-drachm or drachm
AGARICUS MUSCARIUS.
63
doses as a purgative; in larger doses as an emetic. In doses
of from three to ten grains, gradually increasing to sixty
grains, in the course of the twenty-four hours, it has been
found efficacious in arresting the nocturnal perspiration of
consumptives. Externally, it has been used, together with
the Agaric of the Oak, as a styptic, and said to restrain not
only venous but arterial hemorrhages, without the use of
ligatures. It does not appear, however, to possess any real
styptic power, or to act otherwise than dry lint, sponge, or
other soft applications. Prepared with nitre, as for tinder,
it has been used as a species of moxa.
The P. Officinalis and the P. Pinicola, in doses of from
three to four grains of the powder, repeated every three or
four hours, or of the concentrated tincture in doses of five
drops, have both been found valuable in the cure of obsti-
nate and long standing intermittents, and other diseases com-
mon to malarial districts; as obstinate bilious remittent fever,
chronic diarrhoea, chronic dysentery, periodical neuralgia,
nervous headache, ague cake, and increased flow of urine.
They have likewise proved useful in long standing jaundice,
and in the chills and fever common among consumptive
patients.
The tincture of Boletus exerts a marked influence upon
the spinal and sympathetic nervous system, in certain cases
of disease. It has been successfully employed in the treat-
ment of epilepsy and chorea, and to check the rapid pulse
with hectic fever and night sweats in phthisis. It has also
been recommended in insanity where there is a feeble cere-
bral circulation and imperfect nutrition. And, also, in neu-
ralgia, with similar symptoms.
AGARICUS MUSCARIUS.
(FLY AGARIC.)
Make a tincture of the fresh fungus, using strong alcohol.
Probably the best defined indication for this remedy is in-
voluntary twitching of the muscles of the face, forehead, and
even of the eyes, so that objects are not seen well because
1
64
SPECIFIC MEDICINES.
they seem to move; drawing of the tissues of the forehead
and nose. Pressing pain in the occiput and an inclination to
fall backwards is also a very good indication.
The dose must be small, gtt. i. to water 3iv., or one of the
homoeopathic dilutions.
AGAVE AMERICANA.
(CENTURY PLANT.)
The only report we have of this agent is from Dr. Penn,
U. S. A., in the treatment of scurvy: "Every case has improved
rapidly; the countenance, so universally dejected and de-
spairing in the patient affected with scurvy, is brightened up
by contentment and hope in two days from the time of its in-
troduction. The most marked evidences of improvement were
observable at every successive visit. From observing the
effects of the Maguey in the cases which have occurred in this
command, I am compelled to place it far above that remedy
which, till now, has stood above every other-lime juice.
The manner in which I use it is as follows: The leaves are
cut off close to the root. They are placed in hot ashes until
thoroughly cooked, when they are removed, and the juice ex-
pressed. The expressed juice is then strained, and given in
doses of 3ij. to Ziij. daily.”
I should be glad if some of our southern readers would try
a tincture of the recent leaves, made by cutting them in small
pieces and covering with alcohol. We want to determine its
influence on the circulation and on the nervous system. The
dose would be about ten drops.
AGRIMONIA EUPATORIA.
Preparation.-Prepare a tincture from the fresh herb 3 viij.
to Alcohol 98 Oj. Dose from gtt. j. to 3ss.
Agrimonia exerts a slight stimulant influence upon all the
vegetative processes, and under its use we find an improve-
ment of appetite, digestion and nutrition,
It exerts a specific influence upon mucous membranes,
checking profuse secretion, and giving tone. Thus it has been
ALKALIES.
65
employed with advantage in cases of chronic bronchitis,
phthisis with increased secretion, and humoral asthma.
But it is especially useful in chronic catarrhal disease of
the kidneys and bladder, and will frequently prove curative.
It gives tone and strength to these organs, and may well re-
place the more common tonic diuretics in many cases.
The strongest indication for agrimonia is pain, simulating
colic, pointing in the lumbar regions, or uterine pain asso-
ciated with lumbar uneasiness. Sometimes the pain will
seem to involve the lower portion of the liver.
AILANTHUS GLANDULOSA.
(TREE OF HEAVEN.)
A tincture may be prepared from the fresh inner bark,
using strong alcohol.
The best indication for this remedy is epileptiform con-
traction of muscles. It has been recommended for the cure
of epilepsy, but its reputation has not increased with use.
Dose from the fraction of a drop, or a dilution, to ten drops.
ALISMA PLANTAGO.
(WATER PLANTAIN.)
Prepare a tincture from the fresh root, using alcohol of 98.
Dose, add gtt. v. to x. to water 3iv., a teaspoonful every two
to four hours.
It is indicated by irritation and uneasiness in passing water,
frequent desire to micturate, pains in the loins, and involun-
tary muscular movement. It has been used in chorea and
epilepsy with reported success.
ALKALIES.
It is well to consider the specific use of alkalies in this re-
lation; as they are the opposite of acids. We may say of
these, as of acids, that their deficiency is found as a constit-
uent element in all forms of disease-in some cases being the
basis of a morbid action, in others but a complication; but,
whenever found, an important element and demanding direct
treatment.
66
SPECIFIC MEDICINES.
The symptoms of deficiency of these salts of the blood are
very plain, and, using the language of the Prophet, "He who
runs may read." The tongue is broad and pallid, its coating
pasty and white, or yellowish white. The mucous membranes
are uniformly pallid. As these evidences are absolute and
readily determined, it is not necessary to name others not so
constant.
Whenever we find this deficiency of the alkaline salts we
will observe, as the result: loss of power in the stomach, en-
feebled digestion and slow absorption, impairment of the cir-
culation, arrest of nutrition and waste, and enfeebled inner-
vation. These will correspond in degree to the deficiency.
So marked are these results, that I have long regarded the
diagnosis, with regard to excess or deficiency of the alkaline
salts, as of the highest importance. Indeed in some forms
of disease, especially of a typhoid character, it is the princi-
pal element upon which a successful treatment is based.
Soda is the natural salt of the blood, and exists in the body
in the largest proportion. Whenever, therefore, we have
the evidence of deficiency of the alkaline salts, and no spe-
cial symptoms indicating others, we will give a salt of soda.
In many cases I order bicarbonate of soda in water, in such
quantity that it will make a pleasant drink, and let the pa-
tient have it freely.
If, at the same time, we wish an antiseptic influence, we
may give the sulphite or hyposulphite of soda or the chloride
of sodium.
I am satisfied that I have seen patients die from depriva-
tion of common salt during a protracted illness. It is a com-
mon impression that the food for the sick should not be sea-
soned, and whatever slop may be given, it is almost innocent
of this essential of life. In the milk diet that I recommend
in sickness, common salt is used freely, the milk being boiled
and given hot. And if the patient cannot take the usual
quantity in his food, I have it given in his drink. This mat-
ter is so important that it can not be repeated too often, or
dwelt upon too long.
ALNUS RUBRA.
67
The most marked example of this want of common salt I
have ever noticed has been in surgical disease, especially in
open wounds. Without a supply of salt the tongue would
become broad, pallid, puffy, with a tenacious pasty coat, the
effusion at the point of injury serous, with an unpleasant
watery pus, which at last became a mere sanies or ichor.
A few days of a free allowance of salt would change all this,
and the patient would get along well.
A salt of potash is indicated where there is feebleness of
the muscles to a greater extent than can be accounted for by
the disease. Occasionally such want is expressed in a marked
manner by feebleness of the heart.
Ammonia will, occasionally, prove the best salt for tempo-
rary use, especially where there is great debility. But when
so used, it should be followed by the free use of common salt,
or some salt of soda.
ALETRIS FARINOSA.
The Aletris is a gastric stimulant and improves digestion.
It has also proven a valuable tonic in uterine diseases. It
deserves thorough examination, which I hope some of our
readers will give it and report. Prepare a tincture from
3viij. of the root to Alcohol 76, Oj. The dose would be from
two to ten drops.
ALNUS RUBRA.
(TAG ALDER.)
Preparation.-Prepare a tincture from the recent bark,
3viij. to alcohol 98, Oj. Dose gtt. j. to xx.
We may employ the Alnus in infusion, or in the form of
tincture with dilute alcohol; the first being preferable if we
wish its greatest influence.
It exerts a specific influence upon the processes of waste
and nutrition, increasing the one and stimulating the other.
It is thus a fair example of the ideal alterative, and is one of
the most valuable of our indigenous remedies.
68
SPECIFIC MEDICINES.
Its special use seems to be in those cases in which there is
superficial disease of the skin or mucous membranes, taking
the form of eczema or pustular eruption. In these cases I
have employed it as a general remedy, and as a local applica-
tion with the best results. It does not seem to make much
difference whether it is a phlyctenular conjunctivitis, an ul-
cerated sore mouth or throat, chronic eczema or secondary
syphilis presenting these characteristics, it is equally bene-
ficial.
ALOES.
The use of Aloes in medicine should be quite limited, but
still it has a place. I believe that in small quantity and in
combination with other agents that act upon the upper in-
testinal canal, it proves a good cathartic, as in the following:
R Podophyllin, grs. x.; leptandrin, grs. xxx.; aloes, grs. xx.;
extract of hyoscyamus, 3ss. Make thirty pills. One of them
at night will prove an excellent laxative, and those who em-
ploy cathartics freely will like the formula.
But it is not for this purpose that I would recommend
Aloes, but for one that may seem very singular. In small
doses it exerts a direct influence upon the waste and nutri-
tion of the nervous system. In cases of feeble innervation,
especially in persons of gross habit, it will be one of our best
agents. I have usually prescribed it with tincture of nux
vomica or with tincture of belladonna. The dose of a strong
tincture being from two to ten drops.
In some cases it will prove serviceable when associated with
the bitter tonics, as in this: R Extract of nux vomica, grs. vj. ;
aloes, grs. xv.; hydrastine, 3ss. Make thirty pills. One may
be given three or four times a day.
ALSTONIA CONSTRICTA.
(THE FEVER BARK OF AUSTRALIA.)
The Alstonia Constricta is a native of Australia, being
found in the interior of that vast country. It has been used
for several years by the herdsmen and inhabitants of the in-
ALSTONIA SCHOLARIS.
69
terior as a substitute for quinine. Brought to this country
in 1876, it was exhibited at the Centennial with the Austra-
lian exhibit, but attracted very little attention. A friend of
mine procured a piece of the bark, and gave it a pretty thor-
ough test, with such marked results in the cure of ague, that
he resolved to import it and sell it as an "ague cure. In
this way it came into my hands, and during 1879, it has been
quite largely distributed and tested. Whilst it may not
be as certain in its action as quinine, especially in recent
agues, it seems to produce more permanent results. So that
an ague cured with Alstonia is likely to remain cured, and is
not simply "broken." It seems to be especially indicated in
cases of depraved secretions, the skin being sallow and dirty,
the bowels irregular, the tongue inclined to be dirty, and the
urine depositing a sediment. Agues not curable with qui-
nine, and cases of chronic ague, will give a very good field
for its use.
Those who have used it most claim that it will be found a
most excellent tonic and restorative, especially where the se-
cretions are defective as above.
As an antiperiodic the dose will be somewhat less than qui-
nine, say ten grains in divided doses: as a tonic it may be
given in grain doses.
ALSTONIA SCHOLARIS.
(DITA BARK.)
The Alstonia Scholaris is a native of the Phillipine Islands,
and its bark has been an article of commerce for some years.
Prepare a tincture from the bark, the usual way, using 98
per cent. alcohol. Dose, from the fraction of a drop to gtt. x.
The Alstonia Scholaris is likely to prove an excellent rem-
edy in disease of the bowels, with imperfect digestion and
diarrhoea, especially in malarial regions. It has been claimed
to have antiperiodic properties, but these are feeble, as com-
pared with the Alstonia Constricta.
70
SPECIFIC MEDICINES.
AMMONIUM, BROMIDE OF.
The Bromide of Ammonium is a stimulant to the nerve
centers; increasing waste and improving nutrition.
I have employed it principally in epilepsy, in some cases of
which it is undoubtedly a specific. I do not think I can point
out the exact cases in which it is likely to prove curative, as
the evidences of pathological states in this disease are very
obscure. Its use, therefore, will have to be empirical.
I have used it now for some twenty years, and it has given
excellent satisfaction. But whilst it has effected permanent
cures in a large number of cases, it has only proven of tem-
porary benefit in some, and has wholly failed in others.
We not unfrequently meet with disease, in which there is
disordered innervation, manifesting itself as epileptiform,
partially spasmodic, or in other ways, but in which there is
undoubtedly the same enfeeblement of the cerebro-spinal
centers. In these cases Bromide of Ammonium is the remedy.
In diseases of children, I have been accustomed to employ
this remedy in convulsions, following the first influence ob-
tained by Lobelia or Gelseminum, and with marked success.
When a child is subject to repeated attacks of convulsion,
from slight causes, the Bromide of Ammonium may be used
to remove the predisposition.
In some cases of whooping cough it exerts a direct action,
as it does in many cases of nervous cough in both child and
adult.
I have used it in this proportion: R Bromide of Ammo-
nium, 3ss; water, 3iv. A teaspoonful four times a day.
AMMONIUM, IODIDE OF.
Iodide of Ammonium increases retrograde metamorpho-
sis at the same time that it exerts a stimulant influence upon
the nervous system, especially the sympathetic system. Thus
it can be employed with less risk than Iodide of Potassium,
when the nutritive powers are feeble, as is the case occasion-
ally in secondary syphilis.
1
1
AMYGDALIS PERSICA.
71
It has been employed in certain cases of persistent head-
ache with excellent results. They are those in which the
eye is dull, the face expressionless, the circulation feeble, the
patient being of a full habit. The dose will be: R Iodide of
Ammonium, 3ij.; water, 3iv. A teaspoonful every four hours.
AMMONIUM MURIATICUM.
We employ the Muriate of Ammonia as a stimulant to the
capillary circulation. The best indication for it is a dusky
flush of the skin, the redness effaced by pressure returning
slowly. A dusky redness of mucous membranes, not indica-
tive of blood poisoning, will sometimes call for this remedy.
It is also a good remedy when there is oppressed respiration,
with bronchial sounds on auscultation, neither dry or moist.
We also employ a bath of Muriate of Ammonia as a stimu-
lant to the skin, especially in the eruptive fevers when the
eruption is tardy in appearing. In some cases it is used with
an inunction, being rubbed up with lard.
AMPELOPSIS.
The Ampelopsis comes under the general classification of
alteratives. It is a feeble agent in this direction and will
have but a limited use. It would be well to have it thoroughly
tested, and for this purpose I would suggest a tincture of the
fresh bark, in doses of from one-fourth to one teaspoonful.
AMYGDALUS PERSICA.
(PEACH TREE.)
Preparation. Thus far we have employed infusion of the
bark of the young limbs of the Peach Tree; and, to a limi-
ted extent, a tincture of the recent bark with dilute alco-
hol. The first will be found preferable in cases of acute
gastric irritation; but for ordinary office use, I would suggest
the following:
Take of the green bark of the young limbs (suckers), a
sufficient quantity, and cover with alcohol 50 per cent., one
72
SPECIFIC MEDICINES.
pint to each eight ounces: let it stand for fourteen days, and
express—a press of some kind will be an aid. The dose will
be from five to thirty drops.
The infusion or tincture, as above prepared, has a direct
influence in quieting irritation of the stomach and upper in-
testinal canal. It is also a mild tonic, improving the func-
tions of digestion. For these purposes it is one of the most
valuable articles in the materia medica.
It also exerts an influence upon the circulation, and upon
the nervous system, which deserves investigation.
AMYL NITRITE.
An ethereal liquid of a yellowish color and peculiar not un-
pleasant odor, insoluble in water, but soluble in rectified
spirits with which it should be dispensed. The dose will be
from the fraction of a drop to two drops, or in homoeopathic
dilution; in large doses, or inhaled, it is a powerful poison.
It is indicated by flushing of the surface and burning pain,
a burning pain with natural color of the skin; depression,
difficult breathing, sharp pain in precordial region extending
to shoulder and arm. It has been employed in angina pec-
toris, asthma, epilepsy, nervous headache, chorea, hiccough,
gastralgia, and some other forms of nervous disease.
Dr. W E. Saunders, of Indore, calls attention to the value
of nitrite of amyl in ague, and records a number of cases in
which advantage has been derived from its use. The drug
itself, he remarks, is inexpensive, and goes a long way.
He now uses amyl nitrite mixed with an equal part of oil
of coriander to render it less volatile, and at the same time
to cover its odor. He regards it as the most powerful dia-
phoretic he has seen, and he uses it in all cases of fever to
produce diaphoresis.
Dr. Saunders observes that he does not mean to say that
quinine should not be used in these cases, for there is ample
proof that it tends to check the return of the attacks, and
removes to some extent the septic condition of the blood, in-
duced by the malarial poison, and this more especially if
ANEMONE NEMOROSA.
73
small doses of opium are combined with it. In no case did
the amyl fail to remove the attack in about one-third the
usual time, and in most cases the fever did not return. His
method of administration is this: Four drops of the above
mixture, or two of amyl, are poured on a small piece of lint,
which is given into the hands of the patient, and he is told
to inhale it freely. He soon becomes flushed, and both his
pulse and respiration are much accelerated. When he feels
warm all over, the inhalation is discontined, as the symptoms
continue to increase for some time afterwards. A profuse
perspiration now sets in, which speedily ends the attack. In
some cases, however, the cold stage passes off without any
hot or sweating stage.
ANAGALLIS ARVENSIS.
(RED CHICKWEED.)
This agent possesses active properties, but has not been
studied. It has been extolled in hydrophobia, delirium, ma-
nia, epilepsy, etc., which will suggest the line of experiment.
The best preparation, probably, will be a tincture of the
recent chickweed in dilute alcohol (50), 3 viij. to the pint; dose
quite small-coming within one or two drops.
ANEMONE NEMOROSA.
(WOOD ANEMONE-WIND FLOWER.)
This is also an active agent, and will probably repay care-
ful study. It influences the functions of waste and repair,
but acts directly upon the nervous system. Belonging to the
same family as the Pulsatilla, its action will be somewhat
analogous.
The preparation best adapted for study will be a tincture
of the recent plant, made in the proportion of 3 viij. to alco-
nol 76, Oj.; using pressure to remove the fluid. It will be
well to commence with the fraction of a drop as a dose, say-
R Tincture of anemone, gtt. x., water 3iv.; a teaspoonful
every two to four hours, gradually increasing as we feel our
way.
7
74
SPECIFIC MEDICINES.
ANTIMONII ET POTASSII TARTRAS.
(TARTAR EMETIC.)
I should not recommend the use of this drug except in
very minute doses, and it is best dispensed in a Homœopathic
trituration, from the first to the tenth decimal. Of either of
these from one to five grains may be added to a half glass of
water, of which the dose will be a teaspoonful.
The simplest indication for the minute dose of this remedy
is increased secretion of the respiratory mucous membrane.
To this
may be added, a feeble pulse, pallid skin, cool extrem-
ities, cold sweats, uneasiness in the lower abdomen, and fre-
quent desire to go to stool and urinate. If we were giving it
in the old fashioned dose, the indications would be the reverse
of this. It is successfully used in croup, bronchitis with free
secretion, in broncorrhoea, humoral asthma, and in pneu-
monia with abundant secretion.
APOMORPHIA.
Apomorphia is a white or grayish white powder obtained
from heating hydrochlorate of morphia with hydrochloric
acid. Care must be used in preserving it, as it changes readily
by slight exposure, It is soluble in water.
This agent produces emesis in very small doses, even the
one sixtieth of a grain by hypodermic injection producing
copious vomiting in ten minutes. Hence it has been suggest-
ed as an emetic in cases of poisoning, when the ordinary
emetic could not be given, or would not produce emesis.
effects are very depressing.
APOCYNUM CANABINUM.
(INDIAN HEMP.)
Its
Of
Preparation. The preparation I prefer is, an alcoholic
tincture, representing the crude article, ounce for ounce.
such tincture, the dose will vary from the fraction of a drop
to ten drops, as the maximum. If the physician prepares
his tincture, it should be from the recently dried root, in the
proportion of 3 viij. to alcohol 76, Oj.
APOCYNUM CANABINUM.
75
It is probable that Apocynum Androsæmifolium possesses
identical properties, and as the distinction is recognized with
difficulty, even by those most conversant with botanic medi-
cines, they have been used indiscriminately.
The Apocynum is a true specific for that atonic condition
of the blood-vessels that permits exudation, causing dropsy.
I have employed it in my practice for some eighteen years,
and it has not failed me in a single case, where the diagnosis
was well made.
It is a positive remedy for dropsy, whether it takes the
form of œdema, anasarca, or dropsy of the serous cavities,
where there is no obstruction to the circulation, and no feb-
rile action. We would not expect to effect a cure in dropsy
from heart disease, or ascites from structural disease of the
liver, neither would we where there was a frequent, hard
pulse, and other evidences of febrile action. Still in these
cases, if we can partially remove the obstruction in the first
case, and after an arrest of febrile action in the second, the
Apocynum will remove the deposit.
It is not worth while to inquire how it removes dropsical
accumulations. It seems to strengthen the circulation, and
as absorption takes place there is an increased flow of urine.
I have also employed the apocynum in cases of passive
menorrhagia with advantage. It may be especially recom-
mended in those cases in which the flow is constantly too
profuse, too long, and too frequently repeated. I use it with
water, in the following proportion: R Tincture of Apocynum,
gtt. v. to x.; water, 3iv.; a teaspoonful every three hours.
Latterly it has been used as an anti-rheumatic, with ex-
cellent results in some cases. With this, as with many other
remedies, there are special symptoms indicating its use. If
these are found in any disease, the remedy becomes specific.
Thus in rheumatism, if there is a tendency to oedema, even
slight puffiness of the skin, or a peculiar blanched glistening
appearance, the Apocynum will be found a valuable remedy.
Following these indications I have used it with excellent
76
SPECIFIC MEDICINES.
results in some chronic diseases, especially where pain was a
prominent symptom.
I have already spoken of it as a remedy for menorrhagia.
It will also be found a valuable remedy in chronic metritis,
with uterine leucorrhoea. In one case with profuse watery
discharge from the uterus, it proved curative after other plans
of treatment had failed.
ARALIA HISPIDA.
(DWARF ELDER.)
The dwarf elder has been extensively and successfully em-
ployed in dropsy. The infusion has usually been employed,
and given freely.
I would suggest a tincture of the recent bark, in dilute
alcohol, and in the proportion of 3 viij. to the pint; dose, gtt.
j. to x.
I have employed it to but a limited extent, yet with good
results. It has a very positive influence on the circulation,
and upon secretion. Does it not act on them through the
sympathetic nervous system? and may we not influence all the
vegetative functions with it, as we do with some others? It
is deserving thorough investigation.
ARGENTUM NITRICUM.
(NITRATE OF SILVER.)
Nitrate of silver may be combined with the proper excip-
ient, as extract of liquorice, and given in the form of a pill.
It undoubtedly influences the cerebro-spinal centers, con-
trolling epileptiform movements. It has been administered
in cases of epilepsy with success, though the discoloration of
the skin caused by the large doses given, was a serious objec·
tion. It also exerts an influence in chronic gastritis and
enteritis, and has been given in some cases of dysentery with
advantage. Administered in doses of one-twentieth to one-
fourth of a grain.
ARNICA MONTANA.
77
ARANEA DIADEMA.
(CROSS SPIDER-SPIDER'S WEB.)
Our Homœopathic friends prepare a tincture by putting
the living creatures in strong alcohol. We prefer a tincture
of spider's web, in the proportion of 3ij. to strong alcohol Oj.
It has been employed in ague and malarial disease, when
there was marked confusion of intellect, 'with headache and
burning of the face and eyes. In ague the chill is prolonged,
with great pain in the bones, and a feeling as if bruised.
Dose, from the fraction of a drop, or a dilution, to gtt. x.
ARISTOLOCHIA SERPENTARIA.
(VIRGINIA SNAKE ROOT.)
Prepare a tincture from the recent root, using alcohol of
98 per cent. Dose from the fraction of a drop to five drops.
In large doses it has been extensively used as a stimulant
diaphoretic, and is a most excellent remedy. In small
doses it is indicated by a relaxed atonic skin, cold extremi-
ties, cold perspiration, difficult respiration, and difficult
deglutition. It may be combined with the sedatives in the
eruptive fevers.
ARNICA MONTANA.
(ARNICA.)
Preparation.-Prepare a tincture from the recent flowers,
3 viij. to alcohol 76, Oj. Dose, the fraction of a drop.
It is not necessary to refer to the common local use of this
agent, or discuss the question whether a tincture of arnica is
preferable to alcohol alone as a local application. Every one
has employed it in this way, and each one has formed his own
opinion. I think its local use is valuable, but greatly over-
estimated.
Can it be employed as an internal remedy with advantage?
I am satisfied that it can. It is a valuable stimulant in many
grave diseases where a stimulant is most required. But if
used as a general stimulant, like alcohol, it would be as apt
to do harm as good.
78
SPECIFIC MEDICINES.
It is a specific stimulant to the spinal nervous system, and
will be found useful where there is want of innervation from
this. I have seen most marked benefit from it in advanced
stages of disease, where there was feeble respiratory power;
difficulty of sleeping from impeded respiration; want of con-
trol over the discharge of urine and feces, etc., evidences of
impairment of spinal innervation. In such cases its bene-
ficial influence may be noticed in a few hours.
I have frequently prescribed it for lame back, back-ache,
and feelings of debility and soreness, in the small of the
back. It is only useful in those cases where there is feeble-
ness, with deficient circulation; but in these the influence is
direct and permanent.
Recently it has been employed in the treatment of pneu
monia with good results. The cases reported, so far as I can
learn, were asthenic with an enfeebled circulation. It was
employed alone in doses of five to ten drops every three hours.
ARSENICUM.
(ARSENIC.)
Arsenic is one of the agents that Eclectics have objected
to, on the ground that it, like Mercury, was a depressant,
and should be classified as an antiphlogistic. The use of
Arsenic in the early part of this century, though limited, was
in large and many times poisonous doses. Being a powerful
excitant to the vegetative nerves, this use, if continued long,
would produce a peculiar form of fever-"febris arsenicum"
-with its attendant impairment of vital function. Finally,
with impaired blood-making and nutrition, there would be
developed arsenical dropsy, and in some rare cases death was
the result.
The arsenical fever bears a very close resemblance to quin-
ism, or quinine poisoning, in its symptoms, though there is
not, in a majority of cases, such disturbance of the nervous
system. There is also a difference in the termination, for
whilst in quinism there is continued dryness of skin and
scanty high colored urine, and finally death from uræmia, in
ARSENICUM.
79
chronic poisoning by Arsenic there is finally a stage of re-
laxation, and though there is dropsy, the skin and kidneys
act freely.
We have long since determined that the mere matter of
dose in medicine might be the difference between a poison
and a remedy. If, for instance, we give one grain of Strych.
nia, we poison our patient, whilst if the dose had been but
the fortieth or thirtieth of a grain, it would have proven a
vital stimulant. If we administer five grains of morphia, the
result is death; whilst a medicinal dose of one-fourth of a
grain would have produced refreshing sleep. If we give
large doses of Aconite, (say five drops of a tincture of the
root,) frequently repeated, it increases the frequency of the
pulse, impairs the circulation, and irritates the nervous sys-
tem. But, in medicinal doses, it lessens the frequency of the
pulse, gives freedom to the circulation, and relieves irritation
of the nervous system. If we give large doses of Veratrum,
it impairs the circulation, arrests vital processes, and pro-
duces death; whilst medicinal doses give increased freedom
to the circulation and diminish the frequency of the pulse.
It seems strange to me that these things have not had due
consideration, and that the remedial action of drugs has not
been kept distinct from their poisonous effects when given in
large doses. We have already seen, that the dose of medicine
should be the smallest quantity that will give the desired in-
fluence, and that in a rational system of medicine, its influ-
ence should always be to restore normal function, and not as
a disturbing element.
There is another view of this subject which is important
in this consideration. A drug which may be poisonous in
health, or in some conditions of disease, will be curative in
other conditions of disease. Thus we regard the disease as
antagonizing the remedy, quite as much as the remedy antag-
onizes the disease, and the influence is toward the restora-
tion of healthy function. Give a healthy man almost any of
our common medicines, and after a time he will become dis-
eased, the disease being of that kind and of that part which
80
SPECIFIC MEDICINES.
the medicine cures. Thus, if we give Quinine to cure mala-
rial fever, its influence is kindly, but if there is no malarial
disease, it causes irritation of the nervous system.
If we
give Belladonna when there is an enfeebled capillary circula-
tion, the influence is kindly and curative, but it is the re-
verse if we already have capillary spasm.
This is especially the case with the more powerful remedies,
with which Arsenic should be classed, and they should never
be employed unless the symptoms indicating them are very
distinct.
Such a brief statement of facts I have deemed necessary
in this case, on account of the prejudice of our school to these
agents-a prejudice which grew out of their abuse. This
prejudice is so strong now, that one hardly dare risk making
a study of the tabooed articles, and yet common honesty de-
mands that it be done.
In small doses, and when indicated, Arsenic may be re-
garded as a vital stimulant, and one of the most powerful of
this class. But we must not forget that the dose must be
small, and there must be special indications for its use. What
are these indications?
In that condition of the blood, and of nutrition, where
there is a tendency to the deposit of a low or imperfect albu-
minoid material-yellow tubercle, caseous deposits-or de-
generation of tissue, Arsenic may be used as a blood-maker,
and especially to improve nutrition.
A class of skin diseases depending upon such deposits, or
on enfeebled nutrition, is cured by Arsenic. Among these
are the more chronic affections—the squamæ, the chronic
vesiculæ, some of the pustulæ, and the tuberculæ. It will
not cure all cases, it will do harm if injudiciously used, but
it affords relief in many otherwise intractable.
But, it should never be employed where there is irritability
of the nerve centers, and especially of the sympathetic. This
rule I think is absolute, and must be constantly regarded.
Arsenic is a nerve-stimulant; quite as much so as phosphorus,
with this addition—that its action is greatly intensified when
there is already erythism of the nerve centers.
ARSENICUM.
81
It has been successfully employed in some cases of phthisis,
presenting the condition above named. Prof. Howe uses it
in combination with Veratrum, and there is no doubt that
this renders the system tolerant of Arsenic where it could
not otherwise be employed.
Arsenic is topically employed to destroy malignant growths.
The majority of the cancer specialists" use it in some
form, and their preparations differ only in the inert material
with which it is combined. The preparation now employed
most frequently is made as follows: Take Hydrated Sesqui-
oxide of Iron a sufficient quantity, throw it on a paper filter,
and when of the consistence of an ointment, add an equal
part of Lard. To this add Arsenious Acid, in the propor-
tion of 3ss. to 3j. to the ounce.
Arsenic may be employed in the treatment of some cases of
intermittent fever with excellent results. They are those
marked by impairment of sympathetic innervation, and with
a general want of nervous excitability. The dose should be
very small, gtt. v. to x. of Fowler's Solution to iv. of water;
a teaspoonful every two or three hours. I have used the
Homoeopathic pellets, medicated with Fowler's Solution, and
though the dose was not more than the twentieth to the one-
hundredth of a drop, the effect was marked, where specially
indicated.
It is also used with advantage in atonic diarrhoea, with in-
digestion, the conditions being as above named. Especial
benefit has been observed in those cases in which there were
periods of great depression, followed by hectic fever.
I need hardly say in conclusion, that Arsenic is one of
those agents that will do either good or harm. Good if given
in a proper case, and in medicinal doses; harm if not indica-
ted by special symptoms, or contra-indicated as above named,
or if given in poisonous doses.
Fowler's Solution is a preparation to be preferred. Dose
from the fraction of a drop to two drops.
82
SPECIFIC MEDICINES.
2
ARUM TRIPHYLLUM.
(INDIAN TURNIP.)
Prepare a tincture from the recent root, using alcohol of
98 per cent. The dose will be of gtt. x, to water 3iv., a tea-
spoonful every hour.
It is indicated by hoarsenes and loss of voice, with burning
and constriction of the throat, sneezing, and thin ichorous
discharge from the nose. Our Homoeopathic friends say that
a "keynote" for this remedy is "children pick the nose and
chin persistently."
ARTEMESIA ABSINTHIUM.
(WORMWOOD.)
Preparation. For experiment, I would suggest a tincture
with dilute alcohol, 76 per cent., in the proportion of 3 viij. to
the pint; vary the dose from one drop to one drachm.
This agent has been used principally as a vermifuge, but
lately it has given place to the Chenopodium and to Santo-
nine. It possesses very decided medicinal properties, how-
ever, and deserves a thorough examination. It influences
the nervous system, especially the sympathetic.
ARTEMESIA SANTONICA.
(WORMWOOD.)
We only wish to consider the crystalizable principle-
santonine-here. Its principal use has been as a vermifuge
in cases of ascaris lumbricoides, for which it has been found
quite efficient. But in using it for this purpose many have
noticed that it exerted a peculiar influence upon the brain,
and upon the eyes-rendering objects blue, yellow, or green;
and that it passed off in the urine, giving it a peculiar color.
It exerts a specific action upon the bladder and urethra,
stimulating contraction of the first, and allaying irritation of
the second. It is especially valuable in cases of retention of
urine in children during protracted disease: in doses of
half to one grain, it is prompt and certain. I have also em-
ASCLEPIAS.
88
ployed it to relieve irritation of the urethra, especially in
women suffering from uterine disease, and with good success.
Its influence upon the nervous system needs to be studied.
I judge it to be a nerve stimulant, and have employed it for
this purpose to a limited extent.
APIS MELLIFICA.
(HONEY BEE.)
The honey bee possesses marked medicinal properties, but
from a prejudice against such remedies, has been but little
employed.
An infuison of twelve to twenty honey bees in a pint of
boiling water, is one of the most certain diuretics I have ever
employed in cases of suppression of urine from atony. It is
also a very efficient remedy in retention of urine, and in some
cases of irritation of the urethra.
I have used the tincture for the same purpose, and also for
inflammation of subcutaneous structures, with tensive and
lancinating pains, and in irritation of the skin. I have pre-
pared my own tincture, in the proportion of 3j. to alcohol 98
per cent. Oj. Dose one or two drops.
I have seen a number of cases of disease in women charac-
terized by sensations of heat, and burning pains in the blad-
der and course of the urethra, with frequent desire to mic-
turate. These have been. promptly relieved by the use of
tincture Apis, and in two cases of chronic disease of long
standing, a permanent cure was effected, following the relief
of these unpleasant symptoms.
:
ASCLEPIAS.
(SILK WEED.)
Preparation. The best preparation for experiment will be a
tincture of the recent root, in the proportion of 3 viij. to alco-
hol 76 per cent. Oj.; note its effect in small as well as large
doses.
The A. Incarnata, A. Syriaca, etc., deserve a careful inves-
tigation. In weak infusion they all prove diaphoretic, and to
84
SPECIFIC MEDICINES.
some extent diuretic. It is claimed by those who have made
considerable use of them, that they stimulate all the secre-
tions.
ASAFOETIDA.
Whilst I think but little of this foetid gum as an anti-spas-
modic, I regard it as a valuable gastric stimulant, and also
as a nerve stimulant. In nervous dyspepsia, especially, it
will be found valuable. The following is a good form: R
Asafoetida, 3ss.; hydrastine, 3ss.; aloes, grs. x. Make thirty
pills, and give one three times a day. As a nerve stimulant
I have used & Extract of Nux Vomica, grs. x.; Asaf., grs.
xl. Make twenty pills, and give one at night.
ASCLEPIAS TUBEROSA.
(PLEURISY ROOT.)
Preparation. Whilst I prefer a tincture made from the
recent root, I have used a tincture of the dried root, made
to represent ounce for ounce; the dose being from one drop
for a child two years old, to ten drops for an adult.
It is especially a child's remedy, being feeble in action,
though quite certain. When given freely, it is one of the
most certain diaphoretics we have, providing the pulse is not
frequent, and the temperature increased. Even in the small
dóse of one drop, following the use of the special sedatives,
it will markedly increase the true secretion from the skin.
Recollect that there is a difference between sweating and
secretion. There may be a profuse exudation of water, the
surface being bathed in perspiration, and yet but little secre-
tion. Excretion by the skin is a vital process, and takes
place by means of secreting cells. It goes on best where the
skin is soft and moist, and not when covered with drops of
sweat.
I employ Asclepias in diseases of children, believing that
it allays nervous irritability, is slightly sedative, and cer-
tainly increases the secretion from the skin. I use it with
Veratrum and Aconite, in febrile and inflammatory diseases,
ATROPA BELLADONNA.
85
and in mild cases, very frequently give it alone. Bear in
mind that it is a feeble remedy, and too much must not be
expected.
ASPIDUM FILIX MAS.
(MALE FERN.)
This agent is only used as a vermifuge, especially for the
removal of tape worm. For this purpose the ethereal oil is
used in doses of twenty drops to one drachm.
ATROPA BELLADONNA.
(BELLADONNA.)
Preparation.-Whilst for some purposes a solution of the
alkaloid, Atropia, will prove the best preparation, I prefer,
for general use, an alcoholic tincture of the recent plant, rep-
resenting the crude article ounce for ounce. Of this the
maximum dose will be one drop, but frequently one-fifth to
one-half of this will serve a better purpose.
For hypodermic use, we employ a solution of Atropia, in
the proportion of one grain to the ounce of distilled water.
The dose would be five to ten drops. This is also the best
proportion for use to dilate the pupil. As a collyrium, we
would add 3j. of this solution to 3j. of distilled water.
The specific use of Belladonna is as a stimulant to the cap-
illary circulation, especially of the nerve centers-a remedy
opposed to congestion. My attention was first drawn to it by
an article from Brown-Sequard, giving the results of his ex-
periments with the drug, stating that with the microscope he
had seen marked contraction of the capillaries following its
use. It at once suggested itself to me, that if it would cause
capillary contraction, it would be the remedy for congestion;
and I at once commenced experimenting with it in this di-
rection
I well recall my first marked case: a boy about eight years
old, suffering from malignant rubeola. The entire surface
was swollen and dusky; the eyes dull; the pupils dilated; the
face expressionless; breathing labored, and wholly uncon-
86
SPECIFIC MEDICINES.
•
scious for forty-eight hours. The administration of Bella-
donna alone (in small doses) was sufficient to restore con-
sciousness, and a free circulation, with good appearance of
the eruption, in twenty hours.
The evidences in its favor rapidly accumulated, so that in
eighteen months I used it with a feeling of almost certainty
for this purpose.
Whilst it exerts the same influence on all persons; and at
all ages, the true pathological condition being determimed,
it is especially valuable in treating diseases of children. In
the young, the immature nervous centers suffer more severely,
and we find the opposite conditions, of irritation with deter-
mination of blood, and atony with congestion.
The symptoms calling for the use of Belladonna are usually
very plain the patient is dull and stupid-and the child
drowsy, and sleeps with its eyes partly open; the countenance
expressionless; the eyes are dull, and the pupils dilated, or
immobile; whilst as it continues respiration becomes affected,
and the blood imperfectly aerated.
In these cases I prescribe Belladonna: in the adult, in the
proportion of gtt. v. to gtt. x., to water 3iv.; in the child
gtt. v. to iv.; in each a teaspoonful every hour. As these
are mostly febrile cases, or at least have a feeble, frequent
circulation as an element, I give Aconite in the usual doses.
1
Belladonna is also a specific in incontinence of urine. Not
that it will cure every case, but those in which an enfeeble-
ment of the pelvic circulation is the principal cause. Pro-
bably a lesion of the spinal cord has also much to do with it.
Of course, it gives no relief where the incontinence arises
from vesical irritation. The dose in this case will be the
same as above named, but only repeated four times a day.
Belladonna is also a specific in diabetes insipidus; even a
Belladonna plaster across the loins being sufficient in many
cases for its arrest.
Belladonna is undoubtedly a prophylactic against scarlatina,
as I have thoroughly proven in my practice. Recollect, how-
ever, that it is only prophylactic in small doses; in doses suf-
AURUM.
87
•
ficient to produce dilatation of the pupil, it has no such in-
fluence.
Belladonna has other special uses, but they may be briefly
summed up: if in any case there is an enfeebled circulation,
with stasis of blood, Belladonna is the remedy. Of course,
acting upon some parts more directly than others, its influence
will be more decided, but there is no case, with condition as
above, in which it will not be beneficial.
I may say in conclusion, that we want a good preparation
of the recent herb; and then it must be used in small doses
to obtain the influences named. The doses given are the
maximum. As we have had occasion to say before, the drug-
gists care little about the quality of medicines sold; they are
simply articles of merchandise, and there is little, if any,
professional esprit with them, to aid us in having them good.
Therefore every physician must be on his guard when pur-
chasing, and had better buy of first hands, and of those of
proven honesty.
ous.
AURUM.
(GOLD.)
The preparations of gold have nearly the same properties
as those of mercury, and in large doses are intensely poison-
Thus the chloride of gold is more active than corro-
sive sublimate. The preparation of gold advised, when it is
thought necessary to use a remedy of this character, is the
chloride of gold and sodium. It may be given in doses of
one-sixtieth to one-twelfth of a grain, in solution, and in most
cases it is well to combine a small portion of Phytolacca.
with it.
It is indicated by a moderately red tongue, good circula-
tion to the surface, the patient suffering with secondary syph-
ilis, glandular disease, or chronic disease of the skin.
88
SPECIFIC MEDICINES.
BAPTISIA TINCTORIA.
Preparation.-The Baptisia has been principally employed
in infusion, but as this is inconvenient in many cases, I would
recommend a tincture by percolation, using 3viij. of the
bark of the root to Oj. of Alcohol of 98 per ct. Of an infu-
sion of 3j. to 3iv. of boiling water, the dose is one teaspoon-
ful; of the tincture as named, gtt. x. to water Živ., dose, a
teaspoonful.
The specific indication for Baptisia is a dusky purplish
color of face, like one who had been exposed to cold, face ex-
pressionless; there is a similar color of tongue, fauces and
throat. Occasionally we find this unpleasant discoloration
over an affected part, as the chest, liver, etc., and sometimes
the entire surface of the body is thus discolored.
With some the Baptisia has been a favorite remedy for
sore mouth and sore throat, using it locally, and for this pur-
pose it is one of the most valuable remedies we have. I
judge, however, that if you should ask, in what particular
variety of sore mouth or throat it was found best? you
would have difficulty in getting an answer.
It is in those cases in which there is enfeebled capillary
circulation, and tendency to ulceration, that it is specific
That is, the condition is one of atony, with tendency to mole-
cular death and decomposition. The remedy is, therefore,
stimulant and antiseptic.
It may be employed with the greatest certainty in any form
of sore mouth or throat presenting the characteristics named.
Especially in stomatitis ulcerata, or cancrum orris, in cynan-
che maligna, and in the sore throat of scarlatina maligna;
but it is not only a good local application in these cases, but
a most valuable internal remedy.
It is specific to the condition upon which such sore mouth
and throat is based, whether it is manifested in this way, or
in ulceration of Peyer's follicles in typhoid fever. Thus I
have employed it with very marked advantage, in all cases
showing putresceny, and tendency to softening and breaking
down of tissue.
BEBEERINE SULPHAS.
89
It is not a remedy for acute inflammation, whether erythe-
matous or deep seated, and in ordinary stomatitis or cynan-
che, it is not a remedy. In diphtheria presenting acute in-
flammatory symptoms, it is worse than useless. But in diph-
theria with swollen and enfeebled mucous membranes, dusky
or livid discoloration, or blanched appearance, with tendency
to ulceration and sloughing, there is no remedy more certain.
I have successfully employed the Baptisia in typhoid dys-
entery, as have others. But as will be seen, this is but the
condition named above for its specific action. So long as
there is an acute inflammation, with stools of blood or pure
mucus, it is not beneficial, but when the discharges resem
ble prune juice, the washing of meat, or are muco-pur-
ulent,” with general symptoms of an analogous character,
then it becomes one of our most certain remedies.
BARII CHLORIDI.
(CHLORIDE OF BARIUM.)
The preparation advised is the officinal solution U. S. P. of
which ten drops may be added to water 3iv., and administered
in doses of one teaspoonful every three or four hours.
In its action upon the economy this remedy has some re-
semblance to arsenic, and is indicated by an inelastic dirty
skin, enlarged lymphatics, and feeble respiration. It has been
employed as a remedy in cancer, scrofula, and in scrofulous
phthisis. It has been deemed of especial value in scrofulous
inflammation of eyes, ears, and testes.
BEBEERINE SULPHAS.
This is not the so-called Berbeerin from the Berberis Vul-
garis, or Hydrastis, but a well-defined salt from the Nectan-
dra Rodiæi. As found in commerce, it is in glittering scales
of a brownish-yellow color, and when triturated forms a yel-
lowish powder.
It exerts a specific action upon the uterus, but thus far it
has been principally employed in cases of menorrhagia. In
8
90
SPECIFIC MEDICINES.
•
this case its influence is very marked, controlling the hemor-
rhage, and preventing its recurrence. As we have other rem-
edies for the milder cases, its use might be confined to those
in which there is profuse discharge at each menstrual period,
and when they recur too frequently. The dose will be from
half to three grains every three or four hours.
BELLADONNA.
(See Atropa Belladonna.)
BENZOIC ACID.
I prefer to use benzoic acid in solution in alcohol, 3j. to
the Oj., to the tincture of benzoin, though the latter will an-
swer the purpose. The dose will vary from ten to sixty
drops, according to the effect desired.
Its first use is in irritable bladder, with deposits of uric
acid or triple phosphates; in either case its use will prove
beneficial.
Its second use is in irritation of the sympathetic and spinal
system of nerves, with uric acid deposits.
Its third use is as a stimulant to the brain in cases of ex-
haustion, with phosphuria. I have used it in this case, alter-
nated with a preparation of phosphorus-either the phospho-
retted oil or the tincture-with advantage. These are usu-
ally cases of exhaustion from over-exertion of the mind, as
frequently met with among our business men.
BENZOATE OF SODA.
A
Recently benzoate of soda has been recommended by Ger-
man physicians as a specific in phthisis pulmonalis—the rem-
edy in solution to be used with an atomizing apparatus.
solution of two drachms in five ounces of water was used
daily for some weeks. Later reports contradict the asserted
curative influence, and the results in this country have not
been satisfactory.
BISMUTH.
91
It has also been recommended in the treatment of diph-
theria, scarlatina, cynanche maligna, and zymotic dysentery.
I am inclined to believe that it will be found a good remedy
in nephritis and albuminuria, the tongue being pallid.
BENZOATE OF LITHIA.
I administer benzoate of lithia in solution, ten grains being
added to water 3iv., of which the dose will be from a tea to
a tablespoonful four times a day in a glass of water.
It is indicated by deep-seated pains in the loins, pain in,
the small of the back, uneasiness in the bladder, with fre-
quent desire to pass urine, and deposits of uric acid.
BERBERIS VULGARIS.
(BARBERRY.)
A tincture of the recent bark, in the proportion of 3 viij.
to alcohol 76 per cent. Oj., is suggested. Dose varying from
ten drops to one drachm.
Will some of our Eastern practitioners give us their ex-
perience with this agent; or if it has not been employed alone,
will some one test it thoroughly. Evidently it has an influ-
ence upon the gastro-intestinal mucous membrane, and pro-
bably on associate viscera.
BISMUTH.
We employ Bismuth in two forms. The subnitrate in doses
of from one to two grains; the liquor Bismuth (solution of
citrate of bismuth), in doses of from gtt. x. to 3j.
The first use of Bismuth is to allay irritation of the gastro-
intestinal mucous membrane; and for this purpose it has been
extensively employed. Usually the sub-nitrate in impalpa-
ble powder, is employed in small doses frequently repeated
for gastric irritation, and in doses of five to ten grains for in-
testinal irritation, with diarrhoea.
The second may be called its specific use, for chronic gastro-
intestinal irritation, or dyspepsia with diarrhoea. Here I
92
SPECIFIC MEDICINES.
1
employ the liquor bismuth in doses of from a half to one tea-
spoonful four times a day. In inveterate cases, not amenable
to other treatment, and of years' duration, I have had the
happiest results.
I have omitted to name the common use of Bismuth for
water-brash, in some cases of which it is very effectual.
The powdered sub-nitrate is also a most effectual local ap-
plication for irritation of the skin-chafing—either in the in-
fant or adult. For this purpose the part is thoroughly dusted,
and it is repeated as often as necessary to keep it dry.
BIDENS BIPINNATA-CONNATA-FRONDOSA.
(SPANISH NEEDLES.)
Preparation.-Prepare a tincture from the recent herb, in
the proportion of 3 viij. to alcohol 76 per cent. Oj., using pres-
sure. Dose from five to thirty drops.
The different varieties of Bidens deserve investigation.
Reference to the Dispensatory or Materia Medica will give
the direction it should take. I am especially interested in
the action of the B. Frondosa on the heart and circulation.
BOLDO.
Boldo leaves are the product of an evergreen shrub in
Chili;
they are of a reddish-brown color, have a fragrant odor
and a pungent aromatic taste.
Though largely advertised as a new remedy, it is not likely
to take a very prominent place in medicine. It has been re-
commended and used in anemia, dyspepsia, and nervous de-
bility, the remedy being stimulant to the digestive apparatus
and nervous system
Of a good tincture the dose will be from two to ten drops.
BORAX.
We employ a solution of Borax as an antiseptic dressing
in wounds, injuries, and surgical operations, the strength
being from 3j. to 3iv. in water Oj. It is employed as a topi-
BROMINE.
93
cal application to mucous membranes when there is an ap-
thous condition or exudation, and is equally applicable in
acute or chronic disease.
Internally it may be administered in small doses (grs. j. to
v. in water ziv.) in persistent sore mouth; dyspepsia with
sense of constriction; gnawing pain; uneasy stools; frequent
desire to pass urine, the last part of the discharge being mu-
co-pus; dragging pain in back, and acrid leucorrhoea.
BROMINE.
Bromine is not employed as an internal remedy, though
its salts have been used largely within the last ten years. It
may be employed with advantage as an inhalation in croup
and diphtheria, and as a stimulant in phthisis. For croup
it has been used in the proportion of ten drops to two ounces
of water.
BROMIDE OF POTASSIUM.
Bromide of Potash is a very greatly overestimated remedy.
When I commenced practice it was only used in cases of
spermatorrhoea to relieve sexual irritation—now it is recom-
mended for every nervous ill that flesh is heir to.
I think it has one specific use, and that is as a remedy for
epilepsy when associated with irritation of the reproductive
organs, or especially in irritation of the cerebellum. In such
cases I have used it with much success. The dose will be
about twenty grains three times a day.
I only use it in spermatorrhoea, in those cases in which the
person is of a plethoric habit, with great venereal excitement
-cases approximating satyriasis, rather than spermatorrhoea.
In these I administer it in doses of thirty to sixty grains at
bed-time.
BROMIDE OF AMMONIUM.
(See Ammonium.)
94
SPECIFIC MEDICINES.
BRYONIA.
We employ the German tincture of Bryonia in the propor-
tion of gtt. v. to gtt. xxx. to water 3iv.; a teaspoonful every
one, two, or three hours.
The most marked symptom indicating its use, that I have
noticed, is a dusky flushing of the cheeks, especially over the
right malar. Pain in the right side of the face and head,
burning in eyes and nose, with acrid nasal discharge. The
pulse is full and hard, urine scanty, and bowels constipated.
With the first symptom named I should prescribe it in any
form of disease, though it is used most frequently in rheu-
matism, pneumonia and catarrhal affections.
If in disease the person has a short cough, or makes an
effort to free the lungs, no disease of air passages being pres-
ent, we would think of Bryonia. So if there is pain in se-
rous membranes, or pain simulating this, the remedy is sug-
gested: thus in rheumatism involving the synovial membranes
we would be likely to prescribe this remedy.
BURSA PASTORIS.
(SHEPHERD'S PURSE.)
A tincture is made in the usual way, using 3viij. of the
recent herb to alcohol 98 per cent. Oj. The dose will vary
from the fraction of a drop to fifteen drops.
It may be employed in chronic menorrhagia where the
menstrual discharge occurs too frequently or continues too
long, or when the discharge is almost constant but colorless.
There is a frequent desire to pass urine, and a deposit of
phosphates. It has also proven a remedy in dyspepsia and
chronic diarrhoea.
CACTUS GRANDIFLORUS.
(NIGHT-BLOOMING CEREUS.)
Preparation.—We prepare a tincture from the recent plant,
in the proportion of 3iv: to alcohol 98 per cent. Oj. The dose
will vary from the fraction of a drop to two drops.
CACTUS.
95
4
The influence of Cactus seems to be wholly exerted on the
sympathetic nervous system, and especially upon and through
the cardiac plexus. In does not seem to increase or depress
innervation, (neither stimulant nor sedative), but rather to
influence a regular performance of function. I am satisfied,
however, that its continued use improves the nutrition of the
heart, thus permanently strengthening the organ. It has a
second influence, which is of much importance to the thera-
peutist. It exerts a direct influence upon the circulation
and nutrition of the brain, and may thus be employed with
advantage in some diseases of this organ. We can see very
readily how this may be. The cardiac nerves are derived
from the upper part of the sympathetic, and, judging from
the anatomy of the part, the first cervical ganglion being the
principal nervous mass in the cervical region, must furnish
innervation through the cardiac nerves, as it certainly con-
trols the circulation and nutrition of the brain.
The Cactus is a specific in heart disease, in that it gives
strength and regularity to the innervation of the organ. Its
influence is permanent, in that it influences the waste and
nutrition of the heart, increasing its strength. It exerts no
influence upon the inflammatory process, and hence is not a
remedy for inflammatory disease.
Feelings of weight and pressure at the præcordia, difficult
breathing, fear of impending danger, etc., are at once re-
moved. Such irregularity of action, whether violent, feeble,
or irregular, as is dependent upon the innervation, is readily
controlled. Thus, in the majority of cases of functional heart
disease, it gives prompt relief, and, if continued, will effect
a cure. In those cases in which there is another lesion act-
ing as a cause, as in some gastric, enteric, or uterine lesions,
these must receive attention, and be removed to make the
cure radical.
In structural heart disease, the first use of remedies is to
relieve the distressing sensations in the region of the heart,
and the unnatural fear of danger which attends them. As
these spring from disordered innervation, in the majority of
J
96
SPECIFIC MEDICINES.
cases, the Cactus gives prompt relief. As we have seen above,
its continuance favors normal waste and nutrition, as well
as regular action. Hence, its continued use is followed by
the removal of adventitious tissue, and an increase in the
strength of its contractile fibre. Thus it proves curative in
many cases of structural heart disease.
I have some cases on my case-book of such aggravated
form that no one would believe they could live a twelve-
month; yet, after a lapse of five years, they are enjoying com-
fortable health.
But it will not relieve or cure cases of valvular deficiency,
dilatation of the openings of the heart, or fatty degeneration.
It is well, in estimating its action, to bear this in mind.
In its influence upon the nervous system, it more nearly
resembles Pulsatilla; giving relief in that condition known
as nervousness. But further than this, it gives regularity of
cerebral function, and permanently improves nutrition of the
nervous centers.
CADMII SULPHAS.
Sulphate of cadmium is a very powerful remedy, and must
be used with great care. As a collyrium it may be used of
the strength of one to two grains to the ounce of water; as a
wash in otorrhoea, and as an injection in gleet, the strength
may be five grains to the ounce of water. As an internal
remedy I would employ a solution of one grain to sixteen
ounces of water, of which the dose would be a tea-spoonful.
It would be indicated by nausea, vomiting, colic, giddiness,
feeble pulse and respiration; mental anxiety would be a
prominent symptom.
CAHINCA.
Prepare a tincture from the root in the usual way, using
alcohol of 98 per cent. From gtt. x. to 3ij. is added to water
Ziv., of which the dose is one teaspoonful.
It may be administered when the urine is scanty, and the
patient complains of a sense of weight and fullness in the
loins; and is also indicated by œdema of feet or fullness of
CALENDULA.
97
eye-lids. It has been employed as a remedy in dropsy, the
dose being larger than the one named.
CALCII CHLORIDUM.
(CHLORIDE OF LIME.)
As a disinfectant fresh chloride of calcium has but few
superiors, and its moderate use in cleaning the chamber uten-
sils, mixing with the discharges, and to freshen the air of the
sick chamber, is to be commended in all zymotic diseases.
It is especially recommended to be employed in this way in
typhoid fever, the discharges from the bowels carrying the
germs of the disease.
As an internal remedy it is to be recommended when the
patient has a bad breath, tongue dirty with pasty coat, en-
largement of lymphatic glands, and slow inflammations with
cacoplastic deposits. The dose need not be large; 3j. of the
fresh chloride to water Oj. kept tightly corked, may be given
in doses of a teaspoonful or tablespoonful in a wine-glass of
water.
CALCII SULPHIS.
(SULPHITE OF CALCIUM.)
In doses of one grain the sulphite of calcium exerts a
marked influence in controlling inflammation of connective
tissues, especially the superficial, as in furuncles, or boils.
It also improves digestion, nutrition, and waste. The atten-
tion of readers is especially called to this remedy.
CALENDULA.
(MARIGOLD.)
Prepare a tincture from the fresh plant, using alcohol of
98 per cent.
Added to water in the proportion of 3j. to 3j. in water Oj
it has proven an excellent application to wounds or injuries,
when the patient has the burning pain of an incised wound.
Internally, in the proportion of gtt. x. to water 3iv. it may
be given in congestion of the liver or other viscera, the
9
98
SPECIFIC MEDICINES.
patient complaining of sensations of weight, fullness and
dragging
CALX,
(LIME.)
Lime is used for the ordinary purpose of an antacid, and
in some cases is preferable to any other alkali. This is espe-
cially the case in indigestion, with the formation of lactic
acid from decomposing food. Here there is not unfrequently
an excess of the normal salts of the blood, and we can not
use the salts of soda and potash to neutralize gastric acidity.
It may be stated, as a general rule, that it will be found ben-
eficial in cases of infantile dyspepsia, and in dyspepsia of the
adult with acid eructations during digestion.
Its specific use is in cases of furunculus or boils, and other
inflammations of cellular tissue, terminating in suppuration.
Why it has this specific influence I do not propose to say,
but the fact I have proven in scores of cases. Given, a case
in which boils are being continually developed, the use of
lime-water will effect a radical cure. It is given in doses of
a wine-glassful three or four times a day.
CANNABIS SATIVA.
(INDIAN HEMP.)
The tincture of Cannabis should be prepared from the re-
cent wild plant whilst in flower, but as we can not get this,
we use a tincture prepared from the churrus, a species of ex-
tract from the recent plant, imported from India. The dose
will vary from the fraction of a drop to five drops.
In small doses it is stimulant to the cerebro-spinal centers;
in large doses it produces intoxication, and finally arrest of
function. It exerts an influence upon the urinary and repro-
ductive apparatus that may be rendered available in practice,
and also to some extent upon the skin.
I have employed the Cannabis specially to relieve irritation
of the kidneys, bladder, and urethra. It will be found bene-
ficial in vesical and urethral irritation, and is an excellent
remedy in the treatment of gonorrhoea.
CAPSICUM.
99
I do not like it as a remedy for intemperance, (chronic
alcoholism), so well as a combination of nux vomica and
iodine, with a bitter tonic; though in some cases it may be
used with marked advantage, and the habit finally broken up.
CAMPHOR.
Camphor in small doses is a stimulant, in large doses a sed-
ative, to the nervous system. I do not regard it as having a
very extended use in medicine, though for the purpose named,
it may sometimes be employed with advantage. In low forms
of disease, with insomnia and restlessness, I have used it
alone, and in combination with stimulant doses of opium or
morphia, and quinine.
As a topical stimulant, it may be employed with advantage,
when the integrity of the part is threatened from enfeebled
circulation.
CANTHARIS VESICATORIA.
(SPANISH FLY.)
I object to the use of the blister, as a means of counter-
irritation, and going further than this, I object to counter-
irritation as a means of cure, when it can possibly be avoided,
and I think it may be avoided in nearly all cases.
As an internal remedy, Cantharis will have but one use-
as a stimulant to the urinary apparatus, especially the blad-
der. For this purpose it may be employed in small doses.
CAPSICUM.
(CAYENNE PEPPER.)
Capsicum is a powerful topical stimulant; but its general
influence is feeble. As Capsicum, it never gains admission
to the circulation, and, in the process of digestion, it almost
wholly loses its properties as a remedy.
Capsicum is used as a topical stimulant to the skin, and
with advantage where the circulation is feeble, and there is
need of such stimulation. It also exerts the revulsive influ-
ence of other rubefacients.
100
SPECIFIC MEDICINES.
Its influence, when taken into the stomach, is of the same
character. It excites the nerves, and calls an increased flow
of blood to the part. In torpid states of the gastric mucous
membrane, such action may be very desirable, may even be
essential to life, as in congestive intermittent. It is the top-
ical action upon the gastric mucous membrane that is bene-
ficial in some cases of delirium tremens.
The solar plexus, the most important of the vegetative
nerve centers, may be thus influenced from the stomach.
The stimulant influence of Capsicum may, therefore, be ex-
tended through this, and be of marked advantage in states
of great and sudden prostration with tendency to congestion.
CARBO-LIGNI.
(WOOD CHARCOAL.)
Is an absorbent and antiseptic, and has this general use,
both internally and topically. Given in water-brash, or where
there is decomposition of the food, it is sometimes beneficial.
So in topical disease with free secretion and tendency to
sepsis-its local application absorbs the one and checks the
other.
The specific use of charcoal is to arrest hemorrhage from
the bowels. It has been used in enema, 3ss. to 3j. finely pow-
dered, to four ounces of water, thrown up the rectum. Why
this checks it. I can not tell; that it does it, I have the evi-
dence of my own eyes.
For several years I have employed the second decimal trit-
uration as a remedy in passive hemorrhage, with most marked
benefit. I employ it in threatened hemorrhage during ty-
phoid fever, in menorrhagia, especially when chronic, in pro-
longed menstruation, the watery discharge that sometimes
follows menstruation, hemorrhage from the kidneys, hemor-
rhage from the lungs, and in some cases of leucocythemia.
A good indication for this remedy is a small pallid tongue,
with lenticular spots, and with this it may be given in any
form of disease.
The dose of the first or second trituration will be one
grain, repeated as often as necessary.
CARBOLIC ACID.
101
CARBOLIC ACID.
We prepare Carbolic Acid for dispensing in general prac-
tice by adding 3iv. of the crystals to 3xvj. of glycerine. In
this form it is easily carried, and dispensed by adding the
proper portion to water, so that the dose may be one tea-
spoonful.
Carbolic Acid exerts a specific influence in those cases in
which, with a broad moist tongue, there is a cadaverous odor
of the breath. It makes little difference what the name of
the disease is-whether bilious or typhoid fever, cynanche,
pneumonia, diarrhoea, dysentery, disease of the urinary ap-
paratus, or whether the disease is acute or chronic. In these
cases it is used in small doses as-R Solution of carbolic acid
in glycerine, gtt. x. to gtt. xxx.; water, 3iv.; a teaspoonful
every hour.
We employ it with marked advantage in cases of irritable
stomach, and to check nausea and vomiting, when the symp-
toms above named present. The faintest trace of the odor
of putrescent meat will be an indication.
As far as my experience goes, it cannot be used with ad-
vantage where the mouth is dry, or if the tongue is con-
tracted, or enlongated and pointed.
As a topical application, we employ carbolic acid when we
need an antiseptic and a stimulant. Even here there must
be the local symptoms, fullness and relaxation of tissues; when-
ever there is contraction, shrinking and dryness, it will prove
harmful. These rules hold good, whether as a dressing for
wounds, for erysipelas, for burns, for a chancre, for a gargle,
a vaginal injection, or for the treatment of a gonorrhoea or
gleet.
As a local application in full strength we use this agent to
destroy warts, and epidermal growths of this character. It
is very certain in its action, if thoroughly applied, and the
cure is radical. It is also a remedy in epithelial cancer, and in
some cases it will exert a better influence than the stronger
escharotics. This is especially the case in cancer of the cer-
vix uteri. In solution with glycerine it is applied to old in-
102
SPECIFIC MEDICINES.
dolent ulcers, relieving pain, fœtor, and promoting normal
granulation.
The strength of the solution, in the treatment of cancers,
will vary in different cases. In some the full strength of
the solution in glycerine can be continually applied; in a
few the full strength of the acid, rendered fluid by heat;
but in others it will require dilution with glycerine. Use
that strength that gives greatest ease, and leaves the parts
in best condition. One of the principal objects is relief
from pain, carbolic acid being a true anæsthetic in these
cases, and the strength of the solution will be adapted to
this use.
CARDUUS BENEDICTUS.
(BLESSED THISTLE.)
Prepare a tincture from the fresh leaves and flowering tops,
using alcohol of 98 per cent.
It may be used in doses of from gtt. j. to x. as a stimulant
and tonic, in cases of atony of stomach, liver and bowels.
CASSIA ACUTIFOLIA.
(SENNA.)
Senna is a mild cathartic; but its action is frequently at-
tended with much tormina, and to some is very unpleasant
As it does not increase elimination by the bowels, its use as a
cathartic is quite limited, and it may well be replaced by
other remedies.
It exerts, however, a special influence in colic, which ren-
ders it an important remedy. We have generally employed
it in the form of the Compound Powder of Jalap and Senna,
in doses of five or ten grains, frequently repeated until re-
lief is obtained. An infusion of senna-or the tincture will
answer the same purpose-for the relief of colic, whether
the common wind-colic or that known as bilious, I regard as
one of our best remedies.
CAULOPHYLLUM.
103
CASTANEA VESCA.
(CHESTNUT.)
A tincture is prepared from the fresh leaves in summer,
using alcohol of 98 per cent. The dose will be from the frac-
tion of a drop to ten drops.
Chestnut leaves exert a specific influence in some cases of
whooping cough, so much so, that the relief is apparent in
twenty-four hours. They have usually been employed in in-
fusion, but the tincture will be found as good, and is more
easily dispensed. In convulsive cough or paroxysmal cough,
resembling whooping cough, it has also proven a successful
remedy. It may also be tried in cases where there is un-
steadiness in the gait, and a disposition to turn to one side.
CASTUS INDICUS.
This remedy has been regarded as so valuable that it was
monopolized by the government of Cashmere. A tincture is
prepared from the root which is administered in doses of one
drop; and is employed in giddiness, salivation, and as an
antidote to poisonous bites and stings.
CATALPA.
(BEAN TREE.)
Prepare a tincture from the recent seed and pods (beans),
using alcohol of 98 per cent. Dose from the fraction of a
drop to five drops.
In small doses the tincture of Catalpa relieves irritation
of the bronchial tubes, and gives freedom to respiration. It
has been used in asthma with marked success, and is also
recommended in chronic bronchitis, and in some forms of
functional heart disease.
CAULOPHYLLUM.
(BLUE COHOSH.)
We employ this remedy in infusion as a parturient, and in
the form of a tincture of the recently dried root, 3viij. to
alcohol 76 per cent Oj.
104
SPECIFIC MEDICINES.
Caulophyllum exerts a very decided influence upon the
parturient uterus, stimulating normal contraction, both be-
fore and after delivery. Its first use, in this case, is to re-
rieve false pains; its second, to effect co-ordination of the
muscular contractions; and third, to increase the power of
these. The first and the second are the most marked, yet
the third is quite certain. Still if any one expects the marked
influence of ergot, in violent and continued contractions, he
will be disappointed.
I judge that it exerts its influence through the hypogastric
plexus; though to some extent it influences every process
controlled by the sympathetic. Acting in this way it influ-
ences the circulation, nutrition, and functions of the repro-
ductive organs. I have employed it in chronic uterine dis-
ease with advantage, especially where there is irritation, and
uneasiness.
It may be used with good effect in some cases of nervous
disease; especially in that condition known as asthenic plethora.
As a remedy for rheumatism it is inferior to the Macrotys,
but in some cases it exerts a better influence. My experience
has not been sufficient to point out these cases, and in this
respect the remedy needs further study.
CEANOTHUS.
(RED ROOT.)
Prepare a tincture from the recent leaves, using strong
alcohol of 98 per cent. The dose will vary from the fraction
of a drop to ten drops.
The Ceanothus is a stimulant to the digestive apparatus,
to the portal circulation, to the liver, and especially to the
spleen. It is indicated by enlargement of spleen, sallow
doughy skin, and expressionless face.
A Southern physician reporting his experience with the
remedy writes:-"In chronic cases, when the organ is no lon-
ger tender, under the use of the tincture, even without fric-
tion, it soon becomes painful and tender, then sinks rapidly to
its normal size, and so remains, the patient no longer being
conscious of its presence."
CHAMOMILLA.
105
CERII OXALAS.
(OXALATE OF CERIUM.)
In doses of from one to three grains, this remedy has had
quite a reputation in relieving the vomiting of pregnancy,
though it has not proven so effective in vomiting from dis-
ease of the stomach and adjacent organs. This would go to
show that the remedy exerts a special influence upon
the re-
productive apparatus, and suggest that it might be used in
some cases of uterine disease with good results. I have given
it in the second decimal trituration with apparent success, in
ulceration of the cervix, and in irritation with leucorrhoeal
discharges.
CELASTRUS SCANDENS.
(FALSE BITTERSWEET.)
This belongs to the class alterative. It has no special ac-
tion that I am aware of, though it might be studied with ad-
vantage.
CHAMOMILLA (MATRICARIA.)
(GERMAN CHAMOMILE.)
A tincture is prepared from the recent flowers, with alco-
hol 98 per cent. The dose will range from the fraction of a
drop to ten drops. I employ it in the usual proportion of
gtt. v. to gtt. x. in water 3iv., a teaspoonful every one or two
hours.
In infantile dyspepsia with irregularity of the bowels it
will be found an excellent remedy, in diarrhoea with flatu-
lence and colic, when the person is irritable and restless and
the surface is alternately flushed and pale.
CHAULMUGRA ODORATA.
(CHAULMUGRA OIL.)
In doses of from one to five drops internally, and as a local
application, this oil may be used, in itching and burning pap-
ulæ, psoriasis, chronic eczema, and in superficial neuralgia.
106
SPECIFIC MEDICINES.
"
It is especially beneficial when the affected parts have a fee-
ble circulation, and common sensation is impaired. It has
also been used in nasal catarrh.
CHIRAYTA GENTIANA.
(CHIRETTA.)
A tincture is made from the imported plant, using alcohol
of 98 per cent. The dose will vary from the fraction of a
drop to ten drops.
In India it is much employed in urinary disorders and un-
easiness in lumbar region, frequent desire to pass urine, dif-
ficult urination, and deposits of uric acid. It is also em-
ployed in nervous and atonic dyspepsia, and in convales-
cence from exhausting diseases.
CHELONE GLABRA.
(BALMONY.)
The Chelone exerts an influence on waste and nutrition,
and deserves study. We may prepare a tincture from the
recent leaves, by expression, in the proportion of 3viij. to
alcohol 76 per cent. Oj. Dose, ten to thirty drops.
CHELIDONIUM MAJUS.
(GREAT CELANDINE.)
Among the remedies used by the school of Rademacher,
Chelidonium held an important place. It was used for its
specific influence upon the liver, though its action undoubt-
edly extended to the entire chylopoietic viscera. It has also
been employed by French and German physicians to a limi-
ted extent, and is a remedy valued by Grauvogl, though not
much used by the mass of Homœopaths.
I have been experimenting with it for the past few years,
and its action has been so satisfactory in some cases, that I
am inclined to believe it will prove a valuable addition to our
materia medica. I have used the German tincture thus far,
in the proportion of gtt. x. to water 3iv., a teaspoonful every
three or four hours. I propose, however, to have a tincture
CHELIDONIUM.
107
prepared from our American plant as soon as possible, and
test it; and I would recommend to any of my readers who
know the plant—“Great Celandine, or Tetterwort”—to pre-
pare a tincture from the fresh herb and root, and test it.
on all the organs supplied
In the olden time the liver
I believe I can say that it acts
from the solar plexus of nerves.
was deemed the most important of these organs, and all dis-
eases of the chylopoietic viscera were referred to it, hence
the remedy was said to act specially upon the liver.
The cases in which it has seemed to me to exert the greatest
influence, presented the following symptoms: The tongue
much enlarged, and somewhat pale; mucous membranes full
and enfeebled; skin full and sallow, sometimes greenish; full-
ness in hypochondria; tumid abdomen; light colored feces;
no abdominal pain; urine pale but cloudy, and of high spe-
cific gravity.
I have seen cases of chronic disease presenting these symp-
toms, with the addition of œdema of the feet and legs, in two
of which the influence of the Chelidonium was seemingly
direct and curative. In one, it is associated with other means,
and a sufficient time has not yet elapsed to determine the suc-
cess, yet thus far it is beneficial. In one case of enlarged
spleen, with confirmed dyspepsia, the influence was marked
from the first, and in three weeks the patient concluded to
dispense with medicine, and let nature complete the cure (be-
cause nature makes no charge for medicine.)
I do not wish to introduce the Chelidonium as a remedy
that has been thoroughly studied, though it has a record in
this direction of nearly one hundred years. But from my
experience I think it is one that may be tested with advan-
tage.
CHIONANTHUS VIRGINICA.
(FRINGE-TREE.)
Prepare a tincture from the bark of the root, recent or
fresh, using strong alcohol of 98 per cent. The dose will vary
from the fraction of a drop to ten drops. I have had very satis-
108
SPECIFIC MEDICINES.
factory results from the usual prescription of gtt. x. to water
Ziv., in doses of a teaspoonful.
This remedy exerts a specific influence upon the liver, and
to a slighter extent upon all the organs engaged in digestion
and blood-making. The indication for it is, yellowness of skin
and eyes, slight or fully developed jaundice, with a sense of
uneasiness in right hypochondrium, or general abdominal
pain simulating colic. It is one of the surest remedies I
have ever employed, whether the case is one of jaundice, for-
mation and passage of gall-stones, bilious colic (yellowness of
skin), acute dyspepsia, acute or chronic inflammation of liver,
or the irritable liver of the dipsomaniac.
This agent comes to us with the recommendation of Dr. I.
J. M. Goss, of Georgia, who says:
"It possesses important alterative properties. As a cata-
lytic, it has the most decided influence over the glandular
system of any article I have tried. It pervades the whole
system, combining with the materies morbi, and conveying it
out of the system. I have used it in mercurial cachexy with
the most happy success, in quite a number of instances. But
the most important therapeutical property that it possesses,
is its specific power over morbid conditions of the liver I
have tried it in hypertrophy of that organ, and with uniform
success; and also in obstruction of the liver, in malarious
districts, with like success. Some years ago I called the at-
tention of the profession to its specific effects in jaundice, and
gave several cases in proof of the fact. Since then I have
used the Chionanthus in a great many cases of jaundice, and
have never failed to remove it in but one single case, and that
one I think was a case of obstruction of the gall ducts by cal-
culi; in that case, I tried all the reputed cholagogues, without
success. It removes jaundice of years standing, in from eight
to ten days. I have treated several persons that had been
subject to jaundice, annually, in summer, for several years,
and had been dosed with blue pill, calomel, and other arti-
cles, without any benefit, and I have not failed in a single
instance, to remove the disease entirely. And when it is re-
CHLOROFORM.
109
lieved with the Chionanthus, it does not return; at least it
has not, in any instance to my knowledge. It is as near a
specific in jaundice, as quinine in periodicity. The mode
in which I have used it is to make a tincture of the bark of
the rootin gin, say 3ij. to the quart of gin, and give 3ss. of
this every three hours, or the fluid extract, and give from one
to two drachms every three hours."
CHIMAPHILLA UMBELLATA.
(PIPSISSEWA.)
The Chimaphilla has been used mostly in infusion or de-
coction: but for general use it may be prepared in the form
of tincture, both of the recent and the dried leaves-though
they will differ materially in strength and properties-the
fresh leaves possessing a volatile principle which is lost in
drying.
The Chimaphilla has been principally employed as a tonic
diuretic, influencing the urinary apparatus in a similar man-
ner to the Buchu and Uva-Ursi, though I think it preferable
to either. It relieves irritation of the entire urinary tract,
and improves the circulation and nutrition of these organs.
It also influences the processes of waste and nutrition, and
possesses the properties termed alterative. In this respect
it has not been thoroughly studied, though highly spoken of
by some in the treatment of scrofula and secondary syphilis.
CHLOROFORM.
Chloroform by inhalation exerts a specific influence upon
the brain, arresting its power to receive impressions-a con-
dition known as anæsthesia. If carried still further, it in-
fluences the spinal cord in the same manner, and arrests au-
tomatic movement-respiration. This action is so well known,
that it is not worth while occupying our space with it.
Administered by mouth, in small doses, it is a cerebral
stimulant; in large doses, it lessens consciousness, the effect
being more like poisoning by alcohol, than the anesthetic in-
fluence from its inhalation.
110
SPECIFIC MEDICINES.
In small doses (gtt. v. to 3ss.) it is successfully employed to
arrest convulsions. The small doses are safe, but it will not
do to repeat it often in the larger quantity named. It is also
used to relieve gastro-intestinal pains, especially in the form
of common colic.
In cases of biliary calculus it is used as a prophylactic, pre-
venting the deposit of cholesterin, and causing its solution
when deposited. For this purpose it is used in doses of gtt.
xx., three times a day.
CHLORAL HYDRATE.
The introduction of this new remedy has been attended
with the same enthusiasm displayed in the case of bromide
of potassium.
It is a hypnotic, and may be employed for this purpose,
where there is an enfeebled condition of the brain, with im-
paired nutrition. It relieves pain, when the nervous centers
are suffering from impaired circulation, and may be advan-
tageously employed in these cases.
It has been successfully employed in the treatment of de-
lirium tremens, but in some cases it has failed. I have used
it for this purpose, with good results, sedation having been
effected in sthenic cases, stimulation in asthenic.
The remedy also suggests itself as one adapted to allay irri-
tation and produce sleep in a majority of cases of puerperal
mania. Dr. Playfair reports a case in which it was used with
excellent success.
I am satisfied from its action that it will prove a boon to
the opium cater who desires to break off the destructive habit.
Whilst its influence upon the nerve centers is the same as
stimulant doses of opium, and will thus give present relief,
it gives strength to the cerebral circulation, and will thus
favor normal nutrition; then the dose can be lessened, and
finally the remedy dispensed with.
To give the estimate in which the drug is now held, I quote
from the London Lancet :
CHLORAL.
111
"This interesting drug has now been sufficiently tested by
a large number of eminent practitioners to enable us to form
a tolerably clear idea both of its merits and defects; and as
we perceive that (after the usual fashion in matters medical)
there is going to be an epidemic rage for the new remedy, it
may be well to call the attention of the public to the princi-
pal features of its action which can be said to be fairly made
out.
"In the first place, the term 'anaesthetic' should no longer
be applied to chloral, for it has entirely failed to make good
its claim to this reputation; even the largest doses do but
produce a heavy and prolonged sleep, which is, however, es-
sentially different from true anesthesia. On the other hand,
as a producer of sleep, Chloral is, in many respects, unri-
valed; for though, like every other remedy, it fails in a con-
siderable number of cases, it does succeed in a very large
number. In fact, it is inferior in certainty, as a hypnotic, to
opium alone. Moreover, it is very greatly superior to opium,
and almost every other drug, in the character of its sleep-
producing action; there are no attendant symptoms of cere-
bral oppression; the sleep, though often prolonged, is light
and refreshing, and no unpleasant after-symptoms are expe-
rienced. It is important to observe, however, that this de-
scription only applies to the use of moderate quantities, and
that not only unpleasant but highly dangerous symptoms have
been produced by doses which we regret to see are very com-
monly used. Very careful inquiry leads us to assert that it
is both unnecessary and dangerous to give larger doses than
twenty to thirty grains, repeated once or twice if necessary,
for hypnotic purposes. Doubtless it might happen that 100
consecutive patients might take much larger doses with im-
punity, but the 101st might present the alarming symptoms
described by Dr. Reynolds, in a recent number of the Prac-
titioner, as produced by a dose of fifty grains, and these symp-
toms might easily take a fatal turn.
"As a remedy for pain, Chloral holds a very varying place
in the estimation of medical men, some rating it highly, and
112
SPECIFIC MEDICINES.
others thinking it almost worthless. Perhaps the safest esti-
mate of its power over pain is that it only exerts an indirect
influence by inducing a disposition to sleep, in which the pain
is forgotten. Certainly it has entirely failed, in the hands of
the present writer, to relieve severe pain of a pure neuralgic
type. On the other hand, there is a good deal of evidence
that it relieves suffering where the parts are very tense, and
where mere arterial throbbing counts for much in the produc-
tion of pain; thus it has been very favorably spoken of for
its effects in gout. And this fact, if it be correct, corres-
ponds with certain observations which have been made as to
its action on the circulation. Both from sphygmographic ex-
periments on healthy persons and on patients, and also from
the details of the nearly fatal case reported by Dr. Reynolds,
there is reason to think that Chloral exerts a contracting in-
fluence upon the arteries, powerful in proportion to the dose;
and it may well be that arterial throbbing is checked by this
kind of influence.
"On the whole, however, there can be little doubt that the
great function of Chloral is that of a hypnotic and calmer of
general nervous irritability. In delirium tremens it is excel-
lent: and it is probable that with two such weapons for choice
as bromide of potassium and chloral we shall be able almost
entirely to dispense with the use of opium, which is so un-
certain and dangerous a remedy in that disease In the state
of sleeplessness which threatens the access of puerperal
mania, chloral is probably an unequaled remedy. In melan-
cholia its action as a hypnotic appears to be powerfully and
remarkably sure. In mania, also, it acts well enough as a
hypnotic, though there seems some divison of opinion as to
whether it does permanent good. We may also state that in
the irritable condition of aged persons who find it difficult
to sleep for any length of time continuously, the use of a sin-
gle dose of thirty grains of chloral appears often to answer
excellently well. The minor uses of the drug in relieving
more trivial conditions of nervous irritation, and in allevia-
ting painful spasmodic symptoms of various kinds, are pro
bably considerable."
CINNAMON,
118
CIMICIFUGA.
(See Macrotys.)
CINCHONA.
(See Quinia.)
CISTUS CANADENSIS.
(ROCK-ROSE.)
Preparation.-A tincture is prepared from the recent plant,
in the proportion of 3viij. to alcohol 76 per cent. Oj. The
dose is from ten to thirty drops.
The Cistus has a direct and positive influence on the pro-
cesses of waste and nutrition, and hence possesses the pro-
perties known as alterative. It has been used with especial
advantage in scrofula, and in chronic diseases dependent upon
an enfeebled nutrition, or deposit of imperfectly formed
plasma.
It is also reported to have a specific influence upon the
intestinal canal, curing chronic diarrhoea and dysentery. It
deserves a thorough investigation, which I trust some of
our practitioners will give it.
CINNAMON.
Preparation. We prepare a tincture from the oil, in the
proportion of 3j. to alcohol 98 per cent. viij. Dose five to
thirty drops.
Cinnamon thus prepared exerts a direct influence upon the
uterus, causing contraction of its muscular fibre, and ar-
resting hemorrhage. To a limited extent, it exerts an influ-
ence on the entire circulatory system, checking hemorrhage
from any part.
It is one of the most certain remedies we have for uterine
hemorrhage, either during parturition or at the menstrual
period. I have used it since I commenced practice, and have
never failed to arrest post-partum hemorrhage with it, though
I have had some very severe cases.
10
114
SPECIFIC MEDICINES.
CITRUS LIMONIS.
(LEMON.)
The expressed juice of the lemon is a specific in certain
cases of rheumatism-the tongue being red, and elongated,
and the inflamed part showing an unusual bright redness. It
is also of advantage in other inflammatory diseases, and in
fevers with similar symptoms. In such cases patients have
lemon juice or lemonade to the extent they may have a desire
for it.
It also exerts a marked influence when locally applied, in
hypertrophy of the tonsils, and elongated uvula.
CLEMATIS VIRGINIANA.
(VIRGIN'S BOWER.)
This agent has not been studied, though it deserves inves-
tigation. Prepare a tincture from the recent leaves, in the
proportion of 3 viij. to alcohol 76 per cent. Oj., using pressure.
Dose, gtt. v. to gtt. x., to determine its influence upon the
nervous system and upon the secretions.
COFFEE.
(Java or Rio.)
Take of the berries of Coffee, ground (not roasted) 3 viij.,
alcohol 76 per cent. Oj. Make a tincture by percolation.
Dose, gtt. ij. to gtt. x.
Coffee is a stimulant to the cerebral nervous system, and
may be employed in many cases where there is atony, with
disordered function. Were it not for the general use of cof-
fee as a beverage, it would prove a valuable remedy; but
when persons are habituated to its use, it exerts but little in-
fluence.
COLCHICUM.
It is difficult to procure a reliable preparation of Colchi-
cum, and we have been obliged to use the English wine of
Colchicum. Our manufacturers in this city now prepare a
COLOCYNTH.
115
tincture, representing ounce for ounce of the crude article.
The medium dose is one drop; we do not desire a cathartic
action.
Colchicum has long been used as a remedy for rheumatism
and gout; and, though probably the best of the old materia
medica, it failed of giving its best results because used in poi-
sonous doses. In acute and chronic rheumatism it should be
employed in small doses, following or alternated with the seda-
tives. We only obtain its anti-rheumatic influence when the
pulse and temperature are reduced to nearly a normal stan-
dard.
It is also beneficial in some cases of intestinal disturbance,
especially when there is gaseous accumulation. Thus in
colic from intestinal irritation, it may be employed in the
proportion of gtt. xx. to water ziv., a teaspoonful every two
hours, with prospect of success.
It exerts an influence upon the skin, and may occasionally
be employed with advantage in chronic disease of the surface.
Dr. L. A. Kelley writes me in reference to the specific
indications for Colchicum :-"The pain for Colchicum, so far
as my experience goes, is, sharp-shooting, tearing or dull.
aching, extending from the back to hip, and down the limb,
without fever. It is not the kind of pain so much as its posi-
tion; hence it is of value in certain forms of chronic or sub-
acute sciatica. Whenever I have used it in such cases for
pain in that region, its use has been attended with good
results."
COLOCYNTH.
Colocynth has been employed as a cathartic, but for this
purpose it is harsh and uncertain, and may well be dispensed
with.
I use it wholly as a remedy for dysentery and in colic. And
for this purpose employ the tincture in small doses, usually
gtt. v. to water 3iv. A teaspoonful every hour will give the
best results.
116..
SPECIFIC MEDICINES.
It will also prove beneficial in some cases of diarrhoea at-
tended with tormina and tenesmus. I am satisfied that a
thorough investigation of the remedy in small doses, will de-
velop other important uses.
COLLINSONIA CANADENSIS.
(STONE ROOT.)
We employ a tincture of the Collinsonia, respresenting the
crude article ounce for ounce.
As there are a great many
imperfect preparations in the market, I would advise that it
be procured from one of our own houses in this city.
Collinsonia is a specific in ministers' sore throat; adminis-
tered in the proportion of: R Tincture of Collinsonia,
simple syrup, aa., half teaspoonful to a teaspoonful four times
a day.
It proves beneficial in other cases of chronic laryngitis, in
chronic bronchitis, and phthisis, allaying irritation, and
checking cough.
It also exerts a favorable influence upon the digestive pro-
cesses, improving the appetite, facilitating digestion and act-
ing as a general tonic.
It passes off through the kidneys, and exerts a tonic influ-
ence upon the entire extent of the urinary tract.
I have thought that its influence was specially exerted upon
and through the pneumogastric, relieving irritation of, and
giving strength to parts supplied from this source.
Collinsonia is a specific in the early states of hemorrhoids,
and will sometimes effect a cure in the advanced stages of
the disease. In this case it is employed in small doses: R
Tincture of Collinsonia, gtt. x.; water, Ziv.; a teaspoonful
four times a day.
I have given the therapeutics of. Collinsonia thus briefly,
that the points named might make the greater impression
upon the reader. I regard it as one of the most direct and
valuable agents of the materia medica, and one that will give
satisfaction to whoever employs it.
COMPTONIA.
117
COCA.
(LEAVES OF THE ERYTHROXYLON COCA.)
Coca is a stimulant to the nerve centers, and at the same
time diminishes waste. It allays hunger, and enables the
person to endure great fatigue. The excretions are all di-
minished whilst the person is under its influence.
It may prove useful in the early stages of tuberculosis, by
enabling the person to take the exercise so much needed to
burn the imperfect materials in the blood. The dose of the
crude leaves is from five to ten grains, but it is better em-
ployed in infusion.
COTO BARK.
(AN UNKNOWN SPECIES OF NECTANDRA.)
Coto Bark is imported from Bolivia, and though its source
is unknown it is thought to be a species of Nectandra. It
is one of the "new preparations" extensively advertised. A
tincture is prepared from it in the usual way, of which the
dose is from the fraction of a drop to ten drops.
It has proved a valuable remedy in profuse sweating and
in atonic diarrhoea. In the colliquative perspiration of
phthisis, it is thought to give better results than the reme-
dies ordinarily employed. It is also reported to have given
good results in cholera infantum.
COMPTONIA ASPLENIFOLIA.
(SWEET FERN.)
Prepare a tincture from the recent leaves, using alcohol 76
per cent. The dose will range from one drop to 3ss.
It may be employed in diarrhoea with colic, and in dysen-
tery when the febrile symptoms are relieved. It has also
been used as a local application in rheumatism.
118
SPECIFIC MEDICINES.
CONVALLARIA MAJALIS.
(LILY OF THE Valley.)
Make a tincture of the recent plant entire, root and flow-
ers, using alcohol of 98 per cent; or a tincture may be made
of the flowering plant, and at maturity of the rhizome. The
dose will vary from the fraction of a drop to ten drops.
It may be used to lessen the frequency of the pulse, when
there is an impaired capillary circulation, as shown by ecchy-
mosis, or the slow return of blood when it is effaced by the
finger. The tincture of the root has had some reputation in
the treatment of rheumatism and dropsy, and to improve the
digestive functions.
CONVALLARIA MULTIFLORA
(SOLOMON'S SEAL.)
Prepare a tincture from the recent root, using alcohol of
76 per cent., or administered in substance or infusion. The
dose will vary from a dilution to as much as a half drachm
There is no doubt that this remedy exerts a special action
upon the circulation, especially the veins. It relieves con-
gestion of the liver, spleen, and intestine, promotes a better
circulation in the portal system, and relieves and sometimes
cures hemorrhoids. It has also been used in the treatment of
rheumatism.
As a local application it has been used in bruises and
ecchymosis, in acute and chronic conjunctivitis, in hemor-
rhoids, and to varicose ulcers.
CROCUS SATIVUS.
(SAFFRON.)
A tincture prepared from the fresh true saffron will be
found an excellent remedy in the treatment of diseases of
children, especially in the eruptive fevers, or when there has
been a retrocession of the exanthemata.
It may be given with Aconite or alone, adding gtt. x. to
xx. in water Ziv., a teaspoonful every hour.
CUBEBA.
119
CROTON TIGLIUM.
(OLEUM TIGLII.)
A tinctur is prepared by adding 3j. of the oil to alcohol
98 per cent. Oj., which may then be filtered through paper
Add gtt. s, to water 3iv., and give in teaspoontul doses.
It may be given in cardialgia, in hepatic colic, in diarrhoea
with tonesmus, and in dysentery if the patient is free from
fever. It is also employed in chronic diseases of the skin,
especially those which are pustular, and when the surface
burns and itches on getting warm in bed and from active
exercise.
CUBEBA.
Administered in substance in doses of five to twenty grains,
it exerts a direct influence upon the bladder and urethra,
and will sometimes cure an old gonorrhoea or gleet when
other remedies fail. It has also been used in the scalding
of urine in women, and burning and irritation of the vulva.
It will be found useful in some cases of cystitis, the more
acute symptoms having passed away.
The tincture prepared in the usual way, with alcohol of
98 per cent. may be used in minute doses, or in doses of from
gtt. x. to 3ss. In the small dose it may be used in debility
with irritation of the reproductive apparatus, prostatorrhoea,
uneasiness and formication of scrotum and anus, and dis-
eases associated with reproductive weakness.
CUCUMIS SATIVUS.
(CUCUMBER.)
Grate the green cucumber until a sufficient quantity is ob-
tained, and add it to alcohol of 98 per cent. in the propor-
tion of 3viij. to Oj. ; let it stand six days and filter.
This tincture may be given in irritation of the urinary pas-
sages, sharp pains in the loins, and in rheumatic pains of the
shoulders.
120
SPECIFIC MEDICINES.
CUPRUM.
(COPPER.)
For some years I have prescribed Copper in the pleasant
form of greened pickles, with most marked advantage in some
cases of chronic disease. Even yet I prefer to give Copper
in this form, rather than as a medicine, but probably this is
owing to prejudice.
The cases where I have found it especially beneficial, were
those in which with anæmia there was not very great loss of
flesh. The surface would be pallid, or sometimes tawny, the
skin waxy, parts usually colored with blood pale, with some-
times a slight greenish tinge. The tongue broad, pallid, but
usually clean; bowels torpid. The pulse rather full, but with-
out sharpness of stroke.
It makes no difference what the disease is, if these symp-
toms should present I would think of Copper as a remedy.
Rademacher employed Copper in the treatment of acute
diseases, and claimed that there were seasons when the en-
demic constitution of disease demanded it. The symptoms
calling for it were :-"The color of the face was mostly palish-
gray, dirty light blue, seldom reddish, and only a few times,
in evening exacerbations, was it bright red and hot. The
palate was always red. The sweats were moderate, some-
times clammy, and often smelt very sour, and patients felt
worse after them. In most cases there was a tendency to
diarrhoea, or there was more or less of diarrhoea present.
In pneumonia, patients complained of a sense of pressure.
under the sternum and of weight in the chest; though some-
times there would be no complaint, until a sense of suffoca-
tion announced extensive infiltration of the lung."
Grauvogl accounts for the action of Copper in this way:
"Science has already demonstrated that Copper, in a finely
divided state, absorbs immense quantities of ozone. It is
also demonstrated that the ozone in the atmosphere is not
found in the usual quantity in places, for example, which are
affected by cholera, or, in which the atmospheric electricity
is negative. Now Copper is one of the chief prophylactics
CURCAS.
121
against cholera, as we learn from workers in Copper, who re-
main free from cholera. Copper cures this disease in its first
appearance, and in every case, so long as the consequences of
the first stage have not set in, which naturally can no longer
yield to the influence of Copper."
Speaking of water charged with a compound of cyanogen
called iodosmone, he remarks:
"Moreover if one smells too often of this water, or drinks
even a small quantity thereof, he will experience in himself
all the phenomena which precede cholera, followed by violent
cholerine. The surest remedy to arrest, almost in a moment,
this artificially produced state, is water impregnated with
ozone. I convinced myself personally of the truth of this
discovery. If we add to this the property of Copper in a
finely divided state, of absorbing great quantities of oxygen,
then the operation of Copper is explained according to a nat-
ural law; it operates inwardly, administered in a finely divi-
ded state, as a function remedy, as an ozone-bearer, since,
circulating with the blood. it takes up more ozone from the
inspired air than does the blood, and imparts it to the blood.
Accordingly, all disease-forms, in which Copper is the remedy,
are to be referred to a lack of ozone, or an overplus of iodos-
mone in the blood, and these disease-forms naturally consti-
tute as comprehensive a group as the atmosphere forms a
comprehensive condition of life."
CURCAS (JATROPHA.)
(PHYSIC NUT.)
The nuts are the product of a West India shrub, and the
expressed oil has been used in doses of ten or fifteen drops
as a cathartic. If the germ is removed from the seeds the
action is quite mild, but the embryo is intensely irritant to
the stomach and intestinal canal. It has some of the pro-
perties of Croton Oil (though much milder) and has been
used as an external application.
122
SPECIFIC MEDICINES.
CYCLAMEN.
A tincture is prepared from the root (tuber) in the early
spring, or during the rest of the plant. In this country the
tincture will be prepared from the tuber's of hot house
plants. Add gtt. j. to v. to water 3iv., and give a teaspoonful
as a dose.
It may be given to arrest severe vomiting, especially from
cerebral disease, in dizziness, tendency to syncope, inability
to walk strait, and in diarrhoea accompanied by tormina and
tenesmus.
CYDONIUM.
(QUINCE SEED.)
In addition to the common use of a mucilage of quince seed
in sore throat, sore mouth, chapped nipples, and conjuncti-
vitis, it has been recommended to discuss slow inflammatory
deposits, tumors, and to cure cancer (?).
The remedy is prepared in the following way: take quince
seed ŝiv., alcohol 3viij.; macerate for twenty days and ex-
press.
This is mixed with an equal part of turpentine, and the
tumors are thoroughly rubbed twice a day.
CYPRIPEDIUM PUBESCENS.
(LADY'S SLIPPER.)
Preparation.-Prepare a tincture from the recent root, in
the proportion of 3viij. to alcohol 76 per cent. Oj. The dose
will range from gtt. ij. to 3j.
The Cypripedium is a nerve stimulant, improving the cir-
culation and nutrition of the nerve centers. Hence it proves
useful in sleeplessness, nervous irritability from atony, in
neuralgia, delirium, and other disturbances from the same
cause.
It is a feeble agent, and too much must not be expected
of it. It is a stimulant, and will only be applicable in ner-
vous atony.
DELPHINIUM.
123
Its best use will doubtless be found in children, to soothe
irritation of the nervous system. I make the following pre-
scription which is an admirable "Soothing Syrup:"-R Tinct.
of Cypridedium, comp. tinct. of lavender, aa. 3ij., tinct. of
lobelia, 3j. simple syrup, 3iiiss. M.
DAMIANA.
(LEAVES OF THE TURNERA APHRODISIACA.)
The leaves of this plant were introduced from Mexico as
a certain and permanent aphrodisiac, but before the agent
could be thoroughly tested the market was flooded with a
spurious article (a very common practice) so that to day, out
of twenty specimens, nineteen would be fictitious. This is
especially the case with extracts and fluid extracts.
The true Damiana is tonic and slightly laxative, and un-
doubtedly increases the sexual appetite, and the power of the
reproductive organs. Yet we do not believe it will grow new
testes, when they have become atrophied (?) .
DAPHNE INDICA.
A tincture is prepared from the bark of the branches, using
alcohol of 98 per cent. The dose should be very small, one
drop to water 3iv. or a dilution.
The patient has prostatic discharges, a lax and pendulous
scrotum, despondency, and nocturnal emissions.
DELPHINIUM STAPHISAGRIA.
(STAVESACRE.)
Preparation.-A tincture is prepared from the ground seed,
(it having been pressed between bibulous paper to remove the
fixed oil), in the proportion of Zviij. to alcohol 98 per ct. Oj.
The tincture of Staphisagria has a specific action upon the
reproductive organs of both male and female; but more
marked in the first. It quiets irritation of the testes, and
strengthens their function; it lessens irritation of the pros-
tate and vesicula; arrests prostatorrhoea, and cures inflam-
124
SPECIFIC MEDICINES.
mation of these parts. It also exerts a marked influence
upon the urethra, quieting irritation and checking mucous,
or muco-purulent discharges; it influences the bladder and
kidneys, but in less degree.
The action of Staphisagria upon the nervous system is pe-
culiar. It exerts a favorable influence where there is depres-
sion of spirits and despondence, in cases of hypochondriasis
and hysteria, especially when attended with moroseness, and
violent outbursts of passion.
I employ it in the proportion of: R Tincture of Staphisa-
gria, 3j.; water, 3iv. A teaspoonful every four hours.
The seed of the Delphinium Consolida, or Larkspur, pos-
sesses similar medical properties, but is not so active; a tinc-
ture may be prepared in the same way, and used in the same
dose.
DIERVILLA CANADENSIS.
(BUSH HONEYSUCKLE.)
Preparation.-A tincture may be prepared from the recent
leaves and twigs, 3 viij. to alcohol 76 per cent. Oj. Dose gtt.
x. to 3j.
We have no positive knowledge with regard to this agent,
though it is credited with active properties. It would be
well to test its influence upon the urinary apparatus, and to
increase waste and nutrition.
DIGITALIS PURPUREA.
(FOXGLOVE.)
Prepare a tincture from the recent dried leaves in the pro-
portion of 3 viij. to alcohol 76 per cent Oj. Dose, from the
fraction of a drop to five drops.-R Tincture of Digitalis, gtt.
x. to xx.; water, 3iv. A teaspoonful every one or two hours.
Digitalis may be employed for the general purposes of a
sedative, to lessen the frequency of the pulse, and the tem-
perature, in cases of fever and inflammation. It is somewhat
analogous to aconite, and exerts the best influence in atonic
conditions. For these purposes, however, it must be used in
small doses.
1
DROSERA.
125
It is a powerful cardiac tonic when used in small doses, and
may be employed in any case of heart disease where the or-
gan is enfeebled. It not only gives the necessary stimulation
for the present, but it gives a permanent improvement;
doubtless through an improved nutrition.
It exerts an influence upon the capillary circulation, and
may be employed with much certainty to arrest asthenic
hemorrhages. It also influences the absorption of dropsical
deposits, and increases secretion from the kidneys, probably
in the same way.
There is no cumulative effect when Digitalis is used in small
doses.
DIOSCOREA VILLOSA.
(WILD YAM.)
An infusion of the recent Dioscorea will undoubtedly give
the best results. A tincture may be prepared from the re-
cent root in the proportion of 3 viij. to alcohol 76 per cent.
Oj. Dose gtt. j. to 3j.
The article that has been sold for Dioscorea by some drug-
gists for the past ten years, and from which the Dioscorein
has been prepared, is a species of smilax. A very good joke
on Dioscorein! but unpleasant to those who have expected it
to relieve pain in the bowels.
True Dioscorea, when recent, is a specific in bilious colic,
when given in infusion, or even in tincture. In any case it
allays gastro-intestinal irritation, and favorably influences the
vegetative processes. It is a feeble but certain diaphoretic,
and allays irritation of the nervous system.
DROSERA ROTUNDIFOLIA,
(SUNDEW.)
We employ a tincture of the fresh plant prepared in Ger-
many, using it in the proportion of: R Tincture of Drosera,
gtt. x. to 3j.; water, 3iv. A teaspoonful every three or four
hours.
- 126
SPECIFIC MEDICINES.
I use the Drosera as a specific in the cough attending and
following measles, especially where there is dryness of the
respiratory mucous membranes. An experience of twenty
years with it, in a large number of cases, has given me great
confidence in the remedy.
We also use it in cases of whooping cough, especially where
there is dryness of the air-passages, and much irritation of
the nervous system. Whilst it is not a remedy for all cases
of whooping cough, it is a true specific in those to which it
is adapted. I have often seen a serious case of the disease
relieved in twenty-four hours, and an entire arrest of the
cough in two weeks.
We also employ it in cases of chronic cough, with dryness
of the air-passages and nervous irritation, with much advan-
tage. It makes little difference whether it arises from bron-
chial irritation or inflammation or phthisis, if associated with
irritation of the basilar portions of the brain and pneumo-
gastric.
DUBOISIA MYOPŒOIDES.
The leaves of the Duboisia are the product of a tree-like
shrub growing in Australia, but from their varying strength
it has been thought best to employ the alkaloid duboisina,
which may be solved in water and given in doses of one-six-
tieth to one-thirtieth of a grain, by mouth or hypodermic in-
jection.
In action the Duboisina very clearly resembles atropia, the
alkaloid of belladonna, for which it may be used in the same
cases. It dilates the pupil quite as readily as atropia, but
its effects pass off sooner, and it does not interfere so long
with the accommodation of the eye. It arrests profuse per-
spiration, stimulates the capillary circulation, but lessens
the frequency of the pulse, and is not a cerebral stimulant.
We purpose having a tincture made from the recent Du-
boisia, and hope to find it a good remedy.
1
EPILOBIUM.
127
ELATERIUM.
Elaterium is a deposit from the juice of the squirting cu-
cumber, and if fresh is in small flat fragments of a pale
greyish color. For use we make a tincture, adding 3j. to
alcohol of 98 per cent. Oj., macerating for one week and fil-
tering; of this the dose will vary from the fraction of a drop
to a half a drachm.
Prof. King recommended this remedy in chronic cystitis,
and it has been used in a large number of cases with the most
flattering results. He directed that half a drachm be ad-
ministered three times a day until it purged freely, and then
that it be given in doses of five drops three times a day un-
til the disease was subdued. Even in doses much smaller than
this, it will be found to exert a curative influence upon
chronic nephritis and cystitis.
In cathartic doses Elaterium has been a prominent remedy
in the treatment of dropsy, and even in very small doses it
will sometimes cure this disease, and I have alternated it
with apocynum.
EPIGEA REPENS.
(TRAILING ARBUTUS.)
This remedy deserves further and careful investigation.
We wish to determine its influence upon the urinary appa-
ratus, and the intestinal canal.
For this purpose a tincture of the fresh leaves may be
prepared with dilute alcohol,
EPILOBIUM PALUSTRE.
For general use the infusion is the preferable form for ad-
ministration; but we have a tincture prepared with dilute
alcohol, employing pressure.
The Epilobium exerts a specific influence upon the intes-
tinal mucous membrane, relieving irritation, and promoting
normal function. Thus, it is employed in acute diarrhoea and
dysentery, and in colic, with advantage. I have also pre-
128
SPECIFIC MEDICINES.
scribed it to quiet the irritation and check the diarrhoea in
typhoid fever, with marked benefit.
It is especially valuable, however, in chronic diarrhoea and
dysentery; sometimes effecting cures where all other means
had failed. Thus, I employed it extensively in the treatment
of the chronic diarrhoea during the recent war, and with a
success not to be obtained from other remedies. I do not
pretend to account for its action, but its curative influence is
well established.
ERECHTHITES HIERACIFOLIUS.
(FIREWEED.)
Preparation.-A tincture may be prepared from the recent
plant, in the usual proportions, using alcohol of 76 per cent.
Dose, from gtt. j. to 3ss.
We have here another remedy that requires study. It in-
fluences mucous tissue, especially of the bowels and lungs,
and this will be the direction of the investigation.
ERGOTA.
The fresh Ergot may be used in powder, infusion, or a
tincture may be prepared in the usual way, with alcohol of
76 per cent. To strengthen the pains in labor, I should pre-
fer this remedy in infusion, but for medicinal use I prefer
the tincture.
In tedious labors, when the os is dilated, and the soft parts
dilatable, and the pains grow weaker, the patient showing
evidences of exhaustion, Ergot may be given in the usual
doses. I rarely use it in my practice for this purpose.
In passive hemorrhage with a feeble circulation of blood,
tincture of Ergot may be given in doses of five to ten drops,
until the flow of blood is arrested. In dizziness, partial loss
of consciousness, unsteadiness in the legs, with dull eyes and
dilated or immobile pupil, Ergot becomes a prominent remedy.
So also in threatened apoplexy, in the coma that follows apo-
plexy, and in epilepsy followed by marked congestion of the
ERYNGIUM.
129
brain, I give this remedy. In many cases it may be used in
the common way :-R Tincture of Ergot, gtt. x., water 3iv.,
a teaspoonful every two or three hours.
ERIGERON CANADENSE.
(CANADA FLEABANE.)
We employ the Oil of Erigeron in practice, for the arrest
of hemorrhage. For passive hemorrhage it is one of the most
valuable remedies we have, and may be relied upon in hem-
orrhage from any organ or part. For this purpose the dose
will be from five to ten drops on sugar, as often as may seem
necessary.
The Erigeron influences the kidneys in a manner similar
to Buchu. It may be employed in diabetes and albuminuria
with advantage; also, in chronic inflammation of the kidneys,
bladder and urethra. Latterly is has been recommended for
gonorrhoea.
ERYODYCTION GLUTINOSUM.
(YERBA SANTA.)
A tincture is prepared from the recent dried leaves in the
usual way, with alcohol of 98 per cent. It is dispensed with
glycerine and syrup, the dose being from gtt. j. to gtt. x.
The Yerba Santa is a stimulant to the respiratory mucous
membranes, and for this purpose it may be employed in pha-
ryngitis, laryngitis, and bronchitis. It also exerts a favora-
ble influence in catarrhal gastritis.
ERYNGIUM AQUATICUM.
(WATER ERYNGO.)
The Eryngium may be employed in infusion, or in the form
of a tincture of the recent dried root, 3 viij. to proof spirit,
Oj. Dose gtt. j. to gtt. xx.
The Eryngium exerts a specific influence upon the bladder
and urethra, relieving irritation. It is one of the most cer-
tain remedies that can be employed in dysuria from irritation,
130
SPECIFIC MEDICINES.
and in spasmodic stricture; continued, it proves curative in
these cases.
It has been employed for other purposes, and we find it
highly recommended. It undoubtedly deserves a thorough
investigation.
ERYTHROPHLŒUM.
(SASSY BARK.)
Sassy bark is imported from West Africa where it is em-
ployed by the natives as an ordeal poison, and it also enters
in the composition of the fetich of the obi men. It contains
an alkaloid, erythrophleina, which is intensely poisonous.
Given in large quantity in the ordeal it produces giddiness,
and inability to cordinate the voluntary muscles, and it may
produce emesis by which it is ejected from the stomach. If
it produces emesis the patient may live, if not he dies from
paralysis of the respiratory apparatus and heart.
In minute doses (of a tincture one drop to water Ziv.) it
may be given to stimulate the capillary circulation, to in-
crease secretion of urine, arrested by feeble circulation, and
to check atonic diarrhoea.
ETHER.
(SULPHURIC ETHER.)
As an anesthetic Ether is now preferred by many to chlo-
roform, as it is thought there is very much less danger in its
use, and especially if given by persons not familiar with the
administration of anæsthetics. It is inhaled from the cup-
ped napkin, as we administer chloroform, care being used to
admit a sufficient amount of air.
In doses of two to ten drops on sugar it is a stimulant to
the brain and spinal cord, and will relieve nervous headache,
palpitation and irregular action of the heart, imperfect res-
piration, etc.; the face being cool and pallid, and the pulse
feeble.
:
EUPATORIUM.
181
EUCALYPTUS.
A tincture is prepared from the leaves, using alcohol 98
per cent. The dose will vary from the fraction of a drop to
fifteen drops.
It exerts a gently stimulant influence upon the nerve cen-
ters, improves the circulation and respiratory function, and
opposes the influence of malaria in the blood. It is a feeble
antiperiodic but will sometimes arrest an ague; when an ague
is broken, it is a very good remedy to perfect a cure. It is
also a fair means of prophylaxis, though not so good as the
small doses of quinine. It has been employed in bronchitis
with fetid expectoration, dilatation of bronchia, and in some
cases of asthma. It needs further study, for if it ever be-
comes a remedy of first importance, it will be in the very
small dose, and as yet we have not the indications for it.
EUONYMUS ATROPURPUREUS.
(WAHOO.)
Preparation.-Prepare a tincture from the bark of the
recent root, in the proportion of 3viij. to alcohol 76 per cent.
Oj. Dose, gtt. j. to 3ss.
The Euonymus stimulates the nutritive processes, and in
some cases improves digestion. Usually, however, it will
need to be combined with a pure bitter, as Hydrastis, to get
its full action in this direction.
It exerts a marked influence in malarial diseases, and de-
serves the name of antiperiodie, though it is much feebler
than quinine. It may, however, be used in these cases with
marked advantage, after the fever has been once broken.
EUPATORIUM AROMATICUM.
(WHITE SNAKEROOT.)
Preparation. Prepare a tincture from the recent dried root
in the proportion of 3viij. to alcohol 76 per cent. Oj. Dose,
gtt. j. to gtt. xx.
132
SPECIFIC MEDICINES.
This variety of the Eupatorium exerts a marked influence
upon the brain, relieving irritation and promoting normal
action. It is also diaphoretic, and probably influences, to a
slight degree, all of the functions governed by the sympa-
thetic. It will repay careful investigation.
EUPATORIUM TEUCRIFOLIUM.
(WILD HOARHOUND.)
Preparation,—Prepare a tincture from the recent plant,
using dilute alcohol. The dose will vary from one to twenty
drops.
In small doses it stimulates all the functions controlled by
the sympathetic nervous system; improving digestion, blood
making, and stimulates waste and excretion. It may be com
bined with a simple bitter tonic, or preparation of iron, or
the hypophosphites, for its restorative influence, or with the
vegetable alteratives for its other use.
In large doses it is a powerful diaphoretic.
EUPATORIUM PERFOLIATUM.
(BONESET.)
Preparation.-Prepare a tincture from the recently dried
herb in the proportion of 3viij. to proof spirit Oj. Dose,
from the fraction of a drop to ten drops.
The Eupatorium increases functional activity of the skin,
and to a less extent, secretion from the kidneys. It also in-
fluences the circulation, to a slight extent, and does well,
combined with the sedatives.
In quite small doses it stimulates the sympathetic nervous
system, and improves all the vegetative functions. It is not
an active remedy, and too much must not be expected of it;
yet, in many cases, it may well supplant costly foreign drugs.
The best indication for Eupatorium is a frequent, full
pulse, flushed skin, inclined to be moist. Throbbing pain is
the local indication.
EUPATORIUM.
133
EUPATORIUM PURPUREUM.
(QUEEN OF THE MEADOW.)
Preparation.-Prepare a tincture from the recent root, in
the proportion of Zviij. to alcohol 98 per cent Oj. Dose,
gtt. j. to gtt. x.
Its principal influence is upon the kidneys, and it may be
employed whenever an increased volume of urine is de-
sirable.
It has been mostly employed in the treatment of dropsy,
with reported success.
Its influence upon the urinary organs may doubtless be
made valuable, but it requires further study.
EUGENIA JAMBOLLINA.
The
A tincture is prepared from the seeds, and from the bark,
(imported from India), using alcohol of 98 per cent.
dose will vary from the fraction of a drop to ten drops.
It is indicated by giddiness with abdominal pain, colic,
pains in the back and loins, and is thought to be beneficial
in hernia and illeus.
EUPHORBIA HYPERICIFOLIA,
A tincture is prepared from the recent root, using alcohol
of 98 per cent. The dose will vary from the fraction of a
drop to five drops. I generally administer it in the usual
proportion of gtt. x. to water 3iv., the dose a teaspoonful.
This is one of the most certain remedies employed in
cholera infantum, in some cases being much better than ipe-
cac. It is also an efficient remedy in mucous enteritis, irri-
tant diarrrhoea, inflammation of the cœcum, and dysentery.
It is usually administered with aconite. It is also likely to
prove a most efficient remedy in pneumonitis and bronchitis,
especially of children.
134
SPECIFIC MEDICINES.
EUPHORBIUM.
The Euphorbium is an extremely acrid resin, and has been
used for the purpose of counter-irritation. Added to the irri-
tating plaster of our dispensatory it renders it much more
active, or a very small portion may be dusted on an ordinary
strengthening plaster, giving it the activity of an irritating
plaster.
A tincture may be prepared in the usual way, with alcohol
of 98 per cent, which is then used in the second or third de-
cimal dilution. In the very small dose, this remedy may be
employed in gastric catarrh, in atonic diarrhoea, in asthenic
bronchitis, and in abdominal dropsy from asthenia.
EUPHRASIA OFFICINALIS.
(EYEBRIGHT.)
In infusion or a poultice this herb has been employed with
good results in conjunctivitis. For general use prepare a
tincture from the fresh plant, with alcohol of 98 per cent.
The dose will range from the fraction of a drop to ten drops.
In small doses it will be found to exert a beneficial influ-
ence in conjunctivitis, and even in chronic disease of the eye
itself. It is also a good remedy in catarrhal disease of mu-
cous membranes, both of the respiratory apparatus, and intes-
tinal canal. It may also be thought of in disease of the ear,
especially when associated with disease of the throat.
EUPHORBIA COROLLATA.-E. IPECACUANHA.
(BOWMAN'S ROOT-WILD IPECAC.)
Preparation.--Prepare a tincture of the first from the bark
of the root, of the second from the root (dried), 3viij. to
alcohol 76 per cent. Oj. Dose, gtt. j. to x.
These remedies have not been sufficiently studied ; yet, pos-
sessing active properties, they are likely to prove valuable.
The Euphorbia Corollata exercises a direct influence upon
the mucous surfaces, relieving irritation, and promoting func-
tional activity. This is noticed more especially upon the diges-
FERRUM.
135
tive tract. In quite small doses it improves digestion, both
stomachic and intestinal, and tends to overcome constipation
and irregularity of the bowels.
It may be employed with advantage in some forms of diar-
rhoea and dysentery, using it in 'the place of Ipecac. To arrest
inflammatory action in the intestinal canal, seems to be its
specific use.
FAGONIA ARABICA.
An Indian plant recommended by Dr. Honingberger, who
gave the herb in doses of 1-25 of a grain, in hemiplegia,
obscurity of vision, spermatorrhoea, and yellowness of the
cornea.
FERRUM.
(IRON.)
We employ three preparations of Iron-metallic iron in
powder, the tincture of chloride of iron, and the tincture of
acetate of iron. The first is iron by hydrogen, or Quevenne's;
a good article may be known by its iron-gray color and its
effervescing with acids; the spurious is black, and efferves-
ces but slightly. The tincture of chloride of iron should be
ordered of a reliable manufacturer. It will be a clear, deep-
colored tincture, without a trace of yellowness or deposit at
the bottom of the bottle.
We employ iron as a restorative. It is a component part
of the red corpuscles, and experience has shown that its ad-
ministration stimulates the formation of these bodies. In
proportion as the red corpuscles are increased, blood-making
becomes more active and nutrition is improved. It thus be-
comes a very important remedy in cases of anæmia, with im-
paired nutrition.
As a restorative, it is better to administer the necessary
quantity of iron with the food. Experiment has demon-
strated that at other times it is appropriated slowly or not at
all. It does not require a very large amount to accomplish
the object, for iron exists in small quantity in the body. The
136
SPECIFIC MEDICINES.
•
dose of metallic iron need never be more than five grains,
often not more than one; whilst of the tincture, the dose
will be from one to twenty drops.
In the selection of the preparation I would be guided by
the appearance of the mucous membrane. If it is deep-red,
use the tincture of chloride; if pallid, metallic iron.
We also employ iron as a specific against certain zymotic
poisons. The reader has probably employed the tincture of
chloride in erysipelas, and many regard it as a true specific
in the disease, rarely making any other prescription. I think
we may say, that in all cases of erysipelas presenting the
deep-red discoloration of mucous membranes, with the same
deep color of the local disease, the tincture may be prescribed
with great confidence. But my experience with the disease
has shown me that where the mucous membranes are pallid,
the coating of the tongue white and pasty, the sulphite of
soda is the best remedy. In these cases Quevenne's iron
might be tested.
Rademacher claimed that iron was specific to one of his
three epidemic constitutions. This was characterized by pal-
lor of the skin, moderate heat, with a small, thin or soft,
empty pulse. His description, so far as I have seen it in
translation, is so meager that we can hardly determine the
condition in which he valued it so highly, even treating all
the cases of pneumonia in a season with iron alone.
The preparation of iron employed by the school of Rade-
macher was a tincture of the acetate, prepared by the fol-
lowing formula :
"Take of pure sulphate of iron two ounces and seven
drachms; of the pure acetate of lead three ounces: triturate
them together in an iron mortar so long as may be needed
to reduce them to a soft conformable mass; then put the
mass in an iron vessel with six ounces of distilled water and
twelve ounces of diluted acetic acid; heat the mixture until
it boils. After it has become cold, add six ounces of pure
alcohol.
"The mixture is then to be put in a glass vessel with a
ground stopper for at least six months-to be shaken daily—
1
FERRUM.
137
when it will acquire a high red color; then it is to be filtered
through paper.
"By this long process the tincture will have a mild, pleasant
taste, and a smell similar to Malaga wine, more noticeable on
the addition of gum arabic to the mixture. The older the
mixture is the pleasanter the smell and taste, and hence it is
desirable to make it in large quantities.”
A simpler formula than the above is the one of the Dublin
Pharmacopoeia, on page 1253 King's Dispensatory.
It is prescribed in doses of gtt. j. to gtt. x.; and will be
found an excellent preparation where iron is indicated, and
we do not wish the muriatic acid.
Recent investigation has shown that the solid blue colora-
tion of tongue is an indication for small doses of iron in any
disease. For this I would prescribe tincture acetate of iron,
Zij.; water, or syrup, 3iv.; a teaspoonful every three or four
hours.
The majority of our readers are well acquainted with the
use of tincture of muriate of iron in erysipelas, and have
administered it in this disease with a certainty that they
rarely feel with regard to other remedies. I don't think any
one, even the most skeptical in regard to specific medication,
will question the specific action of this remedy in many cases
of this disease. And as it is such a well known example, we
will use it to illustrate certain facts in therapeutics.
The first proposition I will make is, that it is not specific
to all cases of erysipelas. Whilst in many, embracing some
of the severest, it is the only remedy needed, in others you
might quite as well give water, other than the iron proves a
topical irritant.
We ask the question, then, in what condition of this dis
ease is it specific, and what are the symptoms indicating it
use? Or, in what conditions is it contra-indicated, and what
are the evidences that show this?
It is easier to pick out the case where other treatment
would be preferable, and where we would not use the iron. In
any case of erysipelas, with a full bounding, or full hard
pulse, and bright redness of the local disease. I would always
138
SPECIFIC MEDICINES.
prefer veratrum as an internal and a topical remedy. Indeed,
nothing is more certain than veratrum in these cases. Take
again the case presenting the broad, pallid tongue, with moist,
pasty coat, and I would very certainly prefer sulphite of soda;
or if it were a moist, dirty tongue, without so much pallor,
sulphurous acid.
But is it possible to point out the indications for iron? I
think it will be if we examine those cases carefully in which
iron is the remedy. One of the most pronounced symptoms
that I have noticed is a peculiar solid blue color of mucous
membranes, sometimes deepening into purple where there is
a free circulation. The same change in color may oftentimes
be noticed in the local disease. In several cases, other than
erysipelas, I have been tempted to prescribe tincture of mu
riate of iron from this symptom, and with good results. I
hope our readers will watch this point carefully and see if I
am correct. If not, find a certain indication for its use.
Now for the argument. Take a case of erysipelas of the
severest type, in which iron is the remedy-what are the re-
sults of its administration alone? The pulse is 120 to 130,
small and hard; within forty-eight hours it comes down to
80, and is soft and open. The temperature is probably 106°;
in forty-eight hours it comes down to 100°. The skin is dry
and harsh, the urine scanty and high colored, the bowels con-
stipated; in forty eight hours the skin is soft and moist, the
urine free, the bowels act without medicine. The nervous
system is in a state of extreme irritation, possibly the patient
is delirious; in forty-eight hours the patient is conscious and
the suffering relieved. Here we have the most marked effect
of a sedative, diaphoretic, diuretic, laxative and cerebro-spinant,
and yet we have given but the one remedy, tincture of muri-
ate of iron. Now I ask the question, why these results?
You answer, because the iron specificially antagonized
the blood-poison. Yet tincture of muriate of iron is not re-
garded as an antiseptic, and we have a number of cases of
erysipelas, in which iron does not antagonize the blood poison.
How is this? Is it not well worth thinking of? And if
FUCUS.
139
tincture of muriate of iron thus becomes a specific to a cer-
tain form of grave zymotic disease, may we not hope to find
other remedies of a similar character?
I present the subject in this form, that we may think of it,
and hope at some future time to give a rational explanation
of some of these facts in therapeutics.
FRASERA CAROLINENSIS.
(AMERICAN COLUMBO.)
Preparation.-Prepare a tincture from the fresh root, in
the proportion of 3viij. to alcohol 98 per cent. Oj. Dose,
gtt. j. to v.
This remedy has been but little used, and that little has
been of the dried root as a tonic. The recent root possesses
quite active properties, and is likely to repay investigation.
It is stimulant to the circulation, and will doubtless exert
the same influence upon all the vegetative functions. Its
continued use will relieve obstinate constipation.
FRAXINUS SAMBUCIFOLIA-F. ACUMINATA
(ASH.)
Preparation.-Prepare a tincture from the recent bark, in
the proportion of 3viij. to alcohol 76 per cent. Oj. Dose,
from gtt. ij. to f3ss.
Both the black and white ash deserve study. The first, for
its influence in skin diseases, especially of an herpetic char-
acter, and as a general alterative. The second, to improve
secretion, and for its influence upon the chylopoietic viscera.
FUCUS VESICULOSUS.
(SEA WRACK.)
Prepare a tincture in the usual manner, using dilute alco-
hol. Dose from gtt. v. to 3ss.
We wish to determine its influence upon the functions of
waste and nutrition, and especially in cases of degenerations
and growths. It has had some reputation in the treatment
140
SPECIFIC MEDICINES.
of benign and malignant growths. It exerts a direct influ-
ence upon the intestinal canal, and this may suggest the
course of experiment.
The Sea Wrack has been employed in the treatment of
scrofula, and to remove deposits and hypertrophy of tissue.
Recently it has been largely sold to cure obesity, and persons
who have taken it vouch for its curative influence. The ben-
efit, however, may be wholly due to an animal diet, and to
the limited use of fluids, which is a part of the treatment.
FILIX MAS.
(MALE FERN.)
It
The oleo-resin of Male Fern is used as a tænicide, and
whilst not so certan as the pomegranate bark, it will be pre-
ferred in some cases because the dose is much smaller.
should be taken when the stomach is empty, say at 8 or 9
o'clock in the morning, the patient having had no breakfast,
in a dose of twenty drops, followed by ten or fifteen drops of
sulphuric ether, and in two hours by a full dose of compound
powder of Jalap and Senna.
FOENUM GRÆCUM.
(FENUGREEK.)
A sack of ground Fenugreek seed, makes an excellent ap-
plication in chronic disease of stomach, bowels and liver. It
may be rendered stimulating by sprinkling it with any of the
essential oils, hemlock, origanum, cinnamon, etc.
In infusion or tincture it is gently tonic, and improves diges-
tion, and is thought to relieve irritation of the respiratory
apparatus. It has also been used as an emmenagogue, and
to relieve uterine irritation.
GALIUM APARINE.
(CLEAVERS.)
Galium is most frequently employed in infusion, especially
for its influence upon the urinary apparatus. A tincture may
be prepared from the recent herb by expression, using only
sufficient alcohol for preservation.
GAULTHERIA.
141
The first use of Galium is to relieve irritation of the uri-
nary apparatus, and increase the amount of urine. For this
purpose it will be found one of our best remedies. In dysuria
and painful micturition, it will frequently give prompt relief.
It has recently been employed in cancer, used locally and
internally. A case of hard nodulated tumor of the tongue,
apparently cancerous, is reported in the British Medical
Journal, as having been cured with it. Whether it was can-
cerous or not, it suggests a line of experiment which may de-
velop an important use of the remedy.
GALANGA.
(GALANGAL.)
In powder this pungent root is used as a remedy for the
toothache, catarrh, chronic pharyngitis, and laryngitis. A
tincture may be prepared in the usual way, with alcohol of
98 per cent, and used in doses of from one to ten drops. It
has been of service in dyspepsia, lax and pendulous abdo-
men, relaxation of the perineum with hemorrhoids, and as
an adjuvant to remedies for syphilis.
GALEGA OFFICINALIS.
(GOAT'S RUE.)
A tincture is prepared from the fresh herb, and used on
the Mediterranean and in India as a remedy in dyspepsia,
lienteric diarrhoea, tympanitis, and as a restorative in con-
valescence from low forms of disease.
GAULTHERIA PROCUMBENS.
(WINTERGREEN.)
Preparation.-Prepare a tincture from the fresh plant, in
the proportion of 3 viij. to alcohol 98 per cent. Oj. Dose, from
gtt. ij. to gtt. x.
In this form and in these doses, the Gaultheria exerts a
special influence upon the bladder, prostate and urethra,
allaying irritation and inflammation. It may also be employed
142
SPECIFIC MEDICINES.
in dysuria. Probably one of its most important uses is, as
an anaphrodisiac, exerting a direct and quite certain influ-
ence upon the reproductive organs of both male and female.
For this purpose it is employed in some cases of sperma-
torrhea. It will not do, however, to mistake the case, and
use it where the venereal function is already impaired.
GELSEMINUM SEMPERVIRENS.
(YELLOW JESSAMINE.)
The commercial tincture has been so variable in strength
that much harm has resulted from its use. In some cases
the harm has been direct from over doses, in others, indirect
from depending upon a feeble or worthless remedy. Before
the war, we had a very crude tincture prepared from the
green root, with proof spirits (whisky ?), containing about ast
much of the medicinal properties as could be held by such
spirit. During the war, there being difficulty in obtaining a
supply of the root, and greater difficulty in having it shipped.
green, the tincture in the market gradually deteriorated un-
til it was worthless. Even yet it has not regained its medi-
cinal properties with many druggists.
We have thought a good tincture could only be made from
the fresh root. But some who have employed the dry root
(not old), claim that it makes fully as reliable a tincture.
Dr. Locke, of Newport, Ky., prepares his tincture from the
dried root, and claims that it is more reliable than any he
can buy.
It is not worth while to give a formula for the preparation
of a tincture, as it will be purchased by a great majority of
our readers. That which bears the label "Specific Medicine"
will be found very strong. Dose from the fraction of a drop
to gtt. vj.
Gelseminum exerts a specific influence upon the brain, and
to a less extent upon the spinal center and sympathetic. It
relieves irritation and determination of blood, and the dis-
ordered innervation that flows from it. Probably there is
no remedy in the materia medica that is more direct and
GENTIANA.
143
}
certain in its action. Given, a case of irritation and deter-
mination of blood to the brain, marked by flushed face, bright
eyes, contracted pupils, restlessness and irritability, we pre-
scribe Gelseminum with certainty. This being a common
complication in diseases of childhood, it is especially the
child's remedy.
Acting in this direction, it lessens the frequency of the
heart's action, and removes obstruction to the free flow of
blood-a sedative. It also increases secretion in the same
way.
I do not think the Gelseminum exerts any important influ-
ence, other than through this action upon the nervous sys-
tem. But, as will be observed, this is a very important
action.
It is contra-indicated where the circulation is feeble, and
there is tendency to congestion. Especially if there is a fee-
ble circulation in the nerve centers. We never give it if the
eyes are dull, pupils dilated, and the countenance expression-
less. In such cases, it may prove fatal in quite moderate
doses. A number of these cases are on record, three or four
in which death was produced by as small a dose as gtt. xxx.
of a common tincture.
It has one other specific action, which is worthy of mention.
It is the remedy in dysuria from stricture, and will rarely
fail in enabling the patient to pass urine in from four to
eight hours.
GENTIANA LUTEA.
(GENTIAN.)
The Gentian is an excellent stomachic bitter, and resem-
bles, in its medicinal action, our hydrastis. I do not think,
however, it has the same kindly influence in irritable condi-
tions of the stomach.
A very fine preparation may be made by taking five parts
of Gentian, and one part of podophyllum; and making a
tincture by percolation, using dilute alcohol. It is one of the
most efficient remedies I have ever used in atony of the
stomach and bowels, with feeble or slow digestion.
144
SPECIFIC MEDICINES.
GENISTA TINCTORIA.
(DYERS' BROOM.)
A tincture is prepared in the usual way from the young
branches, fresh, using alcohol of 98 per cent. The dose will
vary from the fraction of a drop to 3ss.
It may be employed in ascites and oedema, with cutaneous
disease or erosion of the skin with exudation.
GEUM RIVALE.
(WATER AVENS.)
Prepare a tincture from the flowering plant with alcohol
of 98 per cent. The dose will range from the fraction of a
drop to ten drops.
It is indicated by tearing spasmodic pains in the abdomen,
which recur upon taking food or exercise. It is employed in
diarrhoea and dysentery, dyspepsia, disease of the respira-
tory mucous surfaces, and in leucorrhoea.
GLECOMA HEDERACEA.
(GROUND IVY.)
Prepare a tincture from the fresh plant with alcohol of 98
per cent. The dose will vary from the fraction of a drop to
fifteen drops.
It may be employed in all diseases of the mucous mem-
branes with increased secretion, as bronchitis, catarrhal dis-
ease of stomach, chronic mucous enteritis, dysentery, cysti-
tis, and leucorrhoea.
GERANIUM MACULATUM.
(CRANESBILL.)
The Geranium is an astringent from the presence of tannic
and gallic acids in large quantity; and hence will possess the
medicinal properties of these. It is claimed, however, to
possess other properties, acting more kindly, and giving tone
to mucous membranes. Whilst I believe this remedy has
*
GLYCERINE.
145
been over-rated, I am confident that experiment will develop
some special use.
It may be employed in infusion with good results, espe-
cially when a topical action on the stomach and bowels is
wanted, or in chronic cases when we desire the action of gal-
lic acid. For general use I would suggest a tincture by per-
colation, using alcohol of 50 per cent. The Geranin, though
not entirely worthless, is a feeble and costly medicine.

GERARDIA PEDICULARIA.
Will some of our southern physicians give this remedy a
ial and report. For experiment, make a tincture by perco-
ion, 3viij. to the Oj., using dilute alcohol. Test it as a sed-
ve, a diaphoretic, and an antiseptic.
GILLENIA TRIFOLIATA-G. STIPULACEA.
(INDIAN PHYSIC.)
Preparation.-Prepare a tincture from the root, in the pro-
portion of 3 viij. to proof spirit, Oj. Dose from gtt. v. to 3ss.
These indigenous remedies possess marked medicinal pro-
perties, yet they have been so little used of late years that
most physicians know nothing about them.
They deserve careful study. First to determine their re-
lation to ipecac, and whether they will replace it in practice.
The direction of the experiments may be seen by reference
to this agent. We also wish to determine their influence
upon the functions of digestion and secretion.
GINSENG.
(See Panax.)
GLYCERINE.
Glycerine is principally employed in medicine for its topi-
cal action. It is slightly stimulant to both skin and mucous
membrane, and shields the skin from the action of the air.
In many cases of simple cutaneous irritation, it will prove
146
SPECIFIC MEDICINES.
curative alone. In others it will prove a good vehicle for
the application of other remedies. In some cases of dys-
pepsia, Glycerine is a good remedy, allaying irritation, and
giving gentle stimulation.
Glycerine is an admirable solvent, and may be used as a
basis for many preparations, both for local use, and internal
administration.
In using Glycerine as a local application, a portion of
water should always be added.

GNAPHALIUM POLYCEPHALUM.
(WHITE BALSAM.)
Preparation.-Prepare a tincture from the leaves, us
alcohol of 50 per cent. Dose, gtt. j. to 3ss
This agent has been but little used, yet we think it wor
of investigation. The line of experiment will be, to det
mine its influence upon the urinary and reproductive organ
-in acute and chronic ulcerations-and its action on the
digestive apparatus.
GOSSYPIUM HERBACEUM.
(COTTON.)
Some years since the cotton-root was in considerable de-
mand as an abortive. It was claimed that the Negro women
of the South made common use of it, and that it was so cer-
tain and safe that they could rid themselves of the product
of conception whenever they wished, and without impair-
ment of health. It was singular what a demand sprung up
for cotton root bark; but fortunately for the unborn it had
no influence on the gravid uterus.
Still the reports from the South seemed well authenticated,
that, at least in some cases, it was abortive, and was a very
certain emmenagogue, and a stimulant diuretic. It is only
another example of a fact I have insisted on, that many plants.
possessing medicinal properties when fresh, lose them when
gathered at the wrong season and kept in stock.
GRANATI.
147
Since the first edition of this work was published, careful
experiment has shown that the tincture of the green root is
abortive, and especially that it has marked emmenagogue
properties. It should not be used when there is irritation.
or a tendency to inflammation. It also exerts a direct influ-
uence upon the urinary apparatus, increasing secretion and
acting as a stimulant to the entire urinary tract.
GLONOINE.
(NITRO-GLYCERIN.)

It is employed in dilution with alcohol, the third to the
sixth decimal being recommended.
The indications for its use are a sense of fullness in the
head, dizziness, flushed face, tensive pain as if the head
buld burst, partial loss of consciousness, or difficulty in
rawing conclusions from impressions: throbbing in the
hole body or in a particular part, as if the arteries were
distended with blood, is deemed a good indication for glo-
noine. The physician who must always give a large dose
had better let this agent alone.
GRANATI.
(BARK OF THE POMEGRANATE ROOT.)
The bark of the Pomegranate root is probably the most
certain remedy we have for the expulsion of tape-worm, but
in order to succeed, it must be used as recommended. The
directions of Prof. Locke for making a decoction are as
follows:
Put eight pints of water and eight ounces of prepared
bark into a kettle and boil until the liquid is reduced to
about four pints, then strain through muslin; press well. Add
the contents of the strainer again to the same amount of wa-
ter (eight pints), and boil until reduced to four pints, and
strain as before. Mix the two liquids, and evaporate to the
measure of one pint. When cold add to it one fluid drachm
of fluid extract of Jalap. This is given in two or three parts,
in the morning, the patient fasting.
148
SPECIFIC MEDICINES.
GRAPHITES.
(PLUMBAGO.)
A pure Plumbago is triturated with sugar of milk, ten to
ninety parts, making a first decimal; this is repeated to
the third trituration, when it is added to alcohol in the pro-
portion of ten grains to ninety drops of alcohol. It is this
that I have used in practice.
The indications for its use are, -a feeble circulation of
blood, pallid, transparent skin, pale tongue, impairment of
the sexual function (irritation without power), irregular and
painful menstruation, leucorrhoea.

GRATIOLA OFFICINALIS.
(HEDGE HYSSOP.)
A tincture is prepared from the fresh plant, using alcoh
of 98 per cent. Of gtt. v. to water iv. the dose may be
teaspoonful.
It may be employed in jaundice, dropsy, engorgement of
spleen, fullness and oppression of the brain, and some other
diseases where there is an obstructed circulation. Soreness
and rawness of the mouth may be taken as an indication in
such cases.
GRINDELIA ROBUSTA.
A tincture is prepared from the recent leaves, using alco-
hol of 98 per cent. The dose will range from the fraction of
a drop to ten drops. Glycerine may be used in the prescrip-
tion to hold the remedy in solution with water. I generally
prescribe gtt. x. to 3iv. of glycerine and water; dose, one
teaspoonful
I have employed it with good results in asthma, bronchor-
rhoea, dilated bronchia, old ulcers, and chronic diseases of
the skin, with enfeebled circulation. As a local application
in the proportion of 3j. to 3ij. in water Oj. I have employed
it with marked benefit in the treatment of old and indolent
ulcers.
GUAIACUM.
149
*
GUACO,
(MIKANIA GUACO.)
A tincture is prepared from the dried leaves (from South
America), using alcohol of 98 per cent.
As we have an abundance of astringent remedies for diar-
rhoea, it is hardly worth while to import one, so that this
may be tried in small dose for other effects. It may be tried
in rheumatism and visceral neuralgia.

GUARANA.
The Guarana of the drug market is the ground seed of the
Paullinia Sorbilis, a native of Brazil, This is made into a
tincture in the usual way with alcohol of 98 per cent. The
se will vary from one to ten drops.
It is a stimulant to the cerebro-spinal centers, and its
incipal use now is to relieve headache. If the face is pal-
d, the eyes dull, the face expressionless, it may be used
with advantage. It may be given in those severe headaches
that recur with the menstrual period, the symptoms being as
above, with a prospect of relieving the disease of the repro-
ductive function, as well as the headache.
GUAREA TRICHILIOIDES.
(RED WOOD.)
A tincture is prepared from the bark, (Central America),
using alcohol of 98 per cent. It is administered in the usual
small doses, gtt. v. to water 3iv., a teaspoonful every two or
three hours.
It is indicated by vertigo, dizziness, variable appetite, cough,
and may prove valuable in the early stages of phthisis.
GUAIACUM OFFICINALE.
We prepare a tincture by percolation from the wood, in the
proportion of 3 viij. to alcohol 76 per cent. Oj. Dose, from
ten to thirty drops.
150
SPECIFIC MEDICINES.
The tincture thus prepared may be occasionally used with
advantage in the latter stages of acute, and in chronic rheu-
matism. It may also be associated with the vegetable alter-
atives in the treatment of some chronic diseases, where stim-
ulation of the skin is required. Occasionally it will prove
useful in functional diseases of the uterine organs, especially
in amenorrhoea.
GUILANDINA BONDUCCELLA.
An East Indian nut which has been employed in doses of
one to ten grains in the treatment of agues, and as a prophy-
lactic against malarial fevers. In doses of from one-twenty-
fifth of a grain to one grain, it is a remedy in some eruptive
diseases, in enlargement of the spleen, hepatic pain, a
oedematous swelling; it has also been employed in syphili

GYMNOCLADUS CANADENSIS.
(AMERICAN COFFEE TREE.)
This agent has been but little used in medicine, yet if we
are to judge from its common use as a fly poison, it possesses
active properties that may be made available. For experi-
ment, a tincture may be made of the bark, beans, or pulp
of the seed-pod; the last being regarded as the most active.
Dr. Herring concluded from his experiments that it might
be given with benefit in cases of "cough accompanied or fol-
lowed by tonsilitis; in erysipelas of the face; in scarlet fever;
in so-called hives; in typhoid fever; in remittent or intermit-
tent epidemic fever, with a typhoid character, etc."
The dose would be small. Of a tincture of Ziv. of the
pulp to the Oj., gtt. x. to water, 3iv., a teaspoonful every
three hours would be sufficient.
HAMAMELIS VIRGINICA.
(WITCH-HAZEL.)
I prefer a distilled extract of the fresh leaves to any other
preparation. That known to the trade as "Pond's Extract"
HAMAMELIS.
151
is employed by most physicians who make use of the remedy.
The ordinary fluid extract may be used as a topical applica-
tion, as a gargle for the throat, and for the general purposes.
of an astringent.
Where the Witch-Hazel can be readily obtained, I would
advise that the leaves be gathered in June or July, and if no
apparatus for distilling is at hand, that they be packed in a
percolator, and a tincture prepared with a very weak spirit,
say 30 per cent.
The Hamamelis has a specific action upon the venous sys-
em, giving strength to it, and facilitating the passage of ven-
blood. It may, therefore, be employed with advantage
any case where a part is enfeebled, and there is a sluggish
rculation. Thus we use it in cases of catarrh and ozæna ;
ronic pharyngitis, disease of the tonsils, pillars of the fau-
, vellum and uvula, and in chronic laryngitis. The indi-
tions for its employment are, thickening of mucous mem-
anes, with enfeebled circulation, and increased secretion,
ither mucous or muco-purulent.
It is especially a valuable remedy in the treatment of hem-
orrhoids, sometimes effecting a cure in old and very stubborn
cases without the use of other remedies. Usually, however,
I use the solution of the persulphate of iron as a local appli-
cation.
It is also a very useful remedy in the treatment of diseases
of the uterus and vagina. Given, a case with the conditions
named, thickening, with relaxation, enfeebled circulation,
and increased mucous, or muco purulent secretion, and its
action is very positive.
We employ it also in the treatment of various lesions of the
lower extremities, both as a local application and an internal
remedy, and many times with excellent results.
It is an excellent dressing for erysipelas, and for burns,
giving that slight stimulation that seems to be required in
these cases.
I need not name other cases, as the indications for its use
first given, will suggest its application. I value the remedy

152
SPECIFIC MEDICINES.
very highly, and feel confident that a trial in the cases named
will bring it into general use.
HEDEOMA PULEGIOIDES.
(PENNYROYAL.)
This is a much neglected article, probably because it is so
common. I regard it as one of the most valuable stimulant
diaphoretics; very kindly received by the stomach, and quite
certain in its action. As a remedy for colds it will prove
very useful. To two ounces of the tincture add gtt. x. of
tincture of veratrum, or 3ss. of tincture of ipecac, and give
it in teaspoonful doses every one or two hours.
It is an admirable remedy for amenorrhoea from cold; the
safest and most certain we have, I think. It may be given
in doses of a teaspoonful every hour or two hours, or two
three times in the evening, with the hot foot bath.
Prepare your own tincture in this way: In July, gather
sufficient quantity of the herb, stem it, and at once pack th
leaves in a percolator. Then add dilute alcohol, or even com
mon whisky, in the proportion of Oj. to each 3 viij. Let it
stand twenty-four hours, and then draw off, putting on water
until the tincture measures Oj. to each 3viij.

HEUCHERA AMERICANA.
(ALUM ROOT.)
This agent has been used in domestic practice in the treat-
ment of sore throat, diarrhoea, dysentery, leucorrhoea, and
for the general purposes of an astringent. It may have other
properties, and it would be well to give it a thorough inves-
tigation.
HELLEBORUS NIGER.
(BLACK HELLEBORE.)
Prepare a tincture from the root, using alcohol of 98 per
cent. Of a preparation of gtt. v. to water 3iv. the dose may
be a teaspoonful every two or three hours.
It may be employed as a stimulant to the menstrual flow,
when the patient complains of flashes of heat, burning of the
HEPATICA.
153
surface, especially of nates and thighs, and sensitiveness of
the perineal and pelvic structures. It may also be thought
of in the treatment of hypochondria and hysteria.
HIERACIUM VENOSUM.
(RATTLESNAKE WEED.)
Prepare a tincture from the recent plant, using alcohol of
98 per cent. It may be administered in the usual way—gtt.
v. to x. in water 3iv.; dose, one teaspoonful.
It has had a reputation as an antidote to the bite of poison-
ons snakes, and probably possesses some power in this direc-
tion. It has also been named as a remedy in chronic catar-
rhal disease and in scrofula.
HELONIAS DIOICA.
(UNICORN ROOT.)
True Helonias undoubtedly exerts a marked influence up-
on the reproductive organs of the female, but as it is so fre-
quently supplied from the Aletris, but little dependence can
be placed upon it.
It exerts the general influence of a tonic, and a special
tonic action upon the urinary and uterine organs. It is pos-
sible that if we can obtain a reliable preparation, it will be
found superior to other remedies for these purposes. One of
the special indications for its use is in the mental depression
and irritability that attends many of these affections. I am
of the impression that, in many cases, the relief of this cere-
bral disturbance is its most important action.
HEPATICA AMERICANA.
(LIVERLEAF.)
Prepare a tincture from the fresh leaves, using proof spirit.
Dose, gtt. j. to 3ss.
The Hepatica exerts a slightly stimulant and tonic influ-
ence upon the stomach and small intestines, relieving irrita-
tion and promoting functional activity. Thus it may be em-
154
SPECIFIC MEDICINES.
ployed in atonic conditions of these and associate viscera
with advantage. Culpepper wrote, "It is a singularly good
herb for all diseases of the liver, both to cool and cleanse it,
and is serviceable in yellow jaundice. It is a singular remedy
to stay the spreading of tetters, ring-worms, and other fret
ting and running sores."
It exerts an influence upon all mucous surfaces. Probably
its best action is upon the bronchial mucous membrane,when
enfeebled from inflammation or irritation, attended with pro-
fuse secretion. In these cases it may sometimes be given
with great benefit.
HERACLEUM LANATUM.
(MASTERWORT.)
This remedy has been but little used, but it might repay
careful study. It has been employed as an antispasmodic,
and we would judge that it was a spinal stimulant. For ex-
periment a tincture should be prepared from the green root.
The Wild Parsnip (Pastinaca Sativa) might also be tested.
In poisonous doses it produces great excitation of the ner-
vous system, semetimes with convulsions, followed by coma
and difficult respiration. This would suggest its use as a
cerebro-spinal stimulant. Of course it would be used in
small doses.
HYDRASTIS CANADENSIS.
(GOLDEN SEAL.)
I will give the Hydrastis a brief notice, as it is in such
general use for all the purposes of a tonic, that my readers
kuow as much about it as I do. It improves the appetite
and facilitates digestion; but beyond this it relieves, gastro-
intestinal irritation.
Its topical action, however applied, is that of a tonic,
strengthening the circulation and nutrition. It is in com-
mon use for these purposes, in diseases of the skin, diseases
of the eyes, and diseases of the mucous surfaces.
As a stomachic and tonic, I like the action of the finely
HYDRANGEA.
155
powdered root, as well as the more costly preparations.
Indeed, in most cases, I would prefer this, in equal quantity,
to the Hydrastine.
A tincture made with alcohol of 50 per cent. will be found
a good preparation. It is more convenient for carrying, and
added to water, gives a pleasant stomachic. A very good
prescription would be: R Tincture of Hydrastis, 3ij.; tinct.
of Nux vomica, gtt. xx.; water, 3iv. A teaspoonful every
three or four hours.
The Sulphate of Hydrastia is (when properly made) solu-
ble in water in the proportion of two grains to the ounce; the
Phosphate four grains, and the alkaloid, Berberina, as much
as twenty grains to the ounce of water. They make a valua-
ble collyrium in chronic conjunctivitis. or the latter stages of
the acute. They are also admirable injections in the second
stages of gonorrhoea, and in gleet.
HYDRANGEA ARBORESCENS.
(SEVEN BARKS.)
Preparation.-Prepare a tincture from the fresh or recently
dried root, Zviij. to the Oj., using alcohol of 76 per cent.
Dose, gtt. x. to 3ss.
This is a valuable remedy in diseases of the urinary appa-
ratus. It gives tone to the kidneys, improving their func-
tional activity, and thus tends to arrest the formation of uri-
nary deposits and calculi. We do not believe, as Dr. J. W.
Butler stated, that it will cure stone in the bladder, though
it may prove prophylactic. It relieves irritation of the blad-
der and urethra, and hence proves serviceable in cases of
gravel. It also exerts an influence upon the respiratory mu-
cous track, relieving bronchial irritation.
HYDROCOTYLE ASIATICA.
(WATER PENNYWORT.)
A tincture is prepared from the plant (Asiatic, though
the American species, Ranunculoides and Americana, proba-
bly possess the same properties), with alcohol of 98 per cent.
156
SPECIFIC MEDICINES.
The dose will be small, from the fraction of a drop to three
drops.
It may be employed in chronic skin diseases, and in syph-
ilis with disease of the skin.
HYDROCYANIC ACID.
We employ the dilute hydrocyanic acid of the Pharmaco-
poeia of which five drops may be added to water 3iv. and
given in doses of one teaspoonful.
It is employed to relieve irritation of the stomach, and
check vomiting from this cause, in gastralgia, excited action
of the heart from gastric irritation, and to check gastric
coughs.
HYPERICUM PERFOLIATUM.
(ST. JOHN'S WORT.)
Preparation. We prepare a tincture from the fresh herb,
3viij. to Oj., with alcohol of 76 per cent. The dose is small:
of gtt. x. to gtt. xxx. to water ziv., a teaspoonful every one or
two hours.
According to our Homeopathic friends, the special symptom
indicating its use is, “sensation in the forehead as if touched
by an ice-cold hand, in the afternoon, after which a spas-
modic contraction in right eye." We would be glad to have
the remedy thoroughly tested in diseases of the urinary appa-
ratus, and in nervous affections with depression. Will some
of our readers try it and report.
HYOSCYAMUS NIGER.
(HENBANE.)
Preparation. We prepare a tincture from the recent dried
leaves in the proportion of 3viij. to alcohol 76 per cent. Oj.
Dose, from gtt. ss. to gtt. v.
In medicinal doses the Hyoscyamus is a stimulant to the
cerebro-spinal centers, and may be employed whenever such
action is desirable. It is from this that it has its sleep-pro-
IGNATIA.
157
ducing properties, as well as the relief of pain. With some
persons the tolerance of Hyoscyamus is very great, and even
drachm doses exert this stimulant influence.
It exerts a similar influence upon the vegetative system, in
a slight degree favoring every process that is performed un-
der its influence. It is not only stimulant, but it allays irri-
tation. Thus, in some cases, where a frequent pulse is de-
pendent upon irritation and debility of the cardiac nerves,
it exerts the influence of the special sedatives. It never
arrests secretion, but, as before remarked, it favors it. Thus
small doses of Podophyllin, combined with Hyoscyamus, is
not only less irritant, but more effectual. So we find in irri-
table states of the digestive apparatus, the addition of a small
portion of Hyoscyamus to the bitter tonics improves their
action.
Because Hyoscyamus is poisonous, it is no reason why it
should be an active remedy. Poisoning and curing are two
different things. Whilst it will be found a valuable curative
agent, and quite direct in its action, its influence is rather
feeble than otherwise, and too much must not be expected
from it. The difference between a poison and a medicine, in
this case, is a matter of dose alone, and in this respect it
differs from some other medicines.
IGNATIA.
(ST. IGNATIUS' BEAN.)
A tincture is prepared from the ground seed, with alcohol
of 98 per cent., macerating for a time with gentle heat. I
add gtt. v. to water 3iv., of which the dose will be one tea-
spoonful.
The indications for it are, dragging pains in right hypo-
chondrium, with gastrodynia, deep seated pain in the loins,
uterine colic, dysmenorrhoea with colic, atony of reproduc-
tive organs, wandering pains in pelvis. Our Homoeopathic
friends say that Ignatia is a remedy for women, Nux or
Strychnia for men.
158
SPECIFIC MEDICINES.
IMPERATORIA OSTRUTHIUM.
(MASTERWORT.)
A tincture is prepared from the root, using alcohol of 9
per cent. In the usual proportion of gtt. x. to water iv. it
may be given in doses of a teaspoonful.
It has been used as a stimulant in typhoid fever, in deliri-
um, delirium tremens, in ague, colic, hysteria, and asthma.
INULA HELENIUM.
(ELECAMPANE.)
Preparation.-Prepare a tincture from the fresh root, in
the proportion of 3 viij. to alcohol 76 per cent. Oj.
Elecampane is a feeble stimulant and tonic, but may some-
times be used for these properties with advantage. It not
only exerts this influence upon the digestive track, but also
the skin, and is sometimes beneficial in chronic cutane-
ous diseases.
upon
Its principal use, however, is in bronchial disease, with
increased secretion. It may be used also in combination
with Stillingia. Its action is slow, and it needs to be con-
tinued for some time to experience its benefits.
IODINE.
Iodine, in all its forms, increases retrograde metamorpho-
sis, and, in some degree, stimulates excretion. We have no
reason to believe that it stimulates blood-making or nutri-
tion, other than as it facilitates the removal of worn-out
tissues.
In quite small doses Iodine stimulates the sexual organs.
and increases their power. For this purpose we may use it
in the proportion of: R Tincture of Iodine gtt. xx., simple
syrup 3iv.; a teaspoonful four times a day.
Iodide of Potassium is doubtless its most active form as a
resolvent and a stimulant of waste. There is great difference
of opinion with regard to the proper dose; some think it best
in doses of one to five grains; others in doses of grs. xx. to
IODINE.
159
xl. three or four times a day. Of course our choice of dose
will depend upon the strength of the patient, the character
of the disease, and the rapidity of action desired.
The indication for this salt is, a broad, pallid, leaden-
colored tongue, rather full. With this indication it is a very
certain antisyphilitic, whilst with a red and contracted
tongue, it is pretty sure to do the patient injury.
The Iodide of Sodium has been but little used, and is ob
tained with difficulty in the market, I believe that it is a
better preparation than Iodide of Potassium, especially where
there is asthenia and a feeble circulation. The Iodide of So-
dium may be employed with especial advantage in those cases
that present a pallid tongue and mucous membranes.
The Iodide of Ammonium should be selected when stimu
lation of the nervous system is desirable. Like the others,
it increases waste, but it also improves nutrition, and does
not impair digestion. In secondary syphilis of an asthenic
type, with nervous symptoms, this salt will be found an im-
portant remedy.
I would call especial attention to its action in certain forms
of chronic headache, depending upon an enfeebled circula-
tion and mal-nutrition. In some of these cases it gives
prompt relief, and effects a permanent cure.
We prepare an Iodide of Ammonium for local use as fol-
lows: R Tincture of Iodine (strong) aqua ammonia (strong),
aa., put in a bottle and allow it to stand until colorless. Its
influence is much better than the tincture of Iodine alone ;
it is less irritant and does not discolor the skin. It is a
favorite preparation with me in the treatment of boils, local
inflammations, buboes, etc., in the early stage, when we may
expect resolution.
+
Iodide of Starch is an excellent preparation, affording the
best means of giving Iodine without gastric irritation. It
may be readily prepared in the office as follows: Triturate
twenty-four grains of Iodine with a little water in a mortar,
adding gradually an ounce of finely powdered starch, contin-
uing the trituration until it assumes a uniform blue color,
160
SPECIFIC MEDICINES.
It is then dried with gentle heat, and kept in a well stopped
bottle. The dose will vary from five grains to a teaspoonful,
given in gruel.
IPECACUANHA.
(IPECAC.)
Preparation.-Prepare a tincture from the root (a good ar-
ticle) viij. to alcohol 98 per cent. Oj. Dose from the fraction
of a drop to gtt. v.
Ipecacuanha exerts a specific influence upon mucous mem-
branes, relieving irritation, and arresting the inflammatory
process. It also stimulates a better circulation and innerva-
tion, increases nutrition, and thus favors functional activity.
We employ it as a specific in most cases of cholera infan-
tum. It allays irritation of the stomach, gradually checks
the frequency of the discharges from the bowels, and restores
tone and functional activity. In a large experience in the
treatment of this disease, we have found nothing to equal it.
It is usually prescribed in the following proportions: R
Tincture of Ipecac, gtt. v. to gtt. x.; water iv. A teaspoon-
ful every hour. Aconite is frequently prescribed with it in
this case.
We employ it with very marked advantage in the treat-
ment of infantile pneumonia, associated with aconite and
veratrum. In some cases, the prescription of Ipecac alone
will be sufficient to arrest the disease in two or three days,
especially if given in the first stages. It is also employed
with excellent results in diseases of the respiratory appara-
tus of the adult.
We prescribe it in all cases of muco-enteritis. If there is
little constitutional disturbance, Ipecac is used alone; if
there is some hardness and increased frequency of the pulse,
it is given in combination with Aconite.
We employ it in dysentery, especially in the sporadic form
from cold. The simple prescription of Ipecac is frequently
successful, but with much febrile action it is associated with
a sedative.
IRIS.
161
In small doses we employ it as a stimulant to the entire
digestive tract, associating it with the bitter tonics, or the
restoratives. For this purpose, it will prove very valuable,
especially where there is some gastro-intestinal irritation.
IPOMEA JALAPA.
(JALAP.)
So far as I know, this remedy has only been employed as a
cathartic. It would be well to test it in doses so small that
no catharatic action would follow; some desirable property
might be developed.
IRIS VERSICOLOR.
(BLUE FLAG.)
We find the Iris described in our Dispensatory as "among
the most valuable of our medicinal plants," "termed the mer-
cury of Eclectic practice," and yet I am safe in saying that
there has not been a good article in the market for a dozen
years. The dried root of the drug trade possesses no more
medicinal property than sawdust, and preparations from it,
whether in the form of fluid extract or Irisin, are an impo-
sition.
We would prepare a tincture from the fresh root, using
alcohol of 98 per cent. There are two varieties of it, and
that should be selected which presents a bluish mottled color
on incision.
When prepared as above, the Iris is one of our best reme-
dies. It is directly stimulant to waste and excretion, and
also influences the lymphatic system. It may, therefore, be
employed in all diseases in which there is bad blood, and im-
perfect nutrition. I regard it as one of our most certain
remedies in the treatment of secondary syphilis.
It exerts a specific influence in cases of enlargement of the
thyroid gland, and has effected cures in very severe cases.
Here, as in other cases, we employ it uncombined, giving it
internally, and using it as a local application. The dose of
the tincture of Iris will vary from the fraction of a drop to
ten drops.
14
162
SPECIFIC MEDICINES.
JABORANDI.
The leaves of the Pilocarpus pennatifolius (Brazil) are made
into a tincture in the usual way, with alcohol of 98 per cent.
The dose will vary from the fraction of a drop to one drachm,
according to the action required.
It is one of the most active diaphoretics known; a drachm
and a half of the powdered leaves in infusion, or a drachm
of the tincture, in six ounces of hot water, taken in three or
four doses inside of an hour, will produce profuse diapho-
resis. It has been given in puerperal convulsions, threatened
puerperal fever, to arrest the paroxysm of an intermittent,
at the commencement of a bilious fever, in the early stages
of rheumatism, and in dropsy.
The alkaloid, Pilocarpin, may be used by hypodermic in-
jcction, in doses of one-sixth to one-fiftieth of a grain, and pro-
duces the same effects as the drug given by mouth.
JUGLANS CINEREA.
(BUTTERNUT.)
Preparation.-Prepare a tincture from the fresh inner
bark, in the proportion of 3 viij. to alcohol 76 per cent. Oj.
Dose, from the fraction of a drop to five drops.
In minute doses, the Juglans exerts a marked influence
upon the skin, and may be employed in either acute or
chronic skin disease. Its influence in this direction requires
study.
It also allays irritation of mucous membranes, and pro-
motes their normal function. In some cases of intestinal
dyspepsia, it will be found to give much better results than
the bitter tonics.
A valuable laxative may be formed by making a watery ex-
tract of the Juglans, adding some aromatic to render it
pleasant. I have a distinct recollection of the use of Butter-
nut extract in the olden time to cure ague. It was given in
large doses, and the catharsis would last for days, its influ-
ence being so constant and powerful that the patient would
KALMIA.
163
not have inclination or time to shake. In small doses, it
leaves the bowels in a soluble condition, and is one of the
few cathartics that may be employed to overcome obstinate
constipation.
JEFFERSONIA DIPHYLLA.
(TWINLEAF.)
Preparation. Prepare a tincture from the recent root,
3viij. to alcohol of 76 per cent. Oj. Dose, from gtt. j. to
gtt. xx.
The Jeffersonia is a stimulant to mucous membranes,
increasing their circulation, and checking profuse secretion.
It may be employed in any case where these influences are
desirable, and will give satisfaction. It exerts a feebly stim-
lant influence upon the skin, sufficient, however, to make it
useful in chronic skin diseases. It is also claimed to be
diuretic and anti-rheumatic. The remedy requires study,
and may develop valuable properties.
JUNIPERUS SABINA.
(SAVIN.)
Preparation.-Prepare a tincture from the Savin, in the
proportion of 3viij. to alcohol 76 per cent. Oj. Dose, from
gtt. j. to gtt. v.
Thus prepared, the Savin is a stimulant. It may be em-
ployed in menorrhagia, and in atonic leucorrhoea, with advan-
tage. It may also be used as a stimulant in vesical catarrh,
and in diseases of the urethra. In some cases of amenor-
rhoea it may be employed as a stimulant, but never in those
cases presenting excitement of the circulation.
KALMIA LATIFOLIA.
(SHEEP LAUREL.)
Preparation. Prepare a tincture from the recent leaves,
in the proportion of 3 viij. to alcohol 76 per cent. Oj. Dose,
from gtt. j. to gtt. v.
164
SPECIFIC MEDICINES.
This is a favorite remedy of Prof. King, and he describes
its use as follows: "It is an efficient remedy in primary or
secondary syphilis, and will likewise be found invaluable in
febrile and inflammatory diseases, and hypertrophy of the
heart, allaying all febrile and inflammatory action, and les-
sening the action of the heart. In active hemorrhages,
diarrhoea, and dysentery, it has been employed with excellent
effect. I have extensively used this agent, and regard it as
one of the most efficient agents in syphilis; and have, like-
wise, found it very valuable in inflammatory fevers, jaundice,
and ophthalmia, neuralgia and inflammation.”
I have employed it in secondary syphilis and atonic chronic
inflammations with marked advantage, but have not used it
for other purposes. Will some of our readers test it in the
treatment of fever and inflammation to determine its analogy
to the sedatives?
KRAMERIA TRIANDRA.
(RHATANY.)
In the large dose Rhatany has been used for the ordinary
purposes of an astringent, and is quite as good as many of
the new remedies which depend for their effect upon tannic
acid. In small dose it may be employed in gastric catarrh,
dyspepsia with full, relaxed skin, incontinence of urine, gleet,
prostatorrhoea, leucorrhoea, and in some cases of catarrh.
A tincture may be prepared in the usual way with alcohol
of 98 per cent. Of this gtt. x. to gtt. xx. may be added to
water 3iv., and given in doses of a teaspoonful.
LABURNUM.
A tincture is prepared from the recent bark, using alcohol
of 98 per cent. It may be dispensed in the usual way, gtt. x.
to water 3iv., a teaspoonful every one to three hours.
The Laburnum relieves irritation of the mucous surfaces,
and for this purpose it may be administered in nervous dys-
pepsia, the restlessness and uneasiness that follow overwork
LACTUCA.
165
(mental), and the excitation of gastric and hepatic nerves,
which causes frequent attacks of vomiting from slight exci-
tation.
LAC.
(MILK.)
Milk is a favorite article of diet in acute disease, where
the patient maintains a high temperature, and burns his
tissues to do it. It is usually given hot, with a small portion
of salt added, because hot milk is more readily digested. In
some cases of dyspepsia, especially where there is much gas-
tric irritation, restlessness, uneasiness, sleeplessness, an en-
tire milk diet is sometimes of very great advantage. In some
cases skimmed milk is used, because the patient can not
digest the fat of cream.
In Europe, especially in Switzerland and some parts of
Germany, they have "milk-cures," which are largely patron-
ized, and have excellent success. They are usually in the
Highlands, and people go up the mountain side to take their
pint of milk, thus having air and exercise as a part of the
cure. But in other cases the goats or cows are driven to the
door, and milked for the patient. It is always taken fresh
and warm from the cows or goats.
Serum lactis-whey—is an excellent diet drink in acute dis-
eases, fevers and inflammations. If the tongue is pallid, it is
sweet whey made from fresh cow's milk by the addition of
If the tongue is red, it is acid whey, made by adding
bitartrate of potash or citric acid to boiling milk.
rennet.
LACTUCA VIROSA.
(LETTUCE.)
We prepare a tincture from Lactucarium, Ziv. to alcohol 98
per cent. Oj. Of this the dose will vary from the fraction of
a drop to ten drops; add gtt. x. to gtt. xx. to water iv., and
give a teaspoonful every hour.
It may be given with the special sedatives to give rest to
the nerve centers, and it will sometimes produce sleep in the
small dose, when the large will do no good.
166
SPECIFIC MEDICINES,
LAPPA OFFICINALIS.
(BURDOCK.)
Prepare a tincture from the seed, using alcohol of 98 per
cent. The dose will vary from the fraction of a drop to ten
drops.
It acts directly and very kindly upon the urinary apparatus,
increasing secretion, and removing irritation. Its action in
this respect is especially beneficial in chronic disease, where
old tissue is to be renewed, and the saline diuretics can not
be used. It may also be employed to relieve bronchial irri-
tation and check cough, there being the general indications
for the class of remedies known as alterative.
LARIX AMERICANA.
The American Larch deserves study, not in combination,
as it has been employed, but singly, to determine its real
medicinal value. For this purpose a tincture may be pre-
pared from the recent bark, in the proportion of 3 viij. to
alcohol 76 per cent. Oj. It has been employed in combina-
tion for a large number of diseases, but its influence upon
mucous membranes and upon the skin, is probably most
definite.
LAURUS SASSAFRAS.
(SASSAFRAS.)
A very good preparation of the Sassafras for office use, is a
tincture of the bark of the root by percolation, using dilute
alcohol. It forms a pleasant vehicle for many remedies, when
we desire a gently stimulant and astringent action. Tinc-
ture of podophyllum added to it, in the proportion of zij. to
iv., in teaspoonful doses four times a day, forms an admira-
ble alterative.
In the treatment of secondary syphilis, especially where
manifesting itself in disease of the skin, the infusion will be
found preferable. In this case I would direct an infusion of
Sassafras with a small portion of Podophyllum, 3ss. of the
LEPTANDRA.
167
first, grs. x. of the second, to the pint of water, three times
a day. It may be associated with the vapor bath, spirit-va-
por bath, or sulphur bath in stubborn cases.
LAVANDULA VERA.
(LAVENDER.)
Lavender is the child's stimulant, and nothing, so far as I
am aware, exercises so kindly an influence upon the digestive
apparatus and the nervous system. A tincture may be formed
of Oil of Lavender, 3ij.; dilute alcohol, Oj. But the Com-
pound Spirit will probably answer the needs of most physi-
cians. I would like to test a tincture of the fresh herb, and
if any of our readers are so located as to grow it, and prepare
such tincture, we will be obliged if they will report.
LEDUM LATIFOLIUM.
(LABRADOR TEA.)
A tincture may be prepared from the fresh leaves, using
alcohol of 98 per cent. The dose will vary from the fraction
of a drop to ten drops.
In minute doses it relieves difficult respiration, checks
cough, and aids expectoration. It also increases secretion of
urine, and sometimes relieves pruritus.
LEPTANDRA VIRGINICA.
(BLACK ROOT.)
For general use prepare a tincture of the Leptandra, 3 viij.
to Oj, using alcohol of 76 per cent. For some purposes the
infusion would be preferable, but is so nauseous that most
persons object to it. The dose of the tincture as above will
vary from gtt. ij. to gtt. xx.
The Leptandra exerts a gentle stimulant influence upon
the entire intestinal tract, and its associate viscera, and in
medicinal doses strengthens functional activity. Its action
in this direction is so persistent that it might be called a
gastro-intestinal tonic. There are some functions not well
168
SPECIFIC MEDICINES.
understood, as of the liver and spleen, and it would not much
improve our knowledge to say that it acted upon these. But
it exerts a marked influence in those diseases in which there
is enfeebled portal circulation, and tendency to stasis of
blood. Thus in some cases of typhoid fever occurring in
malarial localities the Leptandra has proven a very valuable
medicine.
We do not believe there is any remedy that acts upon the
liver, according to the old idea of medicine. It has been
conclusively proven that preparations of mercury do not, and
that podophyllin does not; and it is probable that we will
have to give up the idea of cholagogues entirely. There is
no doubt in my mind, however, that Leptandra does influence
the function of the liver; not always to increase secretion of
bile, but rather to bring the organ back to normal functional
activity, whatever may have been the deviation.
Associated with the milder bitter tonics, the Leptandra
improves the digestive function, and stimulates normal excre-
tory action from the bowels. This latter influence some-
times makes it a valuable adjunct to those remedies called
alterative.
It has been employed in the treatment of intermittent
fever with excellent results. Dr. Rolph writes that "for
many years my father's family employed it exclusively, and
though living in a malarial region, they were entirely exempt
from ague. They used a tincture of the recent root, taking
it before each meal." Quite a number of my acquaintances
´employ it after the chill has been broken with quinine, and
claim that its influence in preventing a recurrence is more
decided than that of any other remedy.
LEPTANDRIN.
The best Leptandrin of the market is a dried alcoholic
extract; the strongest is obtained by adding a portion of Podo-
phyllum before tincturing. The resin is nearly worthless.
The dried extract proves a very good remedy in many cases,
and may be used for the same purposes as named for the
tincture or infusion.
LIRIODENDRON.
169
LIATRIS SPICATA.
(BUTTON SNAKEROOT.)
Preparation.-Prepare a tincture from the recent root,
3 viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to x.
The Liatris is gently tonic, and stimulates secretion from
all the emunctories. Hence it has been added to various
alterative combinations, and by some practitioners is very
highly esteemed. It acts more directly upon the urinary
apparatus, and probably upon the reproductive apparatus of
both male and female.
LIQUIDAMBAR STYRACIFLUA.
(SWEET GUM.)
Some years since we had sweet gum, the exudation from
this tree, recommended for the cure of asthma, and a num-
ber of cases from the South were given as proof. But exper-
iments in the Northern States were not favorable. I judge,
however, from some reports of Southern physicians, that the
recent bark contains valuable medicinal properties, as does
the fresh exudation. For experiment I would suggest the
preparation of a tincture from the fresh bark, using alcohol
of 76 per cent. Its influence is probably most marked on
mucous membranes, and probably it influences innervation
from the pneumogastric and from the spinal cord.
LIRIODENDRON TULIPIFERA.
(YELLOW POPLAR.)
Preparation.-Prepare a tincture from the fresh root bark
of the Yellow Poplar, using dilute alcohol. Dose, from gtt. j.
to gtt. x.
The great abundance and wide distribution of these trees.
the ease with which it may be obtained and prepared, and
the really valuable character of the remedy, should bring it
into general use. It is stimulant and tonic to the digestive
apparatus, improving digestion and blood-making. It also
exerts an influence upon the nervous system, strengthening
innervation and relieving those symptoms called nervous.
1-
170
SPECIFIC MEDICINES.
LOBELIA INFLATA.
(LOBELIA)
Preparation.-Prepare a tincture from the ground seed,
3 viij. to alcohol 98 per cent, Oj. Dose, from the fraction of a
drop to ten drops.
The common use of Lobelia as an emetic is so well known
that little need be said about it. In the form of the Com-
pound Powder of Lobelia, or the Acetous Emetic Tincture
of the Dispensatory, it gives us our most valued emetic when
properly used, To obtain the curative effects of a Lobelia
emetic, the remedy should be given in small quantities fre-
quently repeated, as it can be absorbed from the stomach, so
that emesis, when it does occur, shall be from the general in-
fluence of the remedy in the blood, and not from its local
irritant influence upon the stomach. Many physicians fail
⚫ to obtain the benefit they have reason to expect because of
its improper administration; it is not absorbed, but simply
irritates the stomach.
Lobelia as prepared above is one of the most powerful vital
stimulants in the materia medica. It strengthens the circu-
lation, improves innervation, and by its influence upon the
sympathetic nervous system gives increased activity of all
the vegetative functions. These influences come from minute
doses, one drop or less. I usually prescribe it in this pro-
portion: R Tinct. Lobelia gtt. x. to xx., water 3iv.; a tea-
spoonful every one or two hours.
In some cases where there is necessity for a speedy action,
as in cases of angina pectoris or neuralgia of the heart, I
give one or two full doses of twenty drops.
This preparation of Lobelia is specific in difficult labor
from rigid os, vagina, or perineum. It also stimulates the
contractile function of the uterus, and thus strengthens the
pains. This use of Lobelia will be greatly prized when
known. In tardy or difficult labor add 3j. of the tincture to
3iv. of water, and give a teaspoonful every fifteen minutes
until slight nausea is produced, then in smaller quantities.
In rigid os or perineum, I frequently employ it in the same
LYCOPUS.
171
way, and with excellent results, but in other cases give it in
larger doses until nausea is induced.
Lobelia is a sedative, occupying a place between veratrum
and aconite. I would be glad if each reader would put the
tincture of the seed in his pocket case and employ it in fevers
and inflammations in the same doses in which he uses vera-
trum I think it will prove very valuable, especially where
there is necessity for stimulation.
LYCOPUS VIRGINICUS.
(BUGLE WEED.)
Preparation.-Prepare a tincture from the fresh plant
gathered in July and August at the time of flowering, using
3 viij. to alcohol 76 per cent. Oj.
The tincture of Lycopus prepared as above, will be found
a very valuable remedy, and will take place with veratrum
and aconite. It is a very certain sedative, where increased
frequency of pulse is dependent upon want of power. For
this purpose we employ it in all forms of chronic disease with
frequent pulse, and in the advanced stages of acute disease
where there is great debility. No remedy is more certain in
its action in these cases; and we will find that as the pulse
is reduced in frequency, it is increased in strength, and there
is a more regular and uniform circulation of blood.
The remedy evidently acts upon the sympathetic system of
nerves, and we not only have an improvement in the circula-
tion, but every vegetative function feels its influence. Thus
it improves the appetite and blood-making, nutrition and
secretion.
It has been employed more extensively in the treatment of
hemoptysis than in any other disease. In these cases its
action is slow, but very certain, and its influence seems to
come from its sedative action-in this it resembles digitalis.
Employed in phthisis, we find it relieving the cough, check-
ing night sweats and diarrhoea, lessening the frequency of
the pulse, improving the appetite and giving better digestion.
We observe the same influence from the protracted use of
172
SPECIFIC MEDICINES.
veratrum in these cases, evidencing the relationship between
the remedies.
Those who live where the Bugle weed can be gathered,
should not neglect the opportunity of procuring the fresh
plant and preparing a tincture for the coming year. I am
satisfied that it will well repay the trouble.
LIGUSTRUM VULGARE.
(PRIVET.)
The old use of an infusion of Privet for sore mouths and
sore throat will be remembered, and will suggest its further
use in irritation of mucous membranes elsewhere. A friend
of mine has employed a tincture of the fresh leaves with ad-
vantage, and thinks it might take the place of more expen-
sive medicines.
LEONURUS CARDIACA.
(MOTHERWORT.)
Prepare a tincture from the fresh root, with dilute alcohol
in the usual proportions. The line of experiment will be to
determine its influence upon the reproductive organs, and
upon the nervous system. The dose may vary from five to
twenty drops.
LIMONIS SUCCUS.
(LEMON JUICE.)
Lemon juice, or lemonade, is used in fevers and inflamma-
tions, with much advantage, if the patient's tongue is bright.
'red and elongated. The simple desire for an acid drink is
sometimes a sufficient indication.
It is a specific in certain cases of rheumatism-with the
indications above named-and will cure when other remedies
fail. No stronger proof of the doctrine of specific medica-
tion could be wanted than the fact, that of two cases of rheu-
matism seemingly alike, one will be cured with soda, the
LUPULIN.
173
other with lemon juice. But if we examine these cases we
will find that one has a pallid tongue, the other a red tongue.
Lemon juice may also be used in the treatment of enlarged
tonsils and uvula; one or two applications a day being made
with a camel's hair pencil.
LINARIA VULGARIS.
(BUTTER AND EGGS.)
In Germany an ointment is made by digesting two parts of
the plant with one part of alcohol, and then with ten parts of
lard until the alcohol has evaporated. Or the fresh plant is
bruised and covered with ten parts of hot lard or mutton
tallow. It forms an excellent soothing ointment, and has
been extensively used for hemorrhoids.
A tincture is prepared from the fresh plant, with alcohol
of 98 per cent; of this, gtt. x. to water iv. may be given in
doses of one teaspoonful.
It may be used in scrofula, enlargement of spleen and
liver, jaundice, disease of skin, and "bad blood."
LUPULINA.
(LUPULIN.)
The yellow powder separated from the strobiles of the hop,
may be administered in doses of from one to five grains to
relieve irritation of the nerve centers, to give rest, and pro-
cure sleep. In some cases where the irritation is due to sex-
ual excitement or abuse, Lupulin exerts a very good in-
fluence.
A tincture of the hop, may be occasionally employed in
dyspepsia, with restlessness and a disposition to brood over
troubles. It may also be used, following a meal, when the
food undergoes fermentation, giving rise to unpleasant eruc-
tations.
174
SPECIFIC MEDICINES.
•
LYCOPODIUM CLAVATUM.
(CLUB-MOSS.)
A tincture is prepared from the fresh plant, before it casts
its sporules, in the usual way, with alcohol of 98 per cent.
The Lycopodium (sporules) is triturated dry in a porcelain
mortar until it becomes a doughy mass, then placed in a per-
colator and covered with alcohol and allowed to macerate for
four days, when it may be drawn off in the usual way. Of
either of these gtt. x. may be added to water 3iv. and given
in doses of one teaspoonful.
The tincture of the plant may be given in chronic disease
of the kidneys, when there is blood in the urine; in cases of
cough with bloody expectoration, congestive headache, dizzi-
ness and tendency to syncope.
The tincture of the sporules may be given when there is
extreme sensitiveness of the surface; sensitiveness of a part,
and care to prevent its being touched; slow, painful boils,
nodes or swellings; extreme sensitiveness of the organs of
special sense, with pale, livid or dirty complexion.
MACROTYS RACEMOSA.
CIMICIFUGA RACEMOSA.
(BLACK COHOSH.)
Prepare a tincture from the fresh root gathered in Sep-
tember, using 3viij. to alcohol 76 per cent. Oj. Dose, from
the fraction of a drop to ten drops.
For years I have employed Macrotys as a specific in rheu-
matism, and with excellent success. Not that it cures every
case, for it does not; neither would we expect this, for this
would be prescribing a remedy for a name. Rheumatism
may consist of varied pathological conditions, though in all
there is the special lesion of the nervous system, which char-
acterizes the disease. In one case we find the indications
for the use of an acid prominent, and this becomes a remedy
for rheumatism. In another there are symptoms showing
the need of alkalies, and they prove curative.
MACROTYS.
175
Macrotys influences the nervous system directly, relieves
rheumatic pain, when not the result of inflammation, and
probably corrects the diseased condition (formation of lac-
tic acid?) which gives origin to the local inflammatory pro-
cess. Thus in the milder cases, where the disease has not
localized itself as an inflammation, Macrotys is very speedy
and certain in action. In rheumatic fever it is also positive
in its action, and with the special sedatives gives excellent
results. Where rheumatism has localized itself in an inflam-
matory process, all the benefit we obtain from it is, that we
remove the cause, and hence the reason for a long continu-
ance of the inflammation.
It is a remedy for all pain having a rheumatic character,
and for this we prescribe it with the best results. Those
cases which go under the name of rheumatic-neuralgia, are
very speedily relieved by it. In some cases the pains of weeks'
duration disappear in a single day. Whilst the continuance
of the remedy will not unfrequently effect a cure in these
cases, in many it will require the additional means necessary
to give healthy functional activity to some organ or part es-
pecially impaired.
The Macrotys influences directly the reproductive organs.
This influence seems to be wholly upon the nervous system,
relieving irritation, irregular innervation, and strengthening
normal functional activity. For this purpose it is unsur-
passed by any agent of our materia medica, and is very largely
used.
Its influence is very marked in functional disease of the
reproductive organs of women. Associated with pulsatilla
it is specific in many cases of dysmenorrhoea; it should be
given for three or four days before the expected period, and
continued until the flow is free. In amenorrhoea it is also
one of our most efficient agents. In rheumatism of the uterus,
to relieve false pains, or the many unpleasant sensations
attending pregnancy, it has no equal in the materia medica,
and becomes a true partus preparator.
Like all other direct remedies, it may be employed in any
176
SPECIFIC MEDICINES.
}
case, no matter what name the disease may have in our nos-
ological classification, if the condition of the nervous system
calls for it. The heavy, tensive, aching pains are sufficiently
characteristic and need not be mistaken. So prominent is
this indication for the remedy, in some cases (not rheumatic),
that I give it with a certainty that the entire series of mor-
bid processes will disappear under its use.
I had a very marked example of this in severe typho-ma-
larial fever. In one case, the disease had continued through
the first week, growing worse daily under the treatment
adopted, until the remarks of a night-watcher called my
attention to these pains. Questioning elicited the fact that
muscular pains had been severe from the first-but the pa-
tient "thought it was part of the disease, and there was no
use to complain." The treatment was changed from Vera-
trum and the alkaline sulphites to Aconite and Macrotys,
and the patient was convalescing in four days-there was
marked relief in twelve hours.
This will serve as an illustration of the fact, “that a cer-
tain condition of disease may have that prominence in a case
that an entire series of morbid phenomena will pass away
when it is removed; or in other words, that a single rem-
edy may prove curative when a disease is complex-removing
the first in a series of morbid processes, the others disappear
of themselves.
MAGNESIA, SULPHITE OF.
Sulphite of Magnesia was one of the anti-zymotic remedies
recommended by Prof. Polli. We find in all that class of
acute diseases which develop typhoid symptoms as they pro-
gress, a need for remedies which control the septic process in
the blood. Most physicians will have employed sulphite of
soda in these cases, and have found marked advantage from
its use, yet in other cases, presenting somewhat similar gen-
eral symptoms it has done no good, and in some has done
harm,
MAGNESIA.
177
In
We say that sulphite of soda is indicated where the tongue
is broad, pallid, and covered with a pasty white coat.
these cases it will rarely disappoint the practitioner.
But we have need of the same antiseptic remedies in cases
in which the tongue is deep-red or dusky, whether covered
with a brown fur, or presenting the smooth glistening appear-
ance noticed in some of the more severe cases of typhoid
fever, or typhoid disease. Whenever the tongue is thus
dark-red, we can not give the salt of soda, for there is pres-
ent a prominent indication for the use of an acid. We may
use sulphurous acid as the antiseptic, but frequently it is
not well borne by the stomach.
In these cases the sulphite of magnesia will be found an
admirable remedy. We may say that it may always be ad-
ministered when the tongue is dark-red, and shows a dark
fur, and there is need for a remedy to antagonize the septic
process in the blood. It is given in doses of grs. j. to grs.
xx., repeated every three hours.
MAGNOLIA.
The Magnolia Glauca and Accuminata possess tonic and
stomachic properties, which may prove useful in medicine.
Will some of our Southern readers prepare a tincture from
the recent bark, and test it thoroughly. It may not prove
better than a dozen similar articles, and yet supply a very
good medicine to those who live where it is abundant.
It may be used in bronchial catarrh, gastric catarrh, rheu-
matism, and in the convalescence from malarial fevers.
MARRUBIUM VULGARE.
(HOARHOUND.)
Prepare a tincture from the fresh plant when in flower,
using 3 viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to x.
The Hoarhound exerts a marked influence upon the respi-
ratory apparatus. It is stimulant to all mucous surfaces, but
especially to the laryngeal and bronchial, and it may be em-
178
SPECIFIC MEDICINES.
ployed for this purpose. But it evidently has an action be-
yond this, and influences the function of respiration. Any
one who has employed it will have seen this very marked in
some cases. Let us have it thoroughly tried, and it may be
another instance of a very valuable remedy in a common
article.
1
MARUTA COTULA.
(MAYWEED.)
In testing these indigenous remedies, will some one pre-
pare a tincture from the fresh Mayweed, and give it a thor-
ough trial? The direction of the investigation will be shown
by reference to the Dispensatory or Materia Medica.
MANGANESII SULPHAS.
(SULPHATE OF MANGANESE.)
In doses of from one-fourth of a grain to one grain, the
sulphate of manganese will be found a good remedy in dropsy
(ascites) from disease of the liver, especially in those who
have been hard drinkers. It may also be used in jaundice,
with enlarged liver, the patient complaining of fullness and
weight in the hypogastrium. A pale, leaden tongue, dirty,
with full stomach, pendulous abdomen and sluggish bowels,
is sometimes benefited by small doses of this remedy.
A. first or second decimal trituration may be employed to
very good advantage where tissues are old and feeble, the
heart's action feeble, and the circulation of the blood weak.
MELILOTUS OFFICINALIS.
(SWEET CLOVER.)
Prepare a tincture from the plant in flower, using alcohol
of 98 per cent. The dose will range from the fraction of a
drop to ten drops.
It has given excellent results in the treatment of neural-
gia, especially when associated with debility. It has cured
cases of many years' standing. A strong indication for its
use is a marked soreness and lameness, which follows the
MERCURY.
179
attacks of pain. It may be administered in colic, painful
diarrhoea, dysuria with painful desire to urinate, in dysmen-
orrhoea associated with lameness in the hip, and along the
course of the sciatic nerve, and in some cases of rheumatism
where such lameness is a marked feature.
MERCURY.
Eclectics have always been opposed to the common use of
mercury in the treatment of disease, because as commonly
used it did very much more harm than good. In the United
States it has been extensively employed in all the ills that
flesh is heir to, and in all its preparations, from the one-twelfth
of a grain of corrosive sublimate or protoiodide of mercury.
to teaspoonful doses of calomel. The use of mercury to tap
the liver, and touch the gums, and the fearful salivation and
sore mouth that sometimes followed, the protracted sickness,
the increased death-rate, and the lasting wrongs that were
entailed by it, even when patients recovered, are all vividly
in the minds of our people. In the light of to-day, it is no
wonder that the Eclectic school of medicine opposed its use,
and made such a vigorous fight against it for half a century,
until even its advocates are obliged to use it secretly.
The charges made against it have all been sustained, and
respectable practitioners of medicine in the city use mercury
very sparingly, if at all. In the country they still use it, and
patients are still abused by it. The common use of mercury
by the Homœopaths, though the dose is small, is to be dep-
recated, as I have known much harm to result from it. Two
of the worst cases of salivation I ever saw (resulting in death)
were the result of Homœopathic treatment.
And still, if rightly studied, mercury might fill a valuable
place in medicine, but only in the treatment of chronic dis-
But if one does not make up his mind that it is a dan-
gerous agent, and must be carefully studied and very rarely
used, it had better be left alone.
ease.
I have no hesitation in using calomel as a dry dressing in
180
SPECIFIC MEDICINES.
chancroid or chancre, when the sores are pale and covered
with a pultaceous secretion.
In chronic eczema, and in sycosis and barbers' itch, and in
some cases of pruritus, I employ the brown citrine ointment
with advantage.
In secondary syphilis, the tongue being small and of usual
or more than usual redness, I use Donovan's Solution of
Arsenie (containing a minute quantity of iodide of mercury).
generally in combination with Phytolacca.
Mercury in the usual doses should never be given when
the tongue and mouth are pale; fauces, palate and tonsils
pale and full; pale tongue, shiny red spots over it; increased
secretion of saliva; full lips; pallid, expressionless face. In
such cases it is eminently pernicious, and yet these are Ho-
mœopathic indications for it.
If I were giving it, the indications would be, a small tongue
of natural redness, good color of lips, skin elastic. circula-
tion good, urine of usual specific gravity, depositing no sedi-
ment. It is well to have these facts clearly before us, whe-
ther we administer a dose of mercury or not.
MENYANTHES TRIFOLIATA.
(MARSH TREFOIL.)
A tincture is prepared from the fresh leaves, using alcohol
of 98 per cent., the dose of which will vary from the fraction
of a drop to ten drops.
It will be found a useful tonic in impaired digestion and
blood-making, associated with uterine disease and irregular-
ity, and following quinine in malarial diseases.
METHONICA GLORIOSA.
A tincture is prepared from the fresh plant (a native of
India) with alcohol of 98 per cent.; add gtt. x. to water Živ.
and give in teaspoonful doses.
It may be used when there is a sensation of burning and
constriction in the throat, for impotency, spermatorrhoea,
nervousness, hypochondriasis.
MIMULUS.
181
MENISPERMUM CANADENSE.
(YELLOW PARILLA.)
The Yellow Parilla has been considerably employed for
the indefinite purpose of an alterative. We have the testi-
mony of the Dispensatory that: "In small doses, no obvious
effects are produced on the general system." It may be worth
while, however, to examine it further, and it will offer a good
subject of study to some of our readers.
For experiment prepare a tincture from the fresh root,
3 viij. to alcohol 76 per cent. Oj. Use it in doses of from gtt.
j. to gtt. x.
MENTHA VIRIDIS.
(SPEARMINT.
Preparation.-Prepare a tincture from the fresh herb, 3 viij.
to alcohol 76 per cent. Oj. Dose from gtt. j. to gtt. xx.
Mentha Viridis is not only a stimulant, but is one of the
most kindly of the aromatics, and is rarely rejected by the
stomach. As a stimulant, it will furnish a cheap and pleas-
ant vehicle for many medicines.
But it is more than this. I regard it as one of the most cer-
tain of the vegetable diuretics, and employ it frequently for
this purpose. In suppression of urine in children, a tea-
spoonful of the tincture is added to two ounces of water,
sweetened, and given freely. So certain is its action in child-
hood, that I rarely think of giving anything else, except in
cases where there is great irritation of the nervous system,
and then Gelseminum is added to it in the usual doses.
MIMULUS PILOSA.
(MONKEY FLOWER.)
This plant may be found growing in various sections of the
country, but chiefly, as far as I know, in California. I have
employed it topically, and with much success, in local inflam-
mations, as rheumatism, neuralgia, erysipelas, burns, etc., in
which cases the tincture may be used, or a cataplasm made
182
SPECIFIC MEDICINES.
with the plant. I have likewise administered the remedy
internally in rheumatic and neuralgic affections, with appa-
rent benefit. A spray of the tincture made with dilute alco-
hol has given me most excellent results in the treatment of
obstinate bronchitis.
My supply of the agent having been limited, I have not
been able to test it as fully as could be desired, though I hope
ere long to be furnished with a new and larger amount.
Whether other varieties of Mimulus possess similar prop-
erties, I can not say. The principal object of this commu-
nication is to call the attention of our physicians to the plant,
that they may thoroughly investigate its virtues. J. KING.
MITCHELLA REPENS.
(PARTRIDGEBERRY.)
Preparation.-Prepare a tincture from the fresh plant, 3 viij.
to alcohol 76 per cent. Oj. Dose from gtt. j. to 3ss.
The Mitchella exerts a direct influence upon the reproduc-
tive apparatus of the female, giving tone and improving func-
tional activity. It has been extensively used as a uterine
tonic, to promote menstruation, to remove false pains and
unpleasant sensations in the latter months of pregnancy, and
has been thought to be a good preparative to labor, rendering
the birth of the child easier, and less liable to accidents.
Many have failed to obtain these influences from the use
of the common preparation, "Compound Syrup of Partridge-
berry," because it was prepared from old materials. If made
from the green plant, as named above, we think it will give
satisfaction.
MONOTROPA UNIFLORA.
(ICE-PLANT.)
Will some of our subscribers prepare a tincture from the
Ice-plant, and test it in the cases named in the Dispensatory.
We especially want to know its influence upon the nervous
system, and its action as a sedative. It is claimed to be rem-
edial in convulsions, epilepsy, chorea, etc.
MURIATE OF AMMONIA.
183
MOMORDICA BALSAMINA.
(BALSAM APPLE.)
The Balsam Apple is an annual climbing plant, grown in
our gardens for its fruit, which is employed in domestic
practice as a vulnerary, and an application to old sores, piles,
chapped hands, etc. It is commonly prepared for use with
alcohol or whisky. It evidently possesses medicinal proper-
ties, and I have seen good effects from its local use.
•
It is claimed to be poisonous when taken internally, yet I
have known it taken with safety in doses of ten to thirty
drops. Cures of dropsy are reported from its use. The
limited use I have known made of it internally was to relieve
muscular pains, lame back, and stiffness of joints. In some
cases it seemed to do good. As the agent is very common,
and easily cultivated, it would be well to prepare a tincture
from the fresh fruit, 3 viij. to alcohol 76 per cent. Oj., and
test it thoroughly, both as a local remedy and used inter-
nally. Of such a preparation the dose would be quite small,
say commencing with one drop.
MONESIA.
Solve the extract (imported from Brazil) in dilute alcohol,
or in water, adding alcohol sufficient to preserve it. It may
be used in doses of one to three drops.
The Monesia is a mild stimulant and tonic, and may be
given in atonic dyspepsia, in convalescence from the malarial
fevers, in chronic diarrhoea, chronic bronchitis, and incipi-
ent tuberculosis.
MORPHIA.
(See Papaver Somniferum.)
MURIATE OF AMMONIA.
"Muriate of Ammonia is one of those common-place and
unattractive substances which we, in this country, are little
apt to credit with extensive remedial properties in disease."
We quote the first sentence of an eminently suggestive paper
184
SPECIFIC MEDICINES.
by Dr. Anstie (The Practitioner, December, 1868), which
<reats principally of the employment of this remedy for the
elief of (1) various kinds of pain, and (2) of certain cases
of suspended secretion dependent on nervous exhaustion.
Before very briefly describing some of the applications men-
tioned, we think it right to state that we are by no means
prepared to coincide in Dr. Anstie's therapeutics, in so far
as this is founded on physiological data. Under the first
class the disease termed myalgia is said to be specially amen-
able to treatment by Muriate of Ammonia. Doses from
ten to twenty grains are recommended, and by their use this
disease may be cured as certainly as ague by quinia. This
class also includes various neuralgias proper, such as migraine
(usually referred to disorders of digestion) and clavus hys-
tericus; both of which Dr. Anstie believes to be distinct
and primary neuralgias of the fifth cranial nerve. Of all
the internal remedies that can be employed in these head-
aches, none is apparently so beneficial as the Muriate of Am-
monia, its virtue depending on its mildly stimulant proper-
ties. It should be given in the same doses as for myalgia.
MYRICA CERIFERA.
(BAYBERRY.)
Preparation. We prepare a tincture from the recent bark,
in the proportion of 3 viij. to alcohol 76 per cent. Oj.
As the Bayberry deteriorates unless carefully kept, it
would be better to test a tincture of the fresh bark of the
root. The dose will range from gtt. j. to gtt. x.
I do not know that anything can be added to what is known
of this agent. It has been extensively employed as a general
stimulant, and as a special stimulant to mucous membranes,
and with excellent results. Thomson recommended it in
all cases where there was increased secretion from mucous
membranes, whether it was catarrh or sore throat, bronchitis,
disease of stomach or intestinal canal, or leucorrhoea.
It is in these cases especially that it will be found of ad-
vantage. I have employed it in chronic gastritis in small
MYRRH.
185
•
doses, associated with minute doses of Lobelia, with good
success. The same combination will prove very valuable in
typhoid fever, in typhoid dysentery, and in diarrhoea with
increased mucous secretion.
The tincture prepared as above will furnish a much better
form of dispensing, as well as a more reliable remedy than
much of the powder sold, and when once used, will become
a prominent agent in the office and the pocket case.
MYRISTICA MOSCHATA.
(NUTMEG.)
In common use as a condiment, it may occasionally serve a
purpose in medicine, as in passive uterine hemorrhage, as a
stimulant in gastrodynia, and atonic diarrhoea. Dusted over
a larded cloth, it sometimes makes a good application to the
bowels in cholera infantum, and over the stomach to check
vomiting.
MYROXYLON PERUIFERUM.
(BALSAM OF PERU.)
Balsam of Peru is a stimulant to mucous membranes, and
as such may be used in chronic bronchitis with free secre-
tion, laryngitis, gastric catarrh, chronic diarrhoea and dysen-
tery, chronic cystitis, and urethritis. Occasionally it may
be used in chronic disease of the skin. I prefer a solution
in alcohol, and dispense it with glycerine.
MYRRHA.
(MYRRH.)
A tincture is prepared from the powdered myrrh in the
usual way by percolation, using 3iv. to alcohol 98 per cent.
Oj. The dose will vary from the fraction of a drop to ten
drops.
As a local application myrrh may be used for spongy and
ulcerated gums, chronic pharyngitis, where the mucous
membrane is pallid and tumid, elongation of uvula, and
spongy and enlarged tonsils. It may also be used with a
16
186
SPECIFIC MEDICINES.
spray in some cases of catarrh, secretion being profuse.
Internally it is given in chronic gastritis and dyspepsia, the
tongue and mucous membranes being pallid and full, and to
rectify wrongs of the reproductive apparatus, there being a
sense of weight and dragging, with leucorrhoea.
NABALUS ALBUS.
(LION'S FOOT.)
Preparation.-Prepare a tincture from the fresh plant,
3 viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. xx.
This remedy has been but little employed. It was claimed
to be specific to the poison of the rattlesnake, and to have
been used with much success. It influences the nervous sys-
tem directly, and experiment may develop a valuable use for
it. It is not in the market, and we will therefore have to
depend upon those who can procure it green, to determine its
properties.
NARCISSUS PSEUDONARCISSUS.
(DAFFODIL.)
A tincture is made from the bulbs by maceration and ex-
pression, using alcohol of 98 per cent. It may be given in
doses of the fraction of a drop to ten drops.
It has been employed in epilepsy, in diseases showing epi-
leptiform movements of the muscles, in chorea, and in rheu-
matism with unpleasant muscular contraction. It may also
be given (in small dose) in diseases of the brain, the eyes
being dull and the pupils dilated.
NEPETA CATARIA.
(CATNIP.)
Preparation.—Prepare a tincture from the fresh herb, when
in blossom, 3 viij. to alcohol 76 per cent, Oj.
Catnip is a feeble remedy, and yet is as good as many in
general use. Employed in the form named, it will give sat-
isfaction and well repay its preparation. It is a mild dia-
NICOTINE.
187
phoretic, but associated with the hot-foot bath, it will be
found to place the skin in a soft, moist condition, and relieve
nervous irritation. It is especially to be recommended as a
carminative for children. A teaspoonful added to four
tablespoonfuls of hot water and sweetened, may be given
freely, and is better than a tea of the dried herb.
NICOTIANA TABACUM.
Dr. Unzicker, of this city, recommends the preparation of a
tincture from the green plant, and its use as a sedative and
in the treatment of diseases of the respiratory apparatus
of children.
We value the local use of tobacco as a fomentation in
cases of strangulated hernia, in some acute local inflamma-
tions, and in pseudo-membranous croup when the danger is
imminent. It will also prove the best application to wounds
and injuries where there are symptoms of tetanus.
In tetanus the alkaloid, Nicotine, has been employed with
marked success, and it is probably our most certain remedy.
It is given in doses of half to one drop, or if not tolerated
by the stomach, it may be used by hypodermic injection. If
the alkaloid can not be procured, an infusion may be used
by mouth, by injection, or if not retained in sufficient quan- ·
tity in these ways, it may be given by hypodermic injection.
Tobacco has been employed by the school of Rademacher,
with reported success. It has also been employed to a limi-
ted extent in this country. The preparation advised is the
"Aqua Nicotianæ Tabacum Spirituosæ Rademacheri," for
which a formula is given.
This preparation is recommended highly in affections of
the brain accompanying fever, in rheumatismus acutus fixus et
vagus, in other affections of the brain and spinal marrow, in
cholera morbus, and in cholera Asiatica.
To prepare it: Take of choice fresh green leaves of Nico-
tianæ Tabacum eight pounds, and cut them finely. Add of
the best alcohol, by weight one and a half pounds, of distilled
188
SPECIFIC MEDICINES.
water as much as is necessary to distil over eight pounds (by
weight) of the water.
The leaves are to be cut and the distillation effected im-
mediately after they are pulled, with great care that there
shall be no over-heating of the liquid, as, if the liquor be
over heated it will have a very disagreeable odor of tobacco,
which it does not have when the water is properly prepared.
Rademacher uses this water in every stage of the Asiatic
cholera. In the earlier stages he gave the following: R Aqua
puræ, f3vij. ; soda acet.,3jss.; aqua nicotian., f3j. ; gumi arab.,
3ss. M.; dose, one tablespoonful every hour.
The great majority of cases treated with this mixture re-
covered immediately from the attack. In those cases where
the attack was followed with a typhoid condition, he gave:
R Tinct. ferri acetica, f3j.; aqua nicotian., f3j.; aqua puræ,
f3vj.; gumi arabici, 3j. M.; dose, one teaspoonful every hour.
NITRIC ACID.
There are certain conditions of disease in which Nitric
Acid is a very valuable remedy, and if it is possible to tell
when it is indicated it will prove one of the most valuable of
our specifics.
There is a certain condition of stomach, in which there is
irritability with enfeebled function, in which Nitric Acid is
the remedy. And there is a lesion of digestion and blood-
making other than the derangement of the stomach named,
in which Nitric Acid is a direct remedy. There is also
added to this, or separate from it in some cases, an impaired
nutrition as well as a slow and imperfect retrograde meta-
morphosis of tissue and failure of excretion, in which Nitric
Acid will prove a direct remedy.
Prof. E. Freeman imforms me that he has employed it for
some time in a class of stubborn cases, presenting some of
these features, with most marked success. His cases have
embraced those of enfeebled digestion and blood making,
and enfeebled and depraved nutrition; taking some cases of
scrofula, bad blood, and even phthisis.
NITRIC ACID.
189
There are four ways of determining the use of these reme-
dies. The first employs them hap-hazard, in groups, singly or
combined, simply because they have been used in diseases
covered by a name. The second is a better form of em-
piricism, and employs them one after another, in their sup-
posed order of goodness, until some one hits the case in
hand. The third generalizes the symptoms, and determines
the quality of the lesion, and for this prescribes with some
directness. The fourth tries to determine the principal les-
ion-basic lesion we have called it--by some positive signs or
symptoms, and prescribes for this. Sometimes the prescrip-
tion is in reality a pronounced symptom, though if we would
inquire far enough we might know there was a constant lesion
underlying it.
In each of these four ways we may prescribe Nitric Acid;
in the last two we may prescribe it in a rational manner.
I will not undertake to point out the evidences of the
three pathological lesions, in which Nitric Acid has been em-
ployed with advantage, as our readers can read this up in
our text-books; but I will hazard a guess as to the specific
indication in certain instances:
If the tongue, whether pale, rose red, or deep-red, presents
a violet haze, we have an indication for nitric acid. We will
notice the same violet haze wherever blood comes to the sur-
face in the capillary circulation. I think we get the most
decided results when the mucous membranes are moderately
red. Do not mistake the deep, solid purple of the mucous
membranes we see sometimes, for this violet haze, for here
the irritable stomach very frequently presents the red tip
and edges of tongue, and sometimes elongated papillæ.
We do not use it for its acid properties, but probably the
benefit is due to the supply of nitrogen in a peculiar form,
Of course this is but a supposition.
I have treated successfully several cases of inveterate
chronic ague, of malarial headache, and many of other
diseases, and of course, in experimenting, have missed it in
some cases. I have only the desire here to call attention
190
SPECIFIC MEDICINES.
to the remedy, and have it thoroughly tested, asking that the
symptoms be observed, so as to give us definite knowledge of
the cases in which it will prove curative.
I prescribe it as follows: R Nitric acid gtt. xxx., simple
syrup 3iv.; a teaspoonful every three hours.
NITRI SPIRITUS DULCIS.
(SWEET SPIRITS OF NITRE.)
It may seem a little strange to some that an alcohol should
produce sedation, and be classified with the sedatives, yet a
few experiments with this agent will show that it is true, and
that sweet spirits of nitre will lessen the frequency of the
pulse, reduce the temperature, and promote secretion. For
this purpose, one-half to one teaspoonful may be added to a
half glass of water, and given in doses of a teaspoonful every
hour. The common use of the remedy as a diuretic is well
known, though I object to the large dose given.
NITRATE OF SODA.
(CUBIC NITRE.)
Pure Nitrate of Soda is a white salt, crystallizing in rhom-
boidal prisms; hence its common name, cubic nitre.
It is soluble in three times its weight of cold water, giving
a clear solution.
Given to the extent of two or three drachms in twenty-
four hours, it markedly increases the excretion of urea, and
also influences secretion by skin and kidneys. Beyond this
it exerts a special influence upon the vegetative system of
nerves, controlling irritation and inflammation.
It is held in high estimation by the school of Rademacher
as a remedy for dysentery, and also as a remedy. in one of his
three "epidemic constitutions of disease."
The indications for its use in acute diseases are—a swollen
and puffed tongue, covered with a white or yellowish mucus;
the mouth may be dry or moist, but the tongue must never
show contraction, be elongated and pointed, or deep-red. In
NYMPHÆ.
191
other words, we must observe the general indications for the
administration of an alkali.
Probably the special cases in which it will be found of
most advantage are these: when the pulse is full, the surface
flushed, slightly dusky or purplish; eyes injected, though not
dry; an increased perspiration, though the skin remains hot.
The dose of nitrate of soda will range from 3j. to 3j. in the
twenty-four hours. It is best given in solution, largely
diluted with water.
NUPHAR LUTEUM.
(YELLOW POND-LILY.)
A tincture is prepared from the fresh root, using alcohol
of 98 per cent.; gtt. v. to x. of this tincture may be added to
water 3iv., and given in teaspoonful doses every two or three
hours.
This remedy has been employed in diseases of the digestive
apparatus, with morning diarrhoea; to arrest nocturnal emis-
sions, and as a remedy for spermatorrhoea, and to give strength
to the reproductive organs and function. The testimony is
pretty conclusive as to its influence in these directions, espe-
cially in chronic diarrhoea.
NYMPHÆ ODORATA.
(WHITE POND LILY.)
Prepare a tincture from the fresh root of the White Pond
Lily, in the proportion of 3 viij. to alcohol 76 per cent. Oj.
Dose, from gtt. j to gtt. x.
My use of this remedy has been but limited, though from
the reports of others I deem it to possess decided medicinal
properties. The general term alterative will express the kind
of action that may be obtained from it. It exerts a special
influence upon mucous tissues, and has been employed with
advantage in diseases of the bronchia, the gastro-intestinal
mucous surfaces, the bladder and the urethra. This will
suggest the line of experiment, and we hope the remedy will
be thoroughly tested and reported.
192
SPECIFIC MEDICINES.
NUX VOMICA.
(See Strychnos Nux Vomica.)
CENANTHE PHELLANDRIUM,
(WATER HEMLOCK.)
A tincture is prepared from the seeds (European) with
alcohol of 98 per cent.; gtt. x. to gtt. xx. may be added to
water 3iv., and given in doses of one teaspoonful.
It is gently stimulant, and relieves irritation of the nerve
centers, and gives rest. It has thus proved beneficial as a
remedy for cough in bronchitis, phthisis, and in asthma.
CENOTHERA BIENNIS.
(EVENING PRIMROSE.)
A tincture is prepared from the recent plant with alcohol
of 98 per cent., of which the dose will vary from the fraction
of a drop to ten drops.
This remedy has been recommended for almost every ill
that flesh is heir to, and it is difficult to determine, from
what has been written, just what it is good for. If I were
giving the indications for it, I should say—a sallow, dirty
skin, tissues full and expressionless, an expressionless face, a
tongue the color of the skin, very unnatural and large, pa-
tient gloomy and despondent.
I have used it with advantage in dyspepsia, torpidity of
liver, enlarged spleen, enlarged mesenteric glands, and in
some diseases of women, characterized by pelvic fullness and
torpor.
OSTRYA VIRGINIANA.
(IRON WOOD.)
A tincture is prepared from the wood, using alcohol of 76
per cent., the dose being from five to ten drops.
The remedy is a mild stimulant and tonic, and may be used
to improve the appetite and digestion. It has been used as
a prophylactic against intermittent fever, and to effect a cure
when it has been broken by quinine.
ORIGANUM.
193
OLEUM MORRHUÆ.
(COD LIVER OIL.)
We employ a bland and slightly odorous Cod-liver Oil in
practice; probably Caswell & Hazard's will give most satis-
faction.
There is no doubt but benefit follows its use in appropriate
cases, and sometimes the advantage is much greater than
from the use of medicines. The principal indication for its
use is where an exalted temperature is maintained at the
expense of the tissues. Cod-oil in such cases saves the tis-
sues, and the burning of histogenetic food.
I employ it in cases of tuberculosis, scrofula, and in many
forms of chronic disease, when the above indications exist.
Especial attention is called to its use in local disease, with
cacoplastic or aplastic deposits.
As the increased temperature is associated with increased
frequency of pulse, we frequently associate it with veratrum
viride. As a general rule the stomachic bitters are not ad-
vantageous when we give this remedy. Many physicians fail
to obtain advantage from the use of Cod-oil because they
give tonics in excess at the same time.
OSMUNDA REGALIS.
(BUCKHORN BRAKE.)
A tincture may be prepared from the recent root, using
dilute alcohol. The dose will vary from one to twenty drops.
It may be used in chronic cough, with profuse perspiration,
in dyspepsia with slight diarrhoea, and in leucorrhoea.
ORIGANUM VULGARE.
(ORIGANUM.)
Preparation.-Prepare a tincture from the fresh herb, using
3 viij. to alcohol 76 per cent. Oj. Dose gtt. j. to gtt. x.
This agent is a stimulant diaphoretic, and influences the
reproductive organs of the female. It has been used in the
treatment of colds, and in suppressed menstruation from
cold.
17
194
SPECIFIC MEDICINES.
OROBANCHE VIRGINIANA.
(BEECH DROPS.)
Beech drops contain a large proportion of tannic and gal-
lic acids, and may be used for the general purposes of an as-
tringent. I do not know that there is any advantage in tak-
ing a crude material that is scarce and high priced, when we
can obtain its medicinal action from that which is common
and cheap.
PEONIA OFFICINALIS.
Preparation.-Prepare a tincture from the fresh root of
the garden peony, in the proportion of 3viij. to alcohol 76
per cent. Oj. Dose from gtt. j. to 3ss.
This remedy has been but little used, yet the evidence is
pretty conclusive that it possesses a marked influence upon
the nervous system. It has been employed as an antispas-
modic, and to relieve irritation of the nerve centers. Will
some of our friends prepare a tincture in the summer and
test it?
PANAX QUINQUEFOLIUM.
(GINSENG.)
Preparation.-Prepare a tincture from the fresh or recent
root, in the proportion of 3viij. to alcohol 98 per cent. Oj.
Dose from gtt. j. to gtt. x.
We have laughed at the Chinese for their use of Ginseng,
which we have deemed inert, but I am pretty well satisfied
that in this, as in some other things, they have the advantage
of us.
A limited use of the article has given me a very
favorable opinion of its influence.
Its first use, and a very important one, is in the treatment
of nervous dyspepsia. I have obtained more benefit from it
in my own person, than from any other remedy, and I have
employed it with others with equal advantage. It exerts a
decidedly beneficial influence in exhaustion of the brain from
over work, and it is probable that its influence is as much in
this direction as upon the stomach.
PAPAVER SOMNIFERUM.
195
It is one of those remedies, however, that produces no
marked improvement at first, and must be continued for
weeks to obtain its good effects.
PANCREATIN.
Preparations containing Pancreatic juice, or Pancreatin,
may be used in cases of intestinal dyspepsia, attended with
chylous feces, in fatty diarrhoea, where there is disease of the
mesenteric glands, etc. The patient frequently complains
of a sense of uneasiness in the abdomen. It is only a tem-
porary remedy, intended to tide the patient over, until by
other means intestinal digestion is re-established.
PAPAVER SOMNIFERUM.
Before describing the action of Opium, I want to draw the
attention of my readers to the importance of having it good,
and of not using morphia as a substitute. Never buy Opium
in powder, and in selecting the gum, take that which, when
broken, gives the characteristic odor. Lastly, prepare your
own tincture of Opium.
Opium in medicinal doses is a cerebral stimulant, and we
will find this its most important use. From this stimulation
comes sleep and rest to the nervous system.
In less degree it is a stimulant to the spinal-cord, and in-
creases functional activity of all parts supplied from it.
Opium or its salts may be administered for the relief of
pain, to produce sleep, or as a general stimulant to the vege-
tative processes, when the following conditions are present:
A soft, open pulse, or where there is not the element of hard-
ness and smallness; a soft (not dry) skin; a moist tongue; pal-
lid face; and eyes dull, immobile or dilated pupils. It is
contra-indicated, where there is a dry, contracted skin; small
hard pulse; dry tongue; flushed face; bright eye, with con-
tracted pupils.
There is no remedy that has been so much or so badly
used as this. It is highly prized by the profession, and yet
196
SPECIFIC MEDICINES.
every physician can recall cases where its administration has
proven injurious rather than beneficial. It has gained this
extensive use because of the marked relief it gives from
pain, and even though it fails so frequently, the successes are
estimated, not the failures.
I believe the reader, by carefully studying the above indica-
tions and contra-indications, will be enabled to use the rem-
edy so as to obtain its full palliative and curative action; not
having the unpleasantness of failure to accomplish the de-
sired object, or injury to the patient, to regret.
HYPODERMIC USE OF MORPHIA. In this connection we
may consider the advantages to be obtained from the hypo-
dermic use of Morphia. It has been extensively employed
for the relief of pain, and many physicians would hardly
practice medicine if forced to give up their hypodermic
syringes.
The advantages to be obtained from this use of Morphia
has not been over-estimated. But every one who has em-
ployed it, will recollect cases of failure, sometimes of injury,
which were very mortifying. Why this failure?
The indications for the hypodermic use of Morphia
are the same as those just given for Opium, and where there
is present the contra-indications, the use will not give the
expected results, and may prove injurious. Fortunately in
the majority of cases of neuralgia, there is a soft, open pulse,
the cool, pallid skin, and the evidence of an enfeebled cere-
bro-spinal circulation. In such cases, the hypodermic use of
Morphia gives present relief, and from its topical stimula-
tion, may effect a radical cure.
We never employ the hypodermic injection of Morphia
where there is a hard, small pulse, dryness and constriction
of skin, dry tongue, flushed face, bright eyes and contracted
pupils. He who uses it in such cases, will very certainly be
disappointed in its action. In many cases of fever and in-
flammation, though the patient suffers pain, and the ordinary
influence of Morphia in this way would be very desirable, we
withhold it.
PENTHORUM.
197
?
PAREIRA BRAVA.
A tincture is prepared from the bark, using alcohol of 76
per cent.; the dose will vary from one to ten drops.
It exerts an influence upon the kidneys, being strictly
stimulant and tonic, and relieving irritation of the urinary
passages. It is indicated by uneasiness in the abdomen, with
frequent desire to urinate.
PASTINACA SATIVA.
(PARSNIP.)
A tincture is made from the fresh roots of the second
year's growth, using alcohol of 98 per cent.; gtt. v. of this
may be added to water 3iv., and given in doses of one tea-
spoonful.
It has been but little used, but may be tried in cases of
mental depression, especially when asssociated with dyspepsia.
PASSIFLORA INCARNATA.
(PASSION FLOWER.)
A tincture is prepared from the fresh leaves in May or
June, or from the inspissated juice of the leaves, using alco-
hol of 98 per cent.; gtt. x. may be added to water 3iv. and
given in doses of one teaspoonful every two or three hours.
It relieves irritation of the nerve centers, and improves
sympathetic innervation, improving circulation and nutrition.
It may be used in torpidity of the bowels with hemorrhoids,
and in congestion of ovaries and uterus..
PENTHORUM SEDOIDES.
(STONE-CROP.)
A tincture is prepared from the fresh plant, using alcohol
of 98 per cent. The dose will vary from the fraction of a
drop to five drops.
The older authorities gave it as a demulcent and laxative,
and in moderate doses it does relieve irritation of stomach
158
SPECIFIC MEDICINES.
and intestinal canal, and promote normal activity. It will be
noticed that it does not make the impression on the mouth
of an astringent, but on examining the mucous membrane.
after its use, it will be seen that the color is freshened, and it
looks clean. In its influence upon the stomach it resembles
Ipecac when given in small doses.
This remedy exerts a most marked influence upon mucous
membranes, especially when they have been subject to chronic
inflammation. It removes irritation, promotes normal func-
tional activity, and brings the structures back to a healthy
condition. It has proven the most certain remedy in pharyn-
gitis that I have ever employed, and has given such marked
benefit in disease of the superior pharynx, posterior nares,
and eustachian tubes, that I should not like to treat these
cases without it. I have also used it with the spray appara-
tus in nasal catarrh, with most excellent results.
PEPSIN.
Preparations from the mucous membranes of the calf or
hog, containing percentage of this ferment, are in the mar-
ket, and most of them are reliable, but possibly "Schaffer's
Pepsin" may be taken as the standand. This, it is claimed
by the maker, will dissolve 1,500 times its weight of albumen,
but possibly 100 to 200 times its weight would be as much as
could be expected from good commercial Pepsin.
It is a very great mistake to suppose that the administra-
tion of Pepsin is anything more than an aid to digestion,
when the stomach is so feeble or impaired that it can not
furnish this digestive ferment. It adds nothing to the stom-
ach, though it impairs its condition by giving it rest (doing
its work). It adds nothing to the body at large of itself,
though in so far as it fits the food for blood making, it aids
in furnishing tissue-making food.
Pepsin may be given to aid digestion when the stomach is
enfeebled, and can not furnish a sufficient amount of gastric
juice. By continuing its administration for some weeks, and
PETROLEUM.
199
with improved digestion from it, we obtain better blood, and
improved nutrition, increased strength, and an improved con-
dition of stomach.
PEROXIDE OF HYDROGEN.
Water receives an additional equivalent of oxygen, when
it is presented to it in a nascent state. This combining with
the hydrogen forms a deutoxide (H O2.)
It was first brought to the notice of the profession by Dr.
B. W. Richardson, of London, in 1860, and since has been
used to a limited extent. He employed it in acute and chro-
nic rheumatism and in chronic inflammation with aplastic
deposits. It improved digestion and nutrition, increased
waste, oxidation and excretion.
PETROSELINUM SATIVUM.
(PARSLEY.)
A tincture may be prepared from the fresh plant, gathered
when it is coming into bloom, using alcohol of 98 per cent.
The dose will vary from the fraction of a drop to ten drops.
The remedy may be employed to relieve irritation of the
urinary apparatus and increase the secretion. It may also
be used to relieve irritation of the reproductive apparatus,
bringing on the menstrual flow, and relieve pain.
PETROLEUM.
There are two varieties, the heavy and the light coal-oils,
which differ as much in their medicinal properties as they
do in use-probably the heavy should alone be used.
A very pure and heavy oil, known as Mecca Oil from the
well that yields it, is recommended. It is a dark, bland oil,
not unpleasant to the taste, and is furnished by our druggists.
It has been employed with advantage in chronic bronchitis
and laryngitis, and phthisis with bronchial irritation. Some
contend that for bronchial disease it is unsurpassed. It has
200
SPECIFIC MEDICINES.
also been employed in scrofula, chronic disease of the uri-
nary apparatus, and in chronic skin diseases. It would be
well to test it thoroughly in these cases, and also for its influ-
ence upon the nervous system. The dose will vary from one
drop to a teaspoonful.
PHOSPHORUS.
Preparation.-We prepare a tincture of Phosphorus, by
taking 3ij. to alcohol 98 per cent. Oj.
The Phosphorus is divided under water, which being re-
moved the alcohol is poured on; it is allowed to stand for ten
days, when it is ready for use. We use an excess of the
Phosphorus, because in the commercial article there is but
a small portion which can be acted upon by alcohol. When
of full strength, the tincture will contain about four grains.
to the ounce. We prepare it for use by adding one or two
drachms of the tincture to four ounces of water, of which
the dose will be one teaspoonful.
We employ this preparation of Phosphorus principally for
its action upon the urinary and reproductive apparatus. It
is especially useful to relieve vesical and prostatic irritation,
especially when arising from or associated with sexual excess.
We also use it as a nerve stimulant. In some cases its in-
fluence will be quite marked, relieving irritation and improv-
ing nutrition.
THE HYPOPHOSPHITES.
The Hypophosphites, when well prepared, give us Phos-
phorus in the best form as a restorative. There is great dif-
ficulty, however, in obtaining reliable preparations, and many
have been disappointed on this account.
I now use the Compound Syrup of the Hypophosphites, and
it has given good satisfaction. It is especially useful when
it is desirable to improve the nutrition of the nerve centers,
though it exerts a favorable influence over the entire process
of nutrition. I usually prescribe it in doses of a teaspoon-
PHYSOTIGMA.
201
ful three times a day after meals. Its action is slow, like
food, and time must be given to obtain its full benefit.
PHOSPHATE OF SODA.
We employ a pure article of Phosphate of Soda, and de-
mand that it be finely powdered; probably Powers & Weight-
man's will give the best satisfaction.
The Phosphate of Soda has two uses-as a restorative, and
for its influence upon the intestinal tract. As a restorative
I employ it extensively with children, in those cases where.
there is impaired nutrition, with pallidity of tongue and mu-
cous membranes. In these cases it will be found to exert a
markedly beneficial influence. It is generally administered
in milk in doses of one to three grains, four times a day. We
occasionally find a case in the adult where it will prove ben-
eficial. These are uniformly marked by the pallid mucous
membranes, and inaction of the bowels. The dose will vary
from five to fifteen grains,
Its second use is as a laxative for children. We find cases
of constipation that will yield to no remedies, the child suf-
fers from indigestion, and occasionally from colic. In these
cases Phosphate of Soda in doses of from three to five grains,
three times a day, will give permanent relief.
Phosphate of Soda is also an excellent laxative for the
adult, especially in cases of habitual constipation, with har-
dened feces. In this case twenty to thirty grains in a large
glass of water, is taken on going to bed at night.
PHYSOTIGMA VENOSUM.
(CALABAR BEAN.)
A tincture is prepared from the pounded seed, Zviij. to
alcohol of 98 per cent. Oj. The dose will vary from the frac-
tion of a drop to five drops. I prefer it in the proportion of
gtt. v. to water Živ., a teaspoonful every two to four hours.
In disease of the brain or spine, with contracted pupils,
but cool surface, cold extremities, and feeble pulse; in cere-
202
SPECIFIC MEDICINES.
bro-spinal meningitis, with feeble, small pulse, contracted
pupils, and dullness of intellect; in puerperal convulsions,
with feeble, tremulous pulse, eyes forcibly turned upwards,
this remedy is sometimes indicated. It has been successfully
employed in the larger dose in the treatment of tetanus, five
drops being repeated as often as every one or two hours.
Dropped in the eye it causes contraction of the pupil, and
it is frequently used to antagonize the effect of Belladonna.
PHYTOLACCA DECANDRA.
(POKE.)
Preparation. We prepare a tincture from the fresh root,
3 viij. to alcohol 98 per cent. Oj. Dose, from the fraction of
a drop to gtt. v.
This is one of those remedies which loses its medicinal
properties by drying, and the crude article furnished from
drug stores is wholly worthless, as are the preparations
from it.
The tincture of the fresh root is one of my favorite reme-
dies. It exerts a direct influence upon the processes of waste
and nutrition, and therefore possesses those properties called
alterative in a high degree. I have used it in secondary
syphilis, in chronic skin disease, and in scrofula, with excel-
lent results.
It has a direct influence upon the mammary glands, and
will generally arrest inflammation if given in the early stage.
I have used it in scores of cases and with a certainty that
rarely follows the use of medicines. I also employ it in cases
of sore nipples, both internally and locally, with good results.
It is one of the most certain remedies we have in diphthe-
ria, and in some seasons will cure nearly every case.
I gen-
erally employ it in combination with aconite, and even when
the larynx is threatened I feel a confidence that the remedy
will cure if persisted in. In ordinary sore throat, and in
epidemic tonsillitis it is a favorite prescription.
It is also a most valuable remedy in sore mouth, either in
children or adult, and if a patient having another disease
PIX LIQUIDA.
203
complains of sore mouth, Phytolacca is suggested. Even the
nursing sore mouth is frequently cured by this remedy.
It is a prominent remedy in parotitis, and in its metastasis
to the testes I would recommend it in preference to any other
treatment. It may also be employed in gonorrhoeal and syph-
ilitic orchitis, but not with so much certainty.
It will be found a very valuable remedy, and as it is so
common, I would advise every one to prepare a tincture in the
fall and test it in practice.
PIPER NIGRUM.
(BLACK PEPPER.)
We make a tincture of Black Pepper in the proportion of
3 viij. to alcohol 98 per cent. Oj. The pepper should be finely
ground and packed in the percolator, moistened with alcohol
and allowed to stand twenty-four hours, then run the remain-
der of the alcohol through it. Dose, gtt. j. to gtt. x.
Black Pepper is a remedy I value very highly. As a gas-
tric stimulant it certainly has no superior, and for this
pur-
pose we use it in congestive chills, in cholera morbus, and
other cases of a similar character. In atonic dyspepsia it
may be associated with hydrastis or other stomachic bitter,
or sometimes with nux vomica or strychnia. I have used it
associated with tincture of macrotys in atonic amenorrhoea
with advantage, and sometimes the same combination will be
found beneficial in dysmenorrhoea.
It may be used with excellent results in the treatment of
intermittents, preparing the way for quinia and associated
with it. In these cases it is used in full doses.
PIX LIQUIDA.
(TAR.)
We prepare a glycerole of tar for local use in the following
way: Heat a pound of glycerine and of tar in separate ves-
sels; whilst heating, rub up an ounce of starch in a mortar
with a portion of the glycerine, and stir it in until thoroughly
!
201
SPECIFIC MEDICINES.
mixed; when hot pour the two together, boil for a moment,
then stir until cool.
Glycerole of tar prepared in this way is a specific for many
forms of pruritus. In pruritus ani it is so certain in its
action, that I prescribe it with an almost positive certainty
that it will not only give present relief, but will effect a radi-
cal cure. In eczema with pruritis, it has proven an admira-
ble remedy, and has effected cures in protracted and very
stubborn cases. The indication for its use is itching.
Tar has been used internally, with reported good effects.
To test it in chronic bronchial disease, and for the relief of
cough, I would suggest one part of tar to nine parts of gly-
cerine, combined by heat
PLANTAGO MAJOR.
(PLANTAIN.)
A tincture may be prepared from the fresh leaves, or from
the root, but it is as well to take the entire plant, using alco-
hol of 98 per cent. The dose will vary from the fraction of a
drop to five drops.
It has been extensively and successfully employed as a
remedy in toothache, the carious tooth being cleansed, and
the tincture applied with cotton. This may be removed in
half an hour and renewed. A similar application will some-
times relieve earache in a short time. Internally it has been
administered in incipient phthisis, hemorrhage from the
lungs, menorrhagia, leucorrhoea, dysuria, and hemorrhoids.
PLANTAGO CORDATA.
(WATER PLANTAIN.)
Preparation.-Prepare a tincture from the fresh root, 3 viij.
to alcohol 98 per cent. Oj. Dose from gtt. j. to 3ss.
This remedy has been but little used, yet from what we
know of it, we think it deserves careful investigation. It ex-
erts a direct influence upon the nervous system, allaying irri-
PODOPHYLLUM.
205
tation and giving better innervation. It was employed in the
cholera of 1832 with marked success, and Prof. Jones thought
it likely to prove one of the most certain remedies we have
in that disease. Let some of our physicians prepare the
remedy, and report.
PODOPHYLLUM.
(MAY APPLE.)
For common use, prepare a tincture from the root in the
proportion of 3 viij. to alcohol 98 per cent. Oj. Dose, gtt. j. to
gtt. xx.
I am satisfied that a trial of the tincture of Podophyllum
will satisfy any one that it is preferable to Podophyllin in
general practice. It makes no difference whether it is to be
used as a stimulant to the digestive tract, as an alterative,
for its general cathartic effect, or as an emeto-cathartic.
For its stimulant influence and to improve digestion, I fre-
quently use it in combination with the stomachic bitters, or
nux vomica, quinia, and iron; necessarily the dose is small.
As an alterative, a remedy to increase waste, it may be com-
bined with other agents that act in the same direction, with
the bitter tonics and restoratives, or many times with vera-
trum viride.
I am well satisfied that in small doses, associated with the
bitter tonics and restoratives and good food, it is decidedly
the best remedy we have in the treatment of old syphilitic
lesions. Its action may be greatly aided sometimes by the
use of the vapor-bath, or by sulphur and iodine baths.
For the ordinary routine of medicine, as a cathartic, com-
bine it with neutralizing cordial, as R Tincture of Podophyl-
lum, 3ss. to 3ss.; compound syrup of rhubarb, 3jss. A tea-
spoonful every two or three hours. The addition of a small
portion of tincture of lobelia or ipecac will render its action
more efficient aad kindly. As an emeto-cathartic give it with
a ginger-tea, or other stimulant taken freely.
206
SPECIFIC MEDICINES.
PODOPHYLLIN.
To obtain the direct action of Podophyllin, we prepare it
for use by thorough trituration, with sugar of milk or white
sugar. I prefer the trituration one part of Podophyllin to
one hundred of sugar.
The specific use of Podophyllin in this form is to arrest
increased mucous secretion from the small intestine and give
it power to perform its function. It will cure acute or chro-
nic diarrhoea with mucous discharges, and in some cases of
cholera infantum it "acts like a charm. No one who has
used the trituration of Podophyllin in these cases would be
willing to dispense with it, and many will find it of advan-
tage in other cases.
This remedy has been employed in doses much too large,
and physicians are fast learning that in this case, as well as.
some others, small doses are very much better than large
ones. For some years I have employed a little pill that has
given excellent satisfaction, and as it is more easily dispensed
and taken, I give its formula: R Podophyllin grs. ij., phos-
phate of hydrastia grs. x.; make forty pills. One is given at
3 P. M. The one pill improves digestion and blood-making,
and is frequently sufficient to give a regular action of the
bowels.
POLEMONIUM REPTANS.
(JACOB'S LADDER.)
This remedy has been but little used, yet it might repay
study. If some of our friends will prepare a tincture from
the fresh root and test it, we would be glad to hear the
report.
POLYGALA SENEGA.
(SENEGA)
Preparation.-Prepare a tincture from the recent dried
root, viij. to alcohol 76 per cent. Oj. Dose, gtt. ij. to xx.
The stimulant influence of Senega upon the throat and
bronchial mucous membrane is well known, and is probably
:
POLYTHRICUM.
207
its most important use. For this purpose I prefer to use it
in the form of tincture to that of syrup so commonly em-
ployed. In chronic bronchitis with profuse secretion, it may
be combined with small doses of ipecac and veratrum.
Its influence upon the kidneys and reproductive organs
needs to be studied, and I have no doubt some important uses
will be found for it. I have employed it in squamous disease
of the skin, and like its action very much; it is one of a very
few remedies that influence these diseases.
POLYGONUM PUNCTATUM.
(WATER PEPPER.)
Preparation.-Prepare a tincture from the fresh herb, in
the proportion of 3viij. to alcohol 76 per cent. Oj. Dose,
gtt. j. to 3ss.
I regard the tincture of Water-Pepper as one of our most
certain stimulant diaphoretics. It is also one of the best
emmenagogues, especially when the arrest is from cold. It
influences the urinary and reproductive organs, but its action
in these directions needs to be studied.
POLYPODIUM VULGARE.
(POLYPODY,)
This remedy is now but little used, yet will probably repay
study. For experiment, a tincture should be prepared from
the fresh root with dilute alcohol, in the usual proportion.
POLYTRICHUM JUNIPERUM.
(HAIR-CAP MOSS.)
The Hair-Cap Moss has been especially employed as a diu-
retic, and so long as it could be procured without admix-
ture, gave good satisfaction. I do not know that it has any
direct influence, other than to increase the secretion of water
in the urine-a hydragogue diuretic; but it might be well to
study its action more closely.
+
208
SPECIFIC MEDICINES.
POPULUS TREMULOIDES.
(POPLAR.)
Preparation.-Prepare a tincture from the fresh bark of
the white Poplar, in the proportion of 3 viij. to alcohol 76
per cent. Oj. Dose, gtt. v. to 3j.
This remedy is so common and may be so easily prepared,
that it should come into more general use as a tonic and
stomachic. It improves the appetite and strengthens diges-
tion, exerting its influence more especially upon the upper in-
testine. It influences the urinary organs, but its action in
this direction needs to be studied.
POTASSA,
(POTASH.)
The officinal Liquor Potassæ is the preparation I recom-
mend, and this may be employed in doses of from one to ten
drops in a glass of water,
One of the strongest indications for its use is frequent de-
sire to pass water, with sense of contraction in the perineum,
difficult urination, or strangury. Deposits of uric acid are
sometimes removed by the administration of small quantities
of this remedy, and the irritative dyspepsia so frequently
associated with it is also relieved. It may also be used in
some cases of acne (of the face) skin disease in obese persons,
and in some cases of scrofula, the patient being well nour-
ished.
POTASSE PERMANGANAS.
(PERMANGANATE OF POTASH.)
This salt, when pure, is in the form of slender prismatic
crystals, of a dark purple color. It dissolves in five times its
weight of water, the solution being a very dark purple. It
this solution, in any preparation, shows a brownish or muddy
tinge, the salt should be rejected. I am thus particular in
describing its physical properties, for there has been a large
amount of worthless material sold.
We use Permanganate of Potash principally as a local ap-
POTASSEÆ.
209
plication where we have need of an antiseptic and stimulant.
The indications for its use are, where the tissues are swollen
from infiltration into the connective tissue. In cases of
wounds, we will notice that the edges are swollen, and the
process of repair stops. The infiltration continuing, the pus
becomes watery and ichorous, granulations pale and flabby;
the parts separate, and finally slough. In inflammation we
have very nearly the same indications for its use-the inflam-
mation always being of a low grade, and showing infiltration
of cellular tissue.
As a topical application, it will many times arrest the pro-
gress of carbuncle, felons, and like inflammations—a strong
solution being employed. In a solution of ten grains to the
ounce of water, it has been used as an injection in gonorrhoea,
to destroy the virus; afterwards in the strength of two grains
to the ounce, until the cure is complete.
POTASSÆ SESQUI-CARBONAS.
(SESQUI-CARBONATE OF POTASH.)
This has proven one of the most useful remedies in our
materia medica, and I do not care to give it up, though it is
declared to be an imperfect chemical product. One who has
used it will be satisfied that we have yet nothing that will
take its place.
In chronic disease of bone, and in caries, it exerts a most
kindly influence upon the diseased tissues, promoting the
removal of the dead bone, and at the same time stimulating
the living. In disease of the soft tissues going on to suppu-
ration, the same may be said, the local application promoting
the removal of dying tissue in suppuration, yet strengthen-
ing the tissues adjoining. This may be noticed especially in
the treatment of carbuncle, as the thorough injection with a
saturated solution of sesqui-carbonate of potash arrests the
progress of the disease, and establishes healthy suppuration.
In using the remedy for these purposes we usually employ
a full strength solution thoroughly applied, or in some cases.
the powder is applied.
18
210
SPECIFIC MEDICINES.
POTASSII ACETAS.
(ACETATE OF POTASH.)
The Acetate of Potash is the typical renal depurant, and
when it is deemed necessary to increase the process of retro-
grade metamorphosis in the blood, and at the same time in-
crease elimination by the kidneys, this remedy may be
employed.
In many forms of disease it becomes necessary to remove
old and broken down tissues before a cure can be effected.
It is impossible to make good blood, if there are old and
effete materials in it, as it is impossible to improve nutrition
if the old tissues can not be gotten out of the way.
Thus in some cases of chronic ague, it is true, as claimed
by Dr. Golding Bird, that ten days or two weeks of acetate
of potash will cure when antiperiodics have wholly failed.
This is also true in some remittent fevers, as well as inflam-
mations. I have been accustomed to say to my classes that
I should rather have acetate of potash in cases of scrofula,
and inflammations with cacoplastic deposits, than all the
compound syrups that were ever concocted.
Acetate of potash should be used, largely diluted, to the
extent of grs. xxx. to 3iij. in the course of twenty-four hours.
POTASSII BICARBONAS.
(BICARBONATE OF POTASH.)
With a leaden pallor of tongue, and feeble, tremulous mus-
cles, potash may be given with advantage, and the bicarbo-
nate will usually be better borne than liquor potassæ, or the
other salts. With this indication prominent, the remedy
will cure rheumatism, be a benefit in fevers and inflamma-
tions, and relieve many forms of chronic disease.
It should be known that there is a marked difference be-
tween the action of soda and potash, even as a bath, and
some care should be used in their selection. The "alkaline
bath" so frequently used and steadily recommended by the
earlier Eclectics, was not a soda bath. It was “broke-water,"
POTASSII FERROCYANURETUM.
211
or water rendered alkaline with wood ashes; and this will be
found much better in many cases than the modern alkaline
bath prepared with bicarbonate of soda.
POTASSII CHLORAS.
(CHLORATE OF POTASH.)
The indication for Chlorate of Potash is the peculiar fetor
resembling decomposing animal matter; a fetid lochial dis
charge or menstrual flow has the characteristic odor. In
cynanche maligna, and occasionally in diphtheria, we have
the characteristic dissecting-room smell, as we have in the
worst forms of influenza. In all of these cases we administer
chlorate of potash, and use it as a local application.
It is especially the remedy in the puerperal state, when
puerperal fever is feared from retained placenta, decomposi-
tion of blood-clots, or from the absorption of an unpleasant
lochial discharge. Of course the physician will not allow a
placenta to be retained at full term, but previous to the fifth
month it may not be so easy to remove it. and the patient
suffers less from its retention than she would from forcible
removal. In such cases I always feel that my patient is safe
if I prescribe chlorate of potash.
I am very careful not to administer chlorate of potash if
the mucous membranes are dry, and there is a scanty secre-
tion of urine, and I never employ it in scarlet fever. The
danger in these cases is, that it irritates the kidneys, and may
produce desquamative nephritis. Much injury has followed
its injudicious use, and many lives have been lost because
physicians have regarded it as so innocuous an agent.
POTASII FERROCYANURETUM -
(PRUSSIATE OF POTASH.)
This is a remedy I value very highly, and though little used
it is certain to become a favorite. We find it in market in
the form of prismatic crystals of a clear lemon-yellow color,
inodorous, possessed of a sweetish-bitter saline taste. If the
212
SPECIFIC MEDICĪNES.
salt is dirty, dark-colored, or parti-colored, it should be re-
jected. We prepare it for use by adding 3ss. to water, 3iv.
Dose, one teaspoonful every three hours.
In chronic disease where there is marked irritability of
the nervous system, with frequency of pulse, we will find it
an excellent remedy. It lessens irritation of the nervous sys-
tem, and acts as a special sedative to the circulation. In
chronic disease of the reproductive organs in women, with
hysterical manifestations, it exerts a direct and marked in-
fluence so in hypochondriacal affections in the male.
It exerts a decided influence upon mucous membranes.
When they are pallid, lax, and give increased secretion, the
Prussiate of Potash may be used with advantage. It makes
little difference, whether of nose, throat, bronchial tubes, in-
testinal mucous membrane, or chronic vaginitis with leucor-
rhoea, the influence is the same.
This will suggest to the practitioner the cases in which it
may be tested: when there is excitation, but impaired nutri-
tion of the nerve centres, and where there is feebleness of
mucous membranes with increased secretion of mucus.
POTENTILLA CANADENSIS.
(CINQUEFOIL.)
A tincture is prepared from the fresh plant, using alcohol
of 98 per cent. The dose will vary from the fraction of a
drop to ten drops.
It has been strongly recommended when puerperal fever is
feared, and it is claimed that it will cure puerperal fever
when developed. It has also been given in active uterine
hemorrhage, leucorrhoea, vesical irritation, diarrhoea and
dysentery.
PRIMULA OFFICINALIS.
(PRIMROSE.)
Prepare a tincture from the fresh plant, whilst in flower,
using alcohol of 98 per cent, The dose will vary from the
fraction of a drop to ten drops.
PROPYLAMIN.
213
It is indicated by extreme sensitiveness, pain from slight
impressions, restlessness and insomnia. The case in which
it may be tried is suggested by these indications.
PRINOS VERTICILLATUS.
(BLACK ALDER.)
Preparation.-Prepare a tincture from the recent bark of
the Black Alder, in the proportion of 3 viij. to alcohol 76 per
cent. Oj. Dose from gtt. v. to 3ss.
This remedy is a stimulant to the digestive and blood-mak-
ing organs, and may be advantageously employed for the gen-
eral purposes of a tonic. But beyond this, it influences the
vegetative processes, probably through the sympathetic sys-
tem of nerves, strengthening the circulation, aiding nutrition,
and the removal of waste. We have used it but little, yet
the testimony in its favor is such, that we strongly recom-
mend its trial.
PROPYLAMIN.
The Propylamin of commerce is obtained from herring
pickle, and is in the form of a colorless transparent liquid;
the muriate is in the form of powder and is about two-thirds
of its strength. We prepare it for use by adding twenty-four
drops, or thirty-six grains of the muriate of Propylamin to
six ounces of mint water, the dose of which will be from a
tea to a tablespoonful.
Investigation has determined that Propylamin is the same
as the secalin derived from ergot. My use of the remedy
clearly proved the analogy between the Propylamin and er-
got in its poisonous effects.
The remedy was introduced by Dr. Owenarius of St. Peters-
burg, Russia, as a specific for rheumatism, and a large num-
ber of cases were reported in which it had proven curative
in a short time. This was in 1856, and it was tested in this
country as well as in Europe, but without very satisfactory
results.
214
SPECIFIC MEDICINES.
I employed it in quite a number of cases of rheumatism,
and at first thought very favorable of its action, but devel-
oping marked typhoid disease in some cases I became
alarmed and dropped it. I am confident it possesses a
marked influence upon the animal economy, but unless used
with care, it is as likely to be for evil as good. I developed
a typical typhoid fever with it, that ran a course of five weeks,
with intestinal irritation, rose-colored spots and typhomania.
It was evidently due to the medicine, as when its adminis-
tration was commenced it was a case of simple inflammatory
rheumatism about the fifth day, and there was no such thing
as typhoid fever that year.
In employing the Propylamin in the treatment of rheuma-
tism, I think it necessary to first bring the circulation fully
under the influence of the sedatives, and then establish se-
cretion-now the remedy may be used with safety.
In doses much smaller than named, I feel confident the
Propylamin will be found a stimulant to the entire vegeta-
tive functions. It strengthens the circulation, improve nu-
trition, and stimulates waste and secretion. In these direc-
tions it deserves thorough investigation. The proportions
I would recommend would be gtt. v. to gtt. x. to mint water
3iv., a teaspoonful every three or four hours. Or better, R
Muriate of Propylamin, grs. x. ; sugar of milk, grs. 1000; tri-
turate thoroughly; dose, one to five grains.
PRUNUS VIRGINIANA.
(WILD CHERRY.)
The tincture of Prunus should be prepared from the fresh
inner bark, in the proportion of 3 viij. to alcohol 50 per cent.
Oj. Dose from gtt. v. to 3ss.
In addition to its tonic influence, which it possesses in
common with many of our indigenous bitters, it has other
valuable medicinal properties. It allays irritation of mucous
membrane, both of the gastro-intestinal canal, the respira-
tory tract, and urinary apparatus. This will probably prove
its most important use. The influence upon the circulation
PTERIS ATROPURPUREA.
215
and upon secretion is not decided, but in atonic states will
sometimes be found very desirable. In some of these cases
I have combined it with the tincture of nux vomica or solu-
tion of strychnia, with excellent results.
The remedy is so common, and so easily prepared, that it
should find a place in every office, and I have no doubt that
as it is employed, other uses than those named will be de-
veloped.
PTELEA TRIFOLIATA.
(WAFER ASH.)
Preparation.-Prepare a tincture from the bark of the root,
3viij. to alcohol 76 per cent. Oj. Dose, gtt. j. to 3ss.
Ptelea is an excellent tonic, hardly surpassed in its general
uses by any agent of our materia medica, if we except hy-
drastis. It may be employed in all atonic states of the stom-
ach and upper intestinal canal, when it is desirable to in-
crease the appetite and digestion. It exerts a specific influ-
ence in some cases of asthma, giving present relief, and
effecting permanent cures. I have used it in a considerable
number of these cases, but can not give any symptoms which
would lead me to prescribe this in preference to other
remedies.
PTERIS ATROPURPUREA.
(ROCK-BRAKE.)
A tincture should be prepared from the entire fresh plant,
3viij. to alcohol 76 per cent. Oj. Dose from gtt. j. to gtt. x.
This remedy has been but little used except in domestic
practice. It exerts a marked influence upon the excretory
apparatus, controlling diarrhoea, dysentery, night sweats,
hemorrhages, etc. This may depend to some extent upon its
tannic acid, but there is an influence beyond this. Will some
of our practitioners prepare a tincture and test it, and
report?
216
SPECIFIC MEDICINES.
PTEROSPORA ANDROMEDA.
(CRAWLEY.)
Preparation.-Prepare a tincture from the fresh plant and
root, 3 viij. to alcohol 76 per cent. Oj. Dose from gtt. j. to v.
The Crawley is a very scarce article, and in the market
commands a high price. When the practitioner can obtain
it and prepare it himself, he will find it one of the most val-
uable of the materia medica. It possesses decided sedative
properties, and may be employed for this purpose, but its
principal use is to establish waste and excretion. Following
or associated with veratrum or aconite, there is no remedy
that will more quickly and certainly establish secretion from
skin and kidneys. It is probable that other uses will be de-
veloped by experiment.
PULMONARIA OFFICINALIS.
(LUNGWORT.)
Preparation.-Prepare a tincture from the fresh leaves,
Zviij. to alcohol 50 per cent. Oj, Dose from one drop to 3ss.
The Lungwort has a popular reputation as a remedy in
diseases of the chest. It would be well to test it thoroughly
and determine its medicinal action in this direction.
PULSATILLA PRATENSIS.
(PULSATILLA.)
We employ the German tincture prepared from the fresh
herb according to the homoeopathic pharmacy. That pre-
pared from the imported dried herb will not give good satis-
faction. We usually prescribe it in this proportion: R Tinct.
of Pulsatilla gtt. x. to 3ss.; water, 3iv. A teaspoonful every
four hours.
The principal use of Pulsatilla is to relieve certain cere-
bral symptoms with difficulty relieved by other remedies. In
some diseases of women, in spermatorrhoea and prostator-
rhoea, in heart disease, and some other chronic affections, we
find certain head symptoms playing an important part, and
PULSATILLA.
217
giving a good deal of trouble. The patient is nervous, rest-
less, has an active imagination for disease, a fear of impend-
ing danger, etc. These symptoms are very unpleasant, and
not unfrequently prevent the curative action of remedies.
Pulsatilla reaches them and gives prompt and certain relief.
I would not treat some cases of spermatorrhoea without I
could employ this remedy. For with the unnatural excite-
ment of the mind, no remedy would exert a curative influ-
ence So in some cases of heart disease, the head symptoms
are the most prominent and unpleasant features. Relieve
the unpleasant mental sensations and dread of danger, and
we have removed a permanent cause of excitement.
Though Pulsatilla is the remedy for nervousness, it must
not be given with any expectation of benefit where the ex-
citement depends upon irritation and determination of blood.
In this case it will either exert no influence or it will be un-
favorable.
The Pulsatilla exerts a marked influence upon the repro-
ductive organs of both male and female. I regard it as de-
cidedly the best emmenagogue, when the suppression is not
the result of or attended by irritation and determination of
blood; where there is simple suppression from atony or ner-
vous shock, it may be used with confidence. In male or fe-
male it lessens sexual excitement. It does not diminish sex-
ual power, but rather strengthens it by lessening morbid ex-
citement.
There are other uses for the remedy, but those I have
named are prominent ones, and readily recognized. I value
the remedy very highly, and am satisfied from an experience
of twenty years in its use that I do not overestimate it.
PYRETHRUM PARTHENIUM.
(FEVERFEW.)
Preparation. Prepare a tincture from the fresh plant,
3 viij. to alcohol 76 per cent. Oj. Dose from gtt. j. to 3ss.
The Feverfew has the reputation of being an admirable
tonic, at the same time being one of the most pleasant of its
19
218
SPECIFIC MEDICINES.
class. It influences the entire intestinal tract, improves the
appetite and digestion and stimulates secretion. It also ex-
erts an influence upon the skin and kidneys. This is one of
the little used medicines that deserves careful study, and a
it is cultivated in our gardens it is within the reach of all.
PYROLA ROTUNDIFOLIA.
(FALSE WINTERGREEN.)
Preparation.-Prepare a tincture from the fresh plant,
3viij. to alcohol 76 per cent. Oj. Dose from gtt. j. to 3ss.
This is also likely to prove a valuable remedy, and deserves
to be studied. It has marked tonic properties, and exerts an
influence upon the urinary organs, relieving irritation. It is
claimed to exert an influence upon the nervous system, and
to have been successfully employed in convulsions and
epilepsy.
PYRUS, MALUS.
(APPLE TREE.)
Preparation.-Prepare a tincture from the fresh root-bark
of the Apple-tree, 3 viij. to alcohol 76 per cent. Oj. Dose
from gtt. v. to 3ss.
Though so common and easily prepared, this remedy has
been but little studied. It possesses tonic and antiperiodic
properties, and may be employed in a great many cases in-
stead of more costly remedies. The only use I have made of
it was in the intermittent fevers, and whilst it was not a sub-
stitute for quinia, it evidently exerted a good influence upon
the disease, especially in preventing a recurrence of the
paroxysms.
QUERCUS RUBRA.
(RED OAK.)
The Red Oak is not only astringent from its tannic acid,
but it possesses other properties which render it useful in
some cases. Among them is its tonic influence, and its action
upon skin and kidneys. I have used it in chronic eczema
QUINIA SULPHAS.
219
associated with rumex, both as a local and internal remedy,
with marked advantage. A combination of quercus rubra,
rumex and alnus is my favorite remedy in obstinate cases of
scrofula where there are old ulcers, feeble tissues and cica-
trices. In these cases I use it as a local application and as
an internal remedy.
I have employed it principally in infusion and decoction,
but for experiment would recommend the preparation of a
tincture, 3 viij. of the fresh inner bark to alcohol 76 per cent.
Oj. Dose from gtt. j. to 3ss.
QUINIA SULPHAS.
(QUININE.)
There is no occasion to give a lengthy description of the
specific action of Quinine, as every reader is thoroughly con-
versant with it. But it may be of use to some to state the
conditions necessary to its kindly and medicinal action.
Probably there is no remedy in the materia medica which
gives so many failures as this, and I think we may be safe in
assuming that it is given ten times where its specific action
is obtained once. Every one will recollect cases in which it
did not break up periodic disease, many more cases in which
its influence was but temporary, a large number in which it
produced unpleasant cerebral symptoms, and some in which
a quinia disease was developed, which was much worse than
the original malady.
Why is this? Is it the fault of the remedy, the fault of
the patient, or the fault of the practitioner? O, the doctor
answers, it is from idiosyncrasy! So we believe, but we locate
the idiosyncrasy in the doctor's head, and not in the patient.
I have taught for years, that if we are to expect the kindly
and curative action of quinia, the stomach must be in condi-
tion to receive and absorb it, and the system in condition for
its action. If we have a proper condition in these respects,
we will hear nothing of roaring in the ears, vertigo, etc., but
its action will be most kindly. The rule is very simple-
Given, a soft and open pulse, a moist skin, moist and cleaning
220
SPECIFIC MEDICINES.
tongue, and Quinia will act kindly, antidote the malarial poi-
son, or in small doses improve innervation. Always get this
condition before prescribing the remedy, and you will never
be disappointed in its action.
As an antiperiodic I believe in prescribing single doses.
Put the stomach in proper condition, regulate the circula-
tion, establish secretion, and then give one full dose of the
remedy, (10 to 15 grs.) The best form of the remedy is in
solution with one or two ounces of water, using a sufficient
quantity of sulphuric acid.
This is not only the most certain method of administration,
but I think it will be found the most pleasant.
It is hardly necessary to impress upon the reader the
necessity of determining the periodic element in disease.
Whilst we may not know what it is, or how Quinine antidotes
it, we know that its removal cures, or at least paves the way
to a cure.
But Quinine is not specific to all agues. We see it given
day after day, week after week, in many cases, without any
advantage. But on the contrary, it excites the nervous and
vascular systems, and at last produces a chronic erythism of
them, that is correctly named "the Quinine disease." From
this, recovery is far more difficult than from the malarial
affection.
Is it possible, then, to determine the cases in which Qui-
nine will prove specific, and the cases in which it will fail?
I think it is. It antidotes the malarial poison only when
kindly received and absorbed, and when the system is in such
condition that it can be readily excreted. Given, the condi-
tion of pulse, skin and tongue, that we have already named,
and its action is as certain as could be desired.
In some cases, the general treatment directed to obtaining
normal activity of the various functions, is the most success-
ful. In other cases nux vomica or strychnia is preferable.
In others, minute doses of arsenic antagonize the malarial
poison. Whilst in some rare cases, I have treated the dis-
ease most successfully with aconite and belladonna.
RANUNCULUS.
221
As a stimulant to the cerebro-spinal centers, its use is very
important. In many forms of disease, especially in the ad-
vanced stages, we find an impaired innervation, preventing
functional activity, or its restoration and continuance by the
use of remedies. It is essential to success that innervation
be increased, not temporary by the use of stimulants, but
somewhat permanently. This we accomplish by the admin-
istration of small doses of Quinine (grs. to grs. ij). Even
here, we find it necessary to observe the rules for its adminis-
tration already noticed-the patient must be prepared for
its use.
It favorably influences the nutrition of the nerve centers,
and hence is employed in the treatment of chronic disease
with enfeebled innervation, with marked advantage. There
are two classes of chronic disease in which it is useful—the
one in which there is a malarial influence, with obscure peri-
odicity, and the other the enfeebled innervation, as named
above.
Its general tonic and stomachic influence (when obtained),
is most certainly from its action upon the nervous system-
the influence extending to the sympathetic ganglia, as well
as to the cerebro-spinal centers. In some cases this action
is very important, improving digestion and blood-making, and
nutrition, as well as waste and excretion-aiding "the renewal
of life."
RANUNCULUS BULBOSUS.
(CROWFOOT.)
Preparation.-Prepare a tincture from the fresh root in the
proportion of 3viij. to alcohol 76 per cent Oj. Dose, the
fraction of a drop, very largely diluted with water. The
remedy is exceedingly acrid, and must be used with care.
Prof. King reports the cure of nursing sore mouth by its
internal administration in small doses in infusion. It has
also been employed as a stimulant to the vegetative processes
with reported good results. It should be thoroughly tested,
222
SPECIFIC MEDICINES.
and we will be obliged to any one of our readers for a report
Prescribe it in about the following proportion: R Tincture
of Ranunculus gtt. x., water iv. Dose, a teaspoonful
RHAMNUS CATHARTICUS.
(BUCKTHORN.)
Two preparations of this agent may be used. Prepare a
tincture from the fresh bark, in the proportion of 3viij. to
alcohol 76 per cent. Oj. Dose, gtt. vj. to gtt. xxx. Prepare
a tincture from the berries, in the proportion of 3 viij. to
alcohol 76 per cent. Oj. Dose, from the fraction of a drop to
two to five drops, largely diluted with water,
Buckthorn berries have been employed as a cathartic, but
their activity, attended with nausea, dryness of the throat,
thirst and tormina, made their use limited. The tincture of
the berries in small doses may be tested for its influence on
the digestive apparatus, in diseases of the nose, throat, and
respiratory organs, and as a stimulant to the vegetative pro-
cesses.
It is claimed that a preparation from the bark gives one of
the most efficient alteratives of the materia medica. Dr.
William Goltry claimed that a tea made of the bark or ber-
ries would cure cancer and scrofulous diseases generally.
Dr. William S. Knight writes, "I have been using the Rham-
nus Catharticus in all forms of scrofulous disease for the last
two years (1866) with good effect. I make an infusion from
the bark, and let the patient drink as much as he well can
during the day, so as not to act too much upon the bowels."
The bark of the Rhamnus Frangula is employed in Ger-
many as a laxative and cathartic, and is very similar in its
action to the bark of the Rhamnus Catharticus. Prepared
in the form of a tincture, either of them is quite as good as
the extensively advertised Rhamnus Purshiana, and proba-
bly not quite so nasty.
RHEUM.
223
RHAMNUS PURSHIANA.
(CASCARA SAGRADO.)
A incture is prepared from the bark of this western spe-
cies of Rhamnus, using alcohol of 76 per cent. As a laxa-
tive and cathartic, it is used in doses of gtt. v. to 3j.
It is probably slightly milder than the other species, and
not so inclined to produce tormina. All the varieties, if used
in moderate doses, leave the bowels in a soluble condition,
and they may thus overcome habitual constipation, and the
dyspepsia that is sometimes associated with it. If the Amer-
ican species proves better than the others, it will be well, for
as it is very abundant, it will furnish a cheap cathartic med-
icine for those who must have drugs of this class.
RHEUM PALMATUM.
(RHUBARB.)
Preparation.-Prepare a tincture from the best Russian,
Turkey, or India Rhubarb, in the proportion of 3viij. to
alcohol 50 per cent. Oj. Dose, from the fraction of a drop
to ten drops.
It is not necessary to speak of the common use of Rhubarb,
as there is no remedy better known and more used. But it
will be noticed that we have recommended a wholly different
preparation, and we propose to dispense it in the small doses
for its direct action.
In the proportion of R Tincture of Rhubarb, 3j., water,
3iv.. a teaspoonful every half hour or hour, it will be found
one of our best remedies to control irritation of the stomach,
and arrest vomiting. In children it is especially useful,
where there is nervous irritability, manifested by restlessness,
screams, and convulsive contraction of muscles.
In the same doses, less frequently repeated, it will prove
an excellent tonic, strengthening the functions of both stom-
ach and intestines. giving improved digestion. In indigestion,
with some diarrhoea, of a papescent character, it will be
found a good remedy.
224
SPECIFIC MEDICINES.
In some cases it will prove our best remedy in the treat-
ment of obstinate constipation. The cases are those in which
there is an unnatural sensation of constriction in stomach
and bowels, and contraction of the abdominal muscles. I
prescribe it in these cases in doses of ten drops to a large
glass of water, on rising in the morning. In the severer
cases it is associated with thorough fatty inunction over the
abdomen, and friction.
I employ it as a restorative, where there is special need of
increased nutrition of nerve tissue. It is thus associated
with the preparations of phosphorus, and with cod liver oil.
RHODODENDRON CHRYSANTHUM.
(RHODODENDRON.)
A tincture is prepared from the fresh leaves and flowers
collected in September; that we employ is imported from
Germany. Two native species-the R. Maximum and R.
Punctatum possess similar properties, but much milder,
and should be tested.
The influence of the Rhododendron on the circulation is
very marked, It undoubtedly acts like veratrum and aco-
nite, stimulating the circulatory apparatus through the sym-
pathetic, and diminishing the frequency of the pulse by in-
creasing the power of the heart, and removing capillary ob-
struction. Acting in this way, it has been employed with
advantage in rheumatism, gout, syphilis, and some acute dis-
eases. It is claimed to exert an influence upon the repro-
ductive apparatus, being used in orchitis, in suppression of
gonorrhoea, and in hydrocele. It has been but little employed
in this country, but our native specimens deserve a thorough
examination.
RHUS GLABRUM.
(SUMACH.)
Preparation.-Prepare a tincture from the fresh root bark,
3viij. to alcohol 76 per cent. Oj. Dose from gtt. v. to xx.
The Sumach as thus prepared exerts a direct influence
RHUS.
225
upon the processes of waste and repair-alterative. It has
not been much used, and we can not tell whether it will
prove better than others of this class; still it deserves a
thorough trial. It is claimed to be antidotal to the action of
mercury, especially in chronic mercurial disease, and has
been employed in the treatment of secondary syphilis, after
mercurialization, with advantage.
RHUS TOXICODENDRON.
(POISON OAK.)
Prepare a tincture from the recent leaves, 3viij. to alcohol
98 per cent. Oj. Added to water in the proportion of gtt. v.
to gtt. x. in živ., the dose is a teaspoonful. The R. Radicans,
R. Venenata, and R. Pumilum may be prepared in the same
manner, and deserve a thorough investigation.
The indications for Rhus may be briefly summed up as
follows: Sharp pain in frontal region, especially in left orbit,
sharp stroke of pulse; tip of tongue showing small red
points on upper surface; local pain sharp and burning; burn-
ing pain of surface; bright redness of surface. With such
indications it may be administered in any form of disease
with a certainty of benefit.
The Rhus has proven one of our most valuable medicines,
and will be highly prized by every practitioner when its use
is learned. It is antidotal to such animal poisons (zymotic)
as determine to the skin, in erysipelas or erysipeloid disease,
or in low grades of inflammation of cellular tissue, or in low
grades of inflammation of mucous membranes. A frequent,
small pulse, redness of mucous membranes, brown sordes,
bright superficial redness of skin, tympanitis, acrid discharges
from bowels or bladder, are indications for its use. So also
is inflammatory action, presenting tumid, bright reddened
tissues, deep seated or superficial burning pain, inflammation
giving an ichorous discharge, in which the tissues seem to
melt away without sloughing. Old ulcers, that present red-
dened, glistening edges, scrofulous or syphilitic disease, with
tumid-red, glistening swellings.
226
SPECIFIC MEDICINES.
I have preferred to thus point out distinctly the indica-
tions for the use of the Rhus, without reference to the dis-
ease, according to our present nomenclature. It will be seen
to point to erysipelas, typhoid fever and typhoid disease in
general, and the entire list of zymotic diseases.
Our Homœopathic friends give the following indications
for its use:
'Affections of the ligaments, tendons and synovial mem-
branes; tensions, drawing and tearing in the limbs, worse
during rest, and in the cold season, or at night, in bed, fre-
frequently attended with numbness of the affected part after
moving it; creeping pains; sensation in inner organs as if
something would be torn loose; lameness and paralysis, also
hemiplegia; vesicular erysipelas; rhagades; pustules which
break and discharge a fluid; hang-nails; red, shining swel-
ling; violent and spasmodic yawning; evening fever, with
diarrhoea; sweat during the pains, frequently with violent
trembling; illusions of the fancy, and delirium; pain as if the
brain would be torn; painful creeping in the head; swelling
of the head; phagedenic scald-head; small, soft tumors on
the hairy scalp; swelling and inflammation of the parotid
glands; acne rosacea around the mouth and chin; nightly
discharge of yellowish, or bloody saliva; ulcerative pain in
the pit of the stomach as if something would be torn off,
especially when stooping or making a false step; the small of
the back feels as if bruised, especially when lying still on it."
ROBINIA PSEUDO-ACACIA.
(BLACK LOCUST.)
Preparation.-Prepare a tincture from the fresh inner
bark of the Black Locust, 3viij. to alcohol 76 per cent. Oj.
Dose from the fraction of a drop to gtt x.
This remedy has been but little used, yet its activity is
such that we may reasonably expect that experiment will de-
velop some valuable medicinal use. It acts on the stomach
and bowels in large doses, and exerts an influence upon the
nervous system. Will some of our readers test it and report?
RUMEX.
227
RUMEX ACETOSELLA.
(SHEEP SORREL.)
Preparation.-Prepare a tincture from the fresh sorrel,
3 viij, to alcohol 76 per cent Oj. Dose, from gtt. j. to 3ss. It
is employed locally in the treatment of cancer, the following
formula being employed:
*
'Cancer Balsam.-Take the common sheep sorrel when in
bloom, bruise well in a mortar, and add a small quantity of
water; then press the weed so as to obtain all the juice, strain
it, and place in the sunshine in a pewter dish, and let it
evaporate to the consistence of honey. It is then ready for
use, and should be put up in sealed boxes or closely stopped
bottles, in order to prevent evaporation"
A tincture of the sorrel has a very decided action in those
cases where there is a tendency to degeneration of tissue.
It makes no difference whether it is called syphilis, scrof-
ula or cancer, the indication for use is the replacement of
tissue with lower organizations. To what extent it opposes
the processes of degeneration we are unable to say, the use
has been so limited, but it deserves a thorough investigation.
It influences the secretion of urine and the urinary appara-
tus, but its medicinal action in this respect has yet to be
determined.
Its use in the treatment of cancer has been quite exten-
sive, and if we can believe the reports given, it has proven
fully as successful as any other remedy. A full description
of this method of treatment will be found in the Eclectic
Medical Journal for May, 1870, page 142.
RUMEX CRISPUS.
(YELLOW DOCK.)
Preparation.-Prepare a tincture from the fresh root, 3 viij.
to alcohol 98 per cent. Oj. Dose, gtt. j. to 3ss.
We employ Rumex in cases of bad blood, with disease of
the skin; in such cases it is certainly one of the most valua-
ble alteratives we have. In these cases we not only use it
1
228
SPECIFIC MEDICINES.
internally, but as a local application. In scrofulous disease,
with deposit in glands and cellular tissue, with tendency to
break down and feeble repair, I think the Rumex unequaled.
Here, also, we use it internally and locally.
Dr. Hale reports cases of dyspepsia, with sensations of
fullness and pressure in pit of stomach, pain in the chest,
etc., cured by Rumex. Dr. Dunham employed it in catar-
rhal affections of the larynx, trachea and bronchia, with ad-
vantage. I have used it in chronic sore throat with free
secretion, and in bronchorrhoea, with good results; and also
as a remedy for cough, when the patient complains of weight
and fullness.
The general action of the remedy is to increase waste and
improve nutrition.
RUTA GRAVEOLENS.
(RUE.)
Preparation.- Prepare a tincture from the fresh plant,
3viij. to alcohol 98 per cent. Oj. Dose, gtt. j. to gtt. x., largely
diluted with water.
Though little used, this remedy will be found to possess
valuable medicinal properties. It exerts a direct influence
upon the nervons system, relieving irritation and pain, and
in small doses, continued, improving nutrition of the nerve
centers. It acts upon the urinary and reproductive appa-
ratus, and has been employed with advantage as a stimulant
to them. In large doses it is capable of exciting menorrha-
gia, inflammation, and miscarriage. The Homoeopaths claim
that it is a remedy "in eructations of hysteric females; pro-
lapsus of the rectum at every alvine evacuation; frequent
urging to urinate, with scanty emission, also of green urine,
or with renewed ineffectual urging after micturition; gravel;
miscarriage; sterility; corrosive leucorrhoea after suppres-
sion of the menses."
SALICYLIC ACID.
229
SABBATIA ANGULARIS.
(AMERICAN CENTAURY.)
Preparation.-Prepare a tincture from the fresh herb, 3 viij.
to alcohol 76 per cent. Oj. Dose, gtt. j. to gtt. xx.
The Sabbatia has had a considerable reputation as à pro-
phylactic against periodic diseases, and in their treatment—
it will be well to thoroughly investigate this action. As a
bitter tonic, it may be successfully employed in atonic states
of the intestinal canal with increased mucous secretion.
Probably it will prove useful in all diseases of mucous mem-
branes, where there is profuse secretion. It has been but
little used of late, but it deserves study.
SALICIN.
A glucoside, or neutral principle, is obtained from several
species of willow, which will serve an important purpose in
medicine when well studied. As an anti-periodic it has pro-
ven so uncertain as to have almost fallen into disuse, though,
if the case is rightly diagnosed, it will be found superior to
quinine in the few cases where it is indicated. It has also
fallen into disuse for the purposes of an ordinary bitter tonic
and restorative.
The case in which I should recommend it is the one show-
ing distinct periodicity, with rheumatic pain. In this case
it may be given in doses of two to ten grains. It is not only
anti-periodic, but anti-rheumatic.
SALICYLIC ACID.
We prefer the acid prepared from oil of wintergreen to
that made from carbolic acid, as it is less irritating, and bet-
ter borne by the stomach in its internal use, and a more
bland local application. The dose will vary from the frac-
tion of a grain to five grains; as an anti-rheumatic, two
grains every two hours, until ten or twelve grains are taken.
As an internal remedy, it is principally employed as an
230
SPECIFIC MEDICINES.
anti-rheumatic, the indication being a full, purplish or leaden
colored tongue, and locally a redness showing slight purplish
discoloration, especially when pressed upon. The large dose
(grs. x. to grs. xx.) 'is wholly unnecessary, indeed injurious,
and if indicated the remedy will prove curative in the doses
named.
In some cases the remedy will serve a better purpose if
given in solution as a salicylate of potash or soda. The pre-
scription may be- R Salicylic acid, 3ss., acetate of potash
3ij. to 3ss., water 3iv.; a teaspoonful every three hours with
water. Or-B Salicylic acid, 3j., bicarbonate of soda 3ij.; a
teaspoonful every two hours.
As a local application, we combine it with borax, or chlo-
rate of potash, both rendering the acid soluble in water.
We use it with marked advantage as a spray in chronic nasal
catarrh, chronic pharyngitis, and as an injection in some
cases of leucorrhoea or gleet.
SALIX NIGRA.
(BLACK WILLOW.)
Preparation.-Prepare a tincture from the recent bark
3 viij. to alcohol 76 per cent. Oj. Dose from gtt. j. to 3j.
Whilst this, as well as other varieties of the willow, pos-
sesses feeble tonic and antiperiodic properties, there are so
many better remedies of this class that it would be well to
dispense with its use altogether, had it no other action. But
there is a class of cases in which the Salix is a very decided
antiperiodic, and if these can be distinguished, the remedy
will be valuable. I believe it is in those in which there is
increased secretion from mucous membranes, and especially
where there is the septic tendency, marked by fetid dis-
charges, foul tongue, etc. In typhoid disease it may be
employed both as a tonic and antiseptic, using the smaller
dose named. The remedy is easily prepared, and may well
replace some inferior articles that have hitherto been em
ployed.
SAMBUCUS.
231
SALVIA OFFICINALIS.
(SAGE.)
Preparation.-Prepare a tincture from the fresh plant when
in flower 3viij. to alcohol 76 per cent. Oj. Dose, from gtt. j.
to gtt. xx.
The Sage exerts a tonic influence on the skin, and to a less
extent upon the kidneys and mucous membranes. It is not
an active remedy, and hence too much must not be expected
from it. We employ it where the skin is soft and relaxed,
with an enfeebled circulation and cold extremities. In the
treatment of colliquative perspiration it answers an excel-
lent purpose, if the condition above is maintained. If, how-
ever, the night sweat is preceded with hectic fever, and a
dry, harsh skin, it will be useless.
It will prove a good remedy in increased secretion of urine
of low specific gravity; in such cases it may be associated
with belladonna. It may also be associated with the bitter
tonics in all cases in which there is atony and increased se-
cretion from mucous membranes.
SAMBUCUS CANADENSIS.
(ELDER.)
Preparation.-Prepare a tincture from the fresh inner bark
of the Elder, 3viij. to alcohol 76 per cent. Oj. Dose, from
gtt. j. to gtt. x.
The Elder is a stimulant to all the excretory organs, in-
creasing secretion. It may be employed for the general pur-
poses of an alterative increasing waste, in syphilis, scrofula,
and other diseases attended by deposits or depravation of
tissues. It is especially useful in those cases where there is
an oedematous condition, or fullness of tissue from an in-
creased amount of water. We meet a case of chronic dis-
ease occasionally, in which the tissues are full and flabby,
evidently from two much water; in these Sambucus is a good
remedy. It may be employed in dropsy, though its action is
not so decided as the apocynum.
232
SPECIFIC MEDICINES.
As a local application the Sambucus is specific to those
eruptions that arise on full tissues (as above), and are at-
tended with abundant serous discharge. Thus in some forms
of eczema, especially eczema infantilis or milk scall, and in
the above form of the disease, it will alone effect a cure. We
also employ it in idolent ulcers, with soft oedematous borders,
and serous secretion, and in mucous patches with free secre-
tion. An ointment is prepared by simmering the inner bark
in fresh butter (old style), or a glycerole may be made, with
the addition of the usual quantity of starch.
SANGUINARIA CANADENSIS.
(BLOOD ROOT.)
Preparation.—Prepare a tincture from the recent dried root,
3viij. to alcohol 76 per cent. Oj. Dose from a fraction of a
drop to five drops. Nitrate of Sanguinarina is a valuable
preparation, and may be dispensed in syrup, in the propor-
tion of grs. j. to 3j. Dose, gtt. x. to 3j.
In full doses we employ the Sanguinaria as a stimulant to
mucous membranes. This use is valuable in bronchitis with
increased secretion, and in atonic conditions of stomach and
bowels with increased secretion of mucus. In minute doses
we employ it in cases of cough with dryness of the throat
and air passages, feeling of constriction in the chest, difficult
and asthmatic breathing, with sensation of pressure. In the
same doses it is a stimulant to the vegetative system of
nerves, and under its use there is an improvement in the cir-
culation, in nutrition, and secretion.
As a remedy in diseases of the respiratory tract, I prefer
the Nitrate of Sanguinarina to the tincture.
SANICULA MARILANDICA.
(SANICLE.)
Preparation.—Prepare a tincture from the recent root in
the proportion of 3 viij. to alcohol 76 per cent. Oj. Dose from
gtt. ij. to gtt. xx.
SARRACENIA.
233
The Sanicula has had considerable reputation as a domes-
tic remedy, and like most of them it has been employed for
very different purposes. It evidently exerts a direct influ-
ence upon the nervous system, relieving irritation, and this
probably extends to the sympathetic. It would be well to
give it a trial in those cases in which there is enfeebled func-
tion with nervous irritability.
SANTALUM ALBUM.
(SANDAL WOOD.)
The oil of Sandal-wood has been employed as a stimulant
to the urinary apparatus, and especially as a remedy in gon.
orrhoea. The action is very similar to that of copaiba, but
it is thought less offensive to taste and smell, though both
are very persistent. It is given in doses of ten to twenty
drops three times a day, usually in capsules.
SANTONIN.
(See Artemisia Santonica.)
SARRACENIA PURPUREA.
(SARRACENIA.)
•
Preparation.—Prepare a tincture from the fresh root, in
the proportion of 3 viij. to alcohol 76 per cent. Oj. Dose,
from gtt. j. to gtt. xx.
The experiments of Dr. Porcher, of South Carolina,
showed that it exerted a marked influence on the sympa-
thetic. From a large dose there was congestion of the head,
with irregularity of the heart's action, lasting several days.
Following this first effect, the general vigor of the digestive
apparatus was increased, and the appetite was unusually
active. It is claimed that it has been successfully employed
in chlorosis, and other diseases of a similar character.
It was introduced to the notice of the profession by Dr.
W. Morris, of Halifax, in 1861, as an antidote to the virus of
small-pox. He made the following statements in a letter to
the American Medical Times:
20
234
SPECIFIC MEDICINES.
'Sir-You have by this time, in all probability, heard
something of an extraordinary discovery for the cure of
small-pox, by the use of Sarracenia Purpurea, or Indian Cup,
a native plant of Nova Scotia. I would beg of you, how-
ever, to give full publicity to the astonishing fact, that this
same humble bog-plant of Nova Scotia is the remedy for
small-pox, in all its forms, in twelve hours after the patient
has taken the medicine. It is also as curious as it is won-
derful that, however alarming and numerous the eruptions,
or confluent and frightful they may be, the peculiar action
of the medicine is such that very seldom is a scar left to tell
the story of the disease. I will not enter upon a physiologi-
cal analysis now; it will be sufficient for my purpose to state,
that it cures the disease as no other medicine does not by
stimulating functional reagency, but by actual contact with
the virus in the blood, rendering it inert and harmless; and
this I gather from the fact that if either the vaccine or vari-
olous matter be washed with the infusion of Sarracenia, they
are deprived of their contagious properties. The medicine,
at the same time also, is so mild to the taste, that it may be
mixed largely with tea or coffee, as I have done, and given to
connoisseurs in these beverages to drink, without their being
aware of the admixture. Strange, however, to say, it is
scarcely two years since science and the medical world were
utterly ignorant of this great boon of Providence; and it
would be dishonorable in me not to acknowledge that had it
not been for the discretion of Mr. John Thomas Lane, of
Lanespark, county Tipperary, Ireland, late of Her Majesty's
Imperial Customs of Nova Scotia, to whom the Mec-Mac
Indians had given the plant, the world would not now be in
possession of the secret. No medical man before me had
ever put this medicine upon trial, but in 1861, when the
whole province of Nova Scotia was in a panic, and patients
were dying at the rate of twelve and a half per cent., from
May to August, Mr. Lane, in the month of May, placed the
Sarracenia in my hands to decide upon its merits; and, after
many trials then and since, I have been convinced of its
SARRACENIA.
235
astonishing efficacy. The only functional influence it seems
to have is in promoting the flow of urine, which soon becomes
limpid and abundant, and this is owing perhaps to the defe-
cated poison or changed virus of the disease exclusively
escaping through that channel. The Sarracenia, I have rea-
son to believe, is a powerful antidote for all contagious dis-
eases-lepra, measles, varicella, plague, contagious typhus,
and even syphilis-also a remedy in jaundice. I am strongly
inclined to think it will one day play an important part in
all these."
This report was confirmed by Dr. Herbert Miles, of the
British army, and Captain Hardy of the Royal Artillery.
The evidence in its favor from physicians and residents of
Nova Scotia would seem to be complete, that the Sarracenia
has a direct prophylactic influence, and a direct and prompt.
curative action when the disease is developed.
The remedy, however, has been thoroughly tried by a num-
ber of physicians in the United States, and by physicians in
private practice and in the hospitals in England, with the
report that if not entirely inert, it has no such antidotal
power as has been ascribed to it. The evidence against it is
just as positive as that in its favor.
What conclusion can we come to then? The only way we
can reconcile these opposing statements is, that the same
agent was not employed in both cases. In Nova Scotia, where
the plant is abundant, we may suppose it was used fresh; in
the United States and in England, it was dried and so old
that it had lost its medicinal properties. I am confirmed in
this opinion by my experience. Wishing to try this remedy,
I obtained three samples, and neither of these possessed in
the least degree the physical properties attributed to Sarra-
cenia. When fresh, it is bitter and astringent, leaving a some-
what pungent inpression on the fauces. The specimens I ob-
tained had no taste.
In order to give the remedy a fair trial, let us have it pre-
pared from the fresh root, obtained at the proper season. If
an antidote to small-pox, its value can not be over estimated;
236
SPECIFIC MEDICINES.
!
if it only exerts the influence over the sympathetic first
named, it will prove a valuable remedy.
SCILLA MARITIMA.
(SQUILL.)
Preparation.-Prepare a tincture from the bulb, 3viij. to
alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
In the larger dose, the Squill is a stimulant to mucous
membranes, especially those of the air passages, and may be
employed to check profuse secretion. In minute doses it re-
lieves irritation of mucous tissues and stimulates secretion.
In dropsy presenting a dry, harsh skin, parched tongue,
fevered lips, and contraction of features, the Squill may be
employed as a diuretic. In the majority of cases it has been
used with digitalis, the dose being large, but it then proved
beneficial in the opposite class of cases-where the circula-
tion was feeble.
Though it has been so extensively employed, it needs to be
re-studied.
SCROPHULARIA MARILANDICA.
(FIGWORT.)
Preparation.-Prepare a tincture from the leaves and root,
3 viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to xx.
The Scrophularia stimulates waste and excretion, and is
probably as certain in its action as any of our vegetable alter-
atives. Beyond this it seems to exert a marked influence in
promoting the removal of cacoplastic deposits. We employ
it in scrofula, in secondary syphilis, in chronic inflammation
with exudation of material of low vitality, and in chronic
skin diseases. In the latter case it is frequently used as a
local application, as well as an internal remedy.
It exerts an influence upon the urinary and reproductive
organs, and has been employed in some obscure affections of
these with advantage. Still it is feeble and slow, and too
much must not be expected from it.
SECALE CORNUTUM.
237
SCUTELLARIA LATERIFLORA.
(SKULL-CAP.)
Preparation.-Prepare a tincture from the fresh herb,
gathered whilst in flower, 3viij. to alcohol 76 per cent. Oj.
Dose, from gtt. j. to gtt. xx.
We have here another remedy that loses its medicinal pro-
perties by drying, until by age they are entirely dissipated.
I have seen specimens furnished physicians by the drug trade
that were wholly worthless; no wonder they were disappointed
in its action.
The Scutellaria exerts a direct influence upon the cerebro-
spinal centers, controlling irritation. It is possible that it
may also exert a tonic influence, favoring nutrition. It has
been employed with success in chorea, convulsions, epilepsy,
mania, etc., and especially in hysteria, monomania, and that
undefined condition that we call "nervousness." I value the
remedy highly, but only recommend it when prepared from
the fresh plant as above.
SECALE CORNUTUM.
(ERGOT.)
Preparation.-Prepare a tincture from the recent Ergot,
3viij. to alcohol 76 per cent. Oj. Dose from the fraction of
drop to 3j. Ergot loses its properties with age, and it is es-
sential, if we wish its specific action, that the tincture be
prepared from the grains of the present season.
The Ergot may be taken as the type of a specific medicine.
Its action on the uterus, when fresh and good, is so certain
and decided, that no one can fail to see that at least one rem-
edy acts directly. It is true, that there have been many
failures in obtaining this action, but this can be attributed
to worthless medicine; a large amount of that furnished phy-
sicians from drug-houses being inert from age.
Ergot may be employed in two ways, to facilitate labor.
In quite small doses, say-R Tincture of Ergot, 3i., water,
3ij., a teaspoonful every half hour or hour, it exerts a stim-
ulant influence, strengthening uterine contractions, and aid-
238
SPECIFIC MEDICINES.
ing dilatation of the os. It is especially useful in those cases
in which there is an enfeebled circulation, with puffiness of
face, and oedema of the feet-among the worst cases we are
called to treat. Associated with small doses of lobelia, it is
an admirable remedy in rigidity, the os being thick and
doughy. Its common use in large doses, in the second stage
of labor, is so well known that it need not be described.
We employ Ergot in small doses, in the latter months of
gestation, when there are false pains, with weight and pres-
sure in the pelvis, fullness of labia and uneasiness, oedema.
and especially if there is dullness and hebetude, with ten-
dency to coma. In these cases no remedy will give greater
satisfaction.
Ergot is a spinal stimulant, and influences the vegetative
system of nerves. In some respects its action is similar to
belladonna, especially upon the circulation. Not unfre-
quently, we find it necessary to alternate them in order to
maintain this influence.
In any case, marked by an enfeebled capillary circulation,
with tendency to congestion, especially of the nerve centers,
Ergot may be prescribed with advantage.
This stimulant influence upon the spinal cord and sympa-
thetic is manifested in contraction of non-striated muscular
fiber. Hence Ergot becomes an important remedy in hemor-
rhage when dependent upon atony.
SEDUM ACRE.
(STONE-CROP.)
A tincture is prepared from the fresh plant in flower, using
alcohol of 98 per cent. Ten drops may be added to four
ounces of water, and given in doses of a teaspoonful.
It relieves irritation of the nerve centers, and gives rest.
It has been employed in epilepsy with reported good results,
and will relieve the extreme sensitiveness associated with
disease of the reproductive function.
SEPIA.
239
SEMPERVIVUM TECTORUM.
(HOUSE-LEEK.)
A tincture is prepared from the fresh leaves before flow-
ering, using alcohol of 98 per cent. Of this gtt. x. may be
added to water iv., and given in doses of one teaspoonful.
It is indicated by flushed surface and stinging pains, as
from the sting of a bee or mosquito It has been used in
erysipelas and in disease of the connective tissue.
The fresh leaf split and applied to bites of insects, stings
of bees, and poisoned wounds, will sometimes giye quick
relief.
SERPENTARIA.
(VIRGINIA SNAKE-ROOT.)
A tincture is prepared from the recent root, using alcohol
of 98 per cent. The dose will vary from the fraction of a
drop to ten drops.
It is a stimulant to the skin, increasing secretion, and even.
in small doses will exert a good influence. It may also be
used when patients complain of a sensation of weight and
dragging in the loins, with scanty secretion of urine, or urine
containing the triple phosphates. A sense of fullness in the
chest, with difficult respiration, will also be an indication.
SEPIA OFFICINALIS.
(CUTTLEFISH.)
Triturations of the dried black liquid found in the cuttle-
fish, are employed by Homœopathic physicians, and valued
highly.
The leading indications ("expressions"), according to Cow-
perthwaite, are, "a peculiar cachectic aspect, yellow, earthy,
waxy complexion, with puffiness of the soft parts, and with
mental depression and apathy." Other indications are, arte-
rial throbbing, melancholy, involuntary shaking of the head,
excessive appetite, frequent micturition, and excessive sex-
ual desire.
240
SPECIFIC MEDICINES.
SENECIO AUREUS.
(LIFE ROOT.)
Preparation.-Prepare a tincture from the fresh herb
and root, 3 viij. to alcohol 76 per cent. Oj. Dose from gtt. j.
to gtt. x. (Much disappointment has been experienced from
the purchase of the crude article when old, and from worth-
less preparations. I would advise the practitioner, when it
can be obtained, to prepare his own tincture from the fresh
plant.)
The Senecio exerts a specific influence upon the reproduc-
tive organs of the female, and to a less extent upon the male.
It relieves irritation and strengthens functional activity.
Hence it has acquired the reputation of a "uterine tonic."
It may be prescribed in all cases in which there is an atonic
condition of ovaries or uterus, with derangement of function.
It makes little difference whether it is amenorrhoea, dys-
menorrhoea or menorrhagia, or whether it takes the form of
increased mucous or purulent secretion, or displacement.
The remedy acts slowly, and sufficient time must be given.
In the male we prescribe it in cases of fullness and weight
in the perineum, dragging sensations in the testicle, and dif-
'ficult or tardy urination. In both male and female we some-
times use it with advantage in painful micturition with
tenesmus.
SILICIA.
(SILICA.)
We employ the third decimal trituration of silica, in grain
doses three or four times a day.
It may be given in cases of abscess where there is a slow
and poor reparative process, or no inclination to repair; in
nasal catarrh, with obstruction, the mucous membrane being
pale, with watery secretion; perverted nutrition, disease of
the epithelial covering of skin, deformity of nails, dry and
harsh hair, etc.
SILPHIUM.
241
SILPHIUM GUMMNIFERUM.
(ROSIN WEED.)
Preparation.-Prepare a tincture from the fresh plant,
3 viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
The tincture of the root may be employed in some cases of
cough, but is not so good as from the plant.
The Rosin Weed exerts a direct influence upon the respi-
ratory tract, especially upon the nerve centers controlling the
function. Its principal use thus far has been in the treat-
ment of asthma, in some cases of which its action has been
very decided. I think the cases in which it has proven most
beneficial, are those in which there is a spasmodic dry cough,
with sensations of dryness and constriction in the throat. I
have not found it beneficial in lymphatic persons, or where
there was congestion of mucous membranes, or profuse se-
cretion.
I have employed it in the treatment of cough, with some
advantage, but can not specifiy the cases in which it was use-
ful or those in which it failed. It deserves thorough investi
gation, and will probably prove a valuable remedy. The
tincture of the root has been furnished the profession by
druggists, and the want of success with it is no evidence that
the preparation from the plant is not anti-asthmatic.
SILPHIUM PERFOLIATUM.
(INDIAN CUP-PLANT.)
Preparation.-Prepare a tincture from the fresh root,
3viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
in water.
The action of this variety of Silphium, if we are to believe
the reports of the few who use it, is very direct and certain
upon the chylopoietic viscera. It is claimed that it is one of
the best remedies in the treatment of ague-cake, and conges-
tion of liver and spleen, so frequently associated with chro-
nic intermittents. It is but little employed, but deserves
thorough investigation.
21
242
SPECIFIC MEDICINES.
SODII CHLORIDUM.
(COMMON SALT.)
I do not wish to call attention to common salt as a medi-
cine, so much as a necessity for the sick-a food. It is often
forgotten that, in our civilized life, at least, common salt is
necessary to health. Things that are so common are fre-
quently overlooked. It also seems to be forgotten that com-
mon salt is necessary to the well-being of the sick, though it
would seem that at least this should not be overlooked. A
person with protracted disease, like typhoid fever, will be
allowed to go days, and even weeks, without salt in his food,
especially if he is having a milk diet. This should be care-
fully looked after, for it may be the difference between a good
recovery and death. I have seen a marked improvement
within twenty-four hours, from the giving of salt with food,
or in the drink.
In the infantile dyspepsia of children nursing the bottle,
marked benefit will sometimes follow the addition of a small
portion of salt to the milk, and the child will make flesh and
become plump, and much to the mother's satisfaction, good
tempered. It is also a most excellent remedy in some cases
of cholera infantum.
Some years since common salt was used very successfully
in our South-western country to cure ague. It was given in
doses of from ten to thirty grains every three hours, and if
the stomach was loaded it was first used as an emetic. I have
used it successfully in a few cases, the tongue being broad
and pallid, or simply broad (natural color) but pitting where
it came in contact with the teeth.
As a local application (3ij. to 3ss. in water Oj.), it exerts a
very pleasant and cleansing influence upon mucous tissues,
and is thus used as a douche or spray in nasal catarrh, as a
gargle in pharyngitis, and as an injection in leucorrhoea and
gleet.
A solution of common salt (grs. v. to grs. xx. in water 3j.)
is a most excellent stimulating collyrium, and will sometimes
SODII SULPHAS.
243
cure chronic conjunctivitis. It is certainly one of the best
remedies we have for disease of the canaliculi and lachrymal
sac.
SODII SULPHAS.
(SULPHATE OF SODA.)
To stimulate the process of retrograde metamorphosis, and
stimulate excretion, we use a very dilute solution of sulphate
of soda, say ten to twenty grains to the pint of water, to be
taken freely. In this way we obtain the effects of some of
the best mineral waters (laxative sulphur waters.) In cases
of gall-stones (deposits of cholesterine), this will be found an
excellent treatment; as it will when the tissues are full, pale
and sodden, the tongue also full and pale, and pitting where
it comes in contact with the teeth.
A solution of sulphate of soda is also one of the best rem-
edies for lead poisoning, and may be used by workers in lead
as a prophylactic. Whilst the iodide of potash would be
preferred in severe cases, the sulphate of soda is borne for a
much longer time.
SODII HYPOSULPHIS.
(HYPOSULPHITE OF Soda.)
SODII SULPHIS.
(SULPHITE OF soda.)
It is well to procure these salts of reliable manufacturers
(say Powers & Weightman), as there are many imperfect
specimens in the market. The first is in the form of large
colorless transparent crystals, freely soluble in water, the sec-
ond in white prismatic crystals soluble in four parts of cold
water: a want of solubility should cause the preparation to
be rejected. It should be kept tightly corked, for it changes
by exposure to the air. Dose, grs. v. to grs. xxx. every two
or three hours.
In the first part of this work (Alkalies), will be found the
general indications for the use of alkaline salts. They are
244
SPECIFIC MEDICINES.
very distinct, and can not be mistaken-pallid mucous mem-
branes, and white coating on the tongue.
We employ the Sulphite and Hyposulphite of Soda as an-
tizymotics, where there are the indications for the use of an
alkaline salt as above. As a general rule, the indications
for these salts will be-pallidity of mucous membranes, with
a thick, pasty, white or dirty-white fur upon the tongue.
The influence of zymotic causes of disease on the fluids
and solids is not well understood, but we know that it im-
pairs their life, even if it does not cause more rapid sepsis
In some cases this impairment of vital power is all the
change that can be noted, retrograde metamorphosis pro-
gressing more slowly than in health or ordinary disease. But
the remedies we are studying are more than antiseptics-they
antagonize the zymotic cause whether it produces sepsis
or not.
In local diseases from a zymotic cause, as diphtheria, cy-
nanche maligna, some forms of catarrh and influenza, erysip-
elas, surgical fever, etc., these remedies exert their specific
action when locally employed, as well as in their internal ad-
ministration. The indications, however, must be as named
above-pallidity, with pasty exudates upon tongue.
Their action in arresting the growth of microscopic fungi,
and during diseases arising from this cause, is specific. In
yeasty vomiting, presenting sarcina ventriculi, the disease is
speedily checked by the Sulphites. In some forms of ap-
thous sore mouth and throat, speedy relief is given by their
local application. Some chronic skin diseases are rendered
very stubborn by these minute growths, and here also the
Sulphites will prove valuable.
SULPHUROUS ACID.
We consider the Sulphurous Acid here, rather than under
the head of Acids, from its relations to the Sulphites just
noticed. We employ it as an anti-zymotic, and a parasiticide,
and not for the common purposes of an acid, though here, as
SULPHUROUS ACID.
245
in the cases of the alkaline sulphites, there must be the gen-
eral indications for an acid, as there was with them for an
alkali.
The Sulphurous Acid, like the alkaline sulphites, specifi-
cally antagonizes zymotic causes of disease. It is well to
keep in mind the fact that this is something more than sim-
ply arresting or modifying the septic process, for we have
already seen that the zymotic influence frequently destroys
the life of the fluids and solids without producing putres-
cency. We prescribe sulphurous acid as an anti-zymotic in
cases which present reddened mucous membranes, with
brownish coatings of tongue and sordes. Given, the indica-
tions for the use of an anti-zymotic, with the indications for
the use of an acid, and we select the sulphurous acid.
Sulphurous acid may be employed in yeasty vomiting, in
apthous mouth and throat, or wherever the presence of mi-
croscopic fungi is suspected, with the same certainty as the
sulphite of soda. We also use it in porrigo, trichosis of
scalp, and ptyriasis versicolor, with excellent results. As a
local application it should be diluted with from two to six
parts of water.
I wish to call especial attention to its use in some diseases
of the throat, by the spray or atomizing apparatus. In diph-
theria, with dark redness of mucous membranes, and fullness
with relaxation, there is no local remedy equal to sulphurous
acid spray. It is equally beneficial in those cases of cynanche
maligna, with dark redness of mucous membranes. Whilst
in ordinary sore throat from cold, with dusky discoloration,
it offers one of the best local applications in the materia
medica.
SODII NITRAS.
(See Nitrate of Soda.)
SODII PHOSPHAS.
(See Phosphate of Soda.)
246
SPECIFIC MEDICINES.
SOLANUM DULCAMARA.
(BITTERSWEET.)
Preparation.- Prepare a tincture from the fresh twigs
gathered in the fall, when the leaves have fallen, 3viij. to
alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
The Bittersweet has the reputation of being a good alter-
ative, in cutaneous diseases, syphilis, scrofula, and inflamma-
tory deposits, and we conclude that it increases waste and
excretion. It exerts a marked influence upon the cerebro-
spinal centers, when used in large doses, but this has not
been studied.
I would advise the employment of the remedy in small doses
in those cases of chronic disease in which the circulation is
feeble, the hands and feet cold and purplish, with fullness of
tissues and tendency to oedema. I do not know that it will
prove better than other remedies, but it deserves investi-
gation.
SOLANUM NIGRUM.
(GARDEN NIGHTSHADE.)
Prepare a tincture from the fresh herb in bloom, using
alcohol of 98 per cent.; of this gtt. v. to gtt. x. may be added
to water 3iv. and given in doses of one teaspoonful.
Its action is very similar to Belladonna, being a stimulant
to the capillary circulation. It may be employed in conges-
tion of the nerve centers, of the abdominal viscera, and of
the kidneys. A careful examination will doubtless deter-
mine some valuable uses.
SOLIDAGO ODORA.
(GOLDEN ROD.)
A tincture is prepared from the fresh plant in flower, using
alcohol of 98 per cent. The dose will vary from the fraction
oí a drop to ten drops.
It is a mild stimulant, improving the circulation and pro-
moting diaphoresis. It relieves irritation of stomach and
bowels, colic, and is said to promote the menstrual flow.
SPONGIA.
247
SOPHORA SPECIOSA.
A tincture is prepared from the seeds, using alcohol of 98
per cent.; of this gtt. v. may be added to water 3iv. and used
in teaspoonful doses.
It may be employed as a stimulant to the cerebro-spinal
centers, when there is a defect of reflex action, imperfect
respiration, and threatened paralysis. It also relieves the
excited innervation from atony, and thus gives rest and sleep.
SPILANTHES OLERACEA.
A tincture is prepared from the recent herb, using alcohol
of 98 per cent.; gtt. x. may be added to water iv., the dose
being a teaspoonful.
It may be used in inflammation of the mouth and throat,
and in disease in which this is a continuous complaint, or
where there is profuse secretion of saliva (not mercurial.) It
has been employed in rheumatism, neuralgia, and irritation
of the urinary passages, with reported good results
SPIREA ULMARIA
(HARDHACK.)
A tincture is prepared from the fresh root, or from the
bark and leaves, using alcohol of 98 per cent. The dose will
vary from the fraction of a drop to ten drops.
It relieves irritation of the urinary passages, influences
the prostate gland, checks gleet and prostatorrhoea, and may
be employed in chronic inflammation of the cervix uteri, and
in chronic vaginitis with leucorrhoea.
SPONGIA USTA.
(BURNT SPONGE.)
Take of ordinary sponge a sufficient quantity, cut it in
pieces, and burn it in a close iron vessel until it is brown and
can be pulverized without much trouble. Now, take of this
powder four ounces, pack in a percolator, and gradually add
248
SPECIFIC MEDICINES.
alcohol 76 per cent. Oj. Dose of the tincture, from the frac-
tion of a drop to 3ss.
I give the formula for the preparation of a tincture of burnt
sponge, not because I think it possesses all the properties at-
tributed to it by Homœopaths, but that it may be tested. I
have used it in some cases with seeming advantage, and have
seen results following its prescription by others, that in the
ordinary use of medicine we would call remarkable cures.
A. quotation from Jahr's Repertory will show the Homoeo-
pathic uses:
"Diseases of the lymphptic vessels and glands; heat, with
dry, hot skin, thirst, headache and delirium; redness of the
eyes, with burning and lachrymation; frequent eructations,
with cutting and tearing in the stomach; relaxed feeling in
the stomach, as if the stomach were open; orchitis; indura-
tion of testes; pain in the larynx on touching it and turning
the head; burning in the larynx and trachea; dryness, husky and
hoarse voice; inflammation of the larynx, trachea and bronchi ;
croup; laryngeal and tracheal phthisis; cough, deep from the
chest, with soreness and burning, or chronic cough with yel-
lowish expectoration and hoarseness; wheezing inspirations;
asthma with amenorrhoea; goitre; hard goitre."
STAPHISAGRIA.
(See Delphinum Staphisagria.)
STAPHYLEA TRIFOLIA.
(BLADDER NUT.)
Preparation.-Prepare a tincture from the bark of the root,
3viij. to alcohol 76 per cent. Oj. Dose, from gtt. v. to 3j.
The Staphylea has been confounded with the Ptelea, until
we hardly know whether a writer in the olden times was
describing one or the other. The probabilities are, however,
that the article described by Prof. I. G. Jones, and valued
so highly by him as a tonic, was the article under considera-
tion. At least it would be well for some of our friends who
know the article, to procure specimens and thoroughly test it.
STILLINGIA.
249
Dr. Jones claimed that it was a pure unirritating tonic,
having a soothing influence upon mucous membranes. He
employed it in the convalescence from fevers and inflamma-
tions, and whenever the stomach was feeble and irritable.
STATICE CAROLINIANA.
(MARSH ROSEMARY.)
A tincture is prepared from the recent root, using alcohol
of 98 per cent. It may be given in doses of one to ten drops.
The marsh rosemary is an excellent astringent, and at the
same time relieves irritation of mucous membranes. It may
be used in atonic dyspepsia, in diarrhoea, chronic dysentery,
hemorrhage from the lungs, bronchorrhoea, sore throat,
chronic laryngitis, and in any catarrhal disease with profuse
secretion.
STILLINGIA SYLVATICA.
(STILLINGIA.)
Preparation.-Prepare a tincture from the recent dried
root, 3 viij. to alcohol 98 per cent. Oj. Dose, from gtt. j. to x.
Stillingia increases waste and excretion, but its principal
action probably is upon the lymphatic system, favoring the
formation of good lymph, hence good blood and nutrition.
Experience shows that it favorably influences the system in
secondary syphilis, in some forms of scrofula, and in cases of
chronic disease where the tissues are feeble and not readily
removed and renewed.
I believe it to be more especially useful in those cases
where there is predominant affection of mucous membranes,
and secondly, where the skin is involved. In these cases I
have used the simple tincture as above, largely diluted with
water, with much better results than I have obtained from
any of the compounds of Stillingia or alterative syrups. Evi-
dently in the ordinary manufacture of "Compound Syrup of
Stillingia," the virtues of Stillingia, if it has any, are wholly
lost, simply because water or dilute alcohol is not a proper
menstruum,
250
SPECIFIC MEDICINES.
Stillingia exerts a specific influence upon the mucous mem-
branes of the throat, larynx, and bronchii, relieving irrita-
tion and favoring normal nutrition and functional activity.
Some cases of chronic pharyngitis of years' standing, have
been relieved by this remedy, after other treatment had
failed. It is an excellent remedy in the treatment of some
cases of chronic laryngitis, speedily relieving the irritation.
and cough, and we also employ it in chronic bronchitis with
like good results. Now if it is possible to determine the
class of cases in which it is thus beneficial, the reader may
use it with advantage.
So far as my experience extends, they are those with tumid,
red, glistening mucous membranes, with scanty secretion.
This condition indeed seems to be the index for the use of
the remedy for every purpose. In syphilis, in scrofula, in
chronic inflammation with deposits, the same red glistening
color with scanty secretion, is a guide to the use of Stillingia
STICTA PULMONARIA.
From this variety of Lichen, found growing on trees in
many parts of the United States, is prepared a tincture in
the usual manner. It is a remedy introduced by the Homo-
opathists, and thus far I have employed their tincture. I use
it in the proportion of gtt. x. to 3ss. in water iv. ; a teaspoon-
ful every three or four hours.
I have employed it with success in atonic lesions of the re-
spiratory organs, attended with dull pains in the chest, in-
creased by full inspiration. There is also a sense of soreness,
as if bruised, or that follows very severe exertion. In these
cases it exerted a marked influence, relieving the cough and
unpleasant sensations; even checking the chills, hectic fever
and night sweats, in confirmed phthisis, for some considera-
ble time.
The strongest indication for the Sticta will be found in
pain in the shoulders, back of the neck, and extending to the
occiput. With this indication I find that it will cure rheu-
STRAMONIUM.
251
matism, or indeed almost anything, and the more I use it the
more highly I prize it. During the past winter I have had
occasion to give it in some very unpleasant cases of scarlet
fever, and with most marked benefit.
I have also used it in a few cases of rheumatism with ben-
efit. Dr. C. C. Price, of Baltimore, says: "I have used
Sticta in rheumatism very extensively for the past three or
four years. I find it most useful in those cases, where, in
connection with the larger joints, the small ones are also in-
volved. It matters not whether fingers or toes, there is swell-
ing, heat, and circumscribed redness of the joints.”
I would be very glad if some of our practitioners would
test Variolaria Faginea (Lichen Fagineus) and the Lichen
Parietina. Both have been employed successfully in the
treatment of ague, and are powerful stimulants and restora-
tives.
STRAMONIUM.
(JAMESTOWN WEED.)
A tincture should be prepared from the fresh leaves and
flowering tops, when the odor from the plant is strongest,
using alcohol of 98 per cent.; gtt. v. to gtt. x. may be added
to water 3iv. and given in doses of one teaspoonful.
It may be given in acute disease, when the patient is furi-
ously delirious; in delirium tremens when the patient is en-
raged and inclined to injure those present, destroy the fur-
niture or harm himself; in violent mania; in epilepsy asso-
ciated with or paroxysms followed by maniacal excitement.
In chronic disease it is enough that the patient feels inclined
to violent outbursts of passion, and has difficulty in restrain-
ing himself.
It is in some degree an antidote to the opium habit, and in
some cases, if its use is persisted in, it will effect a cure. In
this case it should be given with some simple stimulant, as
Comp. Spirits Lavender, or Comp. Tincture of Cardamom.
It is employed to relieve asthma, both as an internal rem-
edy and as an inhalation, but it is difficult to describe the
252
SPECIFIC MEDICINES.
cases in which it will prove beneficial. It is also an excel-
lent remedy in chronic disease of the skin, with hypertrophy
and pruritus.
An ointment may be prepared from the fresh flowering
tops and young leaves, by pouring over them hot mutton tal-
low, allowing the vessel to remain where it will be kept just
below the boiling point for two hours. This is strained through
flannel, using some pressure. This ointment will be found
an excellent application to hemorrhoids, and in cases of pru-
ritus ani, with hypertrophy of the skin.
STRYCHNOS NUX TOMICA.
(NUX VOMICA.)
Preparation.-Prepare a tincture from the freshly pow-
dered seeds. viij. to alcohol 98 per cent. Oj., digesting for
24 hours in a closed vessel with gentle heat. Dose, from the
fraction of a drop to five drops. A solution of the Strychnia
may be prepared after the following formula: R Sulphate of
Strychnia, grs. iv. ; water, 3iv.; dose, gtt. v. to gtt. xx.
Nux Vomica exerts a specific influence upon the intestinal
canal and associate viscera that renders it a most valuable
remedy.
In minute doses we employ it to arrest nausea and vomiting,
when this arises from gastric irritability and not from irri-
tant material in the stomach. The cases are those in which
there is feebleness of the organs, and not where there is irri-
tation and inflammation. For this purpose we employ it in
cholera infantum with marked benefit, and in cholera mor-
bus and Asiatic cholera to relieve this symptom.
It is the remedy in all cases of congestion of liver, spleen,
or portal circle. Given, a feeling of fullness in right hypo-
chondrium, pain in side or shoulder, sallowness of face, yel-
lowness of eyes, yellow coat on tongue, I prescribe Nux Vom-
ica with a certainty that I never felt in the olden time.
If an intermittent fever presents these evidences of vis-
ceral derangement, Nux Vomica is the antiperiodic, or at
least it prepares the way for the kindly and curative action
STRYCHNOS NUX VOMICA.
253
of quinine. In bilious remittent fevers, with these symp-
toms, Nux Vomica is the first remedy indicated. In diar-
rhoea, with these symptoms, we prescribe it with the cer-
tainty that the discharges will be speedily arrested, and the
stomach and intestinal canal left in good condition. In dys-
pepsia, with these symptoms, we obtain speedy and perma-
nant relief from the use of the remedy.
It is here, as we have found it in the consideration of other
remedies, if you can once determine the exact indication for
its use, you may employ it whenever you find these indica-
tions, no matter what may be the name of the disease, or the
condition of the patient otherwise.
We employ it to relieve pain in the stomach and bowels,
where there is atony. It makes no difference whether it is
the colic of childhood or of the adult, acute or chronic. It
is not a remedy for pain dependent upon irritation with de-
termination of blood, or upon muscular spasm.
In addition to the symptoms named, as indicating the use
of Nux Vomica, may be named hypochondriac pain, umbil-
ical pain, or pain in forehead associated with nausca ; yellow-
ish or brownish maculæ, in chronic disease, are also indica-
tions for its use. In some cases, a peculiar yellowish sallow
ring around the mouth, will be found indicative of impair-
ment of innervation from the solar plexus, and Nux will
prove the remedy.
We find this peculiarity in the action of Nux Vomica,
which we have noticed with some of the more prominent of
the specific medicines, and which, indeed, is true of all-
when distinctly indicated, it may be the remedy for the en-
tirety of a disease. Thus, taking a fever presenting the
symptoms of nausea, hypochondriac and umbilical pains, full,
moist tongue, with slight yellow coat, and sallow skin, Nux
Vomica relieves gastric irritation, is promptly sedative, re-
lieving irritation of the nervous system, stimulates secretion
—indeed it is promptly curative. Take a case of dysentery
with these characteristic symptoms, and relief is speedy and
the cure rapid.
254
SPECIFIC MEDICINES.
•
The influence of Nux Vomica and Strychnia upon the spi-
nal cord is well known, and this seems to be its principal use
in medicine. Whilst I think it better, in the majority of
cases, to restrict its use as above, there are some in which
we employ it for its influence upon the nervous system.
These are:-
In typhoid and asthenic disease, where there is impair-
ment of spinal innervation, and in consequence imperfect or
enfeebled respiration, we give Strychnia or Nux Vomica with
advantage. Indeed, in those cases in which the respiratory
function can only be carried on under the influence of the
will, it is the only remedy we can rely on.
In the same classes of disease, the tendency to retention of
urine is met by the use of the same remedy.
In some cases of the same diseases, where a feeble circula-
tion is associated with general impairment of muscular power
and inability to co-ordinate muscular movement, we use
Nux Vomica with advantage.
Nux Vomica or Strychnia should never be employed in
the treatment of paralysis so long as any evidence of inflam-
matory action exists; neither should it be used, if there are
marked evidences of cerebro-spinal congestion, until this is
removed. It is the first remedy employed in cases of paraly-
sis presenting the symptoms of visceral derangement we have
already named. In other cases it is only employed as a nerve
stimulant, when the nerve centers are free from disease.
SULPHUR.
Preparation.—Prepare Sulphur for dispensing, by thorough
trituration with two parts of sugar of milk. Dose from gr. j,
to 3ss.
We employ Sulphur as a restorative in those cases in
which there is a deficiency of this element in the blood.
"All the protein-compounds contain Sulphur, which seems
to be one of their essential constituents, not capable of entire
separation without the complete destruction of the organic
SULPHUR.
255
substance." (Carpenter.) There are few, probably, who have
thought of Sulphur in this relation; they supply Iron as the
basis of red corpuscles, Phosphorus for the nutrition of the
nervous system, but the protein tissues must get their supply
of Sulphur from the food, or do without.
The indication for the use of Sulphur as a restorative is,
enfeebled nutrition associated with decoloration of tissues
and secretions. The skin is blanched, the iris loses color, the
hair is lighter in color in the young, changes rapidly to gray
in the middle aged, and the urine is light colored as is the
feces. The presence of cystine in the urine is an indication
for the administration of Sulphur.
We also employ sulphur in those cases in which there is
excessive fetor of the excretions. We will occasionally find
a case of chronic disease, in which the breath, the secretion
from the skin, the urine, and the feces have a peculiar cada-
verous odor, and we notice that with this there is a remark-
able tendency to decomposition, and to breaking down of
tissue.
It is possible that this may be explained, by the necessity
of Sulphur in the formation of the taurine of the bile. If
this secretion of the liver is the normal antiseptic, and con-
trols putrescency in the body, we can see why a deficiency of
Sulphur may lead to the condition above named, and its ad-
ministration be directly curative.
SUMBUL.
A tincture is prepared from the imported root (Turkestan),
using alcohol of 98 per cent. The dose will vary from gtt. j.
to gtt. x
It is a mild stimulant to the nerve centers, to the circula-
tion, and to the digestive canal. When first introduced it
was proposed as a specific for cholera, but it was soon found
that it fell far short of what was expected from it.
256
SPECIFIC MEDICINES.
SYMPHYTUM OFFICINALE.
(COMFREY ROOT.)
Comfrey has been principally used in infusion, but a tinc-
ture may be prepared from the recent root, using alcohol of
98 per cent. The dose will be from one to ten drops.
It may be employed to relieve irritation of the bronchial
tubes and lungs, and check cough, and as a remedy for hem-
orrhage from either lungs, bowels, uterus, or kidneys.
SYMPLOCARPUS FŒTIDUS.
(SKUNK CABBAGE.)
Preparation.-Prepare a tincture from the fresh root, 3 viij.
to alcohol 76 per cent. Oj. Dose from gtt. j. to gtt. v.
Though the Skunk Cabbage has been extensively used, it
has been in combination with other remedies, and the reports
are so vague that we can not estimate its remedial action.
It exerts a very decided influence upon the nervous system,
relieving irritation and promoting normal functional activity.
This, probably, will be its principal use. The remedy de-
serves to be thorougly studied.
TANACETUM VULGARE.
(TANSY.)
Preparation.-Prepare a tincture from the fresh herb
gathered in August, using 3viij. to alcohol 76 per cent. Oj.
Dose gtt. j. to gtt. xx. As a local application to the throat
use one part of the tincture to four to ten parts of hot water,
with a spray apparatus; or not having this, vaporize the fluid
and let the patient inhale the steam.
In small doses the tincture as above prepared will furnish
a cheap and agreeable stomachic, relieving irritation and im-
proving functional activity. It exerts a decided stimulant
influence upon the female reproductive organs, and may be
employed in functional diseases when such influence is de-
sirable.
TELA ARANEA.
257
As a local application by spray or inhalation, it is a very
yaluable remedy in the treatment of diphtheria, and some
forms of acute inflammation of the throat, and in epidemic
catarrh. I have employed it in these cases with most marked
advantage, and value it very highly.
TARAXACUM DENS LEONIS.
(DANDELION.)
Preparation.-Prepare a tincture from the fresh root gath-
ered in July or August 3viij. to alcohol 76 per cent. Oj.
Dose, from gtt. v. to 3ss.
The Taraxacum loses its medical properties by drying,
hence that usually supplied by the drug trade is wholly inert
Prepared as above, it will prove a valuable remedy.
It exerts a stimulant influence upon the entire gastro-intes-
tinal tract, promoting functional activity. Whilst its action
is feeble, it is very certain, and will frequently prove more
desirable than the more active remedies.
TAXUS BACCATA.
(YEW.)
A tincture is prepared from the fresh leaves, using alcohol
of 98 per cent.; add gtt, x. to water 3iv. and give in tea-
spoonful doses.
It is a stimulant to the nervous system, and to the urinary
passages, at the same time relieving irritation.
TELA ARANEA.
(SPIDER'S WEB.)
From the web of the common house spider prepare a tinc-
ture by macerating 3ij. in alcohol 98 per cent. Oj. for ten
days. Dose, gtt. j to gtt. x.
It is claimed to be a very certain remedy in the cure of
intermittents. I give a formula for its preparation that it
may be tested. The tincture of the Aranea Diadema is em-
ployed in Germany by some Homœopaths, and cases reported
in which the cure was speedy and permanent.
22
258
SPECIFIC MEDICINES.
TEUCRIUM CANADENSE.
(WOODSAGE.)
A tincture may be prepared from the fresh plant, using
alcohol of 98 per cent.; the dose will be from gtt. j. to x.
It is stimulant and tonic, and is thought to exert a benefi
cial influence in nervous affections, as hysteria, epilepsy,
restlessness (nervousness), and inability to sleep.
THUJA OCCIDENTALIS.
(ARBOR VITÆ.)
Preparation.-Prepare a tincture from the fresh leaves,
Zviij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt., xx.
The leaves of the Arbor Vitæ has been a popular remedy
in the treatment of intermittent and remittent fever, rheu-
matism, scurvy, etc. It would be well for some of our prac-
titioners to prepare a tincture and test it.
TILIA EUROPEA.
(LINDEN.)
Linden flowers are generally used in infusion, but a tinc-
ture may be prepared in the usual way with alcohol of 98
per cent.
It allays irritation, and is gently stimulant and tonic, and
may be employed in colds and catarrhal conditions. It is
thought to relieve nervousness, and give rest and sleep.
TRIFOLIUM PRATENSE.
(RED CLOVER.)
Preparation.-Prepare a tincture from the recently dried
blossoms of Red Clover, 3viij. to alcohol 50 per cent. Oj.
Dose, from gtt. j. to x.
The Red Clover exerts a specific influence in some cases of
whooping cough, and in the cough of measles. It is not cura-
tive in all, but when it does good, the benefit is speedy and
permanent. It may also be prescribed in other cases of spas-
TRIOSTEUM.
259
modic cough, in laryngitis, bronchitis and phthisis. We
should be able to tell the exact condition where it proves
beneficial, and where it fails, but thus far the use has beer
wholly empirical. In the further use of the remedy all the
symptoms should be noted. It has given much satisfaction
thus far, and is likely to prove a very valuable remedy.
TRILLIUM PENDULUM.
(BETHROOT.)
Preparation.—Prepare a tincture from the fresh root, 3viij.
to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
The common use of Trillium in large doses obtained its
astringent influence, possibly from the tannin it contains.
The preparation from the fresh root named above, is but
slightly astringent.
We would employ it in disease of mucous membranes with
increased secretion, and expect decided benefit. In the ear-
lier part of my practice I used Trillium in chronic bron-
chitis, in chronic catarrh, in cough with free expectoration,
with excellent results. It needs to be thorougly studied, and
it will probably supply a want in our materia medica.
TRITICUM REPENS.
(COUCH-GRASS.)
The Couch Grass roots have been used principally in infu-
sion for the relief of irritation of the urinary apparatus. And
at one time it had quite a reputation as a cure for the gravel,
and there is no doubt but that it exerts a marked influence
in this direction. A tincture may be prepared of the recent
roots in the usual way, with alcohol of 98 per cent., the dose
varying from one to ten drops, which, if given with water, will
serve the same purpose as the infusion.
TRIOSTEUM PERFOLIATUM.
(FEVER ROOT.)
Make a tincture from the bark of the recent root, using
alcohol of 98 per cent. The dose will range from one to ten
drops.
260
SPECIFIC MEDICINES.
This remedy is slightly sedative, and increases secretion;
it lessens the frequency of the pulse, and reduces the tem-
perature, in the febriculæ, and in slight inflammation. It
will compare with the asclepias, though its influence upon
the skin is not so decided.
TUSSILAGO FARFARA.
(COLT'S FOOT.)
A tincture may be prepared from the leaves and flowers,
using alcohol of 98 per cent. The dose will range from the
fraction of a drop to ten drops.
It relieves irritation of mucous membranes and may be
used in bronchitis, laryngitis, pharyngitis, gastric and intes-
tinal catarrh.
URTICA DIOICA.
(COMMON NETTLE.)
Preparation.-Prepare a tincture from the fresh plant,
3viij. to alcohol 76 per cent. Oj. Dose, from gtt. j. to gtt. x.
The Urtica has been employed in some diseases of the bow-
els, with reported good results. An old practitioner informs
me, that in chronic disease of the large intestine with in-
creased mucous secretion, he has never found anything so
beneficial as this remedy. It has also been used in diseases
of the urinary organs.
It is now but little used, but deserves investigation.
USTILAGO MAIDIS.
(ERGOT OF CORN.)
A tincture may be prepared from the recent dried fungus,
using alcohol of 98 per cent. The dose will vary from the
fraction of a drop to thirty drops.
In small doses-gtt. x. to water 3iv., a teaspoonful every
one, two, or three hours,-it may be used in capillary conges-
tion, passive hemorrhages, enfeebled circulation to the brain,
with dizziness, unsteadiness, dull headache, (top of head), im-
VERATRUM.
261
paired vision, etc. It exerts a somewhat similar influence to
ergot and may be used to increase the strength of the pains
during labor. In the second or third dilution it may be em-
ployed to relieve false pains, and unpleasant sensations in
the pelvic region, during the latter months of pregnancy.
UVA URSI.
Either in infusion or tincture the Uva Ursi may be em-
ployed as a stimulant and tonic diuretic, and is indicated by
an enfeebled circulation and innervation to this apparatus.
A sense of weight and dragging in the perineum (not depen-
dent upon enlargement of the prostate), may be taken as the
best indication.
VALERIANA OFFICINALIS.
(VALERIAN.)
Preparation.-Prepare a tincture from the root (as recent
as can be obtained), 3 viij. to alcohol 50 per cent. Oj. Dose,
from gtt. ij. to gtt. xx.
Valerian is a cerebral stimulant, and may be employed
wherever a remedy of this character is indicated. It allays
nervous irritability, modifies or arrests pain, promotes rest,
and favors sleep, where these conditions result from an en-
feebled cerebral circulation. It is very extensively used, and
many times without benefit, as the condition of the nerve
centers is very rarely taken into consideration.
Its best use is in the treatment of chorea, associated with
macrotys.
VERATRUM VIRIDE.
(VERATRUM.)
Preparation.-Prepare a tincture from the recent root,
not fully dried, 3 viij. to alcohol 76 per cent. Oj. Dose, from
the fraction of a drop to three drops. Veratrum from West-
ern New York furnishes an excellent remedy, as is that from
North Carolina and Northern Georgia. Specimens I have
seen from the Western States were worthless. The root
262
SPECIFIC MEDICINES.
should be dug in August or September, freed from dirt, and
dried sufficiently to permit of shipment to the place of man-
ufacture. Now, it should be immediately crushed, and the
year's supply of tincture prepared.
As commonly prepared for the drug trade (Norwood's ex-
cepted), it is made of the dried root kept in stock from year
to year, and possesses very feeble, if any medical properties.
In this case, as with some other remedies, the process of dry-
ing destroys that finer medical action upon which we depend
to influence the sympathetic nervous system.
·
We employ the Veratrum to lessen the frequency of the
heart's action. When properly used it not only lessens the
frequency of the pulse, but it removes obstruction to the free
circulation of the blood, and thus gives slowness, regularity,
freedom, and an equal circulation in all parts of the body.
This action we call arterial sedation, though the name is not
a good one.
To obtain this action it is necessary that the remedy be
used in small doses, frequently repeated, and that sufficient
time be given to accomplish the object without disturbing
function or producing depression.
Veratrum is sedative in large doses, and its influence upon
the heart may be speedily obtained in this way. But in this
case its influence is depressing. It evidently causes slowness
of the pulse by paralyzing the cardiac nerves. If the influ-
ence is continued there is impairment of the circulation, with
tendency to congestion. As a general rule, the influence of
large doses can not be maintained; either the remedy pro-
duces irritation of the stomach, so that it will no longer be
tolerated, or its depressing influence upon the circulation be-
comes so great that it must be suspended.
In small doses the Veratrum is a stimulant to all the vege-
tative processes. Acting through the sympathetic or gangli-
onic system of nerves, it removes obstruction to the capil-
lary circulation, gives tone to the vascular system, and
strength to the heart. As the obstacles to a free circulation
are removed, and the vessels through which the blood is dis-
VERATRUM.
263
tributed and returned, regain their normal condition, there
is less necessity for increased action upon the part of the
heart; and as the power of the heart is increased, there is
less necessity for frequent contraction.
I give this as a theory of the action of Veratrum, but
whether true or not, there is no question with regard to the
facts as above stated.
Veratrum is the remedy for sthenia, where there is a fre-
quent but free circulation. It is also the remedy where there
is an active capillary circulation, both in fever and inflamma-
tion. A full and bounding pulse, a full and hard pulse, and
a corded or wiry pulse, if associated with inflammation of
serous tissues, call for this remedy.
As was remarked when describing aconite, the veratrum
exerts a similar influence in acute inflammation, and directly
controls the inflammatory process in its first stages. As a rule,
the remedies that will cure fever will cure inflammation. To
this I believe there are no exceptions, if a proper diagnosis is
made, and we are governed by the same indications for pre-
scribing. Aconite, veratrum, gelseminum, belladonna, nux
vomica, quinia, and other direct remedies, may be prescribed.
with the same certainty in inflammation as in fever. There
is the same necessity for securing a good condition of stomach
and upper intestine for digestion, and giving proper food.
The same necessity for securing normal waste and excretion,
and having the tissues renewed from good blood. The pal-
lid tongue calls for alkalies, the dark redness of mucous
membranes for acids, the pasty white coat for the sul-
phites, etc.
My experience teaches me that local inflammations are
reached directly by this direct medication, and with a cer-
tainty a hundred times greater than by the old routine of in-
ternal and external counter-irritation. It makes no differ-
ence where its location, how great or how little, the treatment
is exactly the same as for a fever presenting the same symp-
toms or indications for remedies.
It must not be expected that the indications for remedies
}
264
SPECIFIC MEDICINES.
will be as pronounced in the case of inflammation as in fever,
but they are always sufficient.
I have treated inflammation of the lungs with veratrum
alone, veratrum with gelseminum, veratrum with ipecac,
ipecac alone, aconite alone, with a success I never saw ob-
tained from the use of nauseants and counter-irritation.
Other cases required the use of the sulphites, of quinia, or the
mineral acids. I am not alone in this experience, for scores
of our more recent students, who have learned this practice
in lectures, give testimony to its success.
The local application of Veratrum, in the early stages of
a superficial inflammation, will not unfrequently arrest its
progress. In this way we use it in erysipelas, in phlegmon-
ous inflammation of cellular tissue, in felons, diseases of the.
bones, tonsilitis, etc.
We employ Veratrum in treating chronic disease for its
stimulant influence upon the vegetative processes. Properly
used, we find that it lessens the frequency of the pulse, giv-
ing a free and uniform circulation; it lessens the temperature;
it increases waste and excretion; and finally it stimulates di-
gestion and nutrition.
My friend, Prof. Howe, regards it as one of the most di-
rect and certain "alteratives" in the materia medica, and in
this opinion he is supported by a large number of practition-
ers. If the remedy has the action above named, we can read-
ily see how it favorably influences chronic disease, and how
frequently it may be employed with advantage.
VERBASCUM THAPSUS.
(MULLEIN.)
Preparation.-Prepare a tincture from the fresh tops and
smaller leaves when the plant is in flower, 3 viij. to alcohol 50
per cent. Oj. Dose, from gtt. v. to 3j.
The Verbascum exerts a mild influence upon the nervous
system, quieting irritation and promoting sleep. It also allays
bronchial irritation, and checks cough. It is very feeble and
has but a limited use.
VIBURNUM.
265
VERBENA HASTATA.
(VERVAIN.)
A tincture may be prepared from the fresh root, with alco-
hol of 98 per cent.; gtt. x. to gtt, xx. may be added to water
3iv., and given in doses of one teaspoonful.
It relieves irritation of the stomach, and intestinal canal,
promotes digestion, and promotes secretion. It is but little
used at the present time, but may be studied with advantage.
VERNONIA FASCICULATA.
(IRON WOOD.)
A tincture may be prepared from the fresh root, using alco-
hol of 98 per cent. The dose will vary from the fraction of
a drop to ten drops.
It is a mild tonic, and promotes waste and excretion, and
may be studied with these objects in view.
VERONICA BECCABUNGA.
(BROOK LIME.)
A tincture may be prepared from the fresh leaves and tops,
using alcohol of 98 per cent. The dose will vary from the
fraction of a drop to ten drops.
It relieves irritation of both mucous membranes and skin,
and has been employed in bronchitis, dyspepsia, and chronic
disease of the skin.
VIBURNUM OPULUS.
(HIGH CRANBERRY.)
Preparation.-Prepare a tincture from the fresh bark,
3viij. to alcohol 50 per cent. Oj. Dose, from gtt. v. to xxx.
The Viburnum has been, employed as an anti-spasmodic
with reported success, hence its name, cramp bark. If we are
to be guided by the descriptions of our earlier practition-
ers, we would conclude that it exerted a direct influence in
controlling spinal irritation, and spasmodic action arising
from this. I have used it with marked benefit in dysmenor-
rhoea, and to prevent abortion.
23
266
SPECIFIC MEDICINES.
VIBURNUM PRUNIFOLIUM.
(BLACK HAW.)
Preparation. Prepare a tincture from the recent bark of
the root, viij. to alcohol 50 per cent. Oj. Dose, from gtt. v.
to gtt. xx.
It is claimed in the Southern States that the Viburnum is
a specific against abortion. I have been told by several par-
ties, that it was a common practice among planters to make
their slaves drink an infusion of the Viburnum daily whilst
pregnant, to prevent abortion from taking the Cotton-root.
A physician from Texas assured me, that from an observa-
tion of fifteen years, he was confident that it exerted this in-
fluence, and that he had prescribed it in many cases without
a failure.
If it exerts this influence upon the uterus, as I am sure it
does, it will prove a valuable remedy, not only as anti-abor-
tive, but in diseases of the reproductive organs.
VIOLA PEDATA.
(BLUE VIOLET.)
A tincture is prepared from the entire plant, when in
flower, using alcohol of 98 per cent. The dose will vary from
the fraction of a drop to ten drops.
It stimulates waste and secretion, relieves nervous irrita-
bility, and improves nutrition. It has been used for those.
purposes called alterative. It deserves study.
XANTHIUM SPINOSUM.
Prepare a tincture from the fresh plant in flower, using
alcohol of 98 per cent. The dose will vary from the fraction
of a drop to ten drops.
It may be employed as a prophylactic against ague, as an
anti-periodic when the patient is subject to profuse sweatings,
and to prevent the recurrence of chills when they have been
broken. It may be employed in any disease where there is
nervous excitement attended by sweating.
ZINC.
267
XANTHOXYLUM FRAXINEUM.
(PRICKLY ASH.)
Preparation. Prepare a tincture from the berries, 3 viij.
to alcohol 98 per cent. Oj. Dose, from the fraction of a drop
to five drops.
The Xanthoxylum has been employed as a diffusible and
topical stimulant. Its general stimulant action is not very
marked, and there are many other remedies preferable.
But as a stimulant to mucous tissues it has no equal in the
materia medica. Whenever it is desirable to obtain such in-
fluence, whether of the throat, the gastro-intestinal tract, the
mucous membranes of the air-passages, or of the urinary or-
gans, we are rarely disappointed in its action. Upon the
throat, the stomach, and upon the intestines, it exerts a top-
ical influence before absorption.
In small doses we occasionally employ it in chronic dis-
eases of mucous surfaces, with good results. The cases are
as above, when the mucous membranes are enfeebled and re-
laxed, with hyper-secretion.
ZINCI CHLORIDUM.
(CHLORIDE OF zinc.)
In the proportion of one grain to water 3iv. Chloride of
Zinc is an excellent stimulant collyrium, and in the same pro-
portion it may be used as an injection in chronic cystitis.
In the proportion of one grain to the ounce it is an excellent
wash in chronic vaginitis and diseases of the cervix uteri, in
gonorrhoea and gleet, and with a spray apparatus, in chronic
nasal catarrh.
It is an excellent escharotic, and has been employed to de-
stroy chancre and chancroid, epithelial growths, and cancer.
For this purpose it is usually combined with an equal pro-
portion of gum arabic and water, until it has the consistence
of a paste.
In using this for the removal of malignant growths, its
application must be most thorough, crowding this paste into
268
SPECIFIC MEDICINES.
every part, and persisting in the application until the dis-
eased structure is wholly destroyed.
ZINCI OXIDUM.
(OXIDE OF ZINC.)
In doses of of a grain to one grain this remedy may be used
in chronic gastritis with free secretion of mucus, and in
ulceration of the stomach. It may also be employed in ner-
vous dyspepsia, the tongue being broad, and abdomen full.
In fine powder it is used as a dressing to moist eruptions
of the skin, balanitis, sore nipples, excoriations, etc.
ZINCI PHOSPHIDUM.
(PHOSPHIDE of zinc.)
We employ Phosphide of Zinc in a second or third decimal
trituration, the dose being one grain four times a day.
It may be used in progressive locomotor ataxy, in aphasia,
paralysis agitans, and in the condition commonly diagnosed
as "softening of the brain."
ZINCI SULPHAS.
(SULPHATE OF ZINC.)
In the proportion of 3j. to water Oj., Sulphate of Zinc is
an admirable dressing to wounds or parts where gangrene or
mortification is threatened. In this strength, and up to sat-
uration, it is used as an injection in old abscesses, fistulæ,
sinuses, disease of bone, etc. In the proportion of grs. x. to
water 3j. it forms the basis of an abortive treatment of gon-
orrhæa. The object is to destroy the disease germs, and
change the condition from a specific to a simple inflamma-
tion. A thorough application of the strong injection is fol-
lowed by a much weaker solution, which is sometimes con-
tinued until a cure is effected.
APPENDIX.
The study of Specific Medication is yet in its infancy,
and it is impossible to present a systematic treatise on the
subject. The intention of the author in first presenting this
little volume to the profession, was to lay before them a con-
cise statement of what was really known of the direct action
of medicines, and to incite to a re-study of the Materia
Medica. It has well served its purpose in calling attention
to the subject, in causing investigation, and in pointing out
the road to a better practice of medicine.
Passing through two editions, it has required some revision,
and some additions. The principal work in this direction,
since its first issue, has been done in the Eclectic Medical
Journal, and we propose to give here the principal articles
that have appeared in the past two years.
It might be better if they were rewritten and systematized,
but probably they will serve the purpose well in their original
form. For if there are repetitions, there is the freshness and
earnestness that attaches to a first presentation of a subject;
and it is sometimes well to see how a thing grows-we can
better estimate its merit.
I have no apology to offer for them. They tell the story
plainly and emphatically, and I have yet seen no reason to
take back ought that has been written.
(269)
270
SPECIFIC MEDICATION.
The Study of Specific Medication.
I admit that the study of medicine, as I would pursue it, is
more difficult than the old routine, and that it also requires
an exercise of brain far beyond it. But surely, if there can
be certainty in diagnosis, and precision in giving remedies, it
is worth all the thought which is given it.
Think for a moment of the imperfections of our present
nosology. We find the most diverse conditions of disease
grouped under the same name. And hence, a list of medi-
cines, as long as the moral law, is named, with a
may be
given in this disease with prospect of advantage." No effort
seems to be made to determine the exact indications for any
particular remedy, and no medicine is studied with reference
to its direct opposition to morbid processes.
Hence flows the shot-gun method of prescribing. whereby
the more common drugs are combined in platoons, and fred
into the sick. To a lover of fun, (medical fun I mean), there
is no better reading than a druggist's prescription book, if the
reader has his eyes open to its absurdity. Passing by the
queer combinations of remedies, ten, twenty, thirty, fifty
different ingredients, (combining compounds), we have all
manner of incompatible mixtures-milky, grumous, flaky,
deposits, etc-all kinds of queer tastes, agreeing only in being
nasty-all kinds of activities represented in the same bottle
-stimulant, sedative, narcotic, tonic, emetic, cathartic, etc.
But beyond this we find the doctor ignoring the law of me-
dicinal incompatibles, and combining his remedies so that
one neutralizes the other-as giving Belladonna and Gelse-
minum, Belladonna and Opium, Stramonium and Opium as a
local application, etc.
Read your Materia Medica, and you find the description of
a remedy commencing-" this agent is said to be emetic,
cathartic, diaphoretic, diuretic, stimulant, tonic," etc. We
never get farther than a "said to be," and a
"said to be," and a "prospect of ad-
vantage." This and-so-forth that is affixed to the end of the
THE STUDY OF SPECIFIC MEDICATION.
271
sentence really covers what we want to know, and I have
often thought that a system of rational medicine might be
written under the title-" The Mysteries of And-so-forth
Revealed."
I name these things, not that I want to ridicule the old
methods, but that our readers may see their absurdity as I
see it. I do not want to be understood as saying that all
practice but mine is absurd, for I know that the large majority
of physicians do prescribe in part directly, and do expect a
definite result by so doing. And I claim further, that every
physician, no matter what school of medicine he belongs to,
finds success in so doing. Examine your methods of treating
disease, and the remedies you use, and you can not but be
convinced of the truth of this. If this is so, hold fast to all
your direct remedies and increase the list as far as you can,
but discard at once and forever all those shot-gun formulæ,
and all indirect methods.
Need I say again "that the earlier Eclectics prescribed
directly," and used "Specifics," and had success by so doing.
If any one doubts it, I will be glad to have him read the five
volumes of "The Medical Reformer," and the early volumes
of the Eclectic Medical Journal. And get especially the
early history of our indigenous remedies, and you will find
that they were given singly, and for their direct curative in-
fluence.
And now we come to the really important point, how will
we study Specific Medication? The question is asked me
every day, and needs an answer.
As has been stated, we must study diagnosis with reference
tc conditions of disease, and not to select a name from the
nosological list. As we must have a standard of health to
start from, and as a basis of comparison, we want a thorough
knowledge of physiology, and to the busy practitioner I
recommend Huxley's, because it is concise and in small com.
pass. Follow this with the "Principles of of Medicine,” and
we learn the physiology of disease-pathology; not with
reference to an arbitrary nomenclature, but as parts of a
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SPECIFIC MEDICATION.
diseased life. We never forget that we are dealing with living
men, and that this which we call disease, is simply abnormal
life.
Then comes the study of remedies with reference to their
power of opposing processes of disease, and favoring the
restoration of normal life. We never forget that in disease
the power of living is enfeebled. We never forget that the
forces of life are weakened, and that the tissues of the body
have lost their functional power, to some degree, as well as
their power of reproduction by which the life of man is
continued.
We never forget that our power, however skillful we may
be, is limited. We can not give life to inorganic matter, we
can not grow a single hair or a cell; all that we can do is to
guide and regulate the forces of life, and even this has its
limits.
But whilst we want to know that our field of action is thus
limited, we also wish to know that inside these limits there is
a broad field for study and use to man. We learn first-not
to take life; we learn secondly-how we may best conserve it
and influence its forces to an orderly activity.
As we go on in this course of study the subject becomes
plainer step by step. As we cease to study dissimilars in the
old nosology, we learn to study similars in specific diagnosis
and medication. We learn to know that similar conditions
of disease are always treated alike, no matter what the
technical name of the disease, or its location. And as we
thus always prescribe for pathological conditions, we find at
last that the practice of medicine is really simplified, and it
becomes a pleasure, instead of being laborious and unpleasant
from its uncertainty.-E. M. Journal, March, 1872.
1:
1
SOME PHASES OF SPECIFIC MEDICATION. 275
Some Phases of Specific Medication.
The basis of specific medication is specific diagnosis. If
the physician can not determine the exact pathological condi-
tions, his prescription must be inexact, and in proportion as
it is so uncertain.
Is it not the fact, that the common idea of the "uncertainty
of medicine" leads to superficial study, carelessness in ex-
amination, careless prescribing, to downright quackery?
Train a man in the popular belief of idiosyncrasies, in-
scrutable providences, et id omne, and why should he give
much thought to the study of disease. This prescribing for
the sick is a random business at best, and he fires his Materia
Medica at his patients, expecting by some lucky shot to hit
the disease; if he should happen to knock the patient into
the next world-is there not an inscrutable Providence?
But the physician need not fire wholly at random, he may
fire in platoons-fire and fall back. For instance, in all dis-
eases, excepting those attended with diarrhoea, he may fire the
class cathartics at his patient, and continue so long as the
patient has bowels to respond. He will find on turning to his
text-books, a mass of authority to sustain him in this course,
much further indeed than he dare go. Or he may charge his
patient with emetics, supplement these with diaphoretics and
diuretics, with a skirmish line of Quinine and Opium. Or
he may make a hodge-podge of them all-a grand corps de
battaile-and assault the enemy flank and rear.
Of course the patient has no need of stomach and bowels
for the digestion of food whilst sick. As he is sick, the un-
pleasant sensations that attend and follow such giving of
medicine, need not be taken into account. As there is dis-
turbance of all the vegetative and vital functions in disease,
the additional disturbance by medicine is a matter of small
moment. Why should we bother our heads about such small
matters as these? Have we not the testimony of ages of
authority-that "this is the way, the truth and the life?"
274
SPECIFIC MEDICATION.
And is it not much easier to walk in the way of our fathers?
But it is not of random medication that we want to talk,
further than to adorn our moral and point this tale. The au-
surdities of old physic are patent to all, a matter of every-day
experience; we want to learn a better way, if there is one.
The first phase of Specific Medication is so plain, "that he
who runs may read ;" it appeals directly to every man's expe-
rience and better judgment; and it needs but a clear presen-
tation to obtain the assent of every man, not governed by
prejudice. We might state it as follows:
There is a standard of healthy life. Disease is a departure
from it. The province of rational medicine is to restore it
This unit of life that constitutes a living man is clearly divi-
sible, and is divided by physiologists into several parts, which
may be studied separately, and for each of which we have a
standard of healthy life. Thus, we study the circulation of
the blood, respiration, digestion and blood-making, nutrition,
waste and excretion, as well as the structure of the blood,
and the solids, and the essential conditions of life-heat and
electricity. And as we study these separately in health, that
we may fix in our mind a healthy standard of life, so we study
them separately in disease that we may know its exact char-
acter.
We see that the departure from health must be in one of
three directions-above, below, from or according to the
classification of Dr. Williams, "in excess, defect, perver-
sion." Common sense would at once suggest a rational treat-
ment-if there is an excess of function, bring it down to the
normal standard—if there is a defect, bring it up—if there is
a perversion, correct it-always selecting remedies that influ-
›nce the part or function affected, directly.
The first lesson in specific diagnosis is to recognize the
separate lesions which compose a disease, and classify them
as named above. We say, that at once a rational treatment is
suggested, but this is only so, to one who has given the sub-
ject some thought; the old therapeutics shed but little light
upon it.
?
SOME PHASES OF SPECIFIC MEDICATION.
275
The first lesson in specific therapeutics is, to learn that
remedies are selective, and that when introduced into the cir-
culation through the stomach, they specially influence certain
parts and functions, and that this action is unvarying.
Now, it is but a simple application of common sense to say,
that if we desire to influence the circulation of the blood, we
shall select a remedy that acts upon the circulatory system,
and not one that acts upon the bowels, skin, kidneys, brain,
or other parts. And it is only one step farther to say, that
the remedy should be selected with regard to the character
of the lesion-if in excess, that it will bring it down-if de-
fective, that it will bring it up-if perverted, that it will cor-
rect it.
This, the reader will see, is but the application of logic to
the practice of medicine. We want precision of observation,
and thus applying the unvarying rules of logic, we reason to
correct conclusions; and a practice thus based must be right.
You can't call this theorizing-it is plain matter-of-fact—
clearly demonstrable in its premises and conclusions—and as
absolutely true at the bedside as in the lecture-room.
The second lesson in specific diagnosis is, to determine the
relative importance of these lesions. We want to know
which stands first, and serves as a basis-we might properly
call this the basic lesion-and then the relative importance of
others which have grown upon it. When we come to study
the "second phase" of specific medication we will find this
to be a principal feature.
We can best illustrate this lesson, by reference to cases :-
For instance, many simple fevers and inflammations have as
a basic lesion, the disturbance of the circulation, and the in-
crease of temperature; arrest of secretion, loss of appetite,
digestion and nutrition, depravation of the blood, and de-
rangement of innervation, are based upon them. The disease
may really be a very active and severe one, and yet rest so
wholly upon the lesion of circulation, that if this is corrected,
they all fade away, and the patient rapidly convalesces. The
special sedative, associated with the proper bath, becomes in
2
276
SPECIFIC MEDICATION.
these cases absolutely curative, and no other medicine is
necessary.
But again, we find cases in which the lesions of circulation
and temperature are quite as marked, and yet the sedative is
not curative; in some cases, indeed, it is not sedative even.
Let us take two very common cases illustrative of this:
A typical malarial fever gives us quite as frequent a pulse
and exalted a temperature, as in the case where the sedative
alone was curative-but now we find it only preparative-the
lesion of the blood is the basic lesion. We prepare the patient
for the use of Quinine, or in some cases give it alone, and the
Quinine is curative.
Again, a patient is suffering with acute fever or inflamma-
tion, the pulse quite as frequent, the temperature as high, and
yet the sedative has no more influence than so much water,
unless it be to irritate the stomach. What now? A direct
sedative not influencing the circulation-have we here an
idiosyncrasy? Oh, no! not at all! the only trouble is, that
the lesion of the circulation and temperature is not the basic
lesion. Supposing we examine the tongue and find it pallid
with white coat, we say at once here is a lesion of the blood,
a salt of soda is required. We give it, and now the sedative
acts kindly, or indeed it may not be necessary, simple bicar-
bonate of soda lessening the frequency of the pulse more
markedly than Veratrum.
We find the same is the case where the symptoms point to
the Alkaline Sulphites, Muriatic Acid, Sulphurous Acid,
Chlorate of Potash, Phosphorus, Iron, Copper, or even Cod
Oil, or food.
If for instance, in an endemic of typhoid fever, we find deep
redness of mucous membranes, this being characteristic of the
basic lesion-a want of acid-we find that Muriatic Acid
becomes sedative, stimulant, restorative, increases secretion,
checks diarrhoea, stops delirium, indeed does all for the
patient that we can wish. Most times we supplement it with
other remedies acting in these directions-but occasionally it
is safest to trust to the acid alone.
SPECIFIC MEDICATION.
277
I have obtained quite as marked results from the use of
Sulphurous Acid in the treatment of typho-malarial fever
this year, as I have in the use of Sulphite of Soda in other
seasons.
Again, we find cases where the predominant affection is of
the nervous system. For instance, the face is flushed, eyes
bright, pupils contracted, increased heat of scalp, restless and
sleepless, determination of blood to the brain-Gelseminum
becomes our best sedative. Why? Because it quiets the irri-
tation of the brain, and removes this, which is the basic
lesion.
So it is in the opposite condition-enfeebled capillary cir-
culation, and tendency to congestion of the cerebro-spinal
centers. The pulse may be quite as frequent, the temperature
as high, secretions arrested, blood poisoning rapid, and yet
sedatives are not sedative. Why? Because there is an un-
derlying lesion. We must influence the vegetative system of
nerves first, to restore capillary circulation-and then our
other remedies act kindly. I have sat by the bedside and
seen the pulse fall from 140 beats per minute to 100, and the
temperature from 107° to 101°, in four hours, under the influ-
ence of Belladonna alone-and yet Belladonna is not seda-
tive? This was a case of Rubeola Maligna, at the fourth
day, with profound coma.-E. M. Journal, February, 1872.
Specific Medication.
Synopsis of a Paper read before the Eclectic Medical Association of Ohio.)
GENTLEMEN :-At the last meeting of the State Society, I
was requested to prepare a paper on Specific Medication,
which should serve as a basis for a discussion of this new
departure (as it has been called) in medicine.
I do not propose, in doing this, to occupy much of your
time in details, but rather to present the principles upon
which specific or direct medication rests.
It will be well for us first, to think for a moment, (if it is
possible for us to realize it), what an un-specific or indirect
278
SPECIFIC MEDICATION.
medication is. It means that we never oppose remedies
directly to processes of disease, but on the contrary, influ-
ence diseased action in a roundabout, indirect, and uncertain
manner.
As examples-We violently excite the intestinal canal with
cathartics to arrest disease of the brain, the lungs, the kidneys,
or other distant parts. Or it is possible that we confine our
ministration first, to the gastric sac, then follow with potent
cathartics. In order, we excite the skin and the kidneys in
the same manner. This not sufficing, we counter-irritate
with rubefacients, blisters, etc., and so far as possible keep up
an influence counter to the disease by unpleasant, nauseating
and irritant medicines.
we'
Whatever may be said in favor of such a practice, and how
fine-so-ever the theories with reference to it may be spun, it
is based upon the idea that two diseases can not exist in the
body at the same time, and if the medicines are sufficiently
potent, their action will surely be the strongest-and the dis-
ease will stop-leaving the patient to recover slowly from the
influence of the medicines.
Did you ever know the patient stop?—instead of the dis-
ease. I have, many a time, and have in this way, myself,
been a wonderful dispensation of Providence. In the olden
time men would not believe that the Doctors aided large
numbers of people out of the world. Oh no! The doctors,
God bless them, pulled the sick through; they would all
have died if it had not been for the Faculty.
It is wonderful how statistics take the conceit out of some
people and some things. When we find hundreds of cases of
severe disease tabulated-such as typhoid fever and pneu-
monia—with a mortality of but one to three per cent., with
only good nursing and food, no medicine; and active. potent
medication gives a mortality of five to fifty per cent.
Do Eclectic physicians kill people too? This brings the
matter home, and one doesn't like to confess his own sins, as
a rule. But in this matter I am like Artemus Ward in the
last war—I am willing to shed the blood of all my relations
SPECIFIC MEDICATION.
279
—and I answer in the affirmative—they do kill-not so many
as the old practice, it is true, but yet enough to cause us to
look at home and rid ourselves of the evil.
Now I am glad to know that you, and Eclectics as a rule,
have a very much better practice than theory. Whilst they
occasionally wander off after these phantasms, it is the ex-
ception and not the rule.
As a body of physicians we recognize the fact that disease
in all its forms is an impairment of life. And we recognize
the necessity of conserving this life, and of employing such
means as will increase it, and enable it to resist and throw off
disease, and restore normal structure and function.
We recognize the importance of the functions of circula-
tion, innervation, excretion, etc., and the necessity of obtain-
ing as nearly a normal performance of them as possible. And
all experience shows, that just in proportion as we get this
normal performance, disease is arrested.
From its inception Eclecticism has been, to a very con-
siderable extent, Specific Medication. The earliest writings
point us to Dioscorea as a remedy for bilious colic, Hydrastis
for enfeebled mucous membranes, Aralia and Apocynum for
dropsy, Baptisia for putrid sore throat, and similar conditions
of mucous membranes, Hamamelis for hemorrhoids, Ma-
crotys for rheumatism, etc.
In our Materia Medicas, remedies were classed as Emetics,
Cathartics, Diaphoretics, Tonics, Alteratives, etc., but in
reading the description of medical properties, some special
use or curative action would be pointed out, and for this it
would be commonly used.
In all acute, and most chronic diseases, our examination of
the patient and our therapeutics will take this order: 1. With
reference to the condition of the stomach and intestinal canal
-bringing them to as nearly a normal condition as possible,
that remedies may be kindly received and appropriated, and
that sufficient food may be taken and digested. 2. With
reference to the circulation of the blood, and the temperature
—obtaining a normal circulation as regards frequency and
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SPECIFIC MEDICATION.
freedom, and a temperature as near 98° as possible. 3. With
reference to the presence of a zymotic poison, or other cause
of disease-which may be neutralized, antagonized or re-
moved. 4. With reference to the condition of the nervous
system-giving good innervation. 5. With reference to the
processes of waste and excretion--that the worn out or
enfeebled material may be broken down and speedily removed
from the body. 6. With reference to blood-making and re-
pair-that proper material be furnished for the building of
tissue, and that the processes of nutrition are normally con-
ducted.
We may illustrate this further by calling attention to the
tongue as a means of diagnosing conditions of the stomach
and intestinal canal, and of the blood.
You will bear in mind that diagnosis-or determining the
real condition of disease is the most important part of Spe-
cific Medication. And that it is not that rough diagnosis
which will enable us to guess off a name for the associated
symptoms, at which name we will fire our Materia Medica
promiscuously. Hence, when we question the tongue, it is
not with reference to a remittent or typhoid fever, an inflam-
mation of lungs, or rheumatism, but it is—I want you to tell
me the condition of the stomach and intestinal canal, and
especially the condition of the blood.
Now let us briefly see what it will tell us, with regard to
the condition of the prima viæ:
If the tongue is heavily coated at its base with a yellowish-
white fur, we know that there are morbid accumulations in
the stomach; and we have to determine between the speedy
removal by emesis, the slower removal by the Alkaline Sul-
phites, or the indirect removal by catharsis.
If the tongue is uniformly coated from base to tip with a
yellowish fur, rather full, moist, we have the history of atony
of the small intestine, and we give Podophyllin, Leptandrin,
and this class of remedies with considerable certainty.
If the tongue is elongated and pointed, reddened at tip and
edges, papillæ elongated and red, we have the evidence of
SPECIFIC MEDICATION.
281
irritation of the stomach with determination of blood. The
therapeutics is plain : get rid of the irritation first, and be
careful not to renew it by harsh medication.
Again, we have a tongue that might be designated as slick.
It is variously colored, but it looks as if a fly should light on
it he would slip up and break his neck. It is the evidence of
a want of functional power, not only in the stomach and
bowels, but of all parts supplied by sympathetic nerves. We
treat such a case very carefully, avoid all irritants, and use
means to restore innervation through the vegetative system
of nerves.
The tongue tells us of acidity and alkalinity of the blood,
and in language so plain that it can not be mistaken:
The pallid tongue, with white fur, is the index of acidity,
and we employ an alkali—usually a salt of soda, with a cer-
tainty that the patient will be benefited. Indeed one who has
never had his attention directed in this way, would be sur-
prised at the improvement, in grave forms of disease, from
one day's administration of simple Bicarbonate of Soda.
The deep-red tongue indicates alkalinity, and we prescribe
an acid with a positive assurance that it will prove beneficial.
Grave cases of typhoid fever and other zymotic diseases, pre-
senting this symptom, have been treated with Acids alone,
and with a success not obtained by other means. But it
makes no difference what the disease is, whether a recent
diarrhoea, or a grave typhoid dysentery, if there is the deep-
red tongue, we give Muriatic Acid with the same assurance of
success.
Impairment of the blood-sepsis—is indicated by dirty coat-
ing, and by dark-colored fur-brownish to black. When we
have either the one or the other we employ those remedies
which antagonize the septic process.
The bitter tonics are indicated by fullness of tissue, with
evident relaxation, impairment of circulation and muscular
movement. The same condition will be an indication for
24
282
SPECIFIC MEDICATION.
Iron. We give Tincture of Chloride of Iron if the tongue is
red, Iron by Hydrogen if the tongue is pale.
The pale, trembling tongue is a very good indication for
the Hypophosphites.
The pale bluish tongue, expressionless, is the indication for
the administration of Copper.
The dusky swollen tongue demands Baptisia.
You will notice that we have made this "unruly member'
tell us a good deal, yet it might tell us more-it will tell us
more when we thoroughly study it. My object is not to point
out all that we might learn from it, but to show that it is pos-
sible to arrive at positive conclusions, from symptoms that
are always definite in their meaning.
In making our diagnosis we question every function in the
same way. We make the pulse tell us the condition of the
circulation, and to some extent the nervous system that sup-
plies it. We question the nervous system, the secretory
organs-in fact every part.
One might suppose that diagnosis in this way would be a
matter of great difficulty, as would the therapeutics based
upon it, from the large number of remedies needed to meet
these varying conditions of the several functions. But this
is not so. On the contrary, the method is not only direct and
certain, but it is easy.
We have but one life, though its manifestations are so
varied. The control of this life is centered in a common
nervous system—the ganglionic-and through this the various
parts and functions are united. Disease is an aberration of
this life-life in a wrong direction. Though it manifests
itself in various ways, and though we study in detail as I
have named, it is to grasp it at last as a unit, and oppose to
it one or more remedies.
In some cases we have a first preparatory treatment, to fit
the patient for the reception of remedies which directly
oppose disease. As when we give an emetic to remove mor-
bid accumulations, or means to relieve irritation of the
stomach, or give an Acid or an Alkali, or use Veratrum and
UNCERTAINTY IN MEDICINE.
283
Aconite to reduce frequency of pulse and temperature, to
obtain the kindly actlon of Quinine in intermittent or remit-
tent fever.
In other cases there are certain prominent symptoms indi-
cating pathological conditions which may be taken as the
key-notes of the treatment. As, when we have the full, open
pulse, indicating Veratrum; the hypochondriac fullness,
umbilical pains, and sallowness of skin, indicating Nux
Vomica; the bright eye, contracted pupil and flushed face,
calling for Gelseminum; or the dull eye, immobile pupil
tendency to drowsiness, which calls for Belladonna.
In some cases the indication for a special remedy, like one
of these, is so marked, that we give it alone, and it quickly
cures most severe and obstinate diseases.
I would like to continue this subject further, for it is one
in which I am greatly interested, and I know it is one in
which you are interested, but the shortness of our session
will not permit further remarks. But when we come together
another year, with another year's experience, we may discuss
it again.-E. M. Journal, September, 1871.
Elements of Uncertainty in Medicine.
>
The practice of medicine is proverbially uncertain, not so
much possibly as regards the termination of disease, as
regards the influence of medicine to palliate or arrest it.
Instead of making this uncertainty a cardinal doctrine, a
belief in which is absolutely essential to regularity, it seems
to me it would be profitable to examine it carefully, and by
analysis determine the "elements of uncertainty;" we might
then hope to determine the "elements of certainty," and by a
simple process of reasoning, avoid error and attain truth.
The most important factor in "medical uncertainty," is un-
doubtedly our present nosology. It is thought to be the chief
end of medical study to attain such skill in diagnosis, that
the diseases met with may be correctly classified, according to
Good, Wood, Da Costa, or others And having thus affixed
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SPECIFIC MEDICATION.
a name by which they may be known, treat that name accord-
ing to a Materia Medica which reads-" this remedy has been
found useful in"—or "this remedy may be employed in,” etc.
The element of uncertainty lies here, that a name employed
to designate a disease, may cover the most diverse pathologi-
cal states. The case of to-day, and the case of to-morrow,
though justly called by the same name, may require a widely
different treatment; the remedies employed successfully in
one, would increase the disease in the other. Every one of
our readers may draw the evidence of the truth of these
propositions from his own practice.
The second "element of uncertainty " we find in the doc-
trine of idiosyncrasy, which is also a cardinal article of faith.
We are gravely taught that in medicine one of nature's laws
-that "like causes produce like effects," is inoperative; and,
on the contrary, "that no man can possibly tell from the
action of a medicine on one, what will be its influence upon
another." The doctrine of idiosyncrasies is broad enough to
cover all shortcomings and failures. And if true, then now
and forever medicine will be a great uncertainty.
The third "element of uncertainty" lies in the application
of the Latin motto, post hoc ergo propter hoc-that which
follows a medicine must be due to its influence. If a man
recovers from sickness after taking Podophyllin or Quinine,
it is due to these agents, and he probably would not have
gotten well without them. But there is this singular fact
here: whilst physicians are willing to credit their remedies
with all relief from suffering, improvement and restoration to
health, they are not willing to reverse it, and concede increase
of suffering, prolongation of disease and death to the reme-
dies, though the sequence is quite as natural in the one case
as the other.
It does seem strange that physicians should have so thor-
oughly believed that medicine saved the lives of the sick,
that without it the majority, or all, would have died. Strange
that they never should have observed, until within the past
score of years, that abundant provision might have been
UNCERTAINTY IN MEDICINE.
285
made by the Creator for the removal of disease, and that it
was possible that medicine might be adding to the death-rate,
rather than lessening it. Even now when all this is proven
beyond cavil, by some of the best observers, we find the
majority won't believe it; even if they concede it in theory.
they deny it in practice.
The fourth element of uncertainty lies in the endeavor to
get direct results from indirect agencies. You want to in-
fluence the circulation and the temperature, and you give
remedies which produce emesis or catharsis. You want to
elect Greeley, and you whip your neighbor because he “rah's”
for Grant.
The fifth element of uncertainty is the administration of
remedies in poisonous instead of medicinal doses. It is true
that the poisonous action may be known with some certainty,
but its influence upon disease is very uncertain.
The poisonous action sets up a new process of disease in so
far as it changes structure and function, and it may be cura-
tive according to the law of substitution. A medicinal action
we understand to be one that restores function, and thus
removes disease.
Give your remedy in medicinal doses, and then you may
expect direct and positive results in the relief of disease.
These are the principal elements of uncertainty in regular
medicine and in our school. To these we might add a num-
ber of minor ones, among which is a belief in "special
providences," inscrutable or otherwise. Indeed any one who
is inclined to shift his responsibility upon his Creator, and to
believe that the laws of nature can be suspended from any
providence, has all the elements of uncertainty with him.
The principal element of uncertainty in Homœopathic
medicine is the making of pain a principal symptom, and the
treatment of symptoms in place of pathological conditions.
The cheerful trust in Nature of the high dilutionist is lauda-
ble, though we can't say so much for their claim to all the
glory of relief and recovery
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SPECIFIC MEDICATION.
This is but a rough sketch of the subject, which we present
as good material for thought. We purpose using it as a text
in the future, and elaborating some of the points. In our
next article, we will consider the "elements of certainty" in
medicine, in the same order.-E. M. Journal, July, 1872.
Elements of Certainty in Medicine.
In our last article we briefly discussed the "elements of
uncertainty in medicine," and we now propose to look at the
other side-how may we attain certainty in medicine. We
all agree that the practice of medicine in the past has been
notoriously uncertain, and that there is yet great room fo.
improvement.
""
The first, and most important element of "uncertainty 18
found in our present nosology, and the constant tendency to
prescribe for names of disease. The first "element of cer-
tainty " will be, therefore, an entire avoidance of this error,
diagnosing pathological conditions and prescribing for these.
We have heretofore seen that disease, as we meet it in the
individual, consists of a series of functional lesions-all dis-
ease is an impairment of function. Certain prominent lesions.
or symptoms give a name to the disease, according to the
present nosology, but the name does not, and can not convey
to the mind the character of the lesions or the treatment re-
quired to remove them. If I say my patient has "pneumonia ''
(taking one of the simplest diseases), I give you no informa-
tion which would guide you to a correct treatment, and if you
prescribe it must be upon the idea that all inflammations of
the lung are alike, unless you follow the expectant plan, and
use the "mush poultice," with rest and good nursing.
In one case the prominent lesion would be of the circula-
tion and temperature; and we would stop the inflammation
by the third day with the use of Veratrum and the bath,
alone. In another case with small pulse, and tendency to
congestion, we would relieve our patient speedily with the use
of Aconite and Belladonna, and the local application of
CERTAINTY IN MEDICINE.
287
Compound Powder of Lobelia to the chest. In a third class
of cases, with especial impairment and feebleness of mucous
structure, Ipecac would be a prominent remedy. In a fourth
class of cases, with special impairment of skin and dryness.
of mucous membranes, we would use Asclepias. In a fifth,
if we had the broad pallid tongue, we might treat the case
with Bicarbonate of Soda alone. In a sixth, of typhoid
character, we would obtain especial benefit from Sulphur-
ous Acid, Muriatic Acid, Sulphite of Soda, or Baptisia.
In a seventh class of cases, with hypochondriac fullness,
umbilical pain, sallowness and puffiness of skin, yellowness
about the mouth, and the coloring matter of bile in urine, I
will cure every case with the single remedy, Nux Vomica.
Eighth, all our readers know that there is a class of cases in
which Quinine is eminently curative, and will alone speedily
arrest the disease.
Is it not most absurd, therefore, to talk about a stereotyped
treatment of pneumonia? We have named eight classes of
cases, and in the entire lot have wanted no remedy for the
lungs. It really makes no difference whether it is an inflam-
mation of the lungs or the nates, only in so much as a man
breathes with the one and sits on the other.
Specific diagnosis is therefore the first element of cer-
tainty in medicine. We want to know the character of the
lesion of the circulation, the temperature, the functions of
digestion, nutrition, secretion and excretion. innervation, etc.,
and knowing these, and how remedies influence these func-
tions, we prescribe with a reasonable degree of certainty.
The second element of certainty is a firm reliance on
nature's law—“ that like causes produce like effects." We
are not looking for "idiosyncrasies" to excuse our ignorance,
or “special or inscrutable providences" to cover our defects
and shortcomings. We want to study those symptoms and
signs that determine exact conditions of disease, and then
knowing the action of remedies we may always give them
with certainty.
The third element of uncertainty we found to be the taking
288
SPECIFIC MEDICATION.
of every good result that followed the administration of
remedy, as being due to its action. This must be carefully
avoided. We study the direct or specific action of remedies
by using them singly, and observing the consequences in
numerous cases; it is confessedly a work of time, and a work
of difficulty, but it can be done.
The fourth element of certainty is found in giving reme-
dies for their direct effects, and not as they produce counter-
irritation or some other disease. If the circulation is wrong,
wo give a remedy that acts directly upon the circulatory sys-
tem, and in such way that the wrong may be righted. If
there is a lesion of the blood, we give a remedy that reaches
the blood and antagonizes the lesion. If the skin, kidneys
or bowels fail to do their work of excretion, we reach them
by remedies that exert their influence directly, and so of the
entire Materia Medica.
The fifth element of certainty consists in the use of reme-
dies in medicinal doses and for their direct curative influence.
No man can tell what influence an active cathartic will have
upon a frequent circulation, any more than he can tell what
the influence of a blister will be in pneumonia. The course
of a medicinal disease is notoriously uncertain, as is ex-
ampled by the use of mercurials.
A sixth element of certainty, and a very important one is-
that we have reliable medicines. If we are to take our reme-
dies "hit or miss" from the drug trade, our practice will be
"hit or miss." The drugs of the market are notoriously
uncertain. We want our indigenous remedies gathered at the
proper season, and prepared for use from the fresh or recent
articles. The best form is a fluid preparation, of the strength
of eight ounces Troy to the pint of product. This can be
kept from season to season, is uniform in strength, easily dis-
pensed, pleasant on account of smallness of dose, and relia-
ble in its action. Without uniformly good preparations, the
practice of medicine must be uncertain, and there will be a
constant tendency to gross medication and drugging.—E. M.
Journal, August, 1872.
DOCTRINE OF SUBSTITUTION.
289
The Doctrine of Substitution.
In the olden time the doctrine of substitution was a prom-
inent feature with some Eclectics. They could see no need
of any change in the commonly received doctrine of the Old
School, and they were firm believers in phlogosis and anti-
phlogistics. Blood-letting, Mercury and Antimony, etc.,
were an offence to them-not because of their general depres-
sant influence, but because they were thought to be unman-
ageable, or exerted some special or permanent pernicious in-
fluence
When the writer attended his lectures, this doctrine of
substitution was prominently brought forward, and lecturers
would labor to show that we had substitutes for the old means,
quite as effectual at the time, but transient in action.
There were a number of substitutes for bloodletting. Prof.
Buchanan spent much time in showing how hemastasis could
be employed, even to the extent of syncope in active inflam-
mation, and when we had obtained the desired influence, the
blood could be gradually let back from the corded limbs into
the general circulation, and thus whilst we had obtained the
antiphlogistic influence of bloodletting in the relief of inflam-
mation, we had saved the vital fluid. "The boy had eaten
his cake and saved it.”
Profs. Jones and Morrow believed that all the good effects
of bloodletting could be obtained by vigorous cathartics;
that in this free catharsis the bloodvessels could be depleted
almost as quickly, and to a far greater extent, whilst the vital
portions of the blood were saved, and the serum would be
quickly renewed.
Prof. Cleveland and some others thought that this influence
could be obtained by the kidneys as well as the bowels, and
that the two at least were equal to bloodletting. Whilst in
addition, you would be promoting the removal of large quan-
tities of effete material.
Mercury, in the form of Blue-pill, Calomel, etc., was the
25
290
SPECIFIC MEDICATION.
Samson of regular practice, acting on the liver and thus re-
moving disease. We must have a substitute for this Samson,
for we too must "touch the liver" of our patients. And it
was claimed that in Podophyllum and Podophyllin we had a
greater than Samson, or if we wanted the certain but mild
action on the liver-like blue-pill-we would use Leptandra
or Leptandrin. But we must "tap the liver," and thus we
could do it safely.
""
But these would not 66
touch the gums," and as our oppo-
nents regarded "touching the gums as essential to the suc-
cessful treatment of some diseases, we must find a substitute
for Mercury in this direction, and touch the gums too. For
this purpose Iris was recommended, or equal parts of Iridin,
Podophyllin and Xanthoxylum, given in grain doses every
hour or two. And we are told "that salivation from vege-
table agents may be known from that by Mercury, by the ab-
sence of mercurial fetor, and no sponginess of the gums or
loosening of the teeth." And that when Eclectics, from hav-
ing produced such salivation, are unjustly accused of using
Mercury, they may excuse themselves by calling attention to
the above differences.
The necessity of vigorous counter-irritation by gut and skin
was recognized, and many similar means were employed to
obtain it. "Profound impression," by active cathartics, was
required in the treatment of many diseases, and for this pur-
pose we would take Gamboge, Scammony, Colocynth, etc.,
and make the combination Eclectic by adding Podophyllum
or other indigenous remedy. We must use the blister, and
Cantharides being the only certain agent, at least the only one
that could be handled with safety, we take it. But as it
would not do to go too far in this direction, we substituted
for the Tartar Emetic ointment, a vegetable irritating plaster.
Nauseant expectorants must be used in diseases of the re-
spiratory organs, and we substituted for Tartar Emetic,
Lobelia and Sanguinaria, but we still retained Ipecac. Stim-
ulant expectorants must be used, and we kept Squills, Senega.
Tolu, etc., because we had none better, and thus the doctrine
DOCTRINE OF SUBSTITUTION,
291
of substitution ramified in every direction, and in some cases
it would be so slight that there would be no real difference.
Was this Eclecticism? Do you think it possible that a
School of Medicine, increasing for thirty years, could be
founded on so small a basis? These were errors that grew
out of a want of a well defined statement of principles, and
especially a want of knowledge on the part of some teachers.
There was a profound conviction that the old depressant
practice was wholly wrong, and that in its stead treatment
should be restorative. So that really whilst substitution was
thus freely talked of, entirely different means were employed.
Just in proportion as the practitioner departed from the old
ideas and methods, and employed restorative means, just in
that proportion he was successful.
But it was not only the rejection of the antiphlogistic plan,
and the recognition of Nature in the cure of disease, that
gave impetus to the Eclectic movement. But beyond this,
and fully as important was the introduction of new remedies,
for their direct action in opposing and removing disease.
Take the Medical Reformer in its five volumes, and all our
earlier medical publications, and you will find a large list of
remedies that had been carefully studied, and the use of which
gave great success in practice. These earlier Eclectics taught
Specific Medication as certainly as has Dr. Scudder, though
they did not use the name. And what is more, they obtained
just the same influences from many of them that he has, and
they describe this action in just the same way.
It need hardly be added, that those earlier publications of
our School, have been a mine of information which the writer
has worked advantageously for the past dozen years.
This doctrine of substitution has been the bane of our
School, constantly drawing us backwards. We want none of
it. We do not believe the old doctrines of disease, we want
no antiphlogistic or depressant treatment in any case.
Eclectic medicine looks to the conservation of vital power, is
restorative, and so far as possible advocates specific medicines
for specific pathological conditions.-E. M. J., June, 1871
292
SPECIFIC MEDICATION.
Poison vs. Medicine.
As we have stated, "almost all drugs have two actions— 8
poisonous and a medicinal. We want to avoid the one and
obtain the other." How shall we study the Materia Medica
to obtain this desirable end?
At first thought it would seem that the difference between
the poisonous and medicinal action was wholly one of dose.
If I administer two grains of Strychnia I give a poison, if the
one-thirtieth of a grain it favors life; if I give five grains of
Morphia the patient dies, if but one-third of a grain he has
refreshing sleep. You can kill a man with large doses of
Podophyllin, Lobelia, Jalap, and a hundred agents of like
character, when small doses would not kill, and might be
medicinal.
But this is only partly true. The dose may be large enough
to be poisonous, and then the size of the dose will be the only
element of danger, but there is another consideration of more
importance.
Those agencies that we call remedies exert an action upon
the body, and change one or more of its functional activities.
If we give a drug to a healthy person, it produces disease,
and it is because it thus acts upon the body that it becomes a
remedy-an agent that had no such action would be useless.
To make this agent a remedy, however, it is essential that
there should be a functional wrong of the part upon which
this agent acts, and that its action opposes the wrong of dis-
ease, and favors the return to health.
If now we mistake, and give a medicine to influence a
functional wrong that does not exist, then we are poisoning
our patient-it may be slowly, but the influence is neverthe-
less poisonous.
To illustrate, we find a condition of the system in some
malarious diseases in which Quinine is tolerated in large
doses, and is curative. We give a dose of twenty grains in
congestive remittent with the happiest results, because the
POISON VS. MEDICINE.
293
remedy is antagonized by the disease; but under different cir-
cumstances the patient would suffer seriously.
We find cases in which patients can take large doses of the
Bromides with safety and benefit for a long time, but in
others the remedies are poisonous in moderate doses. I have
seen serious results from the use of Iodide of Potassium for
a long time, as I have from other remedies given by rote.
I have been censured for giving Copper as a remedy, be-
cause it was a poison. And yet we find pickles greened with
Copper as an article of food on many tables for years. My use
of Copper has been attended with the happiest resul's, and I
use it with quite as clear a conscience as I use Iron, but I
only use it when Copper is wanted.
I have been censured for the use of Bismuth, because it is
not a constituent of the body, and yet I have never seen the
harm following this agent, that I have from Podophyllin.
It has been clearly demonstrated within the past two years,
that Phosphorus and Arsenic are very closely related chemi-
cally and medicinally. That Phosphorus exerts a very similar
influence upon the skin, and may be used in place of Arsenic
in skin diseases. Yet Phosphorus as Phosphorus is by far
the most difficult to use, the most unmanageable, and the
most likely to poison the patient, yet none of these rabid
Eclectics object to the use of Phosphorus?
Why do I object to the use of Mercury? Because its in-
fluence is to impair the vitality of the body It is destructive
in its nature-and I want no remedies of this character. ]
object to the use of Antimony upon the same grounds, to the
use of the lancet, the blister, harsh purgation, the entire
class of antiphlogistics, from what ever source obtained. I
base my objections upon principle, and not because there is a
prejudice against these things. If I believed in the necessity
of antiphlogistics, as some do, I should employ bloodletting
and Mercury as the principal means, because they are the
typical antiphlogistics, and will destroy life faster than any
thing else.-E. M. Journal, August, 1872.
194
SPECIFIC MEDICATION.
Treatment of Disease with a Single Remedy.
The perfection of specific medicine is found in those cases,
in which the entire series of functional lesions is removea
by one drug. Possibly medicine will never attain such per-
fection; it is possible we have quite as much knowledge now
as we ever will have, but as we have some marked examples
of this, it is reasonable to conclude that time will develop
more.
In studying the specific action of Tinctura Ferri Chloridi
we found some singular but well attested facts. We found
that this remedy was specific in a majority of cases of erysipelas,
and that in many of these its action could not be accounted
for by the older therapeutic doctrines.
Here is a disease presenting all the functional lesions of the
severest zymotic fever. A hot, dry skin, temperature of 106°,
pulse 120 per minute, small and hard, mouth dry and parched,
tongue brown, sordes on teeth, delirium, and an unpleasant
local inflammation constantly spreading. We commence the
administration of Tincture of Muriate of Iron in doses of
ten drops. Before the second dose the effect is noticed, and
within twenty-four hours, the pulse has fallen and become
more natural, the temperature is reduced, the skin is soft and
moist, the delirium has passed away, the patient has slept and
is conscious, the mouth is moist, tongue cleaning, and the
local inflammatory process arrested. In a few days the
patient is convalescent, and yet but a single remedy has been
given. It has been sedative, diaphoretic, diuretic, a nervine
and an antizymotic, and a more efficient one than any that
could be selected from the Materia Medica.
Every one of our readers knows these facts with regard to
Iron, in the treatment of some cases of this disease. Is Iron
in erysipelas an anomaly in therapeutics, the one exception to
all general rules?
Let us take Quinine as another example, and I will try to
give a case that the majority of my readers have seen-one of
A SINGLE REMEDY.
295
malarial pneumonia. The patient was attacked with a severe
chill, followed by fever, increasing from day to day. There
was at first an irritative cough, followed by soreness of chest,
difficult breathing, rusty sputa, and the usual physical signs.
Severe from the commencement, it was only aggravated by the
expectorants ad nauseam, the cathartics, blister, and associate
means. Now the ninth day of the disease there is purulent
expectoration, great prostration, and the evidences of early
dissolution. Doctors are changed, and the new one recognizes
it as a case for Quinia. There is relief from the first dose,
and a rapid amendment and convalescence in a few days.
I name this case, because it is one I have seen within the
last few weeks, but the reader can recall many cases of a
similar kind. Here Quinine has been everything that is
good, sedative, diaphoretic, diuretic, stimulant, tonic, a remedy
for the lungs, the one thing necessary.
I have just completed the treatment of one of the severest
cases of carditis, associated with inflammation of the posterior
portion of the lung, that I have ever met with, in which the
action of Quinine at a certain stage was quite as marked.
The patient had been under regular treatment, with consult-
ations for eight days, when he came into my hands. There
was disturbance of the bowels, demanding special treatment,
an unpleasant circulation, effusion into the pericardium, and
delirium, all of which seemed to demand something. By the
end of the week, I saw the place for Quinine, and with four
doses of a grain each, daily, and small doses of Cactus, all
the symptoms rapidly faded away. It relieved the delirium,
gave sleep, quieted the cough, brought the pulse down and
gave it regularity, established secretion, and did all that was
necessary. And I may state this important fact, the patient
was not convalescing when it was commenced, but had had a
severe relapse.
Now I would hardly undertake to point out the symptoms
that caused me to give the Quinine in this case. There was
no malarial poison, nothing seemingly for it to antidote, but
there was an impairment of the nervous system for which it
296
SPECIFIC MEDICATION.
was the remedy. I admit that I should be able to point out
the symptoms so that another could recognize the case, and
tell why I give Quinine in certain cases, as in the one above,
but I can't as yet.
We will sometimes find quite as marked examples in the
administration of Nux Vomica. I recall a case in the past
year of severe fever at the fifth day, not controlled in the
least by the sedatives and associate means. A peculiar
yellowness about mouth, umbilical pains, with increasing
nausea, caused me to give Nux Vomica. The prescription
was: R Tinct. Nux Vomica, gtts. v.; Water, 3iv.; a tea-
spoonful every hour. The next morning there was a decided
amelioration in all the symptoms, and by the seventh day the
patient was convalescent. So I have treated inflammation of
the lungs, fever, dysentery, colic, diarrhoea, and many other
named diseases, with Nux alone, the symptoms pointing to it
distinctly, and with the most satisfactory results.
Doubtless, most of our readers have noticed a peculiarity
of pulse, to which Aconite is the remedy. And with Aconite
alone have been able to treat the entire disease with more
than ordinary success. Given the small pulse, with moderate
hardness, and a singular vibration like a violin, string under
the finger, and we have as near as I can give it the indication.
To be plain, I say give Aconite always when the pulse is
small and frequent, but sometimes it is only one of a number
of remedies necessary, but in some it is all. Now let us learn
to know those cases in which it is all, and then we will obtain
the same results as we see from Quinine when it is specific.
There is a eondition of disease to which Baptisia is specific
in the same way. My first experience with this was in the
Winter of 1859, in an endemic of cynanche maligna. In some
of these cases the symptoms were as grave as in typhoid fever,
and the ordinary treatment was not a success. Yet Baptisia
controlled the frequency of pulse, lessened the temperature,
established secretion, restored digestion, antidoted the rapid
sepsis, and controlled the local disease. I have given it in
three cases of typhoid fever with like results. There were
A SINGLE REMEDY.
297
characteristic symptoms indicating the use of the remedy,
and when given it checked irritation of the bowels, lessened
the fever, stopped the progress of sepis-indeed, did all for
the patients that the most sanguine could have asked. I
have used it in one case of dysentery (alone) with ike results.
Some of our Homoeopathic friends up North give their testi-
mony in its favor, giving a large number of cases like the
above, so that it has not been a single experience. And I find
on reading back, that Eclectics had similar results twenty-
five years since.
We can reach but one conclusion from this, and that is,
that there is a condition of disease to which Baptisia is spe-
cific, and when this condition is the basis of the series of
morbid processes that make the disease before us, it may be
the one remedy for the totality of disease.
I have been guided by two symptoms, the peculiar fullness
and purplish discoloration of fauces and pharynx, and the
papescent, frothy, dark-colored feces. That there are others,
I doubt not, and probably some more positive, but these
would cause me to give Baptisia in any case
I have seen the gravest forrs of disease rapidly fade away,
upon the administration of Bi-carbonate of Soda when the
common means had failed. There was a special indication
for it; any one might see it, if he knew how and where to
look. And now simple Soda becomes sedative where seda-
tives had failed, gives sleep where Opium had failed, estab-
lishes secretion, antidotes the blood-poison, or is actually
antiperiodic where Quinine has proven a failure. In evidence
I may cite Prof. King, who gave me my first instruction in
this, and might add hundreds of others.
If we wanted evidence badly, I might bring forward
Chambers, Anstie, Bennett, Wunderlich, and others, to prove
that very similar results have been obtained from the use of
Muriatic Acid. With it alone, hundreds, yes, thousands of
cases of typhoid and typhus fever have been treated, with a
mortality ranging from less than one per cent. to never more
than three. There was something special in these diseases
298
SPECIFIC MEDICATION.
that the Acid met, and it was the one thing necessary, every-
We have learned to determine this condi-
thing necessary.
tion and we use Acids in a rational way.
I might give other examples, but these will suffice to
awaken attention, and all that the subject wants is thought
and investigation. There is here a broad field for study, and
one that should well repay research. That medicine will
ever reach such perfection, that we will be able to select one
remedy for the totality of disease in all cases, I do not believe,
but that it may be done in a considerable number, I am quite
certain.-E. M. Journal, June, 1872.
Pleasant Medicines.
The great desideratum in the practice of medicine is pleasant
remedies. In the olden times, and with many now, medicine
adds to the sufferings of the sick, and they dread more the
unpleasantness of the doctor's prescriptions than they do the
disease.
In looking over our Materia Medicas and Dispensatories,
it would seem that our object has been to make the concoc-
tions as nauseous as possible. In extemporaneous prescrip-
tions it is the same; the combination of remedies, and the
vehicle, combine to make the mixture unpleasant
It has been thought that sugar or syrup would cover up the
unpleasantness of medicine, and hence it is most commonly
used. The fact is, however, that with the majority of the
sick the sweet is unpleasant, and nothing could be more ob-
jectionable than a nauseous sweet. The doctor don't take
his own medicines, and hence he does not know how objec-
tionable they are, and he continues giving these unpleasant
mixtures year after year, to the detriment of his patient, and
his own pocket.
Let us first get rid of the idea that medicines should be
and can be disguised. It never had one atom of truth in it,
and a very little experimentation will determine its falsity.
Take anything that is unpleasant, and the more you disguise
PLEASANT MEDICINES.
299
it the worse it is. Some medicines are very objectionable in
their taste, but they are less disgusting to the patient alone,
than when mixed with syrup or other vehicle.
The best form of vegetable remedies is a simple tincture by
percolation: the best form for all remedies, if possible, is the
fluid form. It is not only the best as regards the medicinal
action of the remedy, but is also the pleasantest as well.
The best vehicle for the administration of a remedy, is
water, and it also is the pleasantest. But few remedies are
intended to exert a local influence upon the mucous coat of
the stomach. All others must first gain entrance to the cir-
culation, before their curative action can be obtained. To
get into the blood by osmose, it is necessary that the agent be
in solution, and of less specific gravity than the blood. If
you do not have your remedy in solution before its adminis-
tration, its getting into the circulation will depend upon the
stomach supplying the necessary amount of fluid and effecting
the solution.
To the sick, there are but few of our remedies objectiona-
ble, if they are properly prepared with alcoho! and given with
water. The dose of properly prepared remedies is quite
small, so that, added to fresh water in such proportion that
the dose will be a teaspoonful, it is much diluted. Even if
the taste is objectionable, there is evidence of cleanliness,
and nothing to disgust.
For years, I have made my prescriptions in one way-to a
glass of fresh water adding the necessary amount of tincture
or fluid medicine to make the dose a teaspoonful. In acute
diseases the dose should be frequently repeated, hence it is
necessarily small. Of a strong tincture of Aconite or Vera-
trum, gtts. v. to gtts. xx. to 3iv.; of Gelseminum, 3j. to Živ.;
of Macrotys, Asclepias, Lobelia, etc., 3j. to 3iv. As a rule,
these doses exert a more marked curative effect than the
larger ones commonly given.
But it is in the treatment of children that unpleasant
medicine is most objectionable. It is not pleasant to see the
ittle ones start with distrust when the doctor makes his
300
SPECIFIC MEDICATION.
appearance, nor to be obliged to force medicines upon a child.
We get along much better if we have the confidence of the
children, and it is certainly much pleasanter.
I always prepare the medicines before my little patients.
They see the water is fresh, their medicine looks clean and
nice, whilst its quantity is small, and the mixture does not
look objectionable. They taste it when asked, taking the
first dose from the doctor, and give their opinion decidedly
that it is good, (or at least not bad), and after this they take
it kindly as the hour comes around.-E. M. Journal, Jan-
uary, 1871.
Conservation of Life.
It is fortunate for mankind that we have life enough to
resist processes of disease, and the medicaments of the doctor.
This power of resistance, and vital tenacity, is really one of
the most wonderful facts of our existence, and should be an
admirable argument in the hand of the theologian to prove
the fore-knowledge of the Creator It is the salvation of
physic-for if it were not for this strong tenacity, doctors
would soon bury all their patrons, and have to seek other
means of livelihood.
In some seasons, we have this subject forced upon ou
attention in a way that we can not avoid it, and we are obliged
to learn a lesson whether we will or no. As an example.
some physicians have learned this season, for the first time,
that Quinine will not cure all cases of ague, and that it wil
act as a poison, leaving effects that are never recovered from
So many learn the necessity of conserving the life, carefully
guarding the feeble flame, and strengtening it, from some
endemic or epidemic disease of an asthenic character which
they see for the first time. The experience comes to some
with dysentery, in others with inflammation of the lungs,
typhoid fever, or even in the ordinary "bilious" fevers of our
country. One lesson is sufficient for many, but the most of
us require more; but when we have these experiences, and
CONSERVATION OF LIFE.
801
the fact is forced on our attention, our practice undergoes a
change, and we become very conservative.
This experience has come to a great many this year, and we
hear of it constantly in letters coming to our office. To many
it has come through the typho-malarial fever so prevalent
this fall, in which even the simplest depressants-purgatives
for instance-have been sufficient to produce death.
I give an instance from my own practice as an example-the
only fatal case out of seventeen cases of this severe fever:
Was called to see patient who had been sick with this
fever for fifteen days, "given up" by the attending physician,
and was not expected to live out the twenty-four hours.
Careful attention, conserving life, was followed by recovery,
though it required five more weeks. In the second week of
my attendance, two more children took the disease, and
though I did my best, the fever would run its course, and
presently I was satisfied with holding my own-conserving
life, in their cases. Both were convalescent the fourth week.
But in the meanwhile a fourth child took the fever, not worse
than the others, seemingly stouter, and having more vital
tenacity. The sick in that house were getting too thick, and
I concluded that in at least one of the cases I ought to stop
the disease with medicine. The tongue was fearfully dirty,
abdomen tumid, and I concluded to cleanse the prima via
with a cathartic-the child was dead in three days. Instead
of cleansing the "way of life," I wiped it out. There was no
other reason why the boy should not have lived as did his
brothers and sister, and he would have lived, in all proba-
bility, if he had had the same treatment.
It is not pleasant to sit in judgment on oneself, but I have
found it profitable. I know there is no mean between good
and harm in medicine as we use it; it will do one or the
other—if it does not oppose disease, it opposes life. I know
this talk about idiosyncrasy is all bosh, and when a medicine
does harm, I am to blame, not the patient; and I try to learn
a lesson from it, and not to fall into the same error again.-
E. M. Journal, December, 1871.
302
SPECIFIC MEDICATION.
On the Use of Restoratives.
In order that the body may properly perform its functions
it is necessary that there shall be normal nutrition of tissue
Life grows out of the continued change of matter, and it is
active and healthy in proportion to the decomposition and
recomposition of tissue
The food taken each twenty-four hours represents the force
required and used in its organization, and used in the human
body this force is set free as needed, and is living force. Just
as in the wood burned under the steam-boiler, there is locked
up the force required for its organization, derived from the
sun, and which in the process of burning is set free, and
manifests itself to us in the steam engine as power.
If from any cause we have an impairment of nutrition, we
must have an impairment of life in the same proportion.
manifesting itself in simple deficiency of function, or in its
perversion.
Certainly in any such case the restoration of normal nutri-
tion is one of the most important indications of treatment.
And in the majority, we will find that as we approximate
normal nutrition, we return to the condition of health.
If we have an impairment of nutrition, what shall we do?
You answer-give bitter tonics and iron. But experience
proves that this is not always good practice, and if we would
think for a moment we would see that it is very unphilosophi-
cal. Bitter tonics are mostly gastric stimulants, increasing
the appetite and to a limited extent gastric digestion. Iron is
required for the building of red-globules. This it will be
noticed is but a small part of what we have to take into cou
sideration
In studying nutrition and its derangements, we have to
consider: 1st. The food, that it is good, properly propor-
tioned between the histogenetic and calorifacient, and that it
contains all the elements of the tissues in proper proportion
and in such form that it can be appropriated. 2d. That the
PAIN AND ITS TREATMENT.
303
action of digestion-buccal, stomachic and intestinal-shall
be properly performed. 3d. That the blood is free from
effete material, in regular circulation, and the associate blood-
making organs are working w 11. 4th. The material being
properly prepared, and taken to the part, that the part itself
is in condition to appropriate it. (a.) That the old tissues are
removed. (b.) That the formative force is sufficient for cell
reproduction.
We see that the lesion of nutrition may be dependent upor
a wrong in the food; upon a lesion of digestion-either
buccal, gastric, or intestinal; upon effete material in the
blood; upon an impairment of the circulation; upon a defi-
ciency of formative force in the cells of the part; or upon a
defect of waste, the old tissues not being broken down and
carried away.
It may be rectified by selecting proper food, by such ele-
mental substances as are necessary to nutrition, or by getting
good mastication and insalivation, or by those agents which
facilitate gastric digestion, or by those which facilitate intes-
tinal digestion, or by those which remove effete material from
the blood, or by those which favor an equal and uniform cir-
culation of the blood, or by those which stimulate the forma-
tive act in the tissues, or by those which aid the process of
retrograde metamorphosis-removing the old tissues.-E. M.
Journal, April, 1871.
Pain and its Treatment.
What is health? That condition of body in which all
functions are a source of pleasure. What must then be the
condition when the performance of function, or simple exist-
ence, is unpleasant? Disease. We say a person suffers from
disease, and the language of the people correctly expresses the
fact-disease is a condition of suffering, or suffering is a con-
dition of disease. If people did not suffer in disease, they
would think very much less of it than they do, and might
bear the confinement with considerable equanimity.
We ask the question, again—What influence has the ordi-
804
SPECIFIC MEDICATION.
nary practice of medicine upon the unpleasantness of disease
that we call suffering? Let us think for a moment, before
answering this question, and see if we can call up a past ex-
perience in our own bodies to aid in solving the question.
How is it with Castor Oil, Jalap and Senna, Podophyllin, a
pint of Polygonum Punctatum or Eupatorium, a nauseant of
Lobelia, Ipecac, Sanguinaria, et id omne genus? In the
ordinary use of medicines do we increase the unpleasantness
of disease?
In the olden time this was thought necessary to save life,
but we now know that this was a professsonal fiction, and that
instead of saving life, mortality was increased by this use of
medicines. Unpleasantness and suffering are evidences of
disease-impairment of life-increase these by medicines,
and you increase the sum of disease, and still further impair
life.
We conclude from this that a correct practice of medicine
should be pleasant in itself, and that it should look to remov-
ing unpleasantness and suffering, for these are evidences of
disease.
Admitting that it is still necessary to produce a temporary
increase of suffering, to remove the cause of a more prolonged
suffering, as when we give an emetic, or a cathartic of Podo-
phyllin, we want to restrict these necessities as much as possi-
ble, and finally get rid of them if we can.
But there are times when the suffering in disease becomes
unbearable, the patient must have rest and relief from pain,
and for this purpose we are presented with certain drugs
which obtund sensibility-called narcotics. Really, these
consist of Opium and its salts, and the new agent, Hydro-
chloral. So great is the seeming necessity for these, that the
imports of the first amount to some millions of dollars yearly,
and the second is weighed by tons. They are în such common
use, and regarded as so indispensable, that we find them on
every physician's shelves, and in every pocket case and pill-
bags, and prescribed on every page of a druggist's prescrip-
tion-book.
PAIN AND ITS TREATMENT.
805
To these remedies, and to this common use I object, and I
propose to give these objections "form and comeliness," and
if possible present a better way.
I object to the ordinary use of narcotics, because they are
prescribed for symptoms and not for conditions of disease.
It is well known by all who have studied modern pathology,
that pain and sleeplessness may be due to two distinct and
opposite conditions of the brain. In the one case the condi-
tion is active-irritation and determination of blood. In the
other, the condition is one of atony-the circulation and
nutrition being enfeebled. Clearly these two conditions re-
quire different treatment-for which will you prescribe
Opium? and what will you do for the other?
You find your patient alike sleepless in these two opposite
conditions. In one the skin is dry and harsh, temperature
high, pulse frequent and hard, secretions arrested. In the
other the pulse is small and feeble, the face pallid, and the
extremities cold. In which of these cases will you give
Opium? and what will you do for the other?
You find severe pain in a part, the patient wants relief,
must have rest; did it ever suggest itself to you that it was
worth while to take into consideration the condition of the
part-whether it was one of activity or atony, or the general
conditions as named above? In the ordinary use of narcotics
these things are not considered, and hence the common use
of these drugs is the worst form of empiricism.
I have nothing to say about the uncertainty of their action,
and the ill effects so frequently following their use. Every
reader has had these experiences, and I have no doubt, would
be only too glad to know how to get along without them, or
learn to use them with greater certainty.
I recognize the fact that there are two factors in this prob-
lem of unpleasantness-pain, sleeplessness. The one is the
general condition of the body, embracing every function; the
other is the condition of the brain and its sensitive nerves.
And I formulize it in this way. As is the departure from the
normal standard of health in function and condition, so will
26
306
SPECIFIC MEDICATION.
be the unpleasantness, pain, sleeplessness. Conversely, when
we have either of these, we may expect relief just in propor·
tion as we restore the body to its normal condition, and the
brain to its normal condition.
Thus, when my patient is suffering, or sleepless, I deter-
mine as near as may be, what derangement of function is the
cause, and instead of prescribing narcotics, I adopt those
means that restore the diseased function.
If the condition is one of irritation and determination of
blood to the brain, relief and sleep come from the use of the
sedatives and Gelseminum. If the condition is one of atony,
it comes from the use of stimulants, tonics, and food.
Prescribing for the basic element of disease, is a very cer-
tain way of relieving pain and giving sleep. You will get
those results from the simple administration of Bicarbonate
of Soda, Muriatic Acid, Sulphuric Acid, Baptisia, Phytolacca,
when these are specially indicated, as well as from the use of
remedies that more especially influence the nervous system.
Hoping that I have at least placed this subject in such
light that our readers can think of it, and solve the problem
for themselves, we will leave it for this time. I may remark,
in conclusion, that I have not given a narcotic in eighteen
months, and have not used the equivalent of a drachm of
Morphia in five years.-E. M. Journal, April, 1872.
Diagnosis and Treatment of Obscure Cases.
We all have our troublesome cases, in which the symptoms
are not pronounced, and the diagnosis is obscure, and the
treatment being guess-work, proves a failure. The best men
may make mistakes in diagnosis, but it should be of rare
occurrence, and never one that will lead to the improper ad-
ministration of medicine.
Let us take a single condition of the intestinal canal as aL
example. We are sent for to see a patient, and find him con-
fined to room or bed, and complaining of inaction of the
bowels. Question him as you will, the end is the same-con
OBSCURE CASES.
807
stipation and he feels certain if his bowels are moved, all
will be well. Will we give him a physic? And continue to
repeat it, increasing its strength?
Not by any means. We e sce in constipation but a symptom
and not one especially indicating the character of the disease.
It might be the disease called "bilious colic." I have seen
it with a very moderate amount of pain; and though Com-
pound Powder of Jalap, in broken doses, would prove cura-
tive, Podophyllin and the harsher cathartics would kill. It
might be acute enteritis, and then the dry skin, small, hard
pulse, white narrow tongue, tenderness on deep pressure,
would determine the character of the disease; and we would
not give a cathartic under any circumstances. Again it might
be hernia some of the obscurer forms, or ileus-invagina-
tion, in either case, a cathartic would be the worst medicine
we could give.
In the above cases the constipation seems to be the direct
symptom, if it is not the disease itself. So in many other
cases, the symptoms that seem to point out the disease, are
quite as likely to lead to wrong as right treatment.
Supposing we take pain in the bowels-colic, as another
example. It won't do, to depend upon the character of the
pain always, to tell us the lesion or the proper remedy-and
it don't do to call it colic, and prescribe at random. As an
example, I was called to see a case that had been under the
care of a Homœopath, who prescribed for the character of the
pain; but the woman had suffered intensely for hours, and
was exhausted by the severity of the pain. The inhalation
of Chloroform for ten minutes gave entire relief, and there
was no return of pain-there was intestinal spasm. Another:
I had prescribed for a case of abdominal pain, in the early
part of my practice, the usual routine of aromatics, stimu-
lants, chloroform by mouth, winding up with Compound
Powder of Jalap, until the stomach refused to tolerate any
more medicine-and all without relief. A Homœopathic
practitioner was called, and prescribing Nux Vomica alone,
had the patient comfortable in three or four hours. I might
308
SPECIFIC MEDICATION.
have done it, as well as he, if I had known then what I know
now. The peculiar yellowness around mouth, sense of full-
ness and oppression in right hypochondrium, and pain point-
ing at umbilicus, told the story clearly. I recollect a case of
green apples in my boyhood, and the drenching with Com
position and diluted No. 6, as prescribed by a disciple of
The suffering becom-
Samuel Thomson, but without relief.
ing fearful, and life endangered, the old Dr. was sent for, and
a grain of Tartar Emetic relieved the stomach, and the boy
was asleep in an hour. So I have had cases which were
speedily relieved by small doses of Sulphate of Magnesia, or
Iodide of Potassium-lead colic. So we will find cases, re-
quiring an absorbent like Charcoal, an Alkali, Ammonia,
Chloroform, Aromatics, even Podophyllin. And again we
reach the concluslon that the pain was not the disease, not
even a reliable symptom.
Thus, in almost every case we are obliged to look beneath
the surface symptoms, and use our reasoning powers, compar-
ing the evidences of disease, and thus determining the exact
functional lesions.
Unless, and here is an important proviso, we have studied
this subject of basic symptoms; then in a number of cases,
no matter what the disease, the remedy will be indicated by a
characteristic symptom. In this I agree with some Homœo-
paths, as I agree that when a drug is thus clearly indicated,
it will probably be the remedy for the totality of the disease.
There is this difficulty here in some cases there is no char-
acteristic symptom, or if there is we have not learned to
know it, or have not learned the remedy.
But the cases given, though illustrating the necessity of
care in diagnosis, and the danger of falling into error, do not
otherwise bear upon our subject. These cases are not obscure
if ordinary care is used, for the evidences of disease are un-
mistakable. We have cases, however, in which great care is
necessary, and our diagnosis must be direct, differential, and
by exclusion.
Probably the shortest road to a correct idea of the methods
OBSCURE CASES.
309
of diagnosis in the treatment of obscure cases, will be found
in the following brief statement of the three methods above
named:
1st. We have direct symptoms pointing to the seat, and the
character of the disease. In simple cases these symptoms are
clear and distinctive; in obscure cases, they are not, but they
point the direction of investigation If we have a single
characteristic symptom, one that we have called basic, then
of course our diagnosis is complete and the treatment definite.
2d. By differential diagnosis, we undertake to determine
the location and character of disease by an analysis of the
symptoms. Seeing which of them are common to all of the
supposed affections-which are undeniably special to a certain
part or function-until we have found one or more that locate
the disease and determine its character.
3d. By exclusion, we give the entire body an examination,
determining the functions that are rightly performed, exclud-
ing these, until finally we have localized the lesion and have
determined its character.
There is hardly a disease so obscure but that it may be ac-
curately determined in this way, if proper care is used. Ne-
cessarily we must know our Anatomy and Physiology, and
the modern teachings of pathologists, then with caution and
a right use of reason, we can hardly fail.
Now if we have determined such obscure disease, and we
have had no experienoe and can find no treatment in our
books, how shall we proceed? Very certainly as follows:
A drug is a remedy because it influences the part or func-
tion diseased. It is an indirect remedy when its influence is
dependent upon the disturbance of some other part or func-
tion; it is a direct remedy, when its influence is directly upon
the part.
Now we have determined the functions that are changed,
and the part affected, we think of those remedies which are
known to exert a more or less direct influence on the particu-
lar part or function; knowing the character of their action,
and the want of the diseased body, we adapt the one to the
310
SPECIFIC MEDICATION.
other. If the case is one new to us, we may have to experi
ment, but the line of experiment will be a rational one, and
likely to lead to good results.-E. M. Journal, June, 1872.
Epidemic or Endemic Constitution of Disease.
You have no doubt observed, that the diseases of some
seasons, no matter how diverse in special characteristics,
would have something in common, which something would
be especially manifest in the treatment; that in some seasons
Quinine would cure every thing, in others the sedatives would
cure every thing, in others a remarkable benefit from Podo-
phyllin, so that when you had once determined a good treat
ment, you would persist in it for all affections, with very little
modification.
And this brings prominently before us the fact, for fact it
is, that there is an endemic or epidemic constitution of dis-
ease, that should be well studied, and always regarded in
treatment. Success or failure will very frequently depend
upon this knowledge, and it is something that must be re-
learned every year.
It was a prominent doctrine of Rademacher and his follow-
ers, and he had remedies for three such constitutions. These
were Iron, Copper, and the Nitrate of Soda. There was some
truth in this-how much I don't know, for I have not had
the opportunity to experiment, and, indeed. have not had
time to give his works the examination they should have, as
I read German slowly, and they have never been translated.
I believe, however, I have passed through one year, in
which Iron was the remedy for almost every thing, and
think probably some of our old practitioners may recollect it,
if they by chance had used Iron. The season commenced in
December with a large number of cases of erysipelas, for
which Iron was a specific, and for some fourteen months I
prescribed Iron daily for almost every thing, with the most
flattering results. I have experimented with Copper and Ni-
trate of Soda to but a limited extent.
CONSTITUTION OF DISEASE.
311
Rademacher applied the principle to chronic disease. Grau-
vogl says: “Our experience gained by this school is worthy
of special consideration, that, in old chronic diseases, the
previous epidemic constitution, always decides, first of all
upon the present indication of a remedy; hence, in every
case which comes up for treatment, the time of its first ap-
pearance should be learned, as far as possible, for by this,
frequently, if the then epidemic curative remedy is known,
the primary seat and the primary kind of the diseased pro-
cess are known also, and this very remedy will still effect a
cure, if a cure is yet possible, or, if the disease is not already
succeeded by another disease of the first affected organ or
blood, or if disease of another organ has not ensued. But,
even in this latter case, that knowledge gives the point of de-
parture for the whole chronic affection'
(6
'That is in gross what we see happen on a smaller scale,
after strong or oft-repeated doses of long-acting remedies.
First appear symptoms at the point of application, then of its
reception in the blood; finally, the affections of the specifi-
cally affected organs and systems in succession, and often at
great intervals, as we have observed very distinctly with
quicksilver, for instance. The only difference consists in this,
that epidemic injurious influences, often after very many
years, to the surprise of many, bring to view their continued
operation as a token of the presence of their results under
various forms of disease, while the continued operation of
drugs is of proportionally shorter duration."-E. M. Journal,
June, 1872.
312
SPECIFIC MEDICATION.
CASES,
Illustrating Specific Medication.
The reader by this time will be impressed, that Specific
Medication must be based upon specific diagnosis; that we
prescribe medicines for pathological conditions, and not for
names of disease; and that we will have success just in pro-
portion as we learn the meaning of symptoms, and train our
senses to close observation and an analysis of all the evi-
dences of changes of function and structure.
True, we have to closely and carefully study our Materia
Medica, and learn the influence of drugs upon the human
body; this is an essential element of specific medication. But
however well the physician may know his Materia Medica,
if he can not recognize the evidences of disease, and the rela-
tion of remedies to definite conditions, he must fail in prac
tice, or at least have only that success which comes from na
ture's efforts to cure, or by hap-hazard or indirect medication.
I confess it is not easy to learn this direct relation between
disease and remedies. It is probably more difficult now than
it will be years hence, when, having been more thoroughly
studied, it will be presented in a clearer light. Still it is our
duty to make the most of what we have, trusting to time and
careful observation to make up our present deficiencies.
I have thought that a report of cases illustrative of specific
medication, would aid the reader, especially as they point out
the symptoms or conditions of disease, that indicate special
remedies. Many of these cases have been reported in the
Eclectic Medical Journal, but I have given them the usual
classification here.
Intermittent Fever.
We will take a series of cases illustrative of the treatment
of intermittent fever. I confess, at the commencement, that
I have not seen one case where others have seen fifty or one
INTERMITTENT FEVER.
313
hundred, but I am very sure I have seen them with different
eyes. It has been my fortune, however, to have seen, in the
way of consultation, a large number of intractable cases, and
one learns more from these than from the ordinary run of
simple ones.
I may say, at the commencement, that while I value Qui-
nine as a specific against the malarial poison (whatever it is)
I do not regard it singly as a specific for the disease, or its
common use as being good practice. I should prefer to dis-
pense with it wholly in the treatment of periodic disease, than
use it as badly as many do.
It is passing strange that doctors having eyes and a mode-
rate amount of brains behind them, should persistently use
Quinine in the most varying and opposite states of disease—
in cases which have not a single thing in common but peri-
odicity, and persist in its use when failure follows failure, and
the only result of its administration is quinism-far worse
than the original disease.
When a case of ague presents itself, we ask ourselves the
question, is it simple, or is there functional or structural dis-
ease? If simple, the intermission is a state of perfect health,
less a certain debility. If complicated, we wish to determine
the exact condition of disease. If simple, we give Quinine
at once; if complicated, we remove all functional and struc-
tural disease by appropriate remedies, and then, wheu simple,
we give quinine if it is necessary. A large number of cases
will not require it.
I administer Quinine differently from most physicians. The
patient being properly prepared for its action, has a single
dose of sufficient quantity to break the ague (grs. x. to grs
xv.), three hours before the expected chill. This is best
taken dissolved in a small quantity of water by the aid of
sulphuric acid. This may be called the big-dose plan. I
have treated a few cases with a single dose of one-eighth of a
grain, given at that period of the day when the patient is most
himself—usually if the period of intermission is divided into
three parts, the end of the first period will be the best time
27
314
SPECIFIC MEDICATION.
I will be glad if some of our readers, who have an abundance
of cases, would try the small dose.
CASE I.—Intermittent Fever-Inflammatory.—F., æt. 41, a
strong, robust man, has had ague for five months, contracted
in the Wabash Valley. Has had it broken with Quinine, on
an average, every two weeks. Has had a Thomsonian course
of medicine, been freely purged with Podophyllin, and his
liver tapped with Calomel and Blue Pill. His chill lasts
from thirty minutes to two hours, and the fever severe, for six
to ten hours, during which he suffers intensely. Is now quo-
tidian.
Examination during the intermission shows: a dry, harsh
skin; a contracted tongue, with slight white coat down its
centre, edges reddened; some headache and backache at
times, face flushed and eyes are bright and somewhat intole-
rant to a bright light; bowels constipated, (the patient claims
they would never move without physic); urine diminished in
quantity one-fourth, not changed in color. The pulse is 80,
full and bounding. Temperature 100° scant.
Prescribed-R Tinct. Veratrum, gtts. xxx.; Tinct. Gelse-
minum, 3j.; Water, 3iv.; a teaspoonful every hour until the
pulse loses its full and bounding character, and the skin
softens, then every three hours. Chlorform, gtts. xv. at the
commencement of next chill. Acetate of Potash commenced
on the third day, 3ij. daily. Hot foot-bath for thirty minutes
every night on going to bed.
The chill and fever became lighter each succeeding day,
and did not recur after the fifth day. If I had not been em-
ploying the remedies to determine their full influence in curing
an ague, I should have given Quinia, grs. x. the third day,
which, I have no doubt, would have broken the chill at once.
The cure was a permanent one.
CASE II.-F., æt. 27, a brother of Case I. contracted the
disease at the same time and place, and has pretty much the
same experience, though Quinine has held the disease in check
INTERMITTENT FEVER.
315
for longer periods. He is a spare man, and in appearance quite
different from his brother, but the chill and fever are quite
as severe. Ague is now tertian.
Examination during the intermission shows: a dry, harsh
skin; pulse 86, small and hard; temperature 991; urine
scanty and high-colored (coloring matter biliverdin); tongue
contracted and reddened; bowels regular.
Can not now take the smallest dose of Quinine without
unpleasant head symptoms, and an increased severity in the
fever.
Prescribed-B Tinct. Aconite, gtts. xx.; Tinct. Asclepias,
3j.; Water, 3iv. A teaspoonful every hour during the fever,
every two hours in the intermission. Quinine inunction twice
daily of: B Quinia Sul., 3ij.; Lard, 3ij.; Oil of Anise, 3ss.
M. Had two recurrences of ague after the treatment was
commenced, but made an excellent recovery.
CASE III.-R., family of three, father, mother and child of
three years. Had ague last year, and were cured with Qui-
nine. (But like many cures with this drug, they were not
entirely well.) Ague commenced this year in May, and for
three months they have had it continuously. No means em-
ployed had done any good, except to break it on the father
for one week. It is of the tertian type, but fortunately the
sick day of one is the well day of the other. The sick day is
a sick day in fact, as they keep the bed the whole day.
The father presents himself at the office on his well day.
Examination shows-skin pallid and relaxed; pulse soft, open
and easily compressed; temperature 99°; bowels tumid, ir-
regular; hands and feet cold; eyes dull, pupils dilated; wants
to sleep; tongue full, broad, with coating somewhat resem-
bling that after eating milk. The others are represented as
having the same symptoms.
Prescribed-R Tinct. Aconite, gtts. xv.; Tinct. Belladonna,
gits. xx.; Water, Ziv.; a teaspoonful every two hours. Child
one-fourth the quantity. Also Sulphite of Soda, grø. xx.
three times a day.
816
SPECIFIC MEDICATION.
Father reported in ten days that neither he nor the child
had had a paroxysm of ague since, (the child did not take the
Sulphite.) The mother had but two chills, but though better
the disease was not arrested. Gave a single dose of Quinine,
grs. x.; chills stopped, and thus far have not recurred. The
entire family seems to be radically cured.
CASE IV.-W., Superintendent of Adams Express in the
West, travels extensively in Southern Indiana, Illinois and
Missouri; very strong and rugged, never had ague until
August, 1870. Returned from Vincennes feeling very much
depressed, had a slight chill, pain in head and back, intense.
muscular pain in right side extending from shoulder to foot.
Eyesight impaired, and partial paralysis followed the subsi-
dence of the pain; ague quotidian. These were the symp-
toms at each recurrence of the chills. I saw him soon after
the second chill. The fever was very slight-notwithstanding
the gravity of the other symptoms.
Prescribed-B Tinct. Aconite, gtts. x.; Tinct. Macrotys,
gtts xxx.; a teaspoonful every hour. The pain was speedily
relieved by the prescription, and he slept well. Gave the suc-
ceeding forenoon, fifteen grains of Quinine in two doses. It
had no more effect on the ague than so much water, but pro-
duced unpleasant head symptoms and deafness, which were
persistent. Concluded to let Quinine alone, gave the first pre-
scription only. There was a steady amendment, and the
fourth day gave a single dose of Quinine, grs. x., and the dis-
ease was at an end for the time. Small doses of Quinine
were taken as a prophylactic in his next trip.
Though the chills were stopped, the deafness continued, as
did the slight paralysis. In September he had a recurrence
of the disease in the same form. Concluded I would not use
Quinine at all. Gave the Aconite and Macrotys the first day;
then in addition-R Tinct. Nux Vomica, gtts. xx.; Water,
Ziv.; a teaspoonful every two hours (the remedies being al-
ternated.) He had no recurrence of chill after the third day,
and recovered his usual health rapidly. Has been in a mala-
INTERMITTENT FEVER.
817
rial region this year-used no prophylactic - and has felt
nothing of it.
The Nux Vomica was used in this case as a cerebro-spinal
stimulant.
CASE V.-Recent Ague.-S. has had quotidian ague one
week; been purged freely; and has had as much Quinine
daily as his head would bear; feels badly, is discouraged, and
concludes he will change doctors.
Characteristic symptoms-a broad, pallid tongue, coated
with a white, pasty fur; breath fetid.
Prescribed-B Sulphite of Soda, grs. xx. every three hours.
Had no more chills, and made a quick and permanent re-
covery.
This is a typical case, and some physicians have found all
the cases of a season to take this character. Thus we had
127 cases reported by one physician in 1868, cured with Sul-
phite of Soda alone; Quinine failed almost uniformly.
Instead of depending wholly upon Sulphite of Soda, how-
ever, I would advise its use until this peculiar condition was
rectified, and then give Quinine.
Common Salt has been successfully employed in the same
class of cases in doses of grs. xx. every three hours during
the intermission. A large number of cases, by different prac-
titioners, were reported in one of our Southern exchanges,
some twenty years ago.
CASE VI.- Ague with Subsequent Typhoid Symptoms.—
Some fourteen years since I had to treat a very stubborn ague
originating in the Little Miami bottoms. The cases would
not yield to ordinary treatment; and in some, typhoid symp-
toms gradually developed, and patients died of what was at
first an ordinary ague.
My first treatment was a complete failure, and it was only
after I had seen a prescription of our old Quaker physician,
Dr. William Judkins, that I had any success.
had any success. It was very
simple. Quinine, gr. j. every two hours during the intermis
818
SPECIFIC MEDICATION.
sion, with the free use of water acidulated with Nitro-Muri.
atic Acid. The treatment was a complete success.
Characteristic symptoms-deep redness of mucous tissues,
and dark coatings upon tongue; and to-day, with the same
symptoms, I should use the same treatment.
CASE VII-Ague with Partial Congestion.-F. has had
ague for six weeks; has been twice broken with Quinine.
Now Quinine has no influence, only to produce cerebral
symptoms and increase the severity of the disease. Has been
thoroughly purged with Podophyllin-worse. Has had two
emetics-worse. Ague tertian.
His skin is sallow; yellowish discoloration about the
mouth; complains of dull pain in right side under false ribs
extending to shoulder; and occasional umbilical pains; en-
largement of spleen, bowels irregular, stools clay colored;
has frequent attacks of nausea; urine highly colored with
bile; pulse in intermission 90, temperature 100°; has little
appetite, and is very much debilitated.
Prescribed-R Tinct. Nux Vomica, gtts. x.; Water, 3iv.;
a teaspoonful every hour. The disease gives way slowly—
patient had two chills after the medicine was commenced.
The remedy was continued without change for two weeks, and
the cure was permanent.
CASE VIII.—Ague with Impaired Innervation. — B. has
had tertian ague for two weeks. There is nothing remarkable
about the case, except the loss of energy and desire to do
anything, and the fact that ordinary means do not reach it
Pulse soft and open, 70 per minute; temperature 99°; skin
relaxed and moist; tongue broad and sodden; bowels irregu-
lar, stools semi-fluid with scybala; urine in large quantity,
colorless.
Prescribed-R Strychnia, grs. 1-30th, every four hours dur-
ing the intermission. Had no recurrence of chill, and made
a good recovery.
I may say in this connection that the treatment of ague
INTERMITTENT FEVER.
819
with Strychnine is sometimes remarkably successful, and is
again a complete failure. I think I have pointed out the
Strychnine case, so that any of our readers may know it—but
I would be very glad to have it confirmed by other observers
Dr. Shultz, of Logansport, employs Strychnine, quite fre-
quently, by hypodermic injection, and expresses himself
pleased with its action.
CASE IX. Ague with Gastric Atony and Secretion of
Mucus.-Some thirteen years since I had to treat a number
of cases of ague in river men. They had contracted the dis-
ease on the Lower Mississippi, Yazoo and Red River, and it
was remarkably stubborn, some cases being continued from
June to Mid-Winter, with temporary arrests from Quinine.
Three-fourths of them presented the following symptoms-
tongue broad, heavily coated at base in the morning, bad
taste in the mouth, weight and fullness in epigastrium, fetid
breath, and unpleasant eructation after eating
I treated every case with thorough emesis, (Compound
Powder of Lobelia), repeated in some cases, and the use of a
solution of Acetate of Potash, 3iij. in twenty-four hours.
No Quinine was used. The treatment was a decided success,
but I obtained a reputation for giving nasty medicine that I
never will get rid of. A few days since I met one of the pa-
tients, and he had to report how Dr. Scudder turned him in-
side out—but, says he, “I have been in the South every Sum-
mer since, and I have not had a shake."
Is this Specific Medicine too? Yea, verily, and very good
practice it will be found in just such stubborn cases.
CASE X.-Ague with Intestinal Torpor.-I will not give a
case, for any one of my readers can put his finger on one or
more. Recollect that constipation is not the symptom; on the
contrary the bowels will frequently move every day, yet the
patient says the unpleasant feelings are never removed by it.
Characteristic symptoms-tongue full and coated from base
to tip with a yellowish, pasty fur; bowels tumid.
320
SPECIFIC MEDICATION.
Prescribe-Podophyllin thoroughly triturated, adding a
small portion of Capsicum or Ginger, to free purgation. To
be followed by Quinine when the system is in proper condi-
tion.
CASE XI.-Ague treated with Arsenic.-The first year of
my practice I was poor, and found it difficult to make both
ends meet. Late in the Fall I was applied to by a Southerner,
who told me he had had ague for over a year; he had tried
everything, and could get no relief. Could I help him? He
had taken Quinine, Fowler's Solution, Salicine, and indeed
all the common drugs.
I answered, yes, I'll cure you, (though I wasn't half as
confident as I seemed).
Prescribed-Filled an ounce bottle one-fourth full of
Homœopathic pellets, and dropped on them Fowler's Solution,
gtts. v. Ordered ten of these every four hours. Only one
chill afterwards, and made an excellent recovery.
The gentleman came to my office in about ten days, and
after telling me that he thought he was well, and was going
home, said, "Now, Doctor, I wont ask you what your bill is.
There is $50 for the bottle of little pills, and you have my
thanks in addition." That was the best money I ever made,
for it enabled me to live until sufficient practice came.
!
In 1864 I had to treat three students who, coming from
Missouri and Illinois, brought ague with them. During
October and the first two weeks of November, they kept the
disease partly in check by the use of Quinine and Podophyllin
pills. But finally these failed, and the disease commenced to
present typhoid symptoms, one of them being confined to his
bed.
The symptoms were peculiar. There was no seeming loss
of flesh, but the tissues seemed sodden, and expressionless.
The tongue and other mucous tissues were tumid and bluish ;
a brownish fur gathered on the tongue, and sordes about the
teeth; the bowels were loose, stools papescent; the chills not
very severe, but the fever intense; pulse in intermissions,
soft and fluent, during fever small and thready.
INTERMITTENT FEVER.
321
They were very bad cases, one was in a dangerous condition.
They had taken the usual remedies, Quinine in full doses, as
well as Strychnine; what should I give them? I decided at
once to try the little pills. In a week the sickest one was at
lectures.
Prof. Jones was told, and he was asked, What the little
pills were made of?" Of course he couldn't tell, and the
very thought of little pills was an offence in his nostrils, and
his remarks about "Dr. Scudder and his little jokers" were
a standing subject for fun for many sessions.
Will the "little jokers" cure all cases of ague? Indeed
they will not. I wish they would, for they are far pleasanter
than Quinine. But they will cure some cases, and those are
usually inveterate ones that Quinine won't reach.
But!" and I imagine some one holds up his hands in
holy horror," that's giving Arsenic." That's a fact, so it is.
I had forgotten that "ratsbane "was in the list of tabooed
medicine. Got it mixed up with "hensbane" somehow.
Very sorry, but these are facts, and we have need to know
them.
CASE XII.-Ague treated with Quinine Inunction.—I re-
ported my first case of ague cured by Quinine inunction some
twelve years ago—and as it was a typical case, I may as well
give it here.
A Mrs. Clark had suffered with ague for some five years—
broken at times-but never free from its effects. It is now
September, and she has had it since May with but one respite.
Is very feeble, very sensitive, very nervous, and suffers severely.
Can not take a grain of Quinine without cerebral symptoms;
can not take the ordinary medicines in use, because they
nauseate and are rejected by the stomach. Evidently a very
bad case, and the young Doctor is at his wits' end to know
what to do.
Had just been studying the action of remedies, and was at
that time especially interested in cutaneous absorption, and
concluded I would ask the skin to do the work of the stomach.
322
SPECIFIC MEDICATION.
射
​Ordered-B Quinia. Sul., 3ij.; Lard, 3ij.; to be thoroughly
rubbed into the axillæ, and the anterior surface of abdomen.
No more chills; made a slow, but excellent recovery.
I have used Quinine inunction in scores of cases since—not
always with such positive results, but nearly always with
Denefit. In children it is a favorite remedy, especially in
cases of slow infantile remittent. A physician of our school
in Dayton, Dr. Kemp, tells me he has employed it in a large
aumber of cases this year and last, and with the most flatter-
ing results.
CASE XIII-Ague cured by Cutaneous Absorption.-John
J. contracted ague during a visit West, Has been treated
some weeks without benefit; has a horror of Quinine.
Used Ether Spray to chill a surface three inches in diame-
ter over the epigastrium, and applied a Solution of Quinine
An application daily for a week, and the disease was perma
nently cured.
I have used Quinine in this way in a few cases, and in part
of them with excellent results. Ether applied with a sponge,
and evaporated by fanning, answers quite the same purpose as
the spray apparatus. The Quinine is absorbed when reaction
occurs, and it makes little difference to what part of the body
it is applied, so the skin is thin.
CASE XIV.-Ague cured with Boletus.-M. has had ague
off and on for two years. Quinine breaks the chill, but it
returns within a week-and then for a time the drug has no
influence. There is no special indication for any remedy.
Prescribed-B Tincture Boletus, 3j.; Water, 3iv.; a tea-
spoonful four times a day. Had no more chills, and the cure
was radical.
I would be glad to have reports from physicians using
Boletus, to show the special condition. if any, in which it is
curative. For whilst curative in some, in others it exerts no
more influence than water.
CASE XV.-Chronic Ague.-M., æt. 38, a river man, has
been in the South-West for some six years, has had ague for
INTERMITTENT FEVER.
328
the last three. Quinine will break it for a few days, but
makes him feel so badly, that he dislikes to take it.
His skin is sallow, looks full and waxy, and has lost its
natural elasticity; extremities are cold most of the time;
urine in usual quantity, but of light specific gravity, 110 to
116; pulse is full, but shows want of power; bowels torpid;
spleen much enlarged and tender; slight cough; tongue
broad and furred white; appetite poor.
Prescribed-B Tinct. Veratrum, gtts. xx.; Water, 3iv,; a
teaspoonful every two hours. R Acetate of Potash, 3ij.
every twenty-four hours, in a considerable quantity of water.
R Tincture of Nux Voinica, gtts. ij. every morning in a glass
of water.
Recovery was slow, but at the end of the month every
vestige of ague had disappeared, and the patient was gaining
flesh rapidly. The cure was permanent-has had no symptom
of ague since, now three years.
The treatment of ague with Acetate of Potash was strongly
recommended by Golding Bird in his work on Urinary De-
posits, and will be found an excellent plan in some cases.
CASE XVI.-Chronic Ague.-C., æt. 26, has been a steam-
boatman on the Lower Mississippi for three years. Had ague
the first year which was cured with Quinine. Ague the sec-
ond year was treated for some time without success, and was
finally broken with Fowler's Solution in large doses-leaving
him with the peculiar puffy condition of face and oedema of
lower extremities, that so frequently follows this use of
Arsenic. The third year the ague came on, and nothing
would reach it, and he came here in September.
Skin is sallow, but looks like parchment and is tightly.
drawn to the tissues; pulse is small and frequent; urine is
scant and high colored; bowels irregular, with occasional
mucous diarrhea; tongue looks lifeless, and is covered with
a milky looking coat; appetite is poor; greasy eructations, and
occasional vomiting of mucoid matter.
Prescribed-B Triturated Podophyllin, 1-100, grs. v.; Hy.
824
SPECIFIC MEDICATION.
drastin, gr. ss. for a dose, three times a day. Quinia inunc-
tions morning and night thoroughly. Every third day a
thorough washing with soap and water.
Gained from the first day, and ceased taking medicine before
the end of the third week. No recurrence of the disease.
The reader is ready to ask by this time, "Dr. Scudder, did
you ever have any unsuccessful cases? Do you want us to
believe that your medicine always works like a charm?" I
answer, I have cases all the time in which my diagnosis is at
fault-sometimes from carelessness, sometimes because I don't
know. I would report these cases as well if I could see how
a report of my want of care or want of skill could benefit the
reader. I doubt not every one of my readers has a sufficient
amount of that experience in his own practice, and need not
go abroad for it.
What we want to know here, as in every other disease is-
the exact condition of disease, and when we know this we can
prescribe with certainty. Very certainly it requires some-
thing more than to say-" this is ague and I'll give Quinine;"
that is further than I can go in Specific Medication.
CASE XVII-Chronic Ague cured with Iron.-S., æt. 31,
has suffered with ague for the past three years. It has been
treated with Quinine, and he is now suffering from quinism,
and at times the nervous symptoms are almost unbearable.
The special symptoms are—a full blue tongue, and a cutaneous
trouble showing the peculiar red glistening surface we see in
some cases of erysipelas.
Prescribed-R Tinct. Muriate of Iron, 3ss; Simple Syrup
and Glycerine, aa. Živ; a teaspoonful four times a day. As
a bath a weak solution of Sulphate of Tron. To wear red
flannel. Made a good recovery, improving from the first, and
has had nothing like ague for the six months past.
CASE XVIII.-Chronic Ague cured with Nitric Acid.-
Dr. H., has suffered with ague for the past three years, which
he has treated with Quinine-which will break the chills, but
REMITTENT FEVER.
325
will not keep them off. Now Quinine irritates the nervous
system, and the remedy is worse than the disease. Its mani-
festation now is in the form of periodic cephalalgia. Special
Symptoms: A peculiar violet color upon a tongue moderately
red. The lips and finger nails show the same violet haze
Prescribed--R Nitric Acid, gtts. xx; Water, Simple
Syrup, aa. Zij; a teaspoonful every three hours. The head-
aches recurred for three days, decreasing in severity, and there
was complete and permanent recovery.
I have prescribed Nitric Acid in various forms of Chronic
disease, when this peculiar symptom presented, with most
satisfactory results, and would advise its trial.
Remittent Fever.
What we want to learn in regard to this disease might be
divided into three parts. That, though the disease is called
bilious fever, the liver has nothing to do with it. That,
though classified as arising from vegetable malaria, for which
Quinine is the specific, it is always best to treat the disease
as if it were not so, until the fever, commencing to pass away,
leaves the system in good condition for the kindly action of
Quinine. And, lastly, there are cases, and seasons, where
Quinine must be avoided, if we wish to have success, and not
injure our patients. These points are pretty clearly set forth
in the "revised edition" of my practice, to which the reader
is referred.
CASE XIX.-Simple Remittent Fever.-There are locali-
ties in which the disease for several seasons will present a
large number of simple cases. The patient has a well marked
chill, followed by febrile action, and then a very decided
remission, together occupying a period of twenty-four hours,
and repeating the febrile exacerbation and remission in the
same way, each succeeding day. You examine the patient
carefully, and you find nothing but fever-no particular lesion
of one part or function, more than another.
326
SPECIFIC MEDICATION.
In these cases it is pretty safe to follow the rule of Prof. I.
G. Jones-Give a sufficient amount of Quinine during the
decline of the exacerbation and remission to stop the disease.
It will require from ten to fifteen grains. But if it fails the
first time, it is safer to prepare the system for its kindly action.
CASE XX.-Simple Remittent Fever-killed by the Doctor.
-James G., æt. 27, a strong, robust man, was attacked on a
Tuesday with a chill followed by high fever; the next morn-
ing a decided remission, lasting an hour, then febrile action;
no symptoms indicating complication, or danger. An Eclectic
was called, and commenced the treatment by the administra-
tion of Podophyliin pills to violent catharsis; then Quinine
in divided doses; then Podophyllin in alterative (?) doses (to
tap the liver); then more Quinine, alternated with Podophyllin.
Remainder of treatment a nauseous diaphoretic stew, and
sweet Spirits of Nitre.
Saw the patient in consultation the next Tuesday morning.
Had furious delirium, requiring to be held on the bed; skin
dry and harsh, pungent heat; mouth and tongue dry, tongue
furred, bleeding, almost black sordes upon teeth; pulse 140,
small and hard; eyes injected, pupils contracted, had not
slept for three days. Prognosis-death; verdict-d-n the.
doctor.
Did I ever do this thing? Probably not so grossly, though
it was rather from skepticism than good teaching that I
escaped. If I had followed instructions closely, I should
probably have ended some of my patients in the same way.
CASE XXI. Simple Remittent Fever Badly Treated.-S.,
æt. 24, a robust, healthy woman, was attacked with remittent
fever, (Dr. called it bilious,) August 2d, From the history of
the case it was the simple form of the disease without complica-
tion. An active cathartic was prescribed, followed by altera-
tive doses of a mercurial. Quinine was given in broken doses,
alternated with Dover's Powder, Spiritus Mindereri, and
Veratrum. The patient continued to get worse day by day,
REMITTENT FETER.
327
and when I was called on the ninth day, was in the following
condition :
Tongue elongated and pointed, very dry, mucous tissues
dusky red, brown fur on center of tongue, and sordes on teeth;
pulse 130, small and sharp, temperature 106° in the evening,
1034° in the morning; delirium-a low muttering; skin harsh
and dry; urine scant and very red, bowels continuously loose
from the action of medicine, from the first.
Prescribed-B Dilute Muriatic Acid, 3ss.; Simple Syrup,
3jss.; a teaspoonful in water, every three hours. B Tinct.
Aconite, gtts. x.; Tinct. Gelseminum, 3ss.; Water, 3iv.; a
teaspoonful every hour. A general sponge bath with soap
and water. After the second day Quinine inunction. A milk
diet.
No change was made in this treatment, and the patient was
convalescent in eight days after I took charge of her, making
seventeen days from the chill.
CASE XXII.-Remittent Fever.-O. B., æt. 17; was called
Aug 20th to take charge of the case, then in the fifteenth
day, the physician in attendance saying that the case must
prove fatal. Had the following history from parents and
physician :
Case not very severe at first; after sharp catharsis Quinine
was freely administered-patient much worse. More physic
and more Quinine, aided by Veratrum and Spiritus Mindereri—
still worse, Passing into the second week a diarrhoea became
a marked feature, for which was prescribed the usual astrin-
gents and Bismuth, but without any effect. Quinine still pushed.
Condition on fifteenth day:
Patient very feeble, lies on his back, has cough and difficult
respiration, has eaten nothing for three days, nor slept. De-
lirium constant, eyes bright and wild. Skin harsh and dry.
urine scanty. Diarrhoea a marked feature, actions passed in
bed whenever he coughs. Pulse 124, full but oppressed.
Temperature 103° morning, 106 evening. The tongue is not
much furred and is moist, but a dusky red. The patient is
328
SPECIFIC MEDICATION.
very deaf, and has been so since the first week. Physical ex-
amination of the chest gives dullness on percussion over the
lower lobe of both lungs, and moist blowing sounds over the
entire chest.
Prescribed, for the diarrhoea-R Tinct. Aconite, gtts. X.;
Tinct. Ipecac, gtts. xx.; Water, 3iv.; a teaspoonful every
hour. It did its work well, and we had no more trouble with
diarrhoea after the fourth day, except for a brief period in the
fourth week. The deep coloration of mucous membranes in-
dicated an acid, and dilute Muriatic Acid was given in the
usual way. Milk diet-the milk given hot four times a day,
sometimes oftener.
For the delirium, I employed Prof. Howe's method-B
Tinct. Aconite, 3j.; Chloroform, 3iij. M. To be applied
freely to the nape of the neck, to control the cerebral disturb-
ance and give sleep. To aid this, Gelseminum was given with
the Aconite when there was no further need of the Ipecac;
but this was only an aid, and we depended principally upon
the local use of Aconite and Chloroform.
The disturbed condition of the brain was the result of
Quinine, and it was the severest and the most persistent I
ever saw. Though the patient was in good condition, and
should have convalesced rapidly after the fourth week, we
were obliged to use the local application of Aconite, for five
weeks, making seven from the commencement, in order that
he might sleep. Even now, thirteen weeks from first attack,
his mind is not steady and he has the unpleasant roaring in
his ears and deafness.
CASE XXIII.-Simple Remittent Fever Badly Treated.-
O., a married woman, æt. 36, has been in feeble health for
some years, though stout in body; was attacked with simple
remittent fever, thought it was but a cold, and took on two
succcessive days a patent pill to free purgation. Growing
worse, a neighbor who dabbled in botanic medicine, proposed
to give her a big sweat. This was effectually done, with a
vapor bath, and an infusion of "boneset," and continued for
REMITTENT FETER.
329
a day and night. Patient so much worse, that the writer was
sent for on the fifth day. Condition:-
Skin relaxed and bathed in perspiration, extremities cold,
trunk hot. Pulse 120°. Tongue moist, and covered with a
dirty fur, mucous membranes blueish. Bowels acted twice
during the day, stools large, papescent and light colored.
Urine moderately free. No appetite. Complained of sense
of fullness and also pain in the hypochondria and epigastrium.
Prescribed-R Tinct. Aconite, gtts. x.; Tinct. Belladonna,
gtts. xv,; Water, 3iv.; a teaspoonful every two hours. B
Tinct. Nux Vomica, gtts x.; Water, 3iv.; a teaspoonful
every two hours. Quinine inunction. Milk diet.
R Sulphurous Acid, 3ss.; Simple Syrup, 3jss.; a teaspoon-
ful every three hours until the tongue cleaned.
The patient progressed favorably from the first, but it was
two weeks before fully convalescent.
CASE XXIV.-Remittent Fever presenting Typhoid Symp-
oms. Mrs. S., æt. 56. Has suffered for four months with
the unpleasant ague of this year, for which she has taken
different remedies, and prescriptions from two schools of med-
icine, but without benefit. Finally, on a visit to her son, the
fever assumed a remittent form, and she was confined to her
bed.
Symptoms-a marked chill with great prostration has been
occurring every day, for three days; before the ague was quo-
tidian. Now her pulse is frequent, small, and oppressed,
skin dry and harsh, temperature 104° in afternoon, 102° in
morning, bowels loose, tongue moist and coated with a very
dirty brownish coat down the centre, sleeps but little, is very
feeble and depressed in spirits. There is a tendency to cold-
ness of the extremities-the feet will get cold if there is not
a hot iron in bed, and the hands get cold when laid upon top
of the cover.
Prescribed-B Tinct. Aconite, gtts. x.; Tinct Belladonna,
gtts. x.; Water, 3iv.; a teaspoonful every hour. On the
second day, in addition, R Sulphurous Acid, 3ss.; Simple
28
330
SPECIFIC MEDICATION.
Sirup, 3jss. M. S. A teaspoonful every three hours. On the
fourth day, there was noticed a peculiar yellowness around the
mouth, and the patient complained of umbilical pains, for
which I gave: R Tinct. Nux Vomica, gtts. x ; Water, 3iv. ;
a teaspoonful every two hours alternated with the sedative.
The patient was free from fever by the seventh day, and
made a sound and permanent recovery. Though two months
have elapsed there has been no recurrence of the chills.
The need of Antiseptics in Typhoid Remittent (Typho-Mala-
rial) Fever-The cases of this year, 1871, have shown the
marked importance of Antiseptics in these diseases. Not a
single case of the seventeen that I treated, but was benefited
by their use, and in some the need of the antiseptic was s0
marked that it alone would have given marked success.
We may study here seperately from the report of cases, four
of the most important of these remedies-Sulphite of Soda
Muriatic Acid, Sulphurous Acid, and Baptisia Tinctoria-the
four fulfilling all the indications for an antiseptic treatment in
all forms of disease. In the old routine of practice no one
would have attempted to point out special indications for the
use of either, but the writer would have said-here are four
remedies that are likely to do good, try them in the order
named until you find one to suit. I prefer, however, to select
the remedy by certain specific symptoms, and not at random.
Sulphite of Soda -The indications for this antiseptic salt
are pallor of mucous membranes, usually fullness of tongue,
and a pasty-white, or yellowish-white fur. We give it in
doses of from five to twenty grains repeated every three
hours.
Muriatic Acid.-We prescribe the acid where there is deep
coloration of mucous tissues (not bright red), tongue con-
tracted, coatings and sordes becoming brown as the disease
aavances. The usual prescription is: R Dilute Muriatic
Acid, 3ss.; Simple Syrup, 3jss. M. A teaspoonful every
three hours, largely diluted with water.
Sulphurous Acid.-This is one of the feeblest of acids, and
one of the most powerful of antiseptics. The indications for
1
REMITTENT FEVER.
881
its use are—a moist tongue, neither pale nor deep-red, but
showing a very unpleasant dirty clay-colored coat in the centre.
The patient complains of fullness and weight in the epigas-
trium, an unpleasant taste in the mouth, and frequently has a
disgust for food or drink. We prescribe it as follows: R
Sulphurous Acid, 3ss. ; Simple Syrup, 3jss. M. A teaspoon-
ful every three hours.
Baptisia Tinctoria.-There are none of our antiseptics that
I value higher than this, and there is none which will give
speedier relief if carefully prescribed. The indications for
its use are clear (some of our readers may pronounce that
queer)—fullness of mucous tissues, especially of throat, with
bluish discoloration. Sometimes it is a bluish pallor, but
more frequently it is deep bluish-red coloration
In the ma-
jority of cases, the breath will be fetid, fullness of epigastrium,
tumid bowels, slimy offensive feces, and unpleasant odor both
of urine and cutaneous excretion. I prefer to give it in infu-
sion, 3ss. to boiling water, 3iv.; a teaspoonful every two or
three hours.
The Use of Belladonna.—In the treatment of the fevers this
year, we have found that Belladonna was a very important
remedy. Associated with Aconite, it would cure ague, when
Quinine had failed, and in many cases of this typho-malarial
fever, its beneficial influence was marked, both upon the
nervous system and upon the circulation.
Now what is the specific indication for Belladonna? It is
clearly this an enfeebled capillary circulation. If this lesion
is principally of the brain, we have impaired innervation-
dullness, somnolence, coma; if of the spinal cord-impaired
respiration, urination, defecation, but more markedly a ten-
dency to congestion of the thoracic and abdominal viscera.
How do I know that Belladonna stimulates the capillary
circulation? I knew it nearly or quite ten years ago through
Brown-Sequard's eyes-he saw the dilated capillaries contract
under the general influence of Belladonna in small doses, as
plainly as I see my hand carrying the pen over this paper.
And I have seen it ever since, in the subsidence of symptoms
332
SPECIFIC MEDICATION.
caused by capillary congestion, where the remedy is properly
administered.
CASE XXV.-Remittent Fever.-J. H., æt. 28, has been feel-
ing badly for the past ten days, and has been confined to the
house for three days. Has had two chills, with constant fever
since—but slight morning remission. Says he feels very sick,
can not sleep, and complains of a sense of weight and oppres-
sion in epigastrium, and indeed the entire abdomen.
The pulse is 120, full but not hard, temperature 1041° even-
ing, 102° morning, skin hot but not very dry, urine scanty and
odor very unpleasant, bowels constipated. The mucous mem-
branes of the mouth markedly pallid, tongue full and coated
with a thick white fur.
Prescribed--Add Bicarbonate of Soda to Water to make a
pleasant drink, to be taken ad libitum. R Tinct. Aconite,
Tinct. Belladonna, aa. gtts. x.; Water, 3iv.; a teaspoonful
every hour. A soda bath once daily. Milk diet. Was mark-
edly improved the first twelve hours, sleeping at night, and
was convalescent the sixth day of treatment.
In this case the indication for the use of the Salt of Soda
was very marked, hence this became the principal element of
a successful treatment; and though the case was a severe one
it rapidly yielded to these simple means.
CASE XXVI.—Remittent Fever.—Mrs. S., æt. 32, has been
suffering with "bilious fever" for six days, and concludes to
change physicians. Presents no very unfavorable symptoms,
though the friends claim that all the medicine she has taken
has made her worse.
Symptoms-skin dry and harsh; evening temperature 106°;
features sharpened, eyes bright and intolerant of light, is
restless and uneasy, and does not sleep well; urine scanty and
high colored; has been freely purged, but bowels still consti-
pated; pulse hard, 120; mouth dry, tongue contracted and
beginning to fissure, brownish sordes in fissures and forming
on teeth; color of mucous membranes deep-red; can not take
·
REMITTENT FEVER.
833
food or medicine without unpleasant sensations in the stomach,
and nausea.
Prescribed-R Dilute Muriatic Acid, 3ss.; Simple Sirup,
3jss. M. A teaspoonful every three hours-added to water
to form a pleasant acid drink. R Tincture Aconite, gtts.
x.; Tincture Gelseminum, gtts. xx.; Water, 3iv.; a tea-
spoonful every hour. An acid bath. Milk diet. Was con-
valescent the fourteenth day of the disease, the eighth of this
treatment.
CASE XXVII.-Remittent Fever.-A., æt 36, a railroad
laborer, has been employed in the Miami bottoms, and came
home very sick—has been feeling badly for a week.
Complains of severe pain in back and limbs, muscles stiff,
feel as if bruised-has had it from the commencement, chill
two days since, high fever following, with morning remissions.
Pulse 110, full and hard; skin hot and dry, temperature 105°
evening; tongue natural in size and color, dry, with a clear
white coat; bowels constipated; urine scanty and high-
colored.
Prescribed-R Tinct. Veratrum, gtts. xx.; Tinct. Aconite,
gtts. x.; Tinct. Macrotys, gtts. xxx.; Water, Živ.; a tea-
spoonful every hour. Alkaline sponge bath Milk diet.
Marked relief from pain in twelve hours, and the fever de-
clining to the fourth morning of treatment, found the skin
soft, pulse soft and full, tongue moist and cleaning-gave two
doses of Quinine, grs. iv., at intervals of three hours, and the
fever was arrested.
CASE XXVIII.—Remittent Fever.-W. R. has been suffer-
ing from fever for four days, medicating himself, aided by his
family. Has taken at an emetic, has taken freely of Podo-
phyllin pills, and on two successive days has had Quinine.
Feels very badly, and is quite sick.
Symptoms-pulse 110, small and oppressed; skin hot and
dry; bowels loose from medicine; urine scanty but colored
with bile; stomach irritable, with nausea; has an uneasy
334
SPECIFIC MEDICATION,
sensation and fullness in hypochondria, with occasional um-
bilical pain; cough beginning to develop itself unpleasantly;
face is sallow, and yellowness is especially marked about the
mouth.
Prescribed-B Tinct. Aconite, Tinct. Ipecac, aa. gtts. x.;
Water, 3iv.; a teaspoonful every two hours. & Tinct. Nux
Vomica, gtts. x.; Water, 3iv.; a teaspoonful every two hours,
alternate. A wet pack over epigastrium. Milk diet. Was
free from fever the fourth day of treatment.
CASE XXIX.
Remittent Fever, with Suppression of the
Menses. Mrs. J. has been feeling badly for ten days, has had
the chills, but the last two days the fever is constant. It is
now time for the menstrual period.
Commenced treatment with the use of Veratrum and
Aconite, the bath, hot foot-bath, a saline purgative, after-
wards a saline diuretic, and continued in this way for five
days, patient getting worse. Gave the sedative more freely,
and in morning remission used the hot foot-bath and Ascle-
pias, and followed with Quinine. Patient grew worse rapidly
after the Quinine was given, being very restless, some delirium,
and the stomach irritable. Treatment has now occupied
seven days-without any benefit—and came to the conclusion
that I had better study the case if my patient is to live.
A few questions and a little thought point out the menstrual
derangement as an important element of the disease. Pre-
scribe-R Tinct. Pulsatilla, gtts. x.; Tinct. Macrotys, gtts.
xx.; Water, 3iv.; a teaspoonful every two hours-alternated
with: R Tinct. Aconite, gtts. x.; Water, 3iv.; a teaspoonful
every two hours. A warm pack to lower abdomen. Patient
was decidedly better in twelve hours, and the fever declined
rapidly, though the menstrual discharge did not commence
until the third day after this change of treatment, and when
patient was nearly freed from fever.
}
INFANTILE REMITTENT FEVER.
335
Infantile Remittent Fever.
If there is any one thing more than another that I prize, it
is the name of being a good doctor for children.” And if
there is any one thing more than another that the Old-School
practice deserves deepest damna.ion for, it is their miserable
life-destroying practice in the diseases of childhood. I shud-
der as I look back on my earlier experience in medicine and
recall the many cases where i have seen the innocents tor-
tured, as only doctors can torture, and I wonder that people
can believe in special providences, when such things were
permitted.
Give the little sufferer from the many ills of childhood,
good nursing, cleanliness, proper food and rest, and you will
have a treatment that at least does not violate the seventh
commandment. Supplement this with the mild but direct
remedies of our practice, and you relieve disease of half its
suffering, shorten its duration, and save life.
CASE XXX. Typical Infantile Remittent.-Pulse 120;
temperature 104° in exacerbation; skin dry; tongue slightly
reddened and covered with a whitish fur; restless and un-
easy during the exacerbations. Remissions in the fever vary
in different cases, sometimes but one, at others three, four or
more, in twenty-four hours. Nothing but fever.
Prescribe-R Tinct. Aconite, gtts. v.; Water, Ziv.; a tea-
spoonful every hour. Bath once or twice daily. No other
medicine.
CASE XXXI. — Infantile Remittent, with Irritation and
Determination of Blood to the Brain. A., æt. twenty-one
months, was attacked with simple fever, and the nearest phy-
sician was called, prescribing the usual cathartic and Sweet
Spirits Nitre. The second day the child was very restless,
its face flushed, the stomach irritable, fever high, and in the
afternoon had a convulsion. Having been the family physi
336
SPECIFIC MEDICATION.
cian, was now sent for. Symptoms-face flushed, eyes bright,
pupils contracted, skin hot and dry, pulse 146, small and
sharp, unconscious, moving head from side to side, involuntary
movements of hands and feet-bad case.
Prescribed-B Tinct. Aconite, gtts. v.; Tinct. Gelseminum,
gtts. xx.; Water, 3iv.; a teaspoonful every thirty minutes,
intil the fever is reduced and head relieved. Towel wrung
out of cold water over stomach and abdomen.
Had relief and sleep by 4 o'clock next morning. Reduced
the proportion of Gelseminum to gtts. x, continuing every
hour, and the fever ceased the fifth day.
CASE XXXII.—Infantile Remittent Fever, with Cerebral
Congestion.-Annie L., æt. three years, was attacked with
fever August 4th. The mother noticed that she was very
dull, and slept with her eyes partly open. Had a Homœopa-
thic case in the house, and gave her Aconite. The night
passed, and the child was worse, and I was sent for, seeing
her about noon. The symptoms now were very distinct—the
child was sleeping with its eyes half open, its face expression-
less, the eyes dull, pupils dilated; the skin was hot and dry.
pulse 130, symptoms of convulsions.
Prescribed-B Tinot. Aconite, gtts. v.; Tinct. Belladonna,
gtts. x.; Water, 3iv.; a teaspoonful every hour.
The coma gradually passed off, the fever was reduced, and
the next morning the child was comparatively comfortable
and was discharged on the 9th.
CASE XXXIII.-Infantile Remittent Fever, with Intestinal
Irritation.-W., æt. 28 months, was attacked with fever Sept.
20th. Called the next day, found febrile action high, stomach
irritable, and some three or four greenish watery discharges
from the bowels.
Prescribed-B Tinct. Aconite, gtts. iij.; Tinct. Ipecac, gtts.
x.; Water, half a teaspoonful every thirty minutes until the
stomach is relieved, then a teaspoonful every hour. Conva-
Jescent on the morning of the 24th.
INFANTILE REMITTENT FEVER.
887
CASE XXXIV. - Infantile Remittent cured with Nux
Vomica.-Pat R., æt. 5, has been sick for a week past. Has
had the city physician, who gave Quinine, which stopped the
fever, and the patient was discharged. Fever returned, with
nausea and vomiting, and I was sent for.
Symptoms - Pulse 120; skin sallow and dirty, yellowish
around the mouth; complains of pain in the abdomen; tongue
broad, moist, and coated with a dirty fur.
Prescribed-B Tinct. Nux Vomica, gtts. iij.; Water, 3iv.;
give half a teaspoonful every fifteen minutes until the vomit-
ing ceases, then a teaspoonful every hour. Better the next
morning, has not vomited since the evening before; pulse 90;
tongue showing a tendency to clean; rested well the after part
of the night. Improved steadily, and was convalescent on the
sixth day, no other medicine being given.
CASE XXXV.-Infantile Remittent-Malarial.-Jessie C.,
æt. 4 years, was attacked with remittent fever September 3d.
Called to see her on the morning of the 4th, presented the
usual febrile symptoms, with some irritation of the brain.
Prescribed-B Tinct. Aconite, gtts. v.; Tinct. Gelsemi-
num, gtts. xx.; Water, 3iv; a teaspoonful every hour; with
the usual bathing and nursing. There was relief from the
nervous irritation, and some mitigation of fever, but the dis-
ease continued. Continued the same treatment to the 9th,
when I concluded, as the child had been on a visit to a mala-
rial region, to give Quinine, grs. iij. There was no more
fever.
CASE XXXVI. - Infantile Remittent - Malarial.-Byrd
Scudder, æt. 3, a stout, active boy, was playing for hours on a
yellow clay bank, one of the hottest days in June. The next
day he had a chill, and following this a very high fever, with
but slight remissions. Irritation of the nervous system,
and strong symptoms of convulsions. One of the sickest
children I ever saw.
Prescribed - R Tinct. Aconite, gtts. v.; Tinct. Gelsemi-
num, gtts. xx.; Water, 3ıv.; a teaspoonful every hour. The
29
888
SPECIFIC MEDICATION.
fever was but little influenced by the medicine, though the
nervous system was relieved, and continued for thirty-six
hours. Now there was a complete intermission of eight
hours, when it recommenced as severe as before, and con-
tinued forty-eight hours, with a second intermission. As he
had an utter disgust for nasty medicine (which, by the by, he
inherited from his father) I withheld Quinine, and continued
the febrifuge. The fever came up as before, and continued
again for thirty-six hours, and again an intermission but not
as complete. Was now ready to give Quinine, and adminis-
tered three grains, and ordered it by inunction.
No more
fever.
I might report a score of cases in which I have adminis-
tered Quinine early, with the result of increasing the disease.
In malarial districts it becomes a part of the treatment of
every case; in some being specific to the disease without
other treatment, but in the majority the system should be
prepared for its use as heretofore named. In our city, mala-
rial disease is the exception, and we don't use Quinine so fre-
quently or so freely.
Continued Fever.
CASE XXXVII.-Continued Fever. Experiment with Qui-
nine. Charles W., æt. 23, had a chill November 20, had
been feeling badly for some two weeks. When called on the
24th found the usual symptoms of continued fever, with no
special indication for treatment other than this.
Prescribed-B Tinct. Veratrum, gtts. xx.; Tinct. Aconite,
gtts. x.; Water, 3iv.; a teaspoonful every hour. Use the
bath once daily. As is common with these remedies there
was slight abatement of the fever from day to day, until on
the 27th it seemed as if but little more would give convales-
cence. The skin was soft, pulse soft and open, tongue moist,
the condition for Quinine. Ordered three grains every two
hours for four doses. The first influence seemed that desired-
the pulse gained fullness and came down to 70, and the sur-
CONTINUED FEVER.
339
face became moist, but following this there was slight chill,
and the fever came up rapidly. The next day the patient was
far worse than he had been, and required constant and care-
ful attention up to the twenty-fourth of the disease.
From this, and some other experience of a similar kind, I
learned not to give Quinine in large doses in continued fever
M
CASE XXXVIII.—Continued Fever. — B―—, æt. 36, has
been feeling badly for ten days. Yesterday had a slight chill
in the morning, and again in the afternoon, fever at night,
gradually increasing. Has the usual symptoms of common
continued fever, which is now prevailing, but without any
special indication for remedies, other than this. Pulse full
and hard, 110; temperature on the third day 103° morning,
105° evening.
Prescribed-R Tinet Veratrum, gtts. xxx.; Water, 3iv.;
a teaspoonful every hour. The usual bathing and good nurs-
ing. No influence upon the fever seemingly, until the morn-
ing of the fifth day, though the patient was relieved of suf-
fering. Now the fever seems inclined to yield, pulse 84 in the
morning and open, temperature 101°; afternoon pulse 96,
temperature 1024°. Prescribed-R Tinct. Veratrum, gtts.
xx.; Tinct. Aconite, gtts. x.; Tinct. Asclepias, 3j.; Water,
3iv. 6th day. Morning, pulse 80, temperature a fraction less
than 100°; evening, pulse 90, temperature, 102°. Added Solu-
tion of Acetate of Potash. 7th day. Morning, pulse 80, tem-
perature 100°; evening pulse 96, temperature 102°. Tongue
is moist and shows a tendency to clean; skin is soft and occà-
sionally moist. Contiuued in this way with but little change
to the fourteenth day, when the fever ceased, and the patient
convalesced rapidly.
In some cases, presenting like symptoms, I have added
small doses of Quinine to the treatment with the effect of ar
resting the fever sooner.
CASE XXXIX.-Continued Fever. Special Indications for
Treatment. I will next present my own case, as reported
February, 1865. Treatment by Prof. King:
340
SPECIFIC MEDICATION.
"Fortunately for me the type of continued fever changed
about the middle of December; whereas previously every
case was attended by disease of Peyer's glands and diarrhoea,
(typhoid), after this time it was common continued fever
without the least tendency to enteric disease. The first con-
clusion forced upon me was that a physician is incompetent to
prescribe for himself; as the disease came upon me, and as-
sumed its most severe form without my being aware of what
was the matter.
"It was attended for the first week with very severe pain in
the back, limbs, joints, etc., so much so that I supposed at
first it was rheumatic fever. The simple means employed at
first-hot foot bath, spirit vapor-bath and diaphoretics-hav-
ing failed, on the fourth day, I resolved to try the virtues of
Quinine to stop the fever, and to relieve the pain, and accord-
ingly took fourteen grains in six hours, and repeated it the
succeeding day. It did seem to arrest all the febrile symp-
toms, but it was followed by great prostration and exhaustion
of the nervous system. Having had enough of my own treat-
ment, Prof. King was called to prescribe, and it is the means
he used that I wish to notice.
“My condition may be briefly described as follows: Tongue
broad, and thickly coated with a white fur, bowels consti-
pated, a feeling of weight and dullness in the basilar and pos-
terior portions of the head, pain in the lower part of the back,
and wandering pain in the limbs. Sleeplessness and nervous
excitement, pulse 130, soft, small and very feeble.
"The doctor claimed that the white tongue indicated acid-
ity, not only of the stomach, but an undue amount in the
blood. To relieve this, he ordered Bicarbonate of Soda, a
teaspoonful to a tumbler of water: a swallow to be taken
every few minutes during the day. Its taste was very pleasant
to me, and its influence agreeable, and though I had not the
slightest feeling of acidity of the stomach, I am satisfied that
it supplied a material that was deficient.
"
To assist in removing the nervous prostration, and to re
lieve the pain, my back and limbs were to be rubbed morning
CONTINUED FEVER.
841
and night with brandy, holding in solution five grains of
Quinine to the ounce; one ounce to be used for a bath. Of
all the remedies I ever employed none had so speedy and
pleasant an effect as this, and I continue it at the present
time. I consider it an item worth recollecting.
Internally I was given a combination of half a grain of
Quinine with four grains of diaphoretic powder, repeated
every four hours. Under this treatment my pulse came down,
I obtained refreshing sleep, and by the third day, secretion
from the skin and kidneys was established. To move my
bowels, I was ordered one grain of Leptandrin, triturated
with white sugar, three times a day; the doctor claiming that
as soon as the liver was stimulated to action my bowels would
move. Having had no operation for four days, the first three
powders moved the bowels kindly; the first instance in which
I was ever satisfied that the remedy would prove cathartic.
Altogether, the treatment was a success, and I am satis-
fied that certain parts of it are well worthy of trial. Conva-
lescence has been slow, and I am still very feeble, but gaining
ground every day. I have proven on my own person what I
had long been convinced of, that the use of tonics and stimu-
lants, in a majority of cases of continued fever, does not facili-
tate convalescence, but that in many cases their action is the
reverse of that desired.
CASE XL.—Continued Fever. Requires an Alkali.—Jas.
L- was attacked Dec. 4th with chill, pain in head and
back and general .malaise; had been feeling badly for some
days. Next day was better, but in the evening had a second
chill. Third day started to business, but felt so badly re-
turned home by 10 o'clock, suffering from chills, and went to
bed; fever came up in the afternoon, and he passed a restless
night.
Called on the morning of the 4th. Pu'se 110, small and
hard, temperature 1031°. Tongue moist, broad, thick, pallid,
and covered with a white pasty coat; breath has a peculiar
sweet, mawkish odor.
342
SPECIFIC MEDICATION.
Prescribed-Bicarbonate of Soda in water as a drink ad
libitum. R Tinct. Aconite, gtts. x.; Water, 3iv.; a teaspoon-
ful every hour. A Soda water bath. Amendment from the
first, and was convalescent by the seventh day of treatment.
The joke was, there was a Regular physician in the house—
a relation, who claimed that there was no salvation for the
patient except by the use of Calomel or Blue-pill; insisting
that the peculiar appearance of the tongue was a strong indi-
cation for mercurials.
CASE XLI.-Continued Fever.-Requires an Acid.—John
B———, æt. 41, has been sick for two weeks with the prevailing
fever, under regular treatment. Friends conclude to change
treatment, and the attending physician is discharged, and I
am called.
Condition-Has been delirious for the past four days, and
sleeps but very little. The face is flushed and dusky, eyes in-
jected. The skin is dry and harsh, the urine scanty, the
bowels freely acted upon by physic, are now irritable, abdo-
men tender. Pulse 130; temperature 107° in the evening.
The tongue is dark red, contracted, and covered with a
brownish fur, sordes on the teeth.
Prescribed-B Dilute Muriatic Acid, 3ss.; Simple Syrup,
3jss.;
add to water to make a pleasant drink, and give ad lib-
itum. Use an acid bath twice daily. R Quinia Sul., 3ij.;
Dilute Muriatic Acid, 3iv.; a tablespoonful to a pint of water,
for a bath. Milk diet.
No change was made in the treatment, the patient improv-
ing steadily to convalescence on the twenty-third day from
the commencement of disease.
nothing but an acid was
Though the indications
I report a typical case, in which
used—it might be called a test case.
for acids are so pronounced that they form the basis of a good
treatment, yet we employ various means in addition, as they
may be indicated.
It might be said that twenty-one days being the natural du-
ration of such a fever, the acid was a mere placebo. But I
CONTINUED FEVER.
843
answer, there was relief from the more urgent symptoms with-
in forty-eight hours, and this alone was worth working for,
without reference to the duration of the disease.
CASE XLII. Continued Fever, with Disease of Peyer's
Glands--Typhoid Fever.-R, æt. 29, now in the second
week of a typhoid fever, has a sudden accession of diarrhoea,
with abdominal tenderness, and an increase of typhomania.
The discharges are very peculiar, frothy, illy concocted, and
have a very unpleasant cadaveric odor. The tongue is
moist, and shows a very dirty coat. The symptoms are very
grave.
Prescribe-R Sulphurous Acid, Simple Sirup, aa. 3j.; a
teaspoonful every three hours. R Tinct. Aconite, gtts. x.;
Tinct. Ipecac, gtts. xx.; Water, Živ.; a teaspoonful every
hour for two hours, the third hour the acid; Quinine inunc-
tion to abdomen. Must maintain the recumbent position.
The treatment served the purpose, the diarrhoea was
checked, and by the third day the patient was taking his milk
kindly, and convalesced the fourth week.
CASE XLIII. Continued Fever, with Disease of Peyer's
Glands-Typhoid.-O. M—, æt. 18, is in the third week of
typhoid fever with Homoeopathic practice, and is "given up"
as incurable.
Condition.-Lies on the back continually, picks at the bed
clothes, muttering delirium, face and eyes congested. Tongue,
fauces and pharynx swollen, and of a deep purplish color,
dark brown, nasty coat on tongue, bowels tympanitic, stools
dark and excessively fetid, pulse 130, without strength, tem-
perature 105 evening.
Prescribed-B Baptisia Tinctoria in infusion, a teaspoon-
ful every two hours, also wash the mouth with it. B Tinct.
Aconite, gtts. v.; Tinct. Belladonna, gtts. x.; Water, 3iv.; a
teaspoonful every two hours. Use an acid bath (muriatic)
with Quinine. On the third day of this treatment there was
decided improvement, the diarrhoea checked. Now added
344
SPECIFIC MEDICATION.
Muriatic Acid internally, and continued to convalescence on
the twenty-sixth day of the disease.
CASE XLIV.-Continued Fever, Typhoid, with Retention of
Urine.-M. C— is in the second week of typhoid fever.
The typhomania has been a marked feature, and is now sink-
ing to a muttering delirium. Muscular feebleness has been
especially marked, and now the patient lies on the back and
slips toward the foot of the bed. On the morning of the thir
teenth day found retention of urine, and difficulty in respira-
tion.
There has been seemingly an indication for an acid treat-
ment in the deep-red of the tongue and mucous membranes.
The feeble pulse and tendency to congestion seemed to call
for Aconite and Belladonna. But the treatment thus far has
been a failure, and unless something more is done the patient
will die.
Drew off the urine with catheter, and prescribed: R Solu-
tion of Strychnia, 3j.; Liquor Bismuth, 3iv.; a teaspoonful
every three hours. Add Bicarbonate of Potash to water, so
that it will be pleasant to take and use as a drink; a weak
lye as a bath once daily. There was marked improvement
within twenty-four hours, and the patient convalesced, with-
out change of remedies.
Here was one of those rare cases in which, though there
was an alkaline condition, there was a want of Potash as
shown by the extreme muscular feebleness, and the salt of
Potash became a true restorative; whilst Strychnia increased
innervation from the spinal cord and sympathetic, and was
just what was needed to increase the strength of the circula-
tion and respiratory movement.
SMALLPOX.
845
Smallpox.
There are three features in this disease that demand par-
ticular attention: 1, The disease is exhaustive; 2, there is
impairment of the function of the skin; 3, there is the ten-
dency to blood poisoning-sepsis. If we neglect to provide
against these, in severe cases we may have death result from
any one of the three.
We say, therefore: That we must keep the stomach and in-
testinal canal in good condition for the reception of food, and
for its digestion; and see that the patient has it frequently
and in proper form. That under no circumstances must the
eruption be determined to the skin so as to impair its func-
tion to the amount of five-sevenths. That in all cases the
patient be protected against blood poisoning, and that the
proper antiseptics be continuously used.
I recognize the fact that the same pathological laws govern
this as other fevers, and that therapeutic means are quite as
definite and certain. As is the frequency of pulse and in-
crease of temperature, so is the severity of the disease-
marked by arrested secretion, impaired digestion, derange-
ment of the nervous system, blood-poisoning, and extent of
eruption. As we follow the ordinary indications in the treat-
ment of a fever-bring down the pulse, lessen the tempera-
ture, establish secretion, and support the strength, the disease
becomes mild, and the eruption discrete.
I propose, therefore, the use of the proper sedatives, the
bath, alkaline diuretics, and occasional laxatives, and the
proper antiseptics, with good feeding, as a rational treatment
of smallpox. I claim that with this treatment, the disease
may not only be rendered much milder, but in some cases
may be aborted, as I have conclusively proven in my practice.
The ordinary treatment of this disease is radically wrong,
and is in part the cause of its fatality. As is well known, it
consists in the frequent and continuous use of purgatives, and
stimulant means to determine the eruption to the skin. The
one impairs the action of the intestinal canal, the other the
346
SPECIFIC MEDICATION.
function of the skin. Both are absolutely prohibited in my
treatment, under all circumstances. I may also say that the
patient can not bear the use of the large doses of Veratrum
named in the books, and a fatal result may be readily ob
tained with this.
CASE XLV.—M- a member of the present class was
attacked in the following way: Had suffered for three days
with a sense of depression, aching in back and limbs, and
loss of appetite. Then a well marked chill, followed by high
fever.
When I was called, found the pulse full and hard, 120 per
per minute; skin dry and hot, face .flushed, eyes bright,
tongue pallid and coated from base to tip with a very nasty
white coat; throat much swollen, showing a bluish pallor; is
very restless and can not sleep, no appetite.
Ordered-Add Bicarbonate of Soda to water to make a
pleasant drink, and give him all he wishes. R Tinct. Vera-
trum, gtts. x.; Tinct Gelseminum, gtts. xx.; Water, 3iv.; a
teaspoonful every hour.
Found the next morning that he had taken the Soda water
by the pint, and that it had passed off freely by the bowels.
The pallor of mucous membranes was replaced by deep red-
ness, the pulse was 90; patient better in every respect. Con-
tinued the sedative, and ordered for the day diluted Muriatic
Acid as a drink. The third day from chill, the eruption
commenced making its appearance, and the next day covered
the body as thickly as I ever saw it in the severest confluent
form of the disease.
•
On the fourth day, Sulphurous Acid was given as the anti-
septic, the Veratrum being continued. And this was the
treatment so long as any was needed. The eruption in the
throat was as severe as ever I witnessed it, and the discharge
from the mouth excessive. The eruption on the face did not
fill, neither did it on many parts of the body. Medicine was
suspended the eighth day.
SMALLPOX.
347
CASE XLVI.-Confluent Smallpox.-L. S., confluent small-
pox of severest type. Throat symptoms very marked, and
secretion of mouth and throat abundant and offensive. The
odor of smallpox is so strong that it permeates the entire
house, and is almost unendurable in the room. It is now the
fifth day from the chill; the patient has been in the hands of
another physician, and doctors are changed because it is im-
possible for him to take medicine. Has had purgatives every
day and various nasty potions. The one favorable feature is-
the eruption is out, though the skin is dusky. Find it abso-
lutely impossible for patient to take medicine or food; the
stomach would not tolerate it, and the patient can not swallow
it.
and a
Treatment-Have the stove taken out of the room,
fire built in the open fireplace; one window being opened to
give free ingress of air. The room thoroughly cleaned, the
patient washed, and clothing of person and bed changed.
Let the mouth and throat be washed with salt water suffi-
ciently often to free it from the secretions, and give small por-
tions of a weak salt water as a drink. Burn a small portion
of Sulphur by the bedside every three hours. Wash the
patient thoroughly with soap and water every day.
On the second day the patient was able to take food, and .
from the third day on he took corn meal gruel and milk
freely. The unpleasant odor had nearly disappeared the
third day, and the septic symptoms rapidly abated. The
patient made a good convalescence in the usual time, no
medicine having been given.
A
I give this as a marked example of the benefit to be ob-
tained from antiseptic treatment. The agent here was Sul-
phurous Acid, set free by burning Sulphur. It influenced
the contagion directly, and its inhalation was quite as efficient
in checking the blood poisoning as if it had been given by
mouth.
CASE XLVII.-Confluent Smallpox.-N., æt. 5, never vac-
cinated, has had severe fever four days, with the pain, full-
848
SPECIFIC MEDICATION.
ness of skin, throat symptoms and peculiar odor that indicate
smallpox. The skin is flushed and dusky, the patient coma-
tose.
Prescribed-B Tinct. Aconite, gtts. v.; Tinct. Belladonna,
gtts. x.; Water, živ.; a teaspoonful every hour.
In twelve hours the nervous system was freed, the patient
conscious, and the eruption coming out nicely. Sulphite of
Soda, the antiseptic indicated, was prescribed in addition,
and with cleanliness, the use of the bath, and fluid food, the
patient convalesced at the usual time.
CASE XLVIII. — Confluent Smallpox.-C. is now in the
seventh day of the disease, eruption out and filling. Pulse is
small and hard, 120 beats per minute, temperature 106°.
Skin dusky, eruption dark colored, mouth dry, tongue almost
black, sordes on teeth, has been delirious since the third day.
Prescribed-R Dilute Muriatic Acid, 3ss.; Simple Syrup,
3jss.; a teaspoonful every two hours in his drink. R Tinct.
Aconite, gtts. xx.; Tinct. Lobelia, gtts. xx.; Water, 3iv.; a
teaspoonful every hour. Fluid food with a small portion of
Brandy every three hours, and Quinine inunction to the ab-
domen.
Lived through it, and made a good convalescence.
Measles.
If I was writing for the profession at large, I would proba-
bly say-dispense with all medicines—and leave the case to
nature, aided by such simple teas as are given in most house-
holds. For here, it is very certain, the mortality is in pro-
portion to the amount of medication, and it is much better to
dispense with the physician when there is real need for aid
than have the ordinary routine of treatment.
were
CASE XLIX.-Rubeola.-Four children of Mr.
attacked with measles in January. Two of them had it quite
severely, the temperature in one marking 109°.
There was
MEASLES.
849
more than the usual bronchial irritation in all, and in one it
was very severe.
In two of the cases there was oppression of the nervous
system, and a tendency to sleep all the time before the erup-
tion. For these I prescribed: R Tinct. Aconite, gtts. v.;
Tinct. Belladonna, gtts. viij.; Water, 3iv.; for a girl of eight
years, a teaspoonful every hour; for a child of four, half a tea-
spoonful every hour. The others had: R Tinct. Aconite,
gtts. v.; Tinct. Ipecac, gtts. xv.; Water, 3iv.; a teaspoonful
eyery hour, until the fever abates; and this was given to the
first two when the eruption had appeared. In but one, was it
necessary to give anything special for the cough, and here an
infusion of Red Clover answered the purpose well.
In the majority of cases of simple rubeola I prescribe: R
Tinct. Lobelia, (seed), gtts. x.; Tinct. Asclepias, gtts. xx. to
xxx.; Water, Ziv.; a teaspoonful every hour, Keep the
patient quiet in bed, but not too warm. If need be, a seda-
tive may be added to the medicine if the fever runs high.
CASE L.-Rubeola--Tardy Appearance of the Eruption-
Coma.-S—, æt ten years, has been exposed to measles, has
the unpleasant appearance of the eyes, and the bronchial irri-
tation so characteristic of the disease; is now the third day
from attack. Skin dry and harsh, temperature high, pulse
140, has been unconscious for some six hours.
Prescribed-B Tinct. Aconite, gtts. v.; Tinct. Belladonna,
gtts. x.; Water, 3iv.; a teaspoonful every hour. The child
gradually regained consciousness, though the eruption did
not appear until the fifth day. After which small doses of
Lobelia and Asclepias controlled the bronchial irritation.
CASE LI.-Rubeola Maligna-Coma.-Was called to see
B, æt. nine years, in a Fifth Street boarding house—all
the surroundings bad. Is now in the seventh day of the dis
ease, eruption has not made its appearance, has had two phy-
sicians who have given him up. Has not been conscious for
three days.
850
SPECIFIC MEDICATION.
Symptoms now: Pulse 120, oppressed, skin turgid and
dusky red, face swollen, eyes reddened, breathes with difficulty
from pulmonary congestion.
Ordered from the nearest drug store Acetous Emetic Tinc
ture of the Dispensatory, and Compound Powder of Lobelia
Made au infusion of the last, and at once proceeded to ad
minister them alternately, in small doses frequently repeated.
In an hour, the stimulant influence was distinctly marked in
an improved circulation and respiration. Thorough emesis
in two hours, with speedy relief to the nervous system; and
the patient was conscious, the eruption appearing freely in
eight hours from first administration. Put the patient upon
the use of: R Tinct. Lobelia, gtts. x.; Tinct. Asclepias, gtts.
xxx.; Water, 3iv.; a teaspoonful every hour. Made a good
recovery.
CASE LII-Rubeola Maligna.-Prof. Jones' Cases of Black
Measles.-Two brothers by the name of Baird, from Mason,
Tenn., attending the Spring course of 1871, became sick, and
after treating themselves for three or four days, sent for me.
They were boarding themselves, and being alone in the room,
had no attention.
Found the eldest brother sitting in his shirt and drawers,
in a cold room, trying to build a fire, his face presenting that
peculiar dark mottled appearance we observe after recovery
from smallpox. Examination determined that it was measles,
and a very unpleasant condition. Both cases were nearly
alike-pulse 130 to 140, small and oppressed, eruption dusky,
tongue dark red, dry, and covered with a brownish fur, sordes
on teeth, cough very bad and expectorating largely a muco-
pus-to the amount of a pint or more in twenty-four hours.
Prescribed-B Dilute Muriatic Acid, 3j.; Simple Sirup,
Zij.; add to water to make a pleasant drink and give treely.
R Tinct. Aconite, gtts. x.; Tinct. Asclepias, 3ss.; Water,
ziv.; a teaspoonful every hour. One showing a marked op-
pression of the nerve centres, and tendency to congestion, had
Belladonna in place of the Asclepias for two days.
*
MEASLES.
851
Their fellow students were very kind as soon as their situs-
tion became known, and kept the room of uniform tempera-
ture, and saw that they had food. We gave boiled milk and
beef tea freely. Both convalesced well, and have had no sub-
sequent trouble
CASE LIII.-Rubeola Maligna.—M æt. 23, has had a
chill, followed by high fever, a harsh dry cough, suffusion of
eyes, with fullness and redness of skin. Now, the third day,
the eruption shows itself, but does not come out freely.
Prescribed-Tinct. Aconite, gtts. x.; Tinct. Ipecac, gtts.
xxx.; Water, 3iv.; a teaspoonful every hour. A hot foot-
bath and a cup of hot sage tea.
Saw him the next day-worse. The surface is somewhat
dusky, eruption scant, tongue excessively dry. Prescribed in
addition R Sulphurous Acid, 3j.; Simple Syrup, 3ij.; a tea-
spoonful every three hours. The unpleasaut symptoms faded
away rapidly, the eruption appeared, and the patient conva-
lesced well.
CASE LIV.-The Cough of Measles.-A child of my own
had measles during one of the severest endemics we ever had
in this city, and as a sequel, had that persistent irritation of
bronchii with cough, which is so unpleasant and so frequently
fatal.
After an ineffectual use of the ordinary means, put her upon
the use of: R Tinct. Drosera, 3ss.; Water, 3iv.; a teaspoon-
ful four times a day. Was entirely relieved in a week or ter
days, and though the cough would return with every slight
cold, for a year following, it was always speedily checked by
the same remedy. I have used the Drosera in scores of
cases with like results, and now never think of prescribing
anything but this or an infusion of Clover Hay.
352
SPECIFIC MEDICATION.
Rheumatism.
The reader will notice that I do not propose to prescribe
for the name rheumatism, any more than I would prescribe
for the name "bilious fever." The cases of rheumatism only
agree in one thing-the character of the pain; and as we have
long since learned, pain is only a symptom, and never to be
prescribed for as the disease.
The reader may suggest, however, that writers agree that
rheumatism is dependent upon the generation of lactic acid
in excess, and that the deposit of this in the tissues is the
cause of the local inflammation. And if so, surely the alka-
line treatment so generally recommended, must be the treat-
ment.
Whilst I admit the probability—that some product of re-
trograde metamorphosis, either of food or tissue, is the mate-
ries morbi in this disease, I am very sure it is not lactic acid;
and you will readily come to this conclusion if you will care-
fully read your Carpenter, Huxley or Draper. And I am
quite as sure that there is in some an excess of alkalinity, in
others an excess of acid, and in still others neither the one
nor the other.
-
CASE LV.-Inflammatory Rheumatism. — A. S., æt. 46,
rheumatic diathesis, will have averaged an attack a year, for
five years, running the usual course in about six weeks.
Was
called to attend him the third day of this attack-symptoms
as follows:
Tongue clean, mucous membranes of normal color; bowels
regular; pulse 110, full and oppressed; some difficulty in
respiration, and oppression in præcordia, requires to be
propped up in bed; the disease is localized in right knee,
which is very much swollen, very painful, and exquisitely
tender to the touch; the most prominent symptom, as well as
the most singular one, is the constant profuse sweating.
Prescribed-B Tinct. Aconite, gtts. xx.; Tinct. Macrotys,
3ss.; Syrup, 3ijss.; a teaspoonful every two hours—no effect
RHEUMATISM.
853
only a severe headache. The next day he was put upon the
use of alkalies, giving them freely in the form of Bicarbonate
of Soda and Acetate of Potash - patient growing worge.
With two days of this treatment changed to lemon juice, and
gave Veratrum as the sedative-amendment for one day, and
then a relapse. Sixth day of treatment gave Colchicum-
English Wine, gtts. v. every two hours. Seventh day patient
much worse. Colchicum has acted upon the bowels freely,
and his stomach is irritable; sweating stopped whilst bowels
were acting, but is now worse than ever. Eighth and ninth
days a placebo; patient is suffering intensely, and talks of
changing doctors. All this time we have been assiduous in
making applications to the inflamed part, changing them from
day to day, so that we have run through the entire list.
Reading up the treatment of phthisis a few weeks since I
noticed the recommendation of a diaphoretic for night-
sweats have tried it in one case with advantage-why not
give a diaphoretic for this prodigious sweating. And so I
order that the patient be put between blankets, thoroughly
rubbed down with dry flannel whenever the skin becomes
wet, and give a strong infusion of Asclepias in tablespoonful
doses. There was a decided amendment the first day, and by
the fifteenth day of the disease the patient was convalescent.
CASE LVI.-Inflammatory Rheumatism.-George C., æt.
15, rheumatic diathesis, has had three very severe previous
attacks, the last confining him to his bed ten weeks, and leav-
ing serious structural heart disease-treatment Eclectic.
Symptoms as follows:-Now the third day; high fever;
pulse 110, full and bounding; skin dry as parchment; urine
scant and high-colored; bowels constipated; no appetite;
mouth dry; mucous membranes natural as to color; tongue
showing a clear white coat; is suffering intensely in one knee
and ankle, the parts swollen, exquisitely tender and present-
ing evidences of active inflammation.
Prescribed-B Tinct. Veratrum, gtts. xx.; Tinct. Macrotys,
gtts. xxx.; Water, 3iv.; a teaspoonful every hour. Acetate
30
354
SPECIFIC MEDICATION.
of Potash added to his drink in small quantity. Put the
patient between blankets, wrap the inflamed parts in flannel
and let them alone.
There was a gradual amendment, and the patient was con-
valescent by the ninth day, though the parts were weak, and
he did not get out of the house until the third week. But
what was most singular, the old heart disease was so im-
proved, that he was comparatively free from suffering in this
respect, and the improvement continuing for some months,
even the marked saw-sound faded out, and to-day his heart
does its work well, with scarce a trace of disease.
CASE LVII.-Inflammatory Rheumatism.-Joseph B., æt.
41, is now in the second week of an attack of rheumatism,
the disease growing worse from day to day. Has had a Col-
chicum treatment with Mercury, with the common applica-
tions to the affected part.
Symptoms are all severe, but the one most pronounced, and
which indicates the line of treatment is-marked pallidity of
mucous membranes, broad pallid tongue, pitting where it
comes in contact with the teeth, and covered with a white
pasty coat.
Prescribed-Bicarbonate of Soda added to water, and give
freely as a drink. Inflamed parts to be wrapped in raw
cotton. Marked amendment in twenty-four hours, and
patient rapidly convalesced. No other remedy was given.
CASE LVIII.-Inflammatory Rheumatism.-K., æt. 30,
rheumatic diathesis, has lain for six or eight weeks in these
attacks; presents the usual symptoms, disease located in lum-
bar region extending to hip.
Prescribed-R Tinct. Aconite, gtts. x.; Tinct. Macrotys,
3ss.; Water, 3iv.; a teaspoonful every hour. Tongue shows
a slight increase of redness; for which give lemonade. Fever
abates, and by the third day patient is apparently comfort-
able. Going on to the sixth day, there is a relapse, worse
than at first.
RHEUMATISM.
355
Notice a peculiar puffiness of hands and face, skin glisten-
ing, and for this give in addition to Aconite and Macrotys :
R Acetate of Potash, 3ss.; Tinct. Apocynum, gtts. xx.,
Water, Zij.; a teaspoonful every three hours. Improves
slowly, and the third day from this, drop the Acetate of
Potash and give him Apocynum and Macrotys. Made a good
recovery by the end of the week.
CASE LIX.-Inflammatory Rheumatism.-J. R. has been
suffering from inflammatory rheumatism for more than three
weeks; one of the worst cases I ever saw. Have treated him
myself, and been assiduous in attention, using all the reme-
dies recommended in such cases. Medicine has invariably
made him worse, feels more comfortable when nothing is
taken.
It is many years since, and just at that time Lemon Juice
was recommended for rheumatism. Concluded to try it, but
without any faith in its virtues, and gave it as freely as the
patient could take it. There was amendment from the first,
and before the end of the week he was very comfortable, and
made a good recovery.
You ask me what was the indication for the Acid? I an-
swer, that I don't know. I was treating names at that time,
and my patient had "rheumatism."
I have not had a case of rheumatism in the past four years,
in which the indications for an acid treatment were so marked,
that 1 would have selected an acid alone; but I am sure I
have had them in the earlier years of my practice.
CASE LX.-Sub-Acute Rheumatism.-M., æt. 35, of rheu-
matic diathesis, has been suffering since early Winter with
sub-acute rheumatism. It shifts its position, and has affected
most of the small articulations. There is slight oedema of
the feet, and general puffiness of the skin, which presents a
peculiar glistening appearance.
Prescribed-B Tinct. Apocpnum Can., gtts. xx.; Water,
ziv.; a teaspoonful every two hours. Improved steadily
356
SPECIFIC MEDICATION.
from the first, and the second week added Tinct. Nux Vomica,
gtts. x.; taking the medicine every three hours. Was en-
tirely free from the disease the third week.
CASE LXI.-Sub-Acute Rheumatism.—-Chas. O. is suffer-
ing from a recent attack of sub acute rheumatism. Two
weeks since he applied for treatment for pain in the chest-
costal rheumatism. Now it is located in the wrist and one
phalangeal articulation.
Prescribed-B Tinct. Aconite, gtts. x.; Tinct. Macrotys,
gtts. xx.; Water, 3iv.; a teaspoonful every hour. The pain
in the chest was removed with four doses of medicine, but
the last attack required three days treatment.
I will not attempt to illustrate the treatment of chronic
rheumatism, because it would be occupying space without ad-
vantage to the reader. It is especially difficult to describe a
case of chronic disease, occupying some weeks of time, so
that the reader can see the relation between symptoms and
remedies.
In adddition to what has been pointed out, I may say, that
we especially study the function of digestion and blood-mak-
ing, and retrograde metamorphosis and excretion, for in some
lesion of one of them we will probably find the disease con-
stantly reproducing itself.
See that the act of digestion is properly performed, and
that no morbid product is introduced into the circulation
from the digestive apparatus. Then see that the waste of
tissue goes on in a normal manner, and that all its products
are removed as speedily as possible.
INFANTILE PNEUMONIA.
857
Infantile Pneumonia.
CASE LXII. - Infantile Pneumonia.-L., æt. four years,
has been sick four days. The first day seemed to have a bad
cold, the second had a chill, followed for two or three hours
by fever. The third had a chill, followed by fever, which
has continued up to the present in a remittent form. Both
lungs are involved to a considerable extent, and the cough is
harassing, sputa slightly "rusty." Pulse full and open.
•
Prescribed-B Tinct. Veratrum, gtts. x.; Water, 3iv.; a
teaspoonful every hour until the fever abates, then in half-
teaspoonful doses. Apply to the chest a cloth spread with
lard, and sprinkled with Comp. Powder of Lobelia. Conva-
lescent with four days of treatment, the inflammatory action
being arrested the first twenty-four hours.
CASE LXIII.-Lobular Pneumonia, with Asthenic Bron-
chitis.-N., æt. six months, has been sick for a week, gradu-
ally growing worse. Has a rattling cough, difficult respiration,
remittent fever. Now seems very much prostrated, pulse
small and frequent, no hardness; when the fever is on the
child is very restless, when it goes off it seems exhausted.
Mucus accumulates, and makes the breathing very difficult.
Prescribed-B Tincture Lobelia, 3j.; Compound Tincture
of Lavender, ziij.; Simple Syrup, 3jss. M. Give in small
doses (teaspoonful) every few minutes at first, then at inter-
vals of an hour. The same local application to the chest as
above.
In this case I gave the old formula. Now I very frequently
add the Tincture of Lobelia Seed to water, and give it in the
same manner as Veratrum and Aconite.
CASE LXIV.—Infantile Pneumonia.-G., æt. three years,
has been sick but two days, yet looks to have been sick a
week. Skin very dry and harsh, hot; pulse 130, small and
sharp; tongue contracted and dry; a very persistent, dry,
hacking cough; crepitation over a greater part of both lungs.
Prescribed-R Tinct. Aconite, gtts. viij.; Tinct. Ipecac,
358
SPECIFIC MEDICATION.
3ss.; Water, 3iv.; a teaspoonful every hour. The plaster of
Lard with Emetic powder to the chest. Was very sick for
two days-breathing difficult. Amendment commenced the
third, and the child was convalescent by the sixth. No other
remedies were given.
This is a very common plan of treatment with me in these
cases, and it is rare to find one that does not yield readily
· CASE LXV.-Infantile Pneumonia, with Congestion.-S.,
æt. four years, has been sick twenty-four hours. Disease
commenced with a well marked chill, fever of an asthenic
character following. The child is semi-comatose, sleeps with
the eyes part open, eyes dull and pupils dilated; the toes are
cold; pulse 120, soft and easily compressed; cough in parox-
ysms, rattling, but no expectoration; an unpleasant rattling,
blowing sound heard over the larger portion of the chest-
the posterior part of the lung on right side is free. Had a
chill the second day, and again the third day.
Prescribed-B Tinct. Aconite, gtts. x.; Tinct. Belladonna,
gtts. x.; Water, 3iv.; a teaspoonful every hour. · Quinia in-
unction-R Quinia Sul., 3j.; Adeps, 3ij.; Oleum Anisi, gtts.
xx. M.-twice daily to be throughly used. Emetic powder
and lard to chest.
The comatose symptoms were removed the first twelve
hours, the chill of the third day was lighter, and the child
was convalescent by the fifth day.
CASE LXVI.-Infantile Pneumonia, with Determination to
the Brain.-A., æt. twenty months, seemed to have had a bad
cold for a couple of days, the third day a very high fever
came up suddenly, the child being extremely restless, and had
a convulsion. Was called at this time. Found the skin hot-
not dry, pulse 140, sharp, mouth not dry but very red, eyes
bright, intolerant to light, pupils contracted to a point. A
very harassing hacking cough, respiration somewhat labored
and abdominal, small blowing sounds when the ear was ap-
plied to the chest.
CHOLERA INFANTUM.
359
Prescribed-B Tinct. Veratrum, gtts. x.; Tinct. Gelsemi-
num gtts. xxx.; Water, 3iv.; a teaspoonful every hour.
Same local application to the chest as before.
The unpleasant symptoms gradually yielded, and the child
was convalescent on the fourth day of treatment.
I think these cases will illustrate pretty well the more fre-
quent departures from the ordinary standard of infantile
pneumonia, and the treatment necessary for the special forms
of the disease. I have employed these remedies in this way
for the ten years past-some of them for a longer time-and
as they have not failed me when I have done my part to make
a correct diagnosis, I recommend them to others with great
confidence.
Cholera Infantum.
CASE LXVII.-Cholera Infantum. — M., æt. twenty-two
months, is suffering from acute cholera infantum of three
days' duration. Evacuations frequent, greenish, and attended
with some tenesmus. Nausea with occasional vomiting; not
as much thirst as is usual in the disease. A rare symptom
in this disease, the pulse is very full and strong, ranging from
100 to 110 beats per minute.
I take the condition of the pulse as the key-note of the
treatment, and prescribe-R Tincture Veratrum, gtts. x.;
Water, 3iv.; given in teaspoonful doses every hour until the
fever declines and the patient is better, then half-teaspoonful
doses.
No other remedy was given. There were but two dis-
charges the third day; the fever had entirely disappeared.
Ordered Quinine inunction once daily, and up to this time,
the fourth week, there has been no return of the disease.
CASE LXVIII.-Cholera Infantum.-C., æt. twenty-eight
months, has had diarrhoea since April, been treated by two
physicians, always worse when taking medicine.
Skin sallow, relaxed and doughy; extremities cold, pulse
soft, and easily compressed; tongue pale and covered with a
860
SPECIFIC MEDICATION.
dirty yellowish fur in streaks; vomits a yellow, unpleasant
fluid mixed with mucus; discharges from the bowels mucoid,
with a trace of pus and broken down blood.
Prescribed-B Triturated Podophyllin, 1-100th, one grain
every two hours. Quinine inunction twice a day. A milk
diet, care being used that the milk be sweet and good, and to
which is added about ten grains of Phosphate of Soda in the
twenty-four hours.
The child made a good recovery in two weeks, the amend-
ment dating from the second day of treatment. I say the
child made a recovery-for it is now eating well, gaining
flesh, is walking, and plays with spirit, yet there is no doubt
but it will have occasional slight attacks until cold weather.
CASE LXIX.-Cholera Infantum.-S., æt. two years, has
had diarrhoea, thirst, and nausea and vomiting for three
weeks, gradually increasing. Has taken Neutralizing Cordial,
Bismuth, Ipecac, Hydrarg. Cum Creta, and astringents, with-
out any good results-or rather with bad results, for the
medicine has increased the disease.
Find on examination that the bowels are camid, especially
in hypochondria; there is umbilical pain at umes, the skin is
sallow and relaxed, the face especially is a sallow yellow, the
tongue full, pale, and slightly dirty.
Prescribed-R Tinct. Nux Vomica, gtts. iij.; Water, 3iv.;
a teaspoonful every hour at first, then every two and three
hours. The child made a good recovery in a week, no other
remedy being given.
CASE LXX.-Cholera Infantum.-F., ac. twenty months,
has had cholera infantum some nine weeks, is very much re-
duced, and the attending physician thinks recovery impossi-
ble. The evacuations from the bowels are copious and
watery, some six or eight in the twenty-four hours; there is
occasional nausea, such as would be produced by tickling the
fauces, and the milk is almost uniformıy thrown up after
nursing.
DYSENTERY.
361
There is one special feature-the child is dull and somno-
lent, the eyes dull and the pupils somewhat dilated and im-
mobile.
The pulse is soft and easily compressed, the abdomen
tumid with evident congestion of the portal circle.
Prescribed-B Tinct. Aconite, gtts. iv.; Tinct. Bella-
donna, gtts. x.; Water, 3iv.; a teaspoonful every two hours.
Amendment was perceptible the next day; the remedy was
continued the first week, and then changed for small doses of
Ipecac. The child made a good recovery..
These six cases will illustrate the specific treatment of
cholera infantum or summer complaint. In ninety-five out
of one hundred cases, the treatment will require but the three
remedies, Ipecac, Aconite and Nux Vomica, one or more,
but there are a few cases that require other means, and when
specially indicated, we find they not only relieve the special
symptoms, but the disease in its totality.
Dysentery.
CASE LXXI.-Dysentery.-G., æt. eight months, had diar-
rhoea, commencing in the morning, but in the evening the
stools became small and bloody, attended with pain and
tenesmus. Pulse 130 and hard, surface hot, very restless,
nausea with occasional retching. Discharges about every ten
minutes. Child regarded by the parents as in a dangerous
condition, one having died in the same house from the same
disease the week before.
Prescribed at 11 P. M.-R Tinct. Aconite, gtts. v.; Tinct.
Ipecac, gtts. xv.; Water, 3iv.; a teaspoonful every hour.
No dysenteric discharges after 4 A. M. the next morning, and
the child was well the second day.
CASE LXXII. - Enteritis with Aphtha. Mary N., æt.
seven months, was taken to church to be baptized during the
cold spell the first of June. The child was considerably ex-
posed, and the rector used water rather freely; the result a
81
362
SPECIFIC MEDICATION.
severe cold with diarrhoea, and the third day a severe aphthous
sore mouth.
Fever is constant-pulse ranging from 120 to 150 as the
fever rises and falls: skin dry and harsh; discharges from
the bowels profuse, greenish, and attended with pain; mouth
hot and red; tongue red and partially coated; papillæ red and
clongated; aphthous patches well defined and a clear pearly-
white. Altogether the patient is very sick, and in the olden
time the prognosis would have been very unfavorable.
Explained to the mother the character of the diarrhoea-
that it was caused by inflammation of the small intestine, and
that hence it would not do to check it suddenly-and that the
sore mouth was but a symptom of the intestinal disease.
Prescribed-Tinct. Aconite, gtts. iij.; Tinct. Ipecac, gtts.
v.; Water, 3ij, (to be kept on ice); half a teaspoonful every
half hour. Also, R Tinct. Nux Vomica gtts. j.; Water, 3ij.;
to be given in teaspoonful doses as often as necessary to re-
lieve the pain.
Slight amendment the second day, the discharges the same,
but the fever not so high, and the pain controlled by the
Nux. Not much change the third day, except that the aph-
tha was slowly disappearing-difficulty thus far in persuad-
ing the friends that mouth washes were unnecessary. Added
to the treatment Quinine inunction twice daily. The diar-
rhoea still continues the fourth day, but there is no pain or
tenesmus, the fever has disappeared, the sore mouth is nearly
gone, and the child is commencing to take milk and digest it.
Thus the case progressed with gradual amendment until
the discharges became natural about the tenth day, and the
child had a perfect recovery. But the father could not see
why the diarrhoea should not be arrested at once, and was
extremely anxious that large doses of some of the older
remedies should be tried. Afterwards he expressed satisfac
tion that his solicitations were refused.
HOW SHALL WE STUDY MATERIA MEDICA?
IN publishing a fifth edition of this little work, I have
thought it best to present the substance of the papers recently
published in the Eclectic Medical Journal-" How shall we
study Materia Medica?" Every reader is interested in this
study, and I have no doubt desires to make original investiga-
tions. At least he desires to know the methods of study pur-
sued in specific medication, that he may better weigh the re-
sults given, and prove their truth, if necessary.
((
Every physician should be in a condition to
prove all
things," and should never accept results, no matter by whom
given, unless they will bear a rigid examination. That he
may form an intelligent conclusion, it is necessary that he
have before him the methods pursued, as well as the results.
In this connection I may say that no amount of facts, as
facts alone, will advance the science of medicine.
Men may
observe for hundreds of years, and if it ends with simple ob-
servation, but little advance will be made. We hear a great
deal said about clinical medicine, clinical teaching, and clinical
observation, and yet I am free to say that medicine has not
made the progress through these methods that many have sup-
posed. Advance in medicine, as in everything else, comes
from the mind within and not from the world without; is the
result of brain-work, and not from impressions on the organs
of special sense. I am assured that this will be disputed at
once, yet I ask the reader to think the matter over without
prejudice, and with the discoveries of the day before him, and
he will reach the same conclusion.
364
SPECIFIC MEDICATION.
The steam-engine was built in the brain before it took form
n iron. The steamboat had taken form in Fulton's mind,
before it had a commencement in fact. So was the spinning-
jenny with Arkwright, and the electric telegraph with Morse,
evolved from the mind and not from the machine shop or lab-
oratory.
And yet I would be the last one to depreciate experiment,
or the advantage of observation, and the accumulation of facts.
These are good if rightly used; good if properly classified and
subject to the mind; not good if allowed to exert an undue
control and govern the processes of thought. We use facts to
reason from, and experiment to guide and prove the action of
the mind.
But we should not commence any investigation with a
prejudiced mind, for in such case neither is the reason free or
observation exact. Freedom from prejudice or bias is then
the first requisite of these studies we are making, and the
man who can not free himself from prejudice will always be a
follower, never a leader in original investigation.
So much as a necessary preliminary. We want facts-di-
vested of bias-to reason from. We want the action of the
mind, from facts to principles, guided by experiment, and the
results proven by experiment.
The first proposition we make is-That causes of disease
act upon the living body, and their action is invariably to im-
pair this life.
Causes of disease are to be removed, when this is possible,
and when it can be done without a still further impairment of
life.
The disease itself is a wrong in the life of the individual,
and is.as much a part of him as is healthy life at other times.
Disease is opposed by remedies which influence the organ-
ism toward a healthy or right performance of its functions.
Remedies. then, may be divided into two classes: (a) Those
which remove causes of disease. (b) Those which restore vital
processes
STUDY OF MATERIA MEDICA.
365
In taking up an individual agent, one probably that has been
employed in medicine for a long time, we get from published
works what seem to be the facts with regard to it, and clas-
sify them as above-to remove causes of disease-to influence
vital processes. The mind very soon separates them, and with-
out our volition will have weighed the facts, found some of
them wanting, and thrown these out, others imperfect and with
a wrong meaning, others that have not had sufficient atten-
tion, etc.
As the process of analysis goes on, it not only discusses
probabilities, but wants to know how the results have been
obtained. In the case of a remedy proposing to remove causes
of diseases, it wants to know how it is done. Is it a chemical
influence, combining with and neutralizing the cause, or does
it extract it, as in pulling a thorn, removing a decayed tooth
or a sequestrum, or is some organism forced to its removal, as
when we produce emesis, catharsis, diaphoresis, diuresis, in-
creased combustion, etc.
Immediately the mind turns to the result of such actions.
How is the life of the individual influenced by such extraction
or removal of disease. A man has taken Caustic Potash-
what will be the result from a sufficient quantity of Sulphuric
Acid to neutralize it? How is the life of the individual influ-
aped by emetics, cathartics, diaphoretics, etc.
Removing the cause of disease is a very good thing in some
gases, a very bad thing in others. Good, when it can be done
without too great impairment of life; bad, when it necessitates
marked derangement of function, and impairment of life.
Does the remedy propose to influence the life, and thus re-
store health, the mind at once asks how?
Is it general or local in its action?
Does it increase the viability of the sick, and thus enable
the body to perform its functions better?
Does it sustain life directly, by furnishing material needed
for nutrition, or for other purposes in the economy?
Does it rectify wrongs in the circulation, innervation, waste
and nutrition?
366
SPECIFIC MEDICATION.
These are a few of the questions that the mind asks, and an-
swers. Not of itself of course, but as the facts are presented
and analyzed. A few hours of careful study in this way works
wonders with a man's Materia Medica. Things that he had
accepted as true lose their basis and fade out; whilst other
and more rational views take their place.
Guided br experimentation—
We commence by gathering together the materials at our
disposal, and we analyze and weigh them as indicated above,
and reach certain conclusion from the premises. It does not
do to dogmatize as yet, we have only commenced the investi-
gation. We bring all our previous experience in therapeutics
to aid us, and we proceed to prove the truth of our conclusions
by direct experiment.
The course of experimentation must vary in different cases,
must indeed be varied in order to reach definite results, and
in all cases must be conducted with care. We can not jump
at conclusions here. We are dealing with a living body, and
one which possesses recuperative power in an eminent degree.
We should be making very great mistakes if we regarded every
thing that followed the administration of a drug, as its direct
result, and yet we are constantly in danger of making such
mistakes.
A man had his child vaccinated, and the next day it fell out
of a fourth story window and broke its neck-he gravely
remarked that nothing would induce him to have another child
vaccinated. (?)
In the above remarks I have endeavored to show the method
of getting old remedies before us for investigation, and the
advantages of thought in the study of Materia Medica. The
judicial mind is one element of success. Without prejudice
we propose to weigh all the evidence, and compare it with our
past experience, and our present physiological and pathological
knowledge. It is nothing to me if there is no word of truth in
the long statements, or if the grain of truth is so covered up
that it is not generally seen.
STUDY OF MATERIA MEDICA.
367
Such analysis is the commencement of a right study, and is
a necessary preparation for subsequent investigation and ex-
perimentation. We want a“right habit of thought,” and a
feeling of freedom from the authorities, that may be obtained
better by this study than by any other.
It is well enough to know how remedies act—at least to a
certain extent. We want to know whether the action of a rem-
edy is topical or from the blood; and whether it is directly
upon the affected part, or indirectly through its action upon
other parts or functions. It is well also to know whether it
influences the life directly by its influence upon the body, or
indirectly by the body's action upon it for removal—whether
in the present condition the remedy is an advantage to the life,
or a toxic agent. The questions also arise, is the action chem-
ical? physical? vital?
The simple proposition" disease is a departure from
health,”—is followed by the pathological question—“in what
direction is this departure"?"—and this by the therapeutic con-
clusion, that a remedy is that which, "opposing" such depar-
ture, brings the part or function to a healthy standard
We want to know the action of drugs in medicinal doses,
upon the human body; not only so far as this action is elective
for different parts, but also as to its kind.
If a drug is elective for the apparatus of circulation, in-
nervation, digestion, nutrition, etc., we think of it as among
the possible remedies in disease of these parts and functions.
If it is elective for brain, spinal cord, lungs, stomach, bowels,
kidneys, skin, serous membranes, mucous membranes, etc., we
think of it as a possible remedy in diseases of these parts.
In direct or specific medication, it is a first requisite that the
drug influence the part or function which is diseased. In
indirect medication it may influence any other part, and if
good results it may be dependent upon counter-irritation, or
the production of a second disease.
Secondly, we want to know the kind of action. What is the
result of the administration of a drug? is it excitant, depres-
368
SPECIFIC MEDICATION,
sant? does it favor an increased circulation, innervation, func-
tional activity, or lessen circulation, innervation or functional
activity?
In prescribing for disease the questions come-what drugs
will influence the particular part? What drugs will influence
it in the direction of health? Disease is wrong life, the ac
tion of the drug is opposed to this, and looks to right life.
The Homœopathic law of cure, similia similibus curanter, is
based upon the fact that many drugs have two actions in kind,
dependent upon the dose-the action of the small or medicinal
dose being the opposite of the large or toxic dose. Drug prov-
ing being done with toxic doses, the medicinal influence is
the opposite of this, and if in disease we see the symptoms of
the toxic action of a medicine, the small dose giving the op-
posite effect will prove curative. Homœopaths may twist and
turn as they please, they can not escape these conclusions.
But as these opposite effects, dependent upon quantity, do not
pertain to all drugs, and vary greatly with many, Homœopathy
has a short leg, and must go halt many times. Still we do not
wish to undervalue their investigations or their methods, for
they will be found very suggestive and instructive.
We propose to study the action of remedies on the living
man-both healthy and diseased, as an important means of
determining their action and use. Drugs influence the life,
-must of necessity influence it to be remedies. They infiu-
ence the life in health as well as in disease, though this influ-
ence may not be so marked, owing to the greater power of
resistance. In health the influence of a drug is of necessity
disease producing, for every departure from the healthy stan
dard is disease.
Wanted to know-the elective affinity of drugs for parts
and functions, we may give the drug to the healthy person.
Wanted to know-the kind of action, we may use the drug
in health. Wanted to know—the curative action of drugs,
we are obliged to test them in disease, though they may
have been pointed out by physiological proving.
STUDY OF MATERIA MEDICA.
369
The method of "proving " is simple. The prover needs be
in good health, and during the proving he should be careful
that no outside or unusual circumstances are permitted to
influence the action of the drug. If a topical action is wanted,
we use it in such form that absorption will be slow. If an
action from the blood is wanted, the drug must be so prepared
that its absorption will be speedy and with little topical action.
It is well in some cases to use it by hypodermic injection,
or obtain its endermic absorption.
The drug may be taken in the usual dose of old medicine, at
first. The mind must be entirely free from prejudice, and no
anticipation of the kind or situation of action indulged in.
I have had some queer illustrations of the influence of the
imagination in giving drug symptoms, one at least in my own
person where the drug had been accidentally changed.
Say, for instance, we take Podophyllum, finely powdered,
grs. v. to x. in the morning on rising. We notice first, an un-
pleasant sensation in the stomach, and our morning meal is
troublesome, with a sense of fullness and weight. Following
this is an unpleasent taste in the mouth, with gustatory sense
impaired; saliva is increased in quantity, and is more tena-
cious; mucous secretion more abundant; tissue of mucous
membrane is fuller, especially marked in tongue; slimy yel-
lowish fur on tongue; fauces tumid. Then comes uneasiness
in hypogastric region, with sense of fullness and need of stool;
fullness and weight in region of bladder, and disposition to
pass urine.
And during the day, a sense of weight in basilar
brain; with some dizziness and loss of perfect command over
the muscles. There will also be a change in the pulse, usu-
ally accelerated; increased temperature, 99° to 100°, and some
change in the skin. Finally if the medicine has sufficient in-
fluence, a stool which is changed in character.
This shows the localized influence of the drug, and the kind
of influence in toxic dose, and will aid in pointing out the
probable curative action. I take Podophyllum because it is
a drug that most of our readers have taken, and have experi-
370
SPECIFIC MEDICATION.
enced its effects in their own person, and not because it is a
good example of the advantage of physiological proving.
Attention has been called to the fact that dose is an im-
portant element in therapeutics, and especially to the fact
that many drugs exert a directly opposite influence in large
and small doses. If this is ascertained with reference to any
drug, then the therapeutic indications are plain. If we know
the action of the large dose, and its influence upon parts and
functions, we conclude that the influence of the small dose is
directly opposite. Given, a disease showing the symptoms of
structural and functional drug disease (large dose), we at once
think of small doses of the same drug-because in small dose
its influence is opposite.
In other instance the action of the drug is the same in
kind both in small and large dose, and knowing this kind of
action, we oppose it to the disease showing opposite symptoms.
There are quite a number of such drugs, and some of them
are quite valuable remedies, there being no danger of mistakes
from dose. Homœopaths employ the first class, but have
little use for the second, as will be obvious to the reader.
Again we find drugs producing some peculiar symptoms
which do not form a part of, and are not recognized in the
ordinary nosological clsssification of disease-symptoms which
may be absent or present in many diseases, and still have
no seeming reference to their origin, progress or duration.
They are peculiar drug symptoms, and they are peculiarly
Homoeopathic. No good comes from shutting our eyes to the
truth, whatever may be its origin, or whoever its discoverer,
and I would quite as soon credit Hahnemann with a discovery
as Galen or Bennett.
Again, we find that certain drugs will prove curative in
disease presenting peculiar symptoms, which these drugs will
not produce. These symptoms may be absent or present in any
disease, without seemingly affecting the origin, progress, or
duration, indeed seeming to have no relation to the pathologi-
cal processes. Here the physiological proving gives no in-
STUDY OF MATERIA MEDICA.
371
formation our knowledge comes from experimentation in
disease, and the direction of experiment is an accidental sug-
gestion.
A few illustrations of these methods of study will prove
interesting and profitable. They will be selected from the
more common remedies, and so described that the reader
may add them to his working Materia Medica, It is well to
take Quinine as the first drug, as upon its “similia," so we are
told, the whole structure of Homœopathy rests-Hahnemann
discovered Homoeopathy in the fever of Cinchona.
The physiological effects of Quinine are correctly given by
Pereira, as I have proven on my own person, and in five other
cases, and as the experience of seventeen years' continued use
shows:
'Excitement of the vascular system, manifested by increased
frequency and fullness of pulse and augmented respiration.
Furred tongue, and other symptoms of a febrile state, are also
observed.
Disorder of the cerebro-spinal functions, indicated by head -
ache, giddiness, contracted, in some cases dilated pupils, dis-
order of the external senses, agitation, difficulty of performing
voluntary acts, somnolency, in some cases delirium, in others
stupor."
All fevers, when measured by the thermometer, are periodic,
the diurnal variation of temperature in the type called contin-
ued ranges from 2° to 4°, and the febrile action from Quinia
poisoning shows every shade from intermittent to continued,
and is not usually the typical intermittent.
But the reader will notice that we do not use Quinine as a
remedy during vascular excitement, except there is a very evi-
dent want of a stimulant to the sympathetic and other nerve
centers. It is the direct stimulus we want, and it has refer-
ence not to the apparent excitement, but to the real depres-
sion. The remedy will produce a fever, and it will cure a fever.
That it produces a fever, shows that its action is directly
upon the functions involved in fever; that it cures a fever is
372
SPECIFIC MEDICATION.
because it gives that stimulus necessary to the normal per
formance of function, and we employ it when such stimulus
is necessary.
This property called antiperiodic, is something we know
little about, except so far as we know the facts by experimen-
tation in disease.
Taking Ipecacuanha as the second example, we have a very
good illustration of the first proposition, that the action of the
small is the opposite of the large dose; and knowing the poi-
sonous action we may predicate the curative.
66
If the powder or dust of Ipecacuanha be applied to the eyes
or face, it acts as an irritant, and causes redness and swelling
of these parts. Inhaled, it irritates the respiratory passages,
and in some cases brings on difficulty of breathing, similar to
an attack of spasmodic asthma"
In but moderate doses continued for a long time, I can grow
an irritation of every mucous tissue in the body, in some situ-
ations going on to inflammation.
In small doses it cures this very condition, and is the remedy
for acute inflammation of mucous membrane. Irritation of mus-
cular fibre underlying the mucous membrane is another symp-
tom of its physiological action, and to this also it is a remedy.
Not, however to the irritation of atony, as in the majority of
cases of asthma, for here, in place of proving curative, it in-
creases the disease.
Tobacco is another very fair example of this action :-" Its
most remarkable effects are languor, feebleness, relaxation of
muscles, trembling of the limbs, great anxiety, and tendency
to faint. Vision is frequently enfeebled, the ideas confused,
the pulse small and weak, the respiration somewhat laborious,
the surface cold and clammy, or bathed in a cold sweat." A
distressing sensation of sinking at the pit of the stomach, is a
characteristic symptom.
Given these symptoms as a group, or the most characteristic
of them, and Tobacco is a very certain remedy when given in
small doses. The best preparation for medicinal use, is a tinc-
STUDY OF MATERIA MEDICA.
373
ture from the fresh leaves, 3 viij. to proof spirit Oj.; macerate,
express and filter-dose, gtts. x. to xx. to Water, giv.; a tea-
spoonful every fifteen minutes to an hour. Of the dried To-
bacco leaf, 3j. to dilute spirit Oj. is sufficiently strong.
"(
Hyoscyamus is another example, though not quite so marked.
Faquier says, Henbane causes headache, giddiness, dimness
of sight, dilatation of pupil, a greater or less tendency to sleep,
and painful delirium. In some cases these symptoms are
followed by thirst, nausea, griping, and either purging or con-
stipation; and in a few instances febrile heat and irritation of
the skin are induced."
Given, a case of headache, with giddiness and dimness of
sight, and Hyoscyamus will prove curative. Given, a fever,
with the same symptoms, and Hyoscyamus will prove a valua-
ble remedy.
Taking examples of the second class, those whose action is
the same in kind, whether the dose is large or small, we have
a large number. And I will endeavor to select those in which
the action is not topical, but from the blood.
Jalap is a good example. Its action is that of an excitant
to the gastro-intestinal canal in any dose. In large doses it is
a painful and drastic purgative; in small doses continued it
causes irritation.
Nux Vomica is perhaps the best example. In the most mi-
nute quantity it is a spinal stimulant, as it is in the largest dose,
and the entire range of its use is as a stimulant to the spinal
and sympathetic centers. Possibly, this assertion may be mod-
ified by saying that in small doses the effect is not so much
stimulation, as it is the prompting to normal functional ac-
tivity.
The characteristic symptoms produced in health by Nux
Vomica are of the muscular system, showing its influence
on the spinal cord: "A feeling of weight and weakness in
the limbs, and increased sensibility to external impressions (of
light, sound, touch, and variation of temperature), with de-
pression of spirits and anxiety, are usually the precursory symp
374
SPECIFIC MEDICATION.
toms. The limbs tremble, and a slight sense of rigidity or
stiffness is experienced when an attempt is made to put the
muscles into action." Then comes the convulsive action of
the voluntary muscles, increasing as the remedy is continued.
I have italicized the symptoms resulting from Nux, and
which met with in disease are cured by Nux.
But in moderate doses continued for some time, Nux Vom-.
ica is an excellent example of the third action, producing cer-
tain peculiar drug symptoms not readily accounted for, by the
usual theory of its action. And, which symptoms being found
in disease, the drug becomes a remedy.
Thus, if the drug is continued for a length of time, it will
in many cases cause an unpleasant colic with pain pointing at
the umbilicus; pain in right hypochondria; and in women at
the menstrul period a peculiar dysmenorrhoea. To these
when observed as the result of disease, the Nux is curative.
It will also give a peculiar sallowness of skin, with relaxation
of connective tissue; a large tongue, with yellowish coating;
and again, for these in disease it is a remedy. Thus whilst we
see that the physiological action, as well as the influence in
disease is that of a spinal and sympathetic stimulant, there is
enough similia to give the drug value in Homœopathic prac-
tice.
If we examine Arnica, we find that it "quickens the pulse
and respiration, and promotes diaphoresis and diuresis," and
shows the properties of a stimulant to the ganglionic nervous
system. It is for this purpose we use it in disease, and know.
ing the action of the drug, we can use it when this stimulant
influence is desirable.
Furthermore, it appears to exert a specific influence over
the nervous system, causing headache, giddiness, and dis-
turbed sleep." These are the results of large doses, aud due
to overstimulation. Here should come in the Homœopathic
similia-when we have the peculiar sore or bruised head-
ache with giddiness and disturbed sleep, give Arnica. It is
an excellent indication, probably the best there is for the in
STUDY OF MATERIA MEDICA.
375
ternal use of the remedy, but they don't say so. To show
what they do say I quote Jahr's Repertory:
ARNICA.-Stinging, creeping, or laming and bruised pains in the affect-
ed parts; pains as if sprained, contused, hurt; red, shining, hot swellings,
a number of small boils; the lower parts of the body feel cold, the upper
hot; tensive pressure in the fore part of the head, as if the brain were
squeezed up in a lump; itching, tearing or stitching in the head; immo-
bility of the scalp; one cheek is hard and swollen; creeping in the face,
nose, scalp, lips and gums; toothache as if the teeth were sprained and
loose; white coated tongue; foul smell from the mouth; foul eructa-
tions; vomiting of coagulate blood; spasmodic pressure in the stomach;
splenetic stitches when walking; fetid flatulence; frequent small mucous
stools; nocturnal enuresis; brown urine with brick-dust sediment; in-
flammatory swelling of the scrotum and spermatic cord; hæmoptoe with
discharge of bright-red blood or black lumps; stitches in the chest,
especially when coughing or moving about; fetid breath; stitches in
the region of the heart, with paroxysms of fainting."
Returning to our first remarks on the subject, we find that
remedies may be classified into- (a) Those which remove
causes of disease. (b) Those which restore vital processes.
Taking up the first class, we want to know the influence
upon the life, of those drugs which remove causes of disease.
We say that morbid accumulation in the stomach is a cause
of disease, and it may be best to remove this with an emetic
--to be determined by the action of different emetic agents up-
on the processes of life, especially the effects subsequent to
the act of emesis. Compare Tartar-emetic, Ipecac, Lobelia,
Sanguinaria. Apocynum, Mustard, Common Salt, Sulphate of
Zinc, as regards the act of emesis, and subsequent influence.
In a given case of predominant wrong in the stomach by
accumlations, we first determine whether this, or the drug ac-
tion will do the greatest wrong to life; and concluding that it is
best to effect its removal, we select that remedy which will
accomplish the object with the least expenditure of vital pow-
er, leaving the organism in the best condition, or doing any-
thing that needs be done to restore normal functional activity.
This is an important study, and the method of comparison
must lead to a better use of remedies, and training the mind
376
SPECIFIC MEDICATION.
to accurate thought it will serve a very important use both in
diagnosis and therapeutics.
As we study the gross action of the group emetics, we study
the class, cathartics, diaphoretics, diuretics. Here is a series
of agents producing alvine dejections-to determine their use,
and the individual agent to be employed. Query first-will
the removal of the intesinal accumulations be a greater relief
to the life than the drug depression: is the patient better with
or without the medicine. Then the comparative action of
Podophyllin, Jalap, Scammony, Colocynth, Castor Oil, Senna,
Magnesia, Cream of Tartar, Crab Orchard Salts, etc.
As has been remarked before, it is a good thing to get our
remedies well in hand, and know them individually. We not
only want to know the gross action, but the more delicate
shades of action; not only the action in health, but also in the
varied changes of disease.
Does a remedy influence the life? At once comes the ques-
tion-how? First, as regards the difference in dose-to be
determined-its influence in large, medium, small and minute
doses, infinitesimal if you choose. Second, as to location of
action—is it general, localized, definite? Third, as to kind of
action—does it increase, diminish, or alter? Fourth, is its
action physiological-the same in kind and quantity in all
cases; or queer, depending upon certain symptoms, which seem
to have little relation to the condition of disease.
If a remedy is not well known, and we wish to give it an
investigation, we commence experimentation with it. Possibly
with a physiological proving, for which a dog is handy, a man
better. You take it yourself, you persuade other persons in
the household to take it. You determine to give it to the
sick-select a case in which the known action of the drug in
small dose is likely to restore some impaired function, or do
something that needs be done. The remedy is used singly-
note the results. You need not be afraid of the patients dying,
they won't die from deprivation of drugs, you may be sure of
STUDY OF MATERIA MEDICA.
377
that, and with the small dose of one medicine you will hardly
poison them.
Many times the discovery of important therapeutic properties
is purely accidental. You prescribe a drug for one thing, and
it does something you did not expect. Now you want to be
wide awake, not only to know what is done, and what has
done it, but the peculiar condition of this patient. And so
certainly as you find the same peculiarity in another case
recollect the same remedy.
We prescribe a remedy for some of its usual effects on func-
tion, and find to our surprise that the entire disease rapidly
fades out before it, and the single agent cures. We ask our-
selves at once, what is there peculiar and distinctive in this
case? and we carefully scan all the symptoms until we find
it. Finding some special symptom, we associate it with the
remedy, and when observed in another case we try the rem-
edy again. We read in a journal or text book, a description
of some disease, and see that the writer has had more than
ordinary success with a remedy; we want to know what is
peculiar in these cases. We examine the text carefully—the
writer may mention it incidentally; if so, we associate the
peculiarity observed with the curative drug, and test it when
we meet similar symptoms.
I have thus briefly called attention to the methods employed
in the study of the Matera Medica, and hope these articles
may stimulate many to give the subject thought. Very evi-
dently it is a broad field for investigation, and must repay the
diligent student. It "pays" to study; possibly, not directly
in money, but certainly in development of mind, and increase
of happiness. A single therapeutic discovery is a blessing to
humanity, and the man who makes it has lived to a good
purpose.
32
378
SPECIFIC MEDICATION.
Obstetric Remedies and their Use.
t
This may not be a very good classification of remedies, but
I think we can make it a useful one. It is well to be able to
think of remedies in groups, and for special uses, and if we
can make a group for obstetrical practice, it will be one step
toward a proper selection. We want a competent materia
medica; the fewer the remedies the better, so they answer
our purposes. We want each to have a well-defined, direct
influence, so closely associated with expressions of disease,
that the idea of the remedy is at once suggested by disease
expression.
If I were to designate a common obstetric materia medica,
or remedies for an obstetric medicine case, it would be-Nux
Vomica, Aconite, Macrotys, Pulsatilla, Lobelia, Gelseminum,
Chloroform, Ergot, Tincture of Oil of Cinnamon, Chlorate of
Potash and Phytolacca, with possibly Fluid Extract of Jalap
and Senna. Here is brevity, and here is certainty as well;
and whilst we can count the agents upon our fingers, a know-
ledge of their use will give more than ordinary success.
If we commence with the functional wrongs of the repro-
ductive apparatus that prevent conception, we will find in the
first four the means that will bring about the desired result.
Dysmenorrhoea will be relieved by Pulsatilla and Macrotys,
aa. 3ss., Water 3iv.; a teaspoonful four times a day, com-
mencing three or four days before the expected period. The
same prescription relieves the common menstrual suppression,
tardy menstruation, insufficient menstruation, or irregular
menstruation. The sub-inflammatory condition of the ova-
ries and uterus, that follows marriage, or is brought on by
sexual excess, is usually relieved promptly by-R Tincture
Aconite, gtt. v.; Tinct. Macrotys. gtt. x.; Water 3iv.; a tea-
spoonful every one, two or three hours. The unpleasant feel-
ing of fullness and weight in the pelvis, with hypogastric pain,
that is associated with menstrual irregularity, is cured by—
R Tinct. Nux, gtt. v.; Tinct. Macrotys, gtt. xv.; Water, Ziv.;
a teaspoonful every two hours. Gelseminum may take the
OBSTETRIC REMEDIES.
379
place of the Aconite, Pulsatilla and Nux, with the Macrotys,
if there is great nervous irritability, with an excited condition
of the circulation.
Thus we have remedies that rectify the usual functional
wrongs that prevent conception, and having thus made a good
commencement, we are ready to look after the ills of preg-
nancy. The first and most prominent of them is "morning
sickness," which sometimes goes on to persistent nausea and
vomiting, endangering the health, if not the life of the pa-
tient. For this Nux Vomica will be found a very certain
remedy. Ę Tinct Nux, gtt. j. to gtt. v.; Water, 3iv.; a tea-
spoonful as often as necessary. If it fails we think of Lobelia
or Gelseminum. Lobelia if the tissues are full and doughy,
Gelseminum if they are contracted. The dose will be small.
R Tinct. Lobelia gtt. j. to gtt. iij.; Water 3iv.; dose, a tea-
spoonful. R Tinct, Gelseminum, gtt. x. to gtt. xxx.; Water,
Ziv.; a teaspoonful as often as necessary.
For the unpleasantnesses that arise during gestation, we
find remedies in the same group. For rheumatism of the
uterus, or pain simulating it,— R Tinct. Aconite, gtt. v.;
Tinct. Macrotys, gtt. xv.; Water, 3iv.; a teaspoonful every
one, two, or three hours will prove effective. For pain in
back and hips, extending down the thighs, we frequently pre-
scribe- Tincture Pulsatilla, Tinct. Macrotys, aa. gtt, xv.;
Water 3iv.; a teaspoonful every three hours. If these pains
are associated with a sense of muscular debility, we substitute
Nux, as- -R Tincture Nux, gtt. v.; Tinct. Macrotys, gtt. x.;
Water, 3iv.; a teaspoonful every two or three hours.
For the unpleasant sensation of weight and dragging in the
abdomen and pelvis, we use Lobelia, as we do for oppression
of the respiratory apparatus, and especially præcordial op-
pression. The dose will vary, but will always be stimulant,
not nauseant.
For the unpleasant nervous sensations, dread, etc., Pulsa-
tilla is an excellent remedy, and will usually give prompt re-
lief, unless they are symptomatic of some distinct wrong.
For the urinary irritation, and difficult micturition some-
880
SPECIFIC MEDICATION.
times seen in gestation, Gelseminum will prove a remedy,
given in the usual doses.
False pains will be relieved by Aconite and Macrotys, or
Pulsatilla and Macrotys, selecting the one or the other as
heretofore named.
For rigid os or perineum, we have Lobelia and Gelseminum.
Lobelia if the parts feel full, Gelseminum if they are thin and
rigid. Lobelia is the remedy commonly indicated, and whether
the parts are full and hard or full and doughy, its influence is
direct and very certain. And there is this beauty in its action
-that whilst it puts the structures in better condition, both
as to dilatation and increase of mucous secretion, it favorably
influences uterine coutraction, so that whilst more efficient, it
is less painful. If there is any one remedy in obstetric medi-
cine more useful than another, it is Lobelia (a tincture of the
seed). Gelseminum is employed when the tissues are thin
and tense, with want of secretion, uterine contractions being
painful; and in this case it will be found to give excellent
results.
Unequal or irregular uterine contractions-giving tedious
labors are relieved by Macrotys; Aconite and Macrotys, if
there is an excited circulation; Pulsatilla and Macrotys, if
the patient is nervous and has unpleasant sensations of dizzi-
ness, or feels that "there is something wrong with the child;
Lobelia and Macrotys, if there is fullness' and oppression of
pulse; Nux and Macrotys, if there is constant complaint of
the back, “as if it would break." It is hardly necessary to
say that relief from unequal or irregular contractions by these
means, implies "better pains," and a speedier delivery.
Want of pain, or tardy pains, are met by Lobelia in some
cases, and by Macrotys in others, the selection being made as
heretofore named.
The use of Ergot is restricted to the second stage of labor,
and to cases of deficient contraction, want of pain, or ineffi-
cient pains. It is better used in infusion, from the fresh drug,
Zij. to boiling water, 3iv.; a tablespoonful every ten or fifteen
minutes.
OBSTETRIC REMEDIES.
881
For post partum hemorrhage the common remedy is Tinc-
ture of Oil of Cinnamon, in doses of one-half to one tea-
spoonful. It is very certain in its action, and rarely fails to
do all that a medicine will do. Ergot may be used when there
is marked want of uterine contraction, though the cases are
very rare. It will not do, however, to substitute medicine
for the necessary attention-the removal of the placenta, the
hand upon the uterine globe until firm contraction, and quiet
in the recumbent position.
After-pains are best met with minute doses of Macrotys, in
combination with either Aconite or Pulsatilla, as may be in-
dicated. Of course this does not arrest them, as would an
opiate, but simply makes them more bearable; but the mother
will get up much better than when the opiate is employed.
Aconite is the remedy for milk fever; though a motion of
the bowels may be solicited by any of the common means, or
by the fluid extract of Jalap and Senna, named in our list.
For caked breast, pains in the breast, mammary inflamma-
tion, chapped nipples, etc., Phytolacca is the remedy, inter-
nally and externally. Internally-R Tinct. Phytolacca (green
root), gtt. x.; Water, 3iv.; a teaspoonful every two hours.
Externally-R Tinct. Phytolacca, 3ss.; Water, 3iv.; applied
as a wet dressing.
•
For scanty or suppressed lochia, we have Aconite, Macrotys,
Pulsatilla, selected according to the indications heretofore
given. They may be supplemented or replaced by an infusion
of Pennyroyal.
For sepsis, fetid lochia, unpleasant breath, or any of the
wrongs that come from the absorption of animal matter, either
from the discharges or in the involution of the uterus, Chlo-
rate of Potash is the common remedy. Under its continued
use we find that a retained placenta may decompose and pass
off with the discharges without serious danger; and it will
usually remove all the unpleasant symptoms that are associ-
ated with sepsis. Of course Chlorate of Potash does not take
the place of proper manual attention on the part of the ac-
coucheur.
382
SPECIFIC MEDICATION.
This is a very brief synopsis of an Obstetric Materia Med-
ica, yet will be sufficient to point out the remedies that need
be studied, and the common use of those named.
Post-Partum Remedies.
We have had in review the principal remedies employed for
the ills of pregnancy and parturition, and may complete the
subject by a brief consideration of the ills and remedies of
mother and child for the month following delivery.
It is a good thing to still bear in mind that we are dealing
with a physiological condition, and not one of disease. Our
patient requires rest, that the tissues engaged in child-birth
may recover their normal condition. In the majority medi-
cine is not required, but instead the mother requires good,
nutritious food, cleanliness, good air and rest. Starvation—
or toast and tea-does not answer very well, and we will avoid
many mishaps by getting rid of the old ideas of light diet and
purgation
For after-pains it has been the rule to prescribe an opiate.
Some would be content with the milder diaphoretic or Dover's
powder, but others would give morphia in pretty full doses.
As a rule, the stronger the dose, or the more frequent the rep-
etition, the worse the patient is off. I am satisfied that many
of the chronic ailments of women may be traced to this as a
cause. I should say to the young physician, never give Opium
in any form in this case. I have the same objection to Chlo-
ral, which, though it acts very kindly in some, is a cause of
blood-poisoning in others, giving a slow and bad getting up.
But as we thus exclude the agents that act directly in ob-
tunding the nervous system, you may say that we can not give
relief, and must lose our practice. Not so fast. It is very
certain that the involution of the uterus in multipara requires
a certain amount of pain-synonymous for uterine contrac-
tion. A reasonable amount of after-pain is a good thing, and
mothers and nurses are not slow in learning the lesson. But
we do not want too much, and to modify it we have Macrotys,
+
POST-PARTUM REMEDIES.
883
Pulsatilla, Viburnum, Nux, and the sedatives. If the circu-
lation is somewhat excited I would prescribe-R Tinct. Aco-
nite, gts. v; Tinct. Macrotys, gtt. xx.; Water, 3iv.; a tea-
spoonful every two hours. If she was nervous and despond-
ent, I should give-R Tinct. Pulsatilla, gtt. x.; Tinct. Macro-
tys, gtt. x.; Water, 3iv.; a teaspoonful every two hours. If
with the pains there was nausea, flatulence, pain about the
umbilicus, I should give-& Tinct. Nux, gtt. ij. to gtt. v.;
Tinct. Macrotys, gtt. x.; Water, 3iv.; a teaspoonful every hour.
It is very rarely that these means will fail in giving the neces-
sary relief.
An offensive lochial discharge means mischief, local or gen-
eral, and calls for cleanliness-and Chlorate of Potash. There
is no mistake that this is the antiseptic of the puerperal state
in a very large majority of cases, and if it was promptly used
when the offensive odor first shows itself, it would save a
great deal of trouble. In some cases there is retention of
blood-clots, which undergo decomposition, and in miscarriages
occasionally a case in which the placenta can not be removed
without too much force. Even in the last case I should feel
entirely safe to leave the case to nature and to-Chlorate of
Potash.
A too free lochial discharge is usually controlled with small
doses of Ipecac, one-tenth to one-fourth grain every two or
three hours. I like the smaller dose, and would prefer it in
a trituration.
If the lochial discharge is scanty or arrested, I prescribe
the sedative indicated, Veratrum or Aconite, with Macrotys,
or a tea of Pennyroyal. Sometimes the two may be associated
together.
The milk-fever is readily controlled with the proper seda-
tive, Aconite being the usual remedy.
Nursing sore-mouth may make its appearance early, and is
one of the most serious ills of nursing, and one for which old
medicine gave us no remedy Possibly we have yet no reason
to boast, as we have nothing absolute; still I think the reader
will find in Phytolacca and Collinsonia, remedies for a large
884
SPECIFIC MEDICATION.
number of cases. I prescribe Phytolacca when the tongue
and mucous membranes show pallor; Collinsonia when the
color is vivid and bright. Of the first-R Tinct. Phytolacca
(green root), 3ss.; Water, 3iv.; a teaspoonful every three hours,
and as a wash. Of the second-R Tinct. Collinsonia, 3j.;
Simple Syrup, 3iij.; a teaspoonful every four hours. Tobacco
smoke is an excellent palliative.
Infantile sore-mouth, as usually met with, is very readily
cured with Phytolacca. Even the severe aphthæ yields to
this more readily than to any other remedy. It is given in
small doses―gtt. v. to water, 3ij.; four to ten drops at a dose.
Mammary irritation or inflammation, in the early stages,
yields readily to Phytolacca in most cases. I have prescribed
it for a dozen years, and with most satisfactory results. It is
given internally in small doses, and applied diluted to the
breast. Do not forget that proper support to the sensitive
breast is of great importance.
Phytolacca is also a valuable remedy for sore nipples, espe-
cially when the structure is swollen and sensitive; sometimes
it will effect a permanent cure. Of course it is not a remedy
for simple erosion and ulceration, unless the gland is also dis-
eased. In these cases we use it internally, and apply it diluted
to the nipple.
Of all the means employed for the relief of ulcerated nip-
ples, nothing has served my purpose so well as the lead nipple
shield. It is hammered in the form of the nipple, so that it
is light and fits accurately, or it is moulded out of thin sheet
lead. The nipple is carefully dried after the child nurses, and
the lead shield is worn constantly.
Infantile colic is treated with Nux or Lobelia and a stimu-
lant. If the child simply shows abdominal pain, and draws
its feet upwards, I prescribe-& Tinct. Nux, gtt. j.; Water,
Ziv.; a few drops frequently repeated until relieved. If the
face looks full, and the respiration oppressed, it would be-
R Tinct. Lobelia (sem.), 3j.; Tinct. Lavender Comp., 3ij.;
Simple Syrup to 3ij; five drops every fifteen to thirty minutes
until relieved. If the features are pinched, and there are fre-
REMEDIES IN DISEASES OF WOMEN.
385
quent discharges from the bowels with straining, give an infu-
sion of Epilobium. It would not do to omit saying, that for
a mother's prescription, there is nothing safer than Catnip tea.
In some cases the lochial discharge, becoming colorless,
persists for a long time, and the mother gets up from her bed
feeble in body, and especially feeble in the reproductive organs.
She is markedly pallid, has a feeble pulse, and a poor appe-
tite. In this case I prescribe Graphites, first dilution, gtt. x.
to water 3iv.; a teaspoonful every three hours.
This is but a small portion of what might be said with refer-
ence to these cases, but our object has been to bring forward
the remedies adapted to the more common ailments.
Remedies in Diseases of Women.
In the list of remedies favoring the menstrual discharge
may be included Iron, not only as a blood-maker, or a general
remedy, but for its local influence. Blueness of parts, usu-
ally with pallor, may be taken as the best indication for its
specific action. Tissues are full, and frequently the lower
segment of the uterus will give a doughy or sodden sensation
to the finger.
The Tincture of Muriate of Iron-a specific in a certain
variety of erysipelas-will be indicated by erysipeloid redness
of the surface, frequently of the lower extremities, and of the
external and even of the internal parts. One of the most
marked indications for iron is constant pain in the posterior
part of the head.
Apocynum is a very valuable remedy in the treatment of
diseases of women. The indications are: fullness of abdo-
men, uterus enlarged, and tendency to oedema of the extrem-
ities.
Graphites may be employed when the monthly discharge is
pale and watery, with prominent hysteric symptoms.
Polygonum, when there is a sensation of weight and full-
ness in the pelvis, with aching in the hips.
33
386
SPECIFIC MEDICATION.
The Mitchella, Senecio and Helonias find a use here, but I
im not able to point out the special indications for either,
Tincture of Phosphorus may be thought of as a remedy
when there is want of innervation, and the reproductive func-
tion (venereal desire) is markedly impaired.
Iodine has a similar use, and is usually associated with Nux
(compound iodine pill), to give energy to the reproductive
organs.
When we think of the remedies for the conditions of too
free, too frequent in recurrence, and prolonged, we wish to
make a classification into those for plus vascular and nervous
excitement—active condition; and minus vascular and ner-
vous excitement-passive condition.
The remedies for the first will be found in the class seda-
tive-Aconite, Veratrum, Lobelia, Bryonia, Rhus, Lycopus,
Gelseminum, Asclepias, and we need not give them an indi-
vidual study here.
The second group may be headed with Carbo-veg., which is
one of our most certain remedies. The indications are-pal-
lor, looseness of tissues, and a soft, open pulse. It not only
regulates the menstrual discharge as to quantity, frequency of
recurrence, and duration, but it exerts a marked influence
upon the nutrition of these tissues. I use a trituration one
to ten, and possibly it would be better in some cases to use a
second trituration.
The Hamamelis is another very valuable remedy, and is
indicated by fullness of pelvic tissues, laxity of perineum,
and impairment of the venous circulation. These are the in-
dications for the remedy, whether there is a wrong of the
menstrual function or not.
Ergot may be employed when the tissues are full and re-
laxed, and when there is oppression of the nervous system,
the patient being dull, stupid and careless,
Ipecac is a very valuable remedy when there is local irrita-
bility with lax tissues, though it may be employed in any case
in which irritability of the mucous membranes is a marked
feature.
REMEDIES IN DISEASES OF WOMEN.
887
The pain or uneasiness associated with the menstrual dis
charge, and felt at other times, is very variable in character
and intensity. There may be nothing characteristic about it
or it may point out the remedy for us
Nux is the remedy we usually think of for uterine colic.
Do not mistake the language-there is a uterine pain that
simulutes colic, even to its wandering character in the lower
abdomen and pelvis. The remedy not only relieves the pain,
but greatly aids in establishing normal nutrition and func-
tional activity I saw a marked case in the early part of the
year 1874, in which the woman had been a constant sufferer
from uterine disease since 1867. The character of the pain
was so decided that I gave her nothing but Nux at first, and
as the results were so satisfactory, no other remedy was em-
ployed, and she made a good recovery in three months.
We do not want to forget that the Macrotys, Caulophyllum,
Actæa and Pulsatilla, are remedies for pain, and may be in-
dicated by pain. As remarked at first, nearly all of these
remedies look toward a normal function, whatever may be the
indication for their use.
The Viburnum (Opulus) high cranberry, cramp bark, is a
most valuable uteriue remedy, and not only looks to normal
innervation, but to normal circulation and nutrition as well.
It is indicated by pain-its common name, cramp bark, is very
suggestive of the kind of pain-uterine spasm.
The Viburnum (Prunifolium), black haw, exerts a very
similar action, and is also indicated by pain-expulsive and
intermittent. Both are remedies for abortion, and especially
to remove the predisposition to it. The reader will recall
cases in which there is a continued tendency to abortion, and
will probably recollect that the ordinary treatment of uterine
disease in such cases is very unsatisfactory. I think the ex-
perienced physician will be able to think of a condition of the
reproductive organs, which, without any history of the case,
would impress his mind as one favoring abortion. These are
the cases for the two species of Viburnum.
888
SPECIFIC MEDICATION.
Rhus is indicated by the usual symptoms, burning pain and
heat, structures pinched.
Indications,
Apis is a very fine remedy in some cases.
burning with itching, especially of the bladder and urethra.
Collinsonia is sometimes a remedy, the indication being a
sense of heat, rawness and contraction, usually about the anus
or in the rectum (associated with hemorrhoids), or sometimes
at the entrance of the vagina.
Cannabis Indica is a remedy for erythism of the reproduc-
tive organs, and venereal excitement.
Staphysagria is a remedy where there is fullness of tissue,
abundant mucoid discharge, and dull brooding of the mind
with involuntary outbursts of passion.
This is a very brief sketch of some of the remedies em-
ployed for their direct action upon the uterus. I have pointed
out some of the more prominent indications for their use,
especially with reference to impairment of the function of the
reproductive apparatus. One can not, in a brief article, give
full descriptions; it is at best suggestive for further study.
In this case, as in some others, I would advise a study of our
materia medica with reference to the action of remedies upon
the reproductive organs and function.
Treatment of Pain.
The evidences of health are-the ability to do the work re-
quired of the whole or a part, and the ability to do it with
pleasure. Every function of the body should be pleasurable
in health. The use of the eye, the ear, the nose, the mastica-
tion of food, the act of digestion, defecation and urination,
the use of the muscular system, and the action of the mind.
As pleasure in living is one of the best evidences of health,
so is discomfort or pain one of the most common evidences
of disease. Indeed, I think we may say that disease is an-
nounced by feelings of discomfort, and these attend it in every
stage of its progress. It is not always severe pain, perhaps in
TREATMENT OF PAIN.
389
the majority of cases it can not be called pain, but it is un-
pleasant.
Let us say, then, that pain and unpleasantness are common
symptoms of disease-symptoms of every disease. It is so
common that we come to regard it as a part of disease, but it
will not do to regard it as the disease itself—it is nothing but
a symptom.
When our attention is called to pain, what should we think
of? Some would answer Opium or Morphine, but I would
suggest that it would be better to think of the disease of which
pain is the expression. If there was no disease of the part
suffering, or of the brain which receives the impression, there
would be no pain; take away the disease, and the pain is gone,
Can you say as much of narcotics-take away the pain, or
obtund the brain so that it can not feel pain, and the disease
is gone? I think you would hardly dare to take that position.
But you say that patients can hardly wait for the removal
of the disease, they want immediate relief. Let us see about
this. One is suffering from facial neuralgia, and you give one-
fourth grain of Sulphate of Morphia; it gives partial relief in
an hour, and possibly the patient has an uneasy sleep for a
couple of hours. When she awakes she awakes with pain,
to which is added an uncomfortable sensation in the head and
stomach; you repeat the dose, but there is only temporary
relief, and a still greater feeling of general discomfort after-
wards. How long, on the average, will it take you to get en-
tirely rid of the disease and the pain?
Suppose the case a pleuro-pneumonia, would you give Mor-
phia, even though the patient was suffering severely? If you
did, you would very likely do the patient a very great wrong,
and you would find that the narcotic at best only gives tem-
porary relief, and that the prolonged unpleasantness of disease
more than compensated for the temporary ease. In such a
case the proper sedative, Aconite or Veratrum, with Ascle-
pias, Bryonia, or Rhus, as indicated, will give permanent re
lief sooner than any narcotic.
Suppose, for instance, you have severe pain in any part, but
890
SPECIFIC MEDICATION.
it is decidedly periodic, and the patient has been in a mala-
rial region, what would you give? A narcotic? It strikes
me that none of my readers would do so foolish a think as
this. You say periodicity, remedy quinine, and at once pro-
ceed to give it in the usual anti-periodic doses; if it is a Qui-
nine case, the relief is prompt and permanent.
If now 1
should tell you that this patient, who is suffering severe pain,
has a flushed face, bright eyes, contracted pupils, and increased
heat of the scalp, what would you give? You say Gelsemi-
num, I say Gelseminum, and we all say the man who would
give Morphia in such a case is a fool, and should be gathered
in by the fool-killer. Why are we so positive in this case?
Because we have learned to recognize this condition of disease
as associated with the curative action of Gelseminum.
Let us have another common example. Here is a patient
suffering severe pain (I care not where), his face is full, his
eyelids full and heavy, the veins of his neck and face are full,
the veins of his hands are full, his tongue is full, put your
hand on the abdomen and you get the sensation of fullness—
what does he want? I say Podophyllin, you say Podophyllin,
and we all say that the man who would give Morphia in such
a case should become a granger, or "go west and grow up with
the country." Why do we say so? Because we know the ex-
pression of disease and its relation to Podophyllin as a remedy,
Again another. Here is a pregnant woman who has been
suffering a multitude of aches and pains in the pelvic region.
and as they have become almost unbearable, she applies for
relief. Evidently they have their starting point in the uterine
globe, and are dependent upon a wrong in its evolution. We
would never give a narcotic in such a case, it would be crimi-
nal mal-practice. But we associate the pain with the known
action of Macrotys, and giving this, we give speedy relief.
Let us take the severe burning pain of erysipelas, as an ex-
ample with which all are familiar. I have seen physicians
who had no more sense than to give Morphia to relieve this
pain, and "give the patient rest "—and it would be frequently
TREATMENT OF PAIN.
891
that rest that knows no awakening. Have you seen such a
case relieved in a few hours with tincture of Muriate of Iron?
If so, you have seen a fair illustration of the teachings of this
work-that the remedy for the disease is the best remedy for
the pain.
In the past two years we have had a series of cases in which
pain was a prominent symptom, no matter where the disease
was located. As a part of this pain, frequently, was severe
orbital pain on the left side; this, together with the sharp
stroke of the pulse, and the peculiar redness of the papillæ
of the tip of the tongue, was the indication for Rhus. I have
seen the remedy relieve the severest pain in an hour, and arrest
it permanently in twelve to twenty-four hours, in cases where
Morphia had wholly failed to give even temporary relief, be-
cause the narcotic dose would not be tolerated. The majority
of my readers have had a like experience.
Let us take the case of rheumatism. Would you not regard
the exhibition of opiates for the relief of this pain as an ab-
surdity-worse, as mal-practice? Every practitioner who has
observed closely and thought of his cases, will have noticed
how speedily pain is relieved, in many cases, by the proper
anti-rheumatic. Here is a series of cases that are promptly
cured by Macrotys-not only does the patient get temporary,
but permanent relief. Here are others, in a different locality
or year, relieved by Bryonia, Sticta, or Colchicum, and an-
other series that yields to acids or alkalies. It seems a little
singular to see pain at once alleviated by the free use of lemon
juice, and the disease speedily cured, and in cases in which
the narcotics would only give partial and temporary relief.
This is a good subject to think of, and it is one that deserves
careful thought. If I have pointed out a series of cases of
severe pain, in which the proper remedies for the disease are
also the very best remedies for the pain, have you any right
to say that the right treatment for the disease would not be
the best remedy for pain in every case? It is true we do not
know the "right" treatment of disease in all cases, but we
392
SPECIFIC MEDICATION.
can learn it if we try, and we can get along very comfortably
without the use of narcotics, in the larger number, until we
do learn.
Classification of Remedies.
If every physician could be convinced that it was necessary
for him to make a study of the action of remedies in the cure
of disease for himself, and not place his entire reliance upon
the teaching of the books, practical medicine would advance
rapidly. The dependence upon authority dwarfs the mind,
obscures the senses, and forms an almost impassable barrier
to individual observation. "If these men, learned, in high
social position, and with all the appliances of science, have
not been able to go further, what can you expect to do who
have none of these?" This question, asked by one who claims
to be a leader in Eclecticism, I propose to answer, and show
that the poorest, most ignorant, and feeblest of physicians
may do a great work for himself, and something for the gen-
eral advancement of medicine.
Every man has some spare time which he should utilize in
study, and I propose that a portion of this be devoted to the
study of remedies. Take your Dispensatory or Materia Med-
ica, and make a list of the drugs you know something about,
preparatory to a classification. In this classification you may
take any statement of the books that your experience has
confirmed, but do not take any thing upon the authority of
the writer alone. Having the group of agents before us, we
propose to classify them ourselves, and to put it in writing,
that we may have it before us for revision as our experience
grows larger. We will make the simplest groupings of med-
icines first.
Let us say, remedies may be first divided into two great
classes-those which have a general, and those which have a
local action. Of course many medicines will have both a
general and local action, but one will be decidedly first and
CLASSIFICATION OF REMEDIES.
393
prominent, so that with the majority the classification is
readily made, as for example:
GENERAL REMEDIES.
LOCAL REMEDIES.
Aconite,
Veratrum,
Quinine,
Baptisia,
Khus,
Macrotys,
Lobelia,
The Sulphites,
Alkalies,
Acids.
Gelse minum,
Nux,
Podophyllin,
Leptandrin,
Chionanthus,
Uvedalia,
Hamamelis,
Eryngium,
Viburnum,
Ipecac.
You notice that it requires a little thought to make this
classification, and you read your authors with more care, and
recall your experience with remedies more fully, in order to
do it satisfactorily. Of course this work requires time, but
it gives an education of the mind that could hardly be obtained
otherwise.
If now we say of the action of remedies, both general and
local, that they must either increase, diminish, or change from
the normal standard, we will be enabled to make a second
grouping in these classes. We might call these excitants,
sedatives, and, using the old term with a new meaning, alter-
atives. Taking the action of remedies in small doses, we
might make a grouping as follows :
SEDATIVES.
EXCITANTS.
Veratrum.
Quinine,
Aconite,
Nux,
Gelseminum,
Belladonna,
Rhus,
Lobelia,
Cactus,
Podophyllum.
Iris,
Pulsatilla,
Sanguinaria,
Macrotys,
Phosphorus,
Asclepias,
Arsenicum,
Ipecac,
Apis,
ALTERANTS.
Baptisia.
The Sulphites,
Leptandra.
Phytolacca,
Drosera.
Stillingia,
Collinsonia,
Viburnum,
Eryngium,
Apocynum,
Graphites,
Lycopus,
Iron,
Acids,
Bryonia,
Cuprum,
Alkalies,
394
SPECIFIC MEDICATION.
•
As you read the lists over you are not so certain it is well
done; you would shift the agents from one class to another,
or at least you would "have to think about it." That is the
very object we bave in view, and in “thinking about it,” you
will learn more of materia medica than you could possibly
learn in any other way.
If now we take our group of general remedies, we find that
we can make sub-classes, according to the action of the med-
icines upon different functions or parts which are general.
Thus we have a nervous system which controls the body,
divided into brain, spinal cord, and sympethetic, and the
remedy may expend its principal force upon either the one or
the other. We have a blood which is the common source of
supply, and the common sewer of the whole body. The rem-
edy may influence the structure of the blood in any of its sev-
eral parts, or may influence the sewage afloat in it. Then we
have the circulation of the blood, and we may have wrongs of
this, which are in frequency, impairment, or irregular distri-
bution. We have a lymphatic system common to the entire
body, which may be a source of disease. The apparatus for
the removal of waste, is also to be taken into the estimate, for
we have here sources of general disease. And finally we have
to take into consideration the condition and forces of life—
heat, electricity, and formative force.
The reader will notice that classification grows more diffi-
cult as we progress, and calls for closer study, and more
thought. But it has this in its favor, that it brings out all
we know of medicine, and enables us to classify our own
knowledge and that of the books, so as to make them useful.
When we study local remedies we find that they may be
classified in a similar manner, some of them readily, others
with difficulty. We have remedies that influence the respi-
ratory organs, the digestive apparatus, the urinary apparatus,
the excretory apparatus-skin, kidneys, bowels-the brain,
etc. We find also that some remedies may be classified as
they influence special tissues-mucous membranes, serous
membranes, connective tissue, bones, etc. We find that rem-
CLASSIFICATION OF REMEDIES.
395
edies not only have an elective affinity for parts, but their in-
fluence is uniform in health, and in similar conditions of
disease.
Let us call this the first study of remedies, a study that
recalls and fixes that which we know, and that gathers from
books the essential facts, or what seems to us essential facts
of drug action. It is work, but I will guarantee that the phy-
sician comes out of it stronger in mind, and very much better
able to prescribe for disease.
There are some things which can only be learned by exper-
iment, and I would urge every one to some effort in this direc-
tion. You have your own bodies, and though you may value
them highly, it will do little harm to test some medicines up-
on your own person. One can also, occasionally, persuade a
friend to take a part in testing a remedy. There is nothing in
medicine that I would not test on my own person, if I was en-
gaged in studying its action. Very certainly if the physician
has occasion to take medicine for any disease, he should care-
fully note its effects from hour to hour.
Let us call this the second method of studying remedies.
It is the Homœopathic method, though employed to some
extent by all classes of physicians. It gives most excellent
and reliable results, and we can not afford to dispense with it.
The third method is by carefully studying the effects of
remedies administered for disease. This study can only be
made to advantage where notes are kept, when care is used in
the diagnosis, and when single remedies, or remedies that act
in the same way, are employed, It is true that we can carry
something in our memories, and by repeated observations
facts will become familiar, but it is not a good plan to trust
the memory too far.
There are two things we want to know-the expression of
disease, and the action of remedies-and in so far as we can,
we want to associate them together. We may keep a record
of cases with but little writing, if we have a plan to commence
with. One word will sometimes express the condition of dis-
ease, it will rarely require more than a line. We write of one
396
SPECIFIC MEDICATION.
fever; to another we prefix the word intermittent, remittent,
continued, typhoid; or it may be variola, rubeola, scarlatina;
or catarrh, laryngitis, pneumonitis, enteritis, phrenitis, etc.
We have a whole history of the common progress of a disease
in a word or two. Now when giving remedies we may note
nearly as briefly the reason why we have selected the remedy,
Pulse small, frequent-Aconite; pulse frequent, sharp-Rhus;
veins full-Podophyllum; tissues full, oedematous-Apocy-
num; muscular pain-Macrotys; nervous, free from fever-
Pulsatilla; periodicity-Quinine; dull, stupid, sleepy-Bel-
ladonna; pain of serous membranes-Bryonia; dusky color-
ation of surface or mucous membranes-Baptisia; mucous
membranes deep red-Acids; mucous membranes pale-Al-
kalies; feeble heart-beef-tea; strong circulation, high tem-
perature-boiled milk.
I give examples as my memory recalls them, but I think
that the majority can have a record in about as many words.
We do not want to write a book for other persons, but to make
such notes as will enable us to recall the entire history of the
disease, with its expressions that have suggested the use of the
remedies employed. The reader will see that the record of the
effect of the medicine can be easily kept. A 0 will tell the
story of no effect, and a group of half a dozen adjectives will
note the more important influences that we wish to record.
My Pocket Case.
In making a study of our working materia medica, it is wel
to note the advantages of carrying remedies, and of extempo
raneous prescription at the bedside. The advantages are
threefold-to the physician, to the patient, and to the friends.
To the physician in that he learns his remedies better, and
prescribes with greater certainty. To the patient, that the
remedies are given in less doses, are promptly administered,
and are not admixed with unpleasant vehicles, and are of more
certain value and action. And to the friends, that much
MY POCKET CASE.
897
trouble is saved in providing the medicines, as well as much
unnecessary expense.
I have no special love for retail druggists, and many un-
pleasant experiences have shown me that it is quite possible
to procure the poorest drugs in the market from them, and
that it is quite uncertain what you will get in any given case.
Of course there are many exceptions, but this is applicable to
the druggist in ordinary, who makes it a rule to buy cheap,
and sell dear. I need not say that a contract between physi-
cian and druggist, by which the former receives a percentage
on prescriptions, is a very small species of swindling, and un-
worthy the profession.
Patients will soon recognize the advantage that comes from
a well filled medicine case, and will pay their bills more
promptly if they are not bled by the druggist. Talking about
bleeding, I have seen, time and again, a poor family saddled
with an expense of from thirty cents to a dollar and a half a
day for weeks, and for drugs that were useless, or in quantities
much larger than were necessary. Recently I counted on the
mantel of a patient, seven four-ounce, two six-ounce, and
three two-ounce bottles, with three boxes of powders, all of
which had been procured in seven days for a child four months
old. This physician probably had a percentage.
As regards the form in which medicines are dispensed, I
greatly prefer fluids, as they are easily measured, miscible
with water, which is the best vehicle, are readily absorbed by
the stomach, and hence of quicker and more certain action.
The physician carrying his medicine in fluid form will soon
learn that the small dose is not only as good but better than
the old doses, and that with the majority of drugs given for
direct action, the standard gtt. x. to the half glass of water
(3iv.), is the maximum.
Prescribed in water in this way, medicines are not unpleas-
ant, and the child will take them without objection. In dis-
pensing, we have them bring one or two glasses half full of
water, and a teaspoon, and prepare the remedy before the pa-
tient. The patient sees that it is not unpleasant to the sight,
398
SPECIFIC MEDICATION.
is clean, and the idea that medicine must be nauseous is e
moved. The child takes its medicine without trouble, and
indeed I do not recollect when I have had a case where the
child required to be forced to take it.
Using but small quantities of the stronger tinctures, an or-
dinary pocket case will carry enough for a very large practice
The pocket case I am using contains twenty-four four-drachm
vials, and sixteen two-drachm vials, is of Eastern manufac-
ture, and cost $3.50. It can be carried in the overcoat pocket,
is sufficiently thick to sit upright in the buggy or on the table,
corks all up--no unimportant matter in carrying fluids.
The first row of twelve vials contains the essentials of
practice the remedies in common use-Veratrum, Aconite
Gelseminum, Lobelia, Belladonna, Rhus, Bryonia, Nux, Ipe-
cac, Phytolacca, Asclepias, Macrotys, and we will give these a
first consideration.
Veratrum. This remedy is employed to slow the pulse, and
is especially indicated when it is full and strong, the large
pulse being the prominent feature. The deep red stripe down
the center of the tongue-marked-is a characteristic symp-
tom, and calls for Veratrum. Fullness of tissue-not con-
traction-is found in cases where Veratrum gives its best re-
sults It is a remedy in erysipelas with full tissue and bright
color, both locally and internally, and in chronic disease with
full pulse and increased temperature. Dose, gtt. v. to x to
water 3iv.; a teaspoonful every hour.
Aconite. This remedy is employed to slow the pulse and is
especially indicated when it is small. It is the child's seda-
tive, and is employed in the entire range of fevers and inflam-
mations. It exerts a special influence on the throat and
larynx, and is thus used in the treatment of quinsy and croup,
being the most certain remedy for the latter we possess. It
exerts its most marked influence on mucous membranes, and
is thus used in acute disease of bronchial tubes or intestinal
canal. In irritative diarrhoea, and in sporadic dysentery, we
use it with the best results. Dose, gtt. iv. to v. to water 3iv.;
a teaspoonful every hour.
▼
MY POCKET CASE.
899
Gelseminum. This is the remedy for irritation of the nerve
centers, marked by flushed face, bright eyes, contracted pupils,
and increased temperature, The dose will vary from the frac-
tion of a drop to five to ten drops.
Belladonna. This is the remedy for congestion, especially
of the cerebro-spinal centers. The indications are dull eyes,
dilated pupils, and somnolence, or coma. We add five drops
to four ounces of water, giving a teaspoonful every hour.
Lobelia. This is the remedy for the oppressed pulse, sense
of weight and oppression in præcordium or chest, and, in ob-
stetric practice, in rigidity of os and perineum, with fullness
of tissue, and in inefficient pains with sense of oppression. It
is especially the remedy in asthenic bronchitis of the child,
with increased secretion. In ordinary cases we add ten drops
to four ounces of water, and give a teaspoonful every hour.
In obstetric practice we give it to slight nausea; and in pul-
monary and cardiac congestion, a full dose of half a tea-
spoonful.
Rhus Tox. This is especially an epidemic remedy, and in
some years will be in constant use; in others we will have
but little occasion for it The indications are-frontal pain,
especially in the left side and orbit, sharp stroke of the pulse,
bright flush on left cheek, or in spots on the surface, burning
pain in the part, especially superficial, and a peculiar redness
of the papillæ of the tip of the tongue. We add two to five
drops to four ounces of water, and give a teaspoonful every
hour.
-
Bryonia. This is a remedy for serous membranes, in rheu-
matism, and diseases of the parenchyma of the lungs. The
indications are-frontal pain, extending to the occiput, right
cheek flushed; pain constant and severe, but without sharp-
ness; pulse of good size and steadily vibratile; cough att led
with lancinating pain, and in rheumatism a steady teusive
ache. Five drops are added to four ounces of water, and
given in doses of a teaspoonful every one or two hours
typhoid disease it must be given in smaller doses and with
care.
In
4:00
SPECIFIC MEDICATION.
ན་
Nux Vomica. This is the remedy for nausea and vomiting
if the tongue shows atony, for colic if the tongue is broad and
pallid, for atony of the liver and associate organs, for habitual
constipation, to improve the innervation from the spinal cord,
and in every case where there is abdominal pain pointing at
the umbilicus. A yellow sallowness of skin and about the
mouth, is an indication in chronic disease. Two to five drops
are added to four ounces of water, and given in teaspoonful
doses as often as necessary.
Ipecac. This is especially the remedy for acute disease of
the mucous membrane of the intestinal canal, whether diar-
rhoea or dysentery. It is an excellent remedy for nausea
when the tongue is contracted, or elongated and pointed, and
it is a prominent remedy in the treatment of infantile pneu-
menia. We generally employ it associated with Aconite.
Five to ten drops are added to four ounces of water, and given
in teaspoonful doses every hour.
Phytolacca. This is the remedy for mammary irritation
and inflammation, for the sore mouth of the nursing child, for
some cases of nursing sore mouth, sub-involution of the ute-
rus, enlargement of the sub-maxillary and cervical lymphatic
glands from sore mouth and throat, and for diphtheria. It is
also an epidemic remedy. The most prominent indication for
it in ordinary cases is a pallid, somewhat leaden colored tongue,
very little coated, and looking slick, as if coated with some
glutinous material. The dose varies from the fraction of a
drop to ten drops.
Asclepias. This is the diaphoretic, and is associated with
the sedatives when an increased action of the skin is required.
Macrotys. This is the remedy first thought of in rheuma-
tism and rheumatic neuralgia. It is the remedy for unpleasant
sensations in the pregnant uterus; for false pains, and to aid
true ones. It is undoubtedly a partus preparator whenever
the woman is troubled with unpleasant sensations in the last
months of pregnancy. It is also a valuable remedy to correct
the wrongs of menstruation, relieving pain, and looking to-
ward normal functional activity. We find the small dose
MY POCKET CASE.
401
much more certain than the large, and rarely add more than
ten drops to four ounces of water, giving a teaspoonful every
hour, or as often as required.
I do not claim that my pocket case is better than many oth-
ers, indeed it is not as good as some, but still it serves my
present purpose. I was looking at a neighbor's a few days
since it was much nicer and contained 120 remedies-but he
was a Homœopath. By-the-by,why should Homoeopaths have
things nicer than Eclectics? I want to know. But then again,
it is decidedly nicer than an "old-fashioned Eclectic's," that
I noticed a few weeks ago; it contained six dirty bottles, a
few paper packages of powder, and a rag containing some out-
landish mixture, altogether smelling like the "last rose of
Summer," or a bad case of cholera morbus. We want nice
medicines, in clean bottles, and in a clean, pleasant looking
case.
My second row contains twelve bottles, and these may be
called incidentals to a good practice. They are Apocynum,
Pulsatilla, Baptisia, Collinsonia, Drosera, Arsenicum, Cheli-
donium, Cuprum, Podophyllin, Quinia, Ferrum, and Carbo-
Veg.
Apocynum. This is a remedy usually thought of in dropsy.
The special indication for it in other cases is fullness of cel-
lular tissue, oedema. It is one of the prominent remedies in
rheumatism, rheumatic neuralgia, disease of joints, disease of
mucous membranes, and always characterized by atony of the
sympathetic nervous system,-the special indications above
named being present. Add gtt. v. to xv. to water 3iv.; a tea-
spoonful every two hours.
Pulsatilla. This is the remedy for "nervousness," especi-
ally when associated with disease of the reproductive organs
or function. Fear of impending danger, dizziness, nervous
dysphagia, unrest, and tendency to look on the dark side, are
among the indications. It exerts a special influence upon the
reproductive organs of both male and female, controlling
sexual excitement in both, and is a prominent remedy to restore
normal menstrual function, and to relieve some unpleasant-
34
402
SPECIFIC MEDICATION.
nesses during gestation. Add gtt. v. to xxx. to water Ziv.;
teaspoonful every two to four hours.
Baptisia. This is one of our most important remedies, and
should have been in the first list. It is the remedy for cynan-
che maligna, and for any disease that gives this peculiar odor.
It is indicated by fullness of mucous membranes, tongue,
fauces, pharynx; by deep coloration of tissue, not red; also
in typhoid disease by a continued moist pasty fur on a tongue
of normal redness. It is an epidemic remedy, and, as in the
present year, will cure typhoid fever, typhoid dysentery, ty-
phoid pneumonia, typhoid sore throat, typho-malarial fever-
or indeed typhoid anything. Add five drops to four ounces
of water; give a teaspoonful every one or two hours.
Collinsonia. This is the remedy for hemorrhoids, with a
sense of heat, burning or constriction in the rectum. It is a
remedy for diseases of digestion, functional diseases of the
urinary apparatus, and diseases of the reproductive organs, if
the above symptoms present. It is a remedy in diseases of the
respiratory apparatus, when the irritation points in the larynx,
with change in the voice, or inability to use it without irrita-
tion. Add gtt. v. to xx. to water iv.; a teaspoonful every
two to four hours
Drosera. This is the remedy for the cough of measles, and
all coughs that resemble it; and in many cases of whooping
cough. Add gtt. v. to xxx. to water 3iv.; a teaspoonful every
four hours.
Arsenicum (Fowler's Solution). This remedy is not in
common use. I employ it in those rare cases of malarial dis-
ease, in which the pulse is soft and feeble, the skin relaxed,
the extremities cold, and the tongue pallid and expressionless.
Possibly these are the best indications in any case, though
there is a peculiar incurved tongue, thick in the center, of a
bluish leaden color, that is a prominent indication; and in
phthisis a dead, inelastic skin that calls for it. Dose, from
the fraction of a drop to two drops. Or-
Chionanthus Chionanthus exerts a specific influence upon
the liver, and is the remedy for jaundice. In ordinary acute
MY POCKET CASE.
408
or chronic disease, if the eyes show the yellowish tinge, or if
the patient complains of pain in the region of the liver, we
employ this remedy. The dose is ten drops every three hours.
Chelidonium, Whilst in some seasons, and in some locali-
ties, this will be a useful remedy, in other seasons and places
it will hardly be called into requisition. Fullness of right
hypochondrium, dull pain in the shoulders, and a brownish
sallow complexion, with dull leaden tongue, are the indica-
tions for it. Add gtt, x. to xx. to water iv.; a teaspoonful
every three hours.
Cuprum. Copper is the blood-maker after exhaustive dis-
charges, as uterine hemorrhage, hemorrhage from the lungs
and kidneys, profuse diarrhoeal discharges etc. It is also a
remedy in those cases of debility simulating these just named.
In Asiatic cholera and some choleraic diseases, these appear-
ances will present with or before the first discharges; in these
copper is a remedy.
a remedy. In some menstrual lesions we observe
the same symptoms, and use copper. I use Rademacher's
tincture, gtt, x. to water iv.; a teaspoonful three or four
times a day. Or-
Dioscorea. Dioscorea is a specific for bilious colic, and we
also employ it in acute disease where abdominal pain and ten-
derness are prominent features. It is a valuable remedy in
the early stage of puerperal peritonitis, and especially valua-
ble in the treatment of typhoid fever when there is tenderness
on pressure and tympanitis.
Podophyllin. This is a stimulant to the solar sympathetic.
It is indicated by full tissues, full veins, full tongue, and by
dirty pallor of surface. In an ordinary season I should carry
granules made of Podophyllin gr. 1-20, Phosphate of Hy-
drastia gr. 1-4. In some seasons, and in malarial localities,
when the full influence of the drug is desired, pills of one-
half grain. Or a trituration of one to one hundred for the
summer diseases of childhood. I need hardly say I should
prescribe it in any disease showing the above indications.
Quinia. The use of this drug is so common and well
known as an antiperiodic and nerve stimulant, that I need
404
SPECIFIC MEDICATION.
but give the condition in which it may be expected to act
kindly. A soft, open pulse, a soft skin, a moist, cleaning
tongue, and absence of nervous irritation.
Ferrum. As Iron is in such common use, every one should
know how to use it. I give it when there is bluish coloration,
and especially when there is dull pain in the back of the head.
Rademacher's tincture, or tincture of muriate, are the best
preparations, though in some seasons metallic iron will be
better. Add gtt. xx. to water 3iv.; give a teaspoonful every
one, two, or three hours. Or—
Uvedalia. This remedy acts directly upon the spleen, and
it is not only employed as a specific in the treatment of "ague
cake," but it may be used in enlargements of the spleen from
any cause. We also employ it as a remedy for the removal of
low inflammatory deposits. The dose will range from one to
twenty drops. And we employ an ointment of Uvedalia as a
local application.
Carbo- Veg. This is the remedy for passive hemorrhage
from any part of the body; the remedy for hemorrhage in
typhoid fever, and the remedy for the hemorrhagic condition
in all typhoid disease. I have used it in uterine hemorrhage
(not post partum), in hemorrhage from the lungs, bowels, kid-
neys, and nasal passages, with most satisfactory results. It is
a valuable remedy in typhoid conditions, with moist tongue,
and tumid abdomen. I employ the first decimal trituration
(one to ten.)
I do not propose to change the pocket case of all my read-
ers, nor to advance any thing specially new with regard to
remedies; yet if it stimulates a removal of old and bad smell-
ing pouches, and suggests additional agents, this article will
have served its purpose. As a matter of profit, I am satisfied
that money expended in nice medicine cases, nice medicines,
and nice surroundings to the physician, will yield an excellent
interest.
We have had two rows of twelve each, and we designated
them as necessities and incidentals; and probably some prac-
titioners could do very well with these. We add a third row
MY POCKET CASE.
405
of sixteen bottles, and as we have no special name for this
row, let us designate it as and-so-forth. This list may vary at
different seasons of the year, and in different localities, but
now it shall consist of Cactus, Apis, Graphites, Viburnum,
Sticta, Boletus, Eupatorium, Ergot, Permanganate of Potash,
Morphia, Santonine, Hydrastia, Nitrate of Sanguinaria, Eryn-
gium, Natrum Nit., Rheum, and Phosphorus.
Cactus. The common idea is that Cactus is the remedy for
heart disease, and so it is if there is irritability with feeble-
ness, the quick movement without strength. But I do not
restrict its administration to cases of heart disease; given,
the quick movement without strength, and I would prescribe
it in a case of fever, inflammation, or functional disease. The
dose will vary from 3j. to gtt. v, to water 3iv.; a teaspoonful
every four hours, or more frequently in the small dose.
Apis. The tincture of the honey-bee is an excellent rem-
edy if the diagnosis is well made. Given, the peculiar burn-
ing pain that one associates with the sting of the bee, and I
should think of this remedy. Burning pain with itching in
the urethra, in the bladder, or any part of the surface, is met
by Apis. I usually add gtt. v. to water 3iv.; a teaspoonful
every two or three hours.
Graphites. This is a remedy highly valued by the Homo-
opaths, and I use it occasionally in diseases of women. Sen-
sation of fullness in the pelvis with watery menstruation,
thin leucorrhoeal discharge, dull eyes, sallow, expressionless
face, dirty skin, are very good indications. I use the first
dilution, gtt. v. to water 3iv.; a teaspoonful every three hours.
Viburnum. This is one of our most valuable remedies, and
should have a wide use. It is the remedy in habitual abor-
tion, in cases where the pregnant woman suffers pains at the
periods for the monthly flow; for tensive, cutting pains in the
last weeks of pregnancy; for severe cutting after-pains, and
in many cases of dysmenorrhoea. It has other uses, but we
have not space to give them a consideration here. I add gtt.
x. to water ziv., and give a teaspoonful every one, two, or
three hours.
406
SPECIFIC MEDICATION.
Sticta. This is a remedy I value highly, and in some sea.
sons it has quite an extended use. It is a remedy for cough
when there is pain in the chest extending to the shoulders,
the neck, or back of the head. The special symptom indica-
ting it is pain in the shoulders (usually the right) extending
up the neck to the occiput; with this pain marked it has
seemed to me it would cure anything. This winter it has been
a prominent remedy for the cure of rheumatism. The Sticta
belongs to a class of agents, the Lichens, which deserve care-
ful study.
Boletus. The Boletus is not in common use, and yet I think
it one deserving study. I employ it in cases other than ague,
in which there are recurring chills or chilly sensations. It is
a remedy for ague, and in some seasons it will be found quite
as certain in its action as Quinine. Add gtt. v. to water 3iv.;
a teaspoonful every two or three hours.
Eupatorium. Of course if we were using this agent in the
olden way, we could hardly carry it in a two-drachm vial. I
administer it in the small dose in cases of fever or inflamma-
tion where there is marked pain in the bones, and throbbing
pain in the head; pulse full, but without distinctness of wave.
Add gtt. v. to water 3iv.; a teaspoonful every hour.
Ergot. I employ Ergot for a use similar to Belladonna.
There is dullness and oppression of the brain, but without
the tendency to sleep; in a further advanced stage, coma. It
is especially indicated where there is deficient spinal innerva-
tion. The dose will range from the fraction of a drop to ten
or twenty drops.
Permanganate of Potash. I carry this remedy as a local
application for phlegmous showing enfeebled capillary circula-
tion, and as a dressing to open wounds when the pus is fetid
and ichorous. Ten grains to the ounce makes a dressing for
the abortion of a phlegmon; ten grains to one drachm in a
pint of water makes an excellent antiseptic dressing.
Morphia. Do not use Morphia as a narcotic; that is, the
dose of the medicine as I use it is always stimulant. I em-
ploy it as a stimulant when the pulse is small, frequent, and
MY POCKET CASE.
407
the waves of blood short. The artery seems like a vibrating
thread. Though the patient may be restless and sleepless,
there is no inclination to wandering of the mind. I use War-
ner's granules, one-eighth grain; one being a dose.
Santonine. I am not sure but the Santonine had better be
triturated with Podophyllin, in numerous sections of country,
as its principal use will be as a worm medicine. For this
bottle the proportions may be-R Santonine, Sugar of Milk,
aa. 3ss.; Podophyllin, gr. ij. The dose of the trituration
would be one grain for a child two to four years of age. As a
remedy for retention of urine in children, it would be better
in many cases with the Podophyllin out, and yet in this form
it will serve the purpose.
Phosphate of Hydrastia. I employ the phosphate because
it is the most soluble, as well as the best preparation of the
Hydrastis. One to two grains to Water 3iv., makes a good
appetizer and tonic. One grain to the ounce is an excellent
collyrium, gargle in sore throat, wash for sore mouth, or in-
jection in gonorrhoea or leucorrhoea. Used in these small
quantities, the remedy is cheap, portable, and easily dispensed.
Nitrate of Sanguinaria. Wm. S. Merrell & Co. introduced.
this salt to the profession, and thus far it has proven the most
available preparation of Sanguinaria. The indications for its
use in colds, bronchial disease, etc., are a sense of fullness in
the upper part of the thorax, and a seeming difficulty in draw-
ing a full inspiration. It is an admirable remedy in asthenic
bronchitis, and humid asthma. A sense of burning and con-
striction of the throat is also an indication. It is a valuable
remedy in diseases of the stomach and upper intestinal canal
with increased secretion of mucus. Be careful not to make
the dose too large-one grain to four cunces of water is suffi-
ciently strong; dose a teaspoonful.
Rheum. I employ a tincture of Rhubarb to relieve irrita-
tion of the stomach, and to aid digestion. Add gtt. x. to
water 3iv.; a teaspoonful every one or two hours.
Eryngium. This is one of our most certain remedies for
diseases of the bladder, urethra, prostate gland, and some
408
SPECIFIC MEDICATION.
wrongs of the reproductive organs of women. The indications
are burning pain with tenesmus in the bladder or urethra. It
has other uses, but I prefer to reserve it for this.
Nitrate of Soda. I employ Nitrate of Soda in cases similar
to those calling for Nitric Acid. Violet color of the tongue
is the indication; and whilst I should use Nitric Acid if the
color was deep, I should use Nitrate of Soda if the color was
light.
Phosphorus. I employ the tincture of Phosphorus for two
purposes to arrest inflammatory processes in the lungs, and
to arrest low grades of inflammatory action in kidneys, pros-
tate gland, testes and ovaries. Languor, debility, impairment
of mind, and want of acute evidences of disease in the part,
may be regarded as the indications.
Thus we have filled up our three rows of forty bottles, and
yet the reader will find that some favorite remedy is left out.
But there are many in that are not in common use, and they
may be exchanged. Some remedies that we value highly can
not be carried in a pocket case. We want Muriatic, Nitric,
and Sulphurous Acids, Phosphate of Soda, Sulphite of Soda,
Bicarbonate of Soda, a convenient emetic, and these are more
or less bulky and difficult to carry.
We have filled up our pocket case, and left some of the es-
sentials out, and I hardly know how we will carry them. It
is not so difficult to arrange for the bulky agents, Sulphite
of Soda, Bicarbonate of Soda, Phosphate of Soda, Acetate of
Potash, etc., as it is for the Acids, which are inclined to get
out of the container, and do some unpleasant burning. How
shall we arrange it?—with another pocket case of one row,
ten four-drachm vials, or by increasing the thickness of our
principal case one row?
I will take it for granted that we must have another case,
and we will make it of ten vials, with rubber corks, and we
will have the manufacturer see that these vials are of extra
strength. It is a pity that he can not devise a cork-retainer,
like the modern soda-water bottle. If we have another case,
it will be necessary to have a nice sack, very like an officer's
MY POCKET CASE.
409
haversack, to carry them in, with instruments and other
things or instead of this, a very nice hand satchel. I saw a
physician with one the other day, and it served the purpose
and looked well.
We commence this list with the acids, which are very im-
portant remedies, and have well defined indications, and in
some seasons will be in very common use. As Acids, the
special indications are, deep-redness of mucous tissues or skin
if blood shows freely. Here we may use Muriatic Acid, hard
cider, or whey, and sometimes lemonade or other vegetable
acids.
Muriatic Acid. This remedy is indicated by the deep-red-
ness of the tongue, contracted, with coatings of a brownish
color, inclined to grow darker as the disease advances. It is
added to water so as to make a pleasant acid drink, and given
ad libitum.
Nitric Acid. This remedy is not employed for the general
purposes of an acid, It is a typical specific, having a positive
indication and a most certain action. The indication is a
violet coloration of tongue, and of other parts where blood
shows freely. In the best marked cases the violet color seems
but a film upon the surface, and you seem to look through it
to the natural, or rather deeper than natural color of parts
below. I usually prescribe it in the following proportion,
when I send the prescription to a drug store: & Nitric Acid,
gtt. x to gtt. xx; Water, Syrup, aa. 3j.; a teaspoonful in water
every three hours.
Sulphurous Acid. This is a feeble acid, and is not used
for the general purposes of an acid. It is one of our group
of antiseptics, and is indicated by full tissues and dirty color
of coatings of tongue, and of other secretions and excretions.
The dose is from five to thirty drops in a little water.
Tincture of Muriate of Iron. In our other case we had a
preparation of Iron, Rademacher's Tincture, or Iron by Hy-
drogen; in this it is well to have the old standard. It is the
remedy for erysipelas when the redness is deep and the pain
has not so much of the burning character. It is a most
410
SPECIFIC MEDICATION.
excellent remeay in diseases of mucous membranes, when the
tongue, fauces or throat, shows the glistening, deep-red, ery-
sipeloid condition; and in any disease in which either skin
or mucous membranes show the characteristic color.
It is a most excellent restorative in some conditions of both
child and adult. I especially prize it in the first. Nutrition
is impaired, digestion poor, tissues relaxed, tongue shows more
the usual deep-redness, with possibly a tinge of blue
ally add gtt. x. to xx. to water and syrup to make 3ij. Dose,
half to one teaspoonful three times a day.
Chlorate of Potash. This is the antiseptic, where there is
a fetor resembling an unpleasant lochial discharge, or decom-
posing animal matter. The fetor of cynanche maligna is
sometimes a very striking dissecting room smell. Chlorate of
Potash is especially the antiseptic in puerperal diseases, and
my readers are all familiar with its common application in
simple sore throats, and other diseases of mucous membranes.
The dose will vary from one to five grains, and as a local ap-
plication, 3j. to water Ziv.
Sulphite of Soda. Sulphite of Soda is one of our most
valuable remedies, as an antiseptic and a destroyer of the
germs of low animal and vegetable organisms. The indication
for its use is a dirty, pallid tongue. We use it in doses of
from one to twenty grains, every three hours.
Bicarbonate of Soda. The physician will find this one of
his most useful remedies in some seasons, preparing the way
for the kindly action of other agents, or sometimes effecting a
cure itself. The indication for its use is pallor of mucous
membranes-a broad, pallid tongue. It is not necessary to
use it in large doses. Add it to water in small quantity so as
to make a pleasant alkaline drink, and let the patient have as
much as he desires.
An Emetic. What will give us the best emetic in small
compass? Suppose we say-R Lobelia Seed, powd., 3iij.;
Ipecac, 3j.; Capsicum, gr. x. Mix. Make two-grain powders,
and give one every ten or fifteen minutes in a wine-glass of
warm water. If the influence is to be prolonged, lessen the
MY POCKET CASE.
411
quantity of water, and increase the distance between the doser
If it is a case where an acetous emetic would be preferable
acidulate the water with vinegar.
Sesqui-Carbonate of Potash. This old-fashioned remedy
should not be forgotten. It is the very best injection to re-
move the debris of tissue in an abscess, and to stimulate the
restorative process, as it is the very best escharotic in caries
of bone. It is the remedy for carbuncle, though a seemingly
severe one. I use it early, injecting the structure thoroughly
from one or more openings, with a saturated solution; and
though it makes the patient dance, this is more than compen-
sated by the relief from pain that follows in ten or fifteen
minutes.
No. 10.-Please fill this bottle to suit yourselves, and thus
complete the little case. We have an abundance of remedies,
and every reader will probably have been looking for a vacancy
for some favorite.
I have done the best I could for the case, in the small com-
pass of this article, and if any thing has been left unsaid,
please add it. If we all live five years we will want to renew
our cases and our studies, and we will probably be able to
make one with a hundred remedies instead of fifty.
INDEX.
Abies Canadensis...
Acetate of Potash....
Achillea Millefolium.........
Acids....
Aconitum Napellus....
Acta Alba…. ………………….
54
.... 210
54
57
..55, 399
59
Actaea Spicata ………..
59
Adansonia Digitata........
Administration of Medicines......
Esculus Glabra..........
59
24
59
Esculus Hippocastanum
...
60
Athusa Cynapium..
61
Agaric
61
Agaricus Muscarius..
63
Agave Americana..
64
Agrimonia Eupatoria.....
Ailanthus Glandulosa..
Alisma Plantago. .
Alkalies........
Alkaline Sulphites....
Aletris Farinosa...
64
65
65
65
47
. 67
Alnus Rubra…………………
Aloes
67
.... 68
Alstonia Constricta
" Scholaris.....
Ammonium, Bromide of.....
Iodide of...………….
4 Muriaticum..
Ampelopsis...
Amygdalus Persica........
Amyl Nitrate.…………………..
. 68
69
70
70
71
71
71
. 72
414
SPECIFIC MEDICINES.
Anagallis Arvensis.
73
Analysis of Disease.....
11
Anemone Nemorosa
73
Antimonii et Potassii Tartras..
74
Apis Mellifica……………..
Apple-tree.......
Apomorphia......
83, 405
........ 218
74
269
Appendix.......
Apocynum Canabinum....
Aralia Hispida………………………….
Arbor Vitæ......
Argentum Nitricum..
Arbutus...
Aranea Diadema...
Aristolachia Serpentaria………..
Arnica Montana.…………………………..
Arsenicum...
Arum Triphyllum
Artemesia Absinthium.
Artemesia Santonica....
Asclepias......
Asafoetida.......
Asclepias Tuberosa.....
Ash.........
Aspidum Filix Mas.
Atony of Stomach..
.....
Atropia Belladonna……………….
Aurum.......
Baneberry..
Baobab.......
Balmony....
Baisam Apple.....
Bayberry...
Balsam of Peru.
Baptisia Tinctoria....
Barberry....
Barii Chloridi
Barium. .........
Belladonna....
.74, 401
76
.........8, 25
76
.127
77
77
77
78, 402
82
82
82
83
84
84
....139
85
40
85
87
59
59
......106
.183
184
....185
...88, 402
91
89
89
85, 398
INDEX.
415
Beth Root.....
Bebeerinæ Sulphas
Benzoic Acid.....
Benzoate of Soda.......
CL of Lithia......
Berberis Vulgaris.
.259
89
90
90
91
91
Best Menstruum for Medicines.
28
Bittersweet.
..246
Bismuth.....
91
Bidens Bipinnata…….
92
Blessed Thistle...
...102
Blue Cohosh ………………...
Black Hellebore..
Black Root
Black Cohosh.....
Black Alder..
...103
...152
.167
..174
..213
Black Locust.
...226
Black Willow....
230
Blood Root......
232
Bladder Nut...
..248
Blood Poisons……..
47
Black Haw
266
.266
Blue Violet........
Boldo.........
Boletus Laracis……….
Boneset.
Borax......
Bromine...
Bromide of Potassium......
Bromide of Ammonium..
Bryonia.........
Bursa Pastoris......
Brook Lime....
Buckeye.......
......
92
62, 406
..132
92
93
93
70
..94, 399
94
.265
59
Butternut
Burdock.....
Button Snakeroot.....
Buckhorn Brake......
Bugle Weed..
....
...
162
166
169
...
193
171
416
SPECIFIC MEDICINES.
Buckthorn.
Cactus Grandiflora………………….
Cadmii Sulphas.....
Cahinca......
Calcii Chloridum.....
Calendula......
Calx..........
Cases........
Cannabis Sativa.........
Camphor....
Cantharis Vesicatoria...……..
Capsicum
Cayenne Pepper….....
Cardiac Stimulants.....
Carbo-Ligni.....
Carbolic Acid........
Carduus Benedictus.....
Cassia Acutifolia.....
Castanea Vesca
Castus Indicus...
Catalpa.........
Caulophyllum..
Catnip.
Cascara Sagrado..
....
....
....
....
.....
222
...94, 405
96
96
97
.97
98
...321
98
99
99
99
99
45
100, 404
...101
.....102
....102
.......
...103
....103
... 103
..103
..186
223
Calabar Bean......
...201
Ceanothus....
104
Celandine........
....106
Cerii Oxalas……….
105
Certainty in Medicine......
..286
Celastrus Scandens........
....105
Centaury
229
Century Plant.........
64
Chamomilla
...
.105
Chaulmugra Oil..
...105
Chirayta.....
Chiretta...
...106
..106
Chelone Glabra ....
Chelidonium Majus...
Chickweed..………..
106
106, 403
73
INDEX.
417
Chloride of Lime………..
Charcoal........
Chestnut..
Chloride of Zinc.........
Chionanthus Virginica...
Chimaphilla Umbellata.
Chloroform.....
Chloral Hydrate....
Cholera Infantum....
Chlorate of Potash.......:
Cimicifuga
Cinchona.
97
100
103
..267
Cistus Canadensis............
Circulation....
Cinnamon.
Citrus Limonis..
Cinquefoil....
Cleavers..
Club Moss...
Clematis Virginiana……….
Classification of Medicines………..
Cohosh White.
Cotton........
Coffee Tree…………………..
Colt's Foot. ……….
Couch Grass....
Comfrey..
Cod-liver Oil.......
Coffee.........
Colchicum
Colocynth...
Collinsonia..
Coca......
Coto Bark
Comptonia Asplenifolia.......
Condition of Stomach.
Condition of the Digestive Organs...
Conservation of Life................. .......……………………………
Continued Fever.........
…………………..107, 402
.109
109
...110
359
211,
410
.....174
•
...219
.113
41
...113
114
.212
.140
...
..174
.114
37, 392
58
.146
..150
.260
259
256
193
• •
..114
..114
115
116, 402
117
..117
..117
39
17
.300
..338
418
SPECIFIC MEDICINES,
Convallaria Majalis.....
........118
Convallaria Multiflora......
....118
Copper
Cranesbill....
Crawley.......
Crowfoot......
Crocus Sativus...
Croton Tiglium..
Cubeba........
Cucumis Sativus...
Cubic Nitre…………………
Cuprum
120
144
...216
221
...
118
119
...
119
119
190
120, 403
Curcas..
121
..122
...122
...
…..122
Cyclamen......
Cydonium.
Cypripedium Pubescens.
Dandelion....………….
Daffodil.....
Damiana...
Daphne Indica.......
Delphinium Staphisagria.......
Disease, Analysis of......
Diagnosis, Specific
Diervilla Canadensis.......
Digitalis Purpurea.......
Dioscorea Villosa......
•
257
186
..128
...123
..123
11
14
124
…..124
125, 403
Dita Bark...……… ……………………
Disease, Rule for Measuring...
Digestive Apparatus, Condition of..
Difference from Homœopathy
Differential Therapeutics of Aconite and Veratrum….. ….………….....
Dose of Medicine...
Doctrine of Substitution.......
Drosera Rotundiflora......
..
69
17
17
..
21
62
30
289
...125, 402
Duboisa........
Dwarf Elder....
...
126
76
...361
Dysentery.....
Elaterium..... …………………
Elecampane…………………..
127
158
INDEX.
419.
Elder......
Epigas Repens......
Epilobium Palustre....
Erecthites Hieracifolius.....
Ergota....
Ergot.........
Erigeron Canadense....
.231
127
..127
128
Eryodyction Glutinosum.
Eryngium Aquaticum...
Ergot of Corn..
Erythrophlæum.
Ether Sulphuric.
Eucalyptus.....
Euonymus Atropurpureus....
Eupatorium Aromaticum.........
Eupatorium Teucrifolium.......
Eupatorium Perfoliatum..
Eupatorium Purpureum..
Eugenia Jambollina.....
Euphorbia Hypericifolia.....
Euphorbium........
Euphrasia Officinalis……………..
Euphorbia Corrollata……………………..
Evening Primrose............
Eyebright......
Elements of Uncertainty in Medicine…………..
Elements of Certainty in Medicine......
Epidemic Constitution of Disease....
Excretion.....
Fagonia Arabica.
Ferrum......
Feverfew
Fever, Intermittent.....
แ Remittent
"" Infantile....
(6
Continued..
Typhoid......
Fever Root... ……… …………………………………
Fever Bark........
...
....
128, 406
..237
...
129
129
129, 407
260
..130
.130
..131
.. 131
..131
...132
..132, 406
133
..133
133
134
...134
..134
192
134
.....283
286
..310
...
20
...135
135, 404
217
312
....325
..335
..338
....343
...
259
68
420
SPECIFIC MEDICINES.
Fireweed......
Figwort
Filix Mas
Fleabane
Fly Agaric..
Fool's Parsley
Fænum Græcum.....
Frasera Carolinensis...
Fraxinus Sambucifolia.
Fringe Tree...……………….
Fucus Vesiculosis
Galium Aparine……..
Galangal......
Galega Officinalis…………….
Gaultheria Procumbens....
Gelseminum.
Gentian.....
Genista Tinctorea..
Geum Rivale..........
Geranium Maculatum,
Gerardia Pedicularia.........
Gillenia Trifoliata....
Ginseng.......
Glycerine
Glecoma Hederacea.......
Glonoine......
Gnaphalium Polycephalum.......
Gossypium Herbaceum.....
Good Nursing…………..
Gold......
Golden Seal......
Golden Rod.....
Granati.......
Graphites..
Gratiola Officinalis....
Grindelia Robusta
Ground Ivy......
Guaco
...
Guarana..
•
...128
236
.......140
....63
61
.....
140
.139
.139
..107
...139
.140
.141
•••••• ... 141
.....141
142, 399
143
.:144
..144
... 144
145
.........145
...194
145
.144
•
147
.146
146
24
87
...154
.246
.....
....
.147
.148
.148
.148
144
.149
149
INDEX.
421
Guarea Trichilioides
Guaiacum Officinale......
Guilandina Bonduccella.....
Gymnocladus Canadensis..
Hardback......
Hamamelis Virginica,
Hedeoma Pulegioides....
Hemlock..........
Heuchera Americana...
Helleborus Niger....
Helonias Dioica
Hepatica Americana
Henbane.........
Heracleum Lanatum.
High Cranberry...
Hieracium Venosum
Honey Bee.......
Honeysuckle
Hoarhound
Horse Chestnut......
Hydrastis Canadensis…....
Hydrangea Arborescens..
Hydrocatyle Asiatica......
Hydrocyanic Acid.....
Hypericum Perfoliatum...
Hypophosphites......
Hyoscyamus Niger.......
...
.......
Hypodermic Injection of Morphia...
Ice Plant.......
Ignatia....
Imperatoria Ostruthium ......
Indian Hemp.....
Inula Helenium.
Indian Physic…………………..
Indian Cup Plant......
Innervation......
Intermittent Fever.........
Infantile Remittent...
Infantile Pneumonia...
...
...149
149
.150
150
247
150
.152
54
152
.152
153
..153
...
..156
...154
.265
...153
83
...124
..177
60
154, 407
...155
155
..156
156
....200
156
.196
...
.182
.....157
158
...74, 98
....158
145
..241
.....
...
50
312
..335
..357
422
SPECIFIC MEDICINES.
Iodine.
Iodide of Potassium......
แ Sodium..........
Ammonium....
Starch......
Ipecacuanha....
Ipomoea Jalapa......
Iris Versicolor…..……………….
Iron.......
....
..158
...158
159
159
.....159
160, 400
161
..161
.135, 408
Iron Wood….....
192
Iron Weed......
.265
Irritation of Stomach..........
......... 39
Jaborandi..……….
...162
Jacob's Ladder......
........206
Jalap......
Jatropha......
....161
........121
Jamestown Weed.
Jeffersonia Diphylla
Juglans Cinerea…………..
Juniperus Sabina...
Kalmia Latifolia.....
Krameria Triandra..
Lady's Slipper.......
Laburnum.........
Lac........
Lactuca Virosa.
Lappa Officinalis....
Larix Americana.
Laurus Sassafras…....
..251
..163
....
...162
....163
.....163
...164
...122
..164
........165
..165
166
...166
.....166
Lavandula Vera
..167
Lavender..........
....
....167
Labrador Tea.
..167
Laws of Cure......
21
Ledum Latifolium....
Leptandra Virginica.........
Lettuce.
...167
...167
165
Lemon.
Leptandrin......
……. 1 14
...168
Lemon Juice......
...172
INDEX.
423
Leonurus Cardiaca....
Liatris Spicata……
Lime......
Liquidambar Styraciflua..
Ligustrum Vulgare
Linaria Vulgaris………….
Lily of the Valley..........
Linden.......
Lion's Foot...
Liriodendron Tulipifera..
Liverleaf... ..
Life, Renewal of……......
Lobelia Inflata...
Lungwort....
Lupulina ...
Lycopodium Clavatum..
...
....
....
...172
... 169
.98
....169
.........172
......173
..118
..258
..186
169
...
153
18
....170, 399
.216
.173
.174
Lycopus Virginicus
...171
Maguey.....
64
Macrotys Racemosa
...174, 400
Magnesia, Sulphate of......
Marsh Rosemary...
Magnolia.....
...176
.......249
..177
Male Fern..
.85
Marrubium Vulgare.........
.....177
Maruta Cotula… ……………… ………………
....178
Marsh Trefoil.
...180
Manganesii Sulphas…..
..178
Mangold.....
97
Malaria....
49
Mayweed.
Masterwort.
May Apple......
Melilotus Officinalis.....
Mercury.......
...178
154, 158
...205
..178
.179
Menispermum Canadense..
Measuring Disease………………………
Menyanthes Trifoliata ……………. ……… ……………………………………………
Methonica Gloriosa. ……………. ……………………… ………………………
Mentha Viridis………………………..
.180
180
..181
..181
.... 15
424
SPECIFIC MEDICINES.
Medicines, Administration of….....
แ
Should act slowly......
Pleasant.....
Dose of...
Proportion of........
(L
Measles......
Mitchella Repens.
Milk.........
Mimulus Pilosa.....
Monotropa Uniflora......
Momordica Balsamina.....
Monesia......
Monkey Flower......
Morphia....
Motherwort...
Muriate of Ammonia......
Mullein.....
Myrica Cerifera.....
Myristica Moschata..
Myroxylon Peruiferum....
Myrrha......
Nabalus Albus.......
Narcissus Pseudonarcissus
Nettle......
Nepeta Cataria…….
Nightshade.
Nicotiana Tabacum…………..
24
.... 26
29
30
31
....348
.182
.....165
181
182
..183
.183
181
.196, 406
....
172
183
....264
.184
185
..185
.....185
.186
.186
...260
...186
241
....186
76
Nitrate of Silver.....
Nitric Acid.......
Night Blooming Cereus
Nitri Spiritus Dulcis.
Nitro-Glycerine......
Nitrate of Soda.......
Nosology......
Nuphar Luteum
Nux Vomica.....
Nutmeg........
Nutritive Processes......
Nymphæ Odorata.......
....188, 409
94
....190
.....147
..190, 408
....
11
..191
252, 400
..185
53
.191
INDEX.
425
Objects of Treatment.....
Obstetric Remedies.
Obscure Cases,
Enathe Phellandrium
Enothera Biennis.
Office Pharmacy.
Oleum Tiglii...
Oleum Morrhuæ..
One thing at a time.........
Opium.......
Opposition to Disease...
·
...
38
....378
....306
192
192
35
....119
... 193
. 25
...195
9
Opponens Opponenda.
22
Origanum Vulgare......
Osmunda Regalis.....
Ostrya Virginiana......
Oxide of Zinc.........
......193
193
.192
268
Pancreatin ....
....195
Papaver Somniferum.
......195
Partridgeberry.......
...182
Pareira Brava.....
...195.
Pastinaca Sativa......
........197
Parsnip
...197
Passiflora Incarnata.....………….
.........197
Passion Flower........
Pain and its Treatment.
.......197
..303
Parsley...
..199
Penthorum Sedoides....
.....197
Peach Tree...
71
Percolation...
Pepsin..
36
198
Peroxide of Hydrogen........
.... 199
Petroselinum Sativum...
..199
Pennyroyal..
Petroleum
Pepper, Black………………………
Permanganate of Potash……………………..
Pipsissewa...
Pix Liquida....
Piper Nigrum..
...152
..
199
....203
208
...........203
..109
.203
426
SPECIFIC MEDICINES.
Phosphorus.....
Phosphate of Soda........
:
Physostigma Venosum................
Phytolacca Decandra.........
Physical Properties of Remedies.....
...200, 408
.201
.......201
202, 400
...
34
Pharmacy, Office……………………………
Plumbago.....
Pleasant Medicines..........
Plantago Major.....
35
148
298
...
204
Plantago Cordata..
..204
Pleurisy Root..
84
Pneumonia, Infantile.......
...357
Pocket Case...
....296
Poke......…………………….
202
Post Partum Remedies.......…. …………………..
...382
Poison vs. Medicine.......
292
Podophyllum..
.205
•
Poison Oak…...
..225
Podophyllin..
206, 403
•
Polemonium Reptans..
..206
•
Polyporus Officinalis…..
62
Polyporus Pinicola....
62
Polygala Senega..
.206
Polygonum Punctatum...
.....207
Polypodium Vulgare......
....207
Polytrichum Juniperinum........
...207
Pomegranate Bark........
...147
Populus Tremuloides
..208
Poplar.........
Potassa..
Potassæ Permanganas…………...
แ
Sesqui-carbonas
Potassii Acetas
Bicarbonas
(( Chloras..........
Ferrocyanuretum.
Potentilla Canadensis....
Privet......
Prickley Ash.......
...208
...208
.208, 406
......209
210
.210
.211
. 211
:
...212
172
…….. 267
INDEX.
427
Primula Officinalis…………..
Prussiate of Potash.....
..212
.211
....212
Primrose...
Prinos Verticillatus.........
Propylamin.....
Proper Food.……………..
Prunus Virginiana…..
Ptelia Trifoliata....
Pteris Atropurpurea..
Pterospora Andromeda.........
Pulmonaria Officinalis.....
Pulsatilla......
Pyrethrum Parthenium
Pyrola Rotundifolia…………..
Pyrus Malus...
Quercus Rubra.....
Quinia Sulphas...
Quinine.......
Quince Seed....
Queen of the Meadow......
Rattlesnake Weed......
•
... 213
...213
19
...214
...215
....215
..216
...216
216, 401
....217
218
..218
.....218
.....219
219,
403
.....122
133
...153
Ranunculus Bulbosus
...221
Red Root
...104
Removal of worn-out Tissue....
17
Retrograde Metamorphosis....
52
Remedies in Diseases of Women
..385
Restoratives.........
.....302
Remittent Fever.....
..325
((
แ
Infantile.......
...335
Redwood....
Red Oak........
Red Clover
Rhamnus Catharticus.......
Rhatany.
Purshiana..
Rheum Palmatum.
Rhododendron...
Rhubarb. ....
Rheumatism...
i
.
149
..218
..258
222
...223
..164
223, 407
..
224
......223
..352
428
SPECIFIC MEDICINES.
Rhus Toxicodendron......
Rock Rose.....
225, 399
113
Rosin Weed...
Robinia Pseudo-Acacia......
Rock Brake.
Rumex Acetosella.............
Rumex Crispus..
Ruta Graveolens...
Rue......
Rule for Measuring Disease..
Rubeola...
Sabbatia Angularis
Salicin....
Salicylic Acid…………………..
Salix Nigra......
Salvia Officinalis.........
Sage........
Saffron.....
Sambucus Canadensis....
Sassy Bark......
Sanguinaria Canadensis..
Sanicula Marilandica...
Santalum Album....
Sandal Wood Oil.......
Santonin........
Savin......
Sassafras ...
Sarracenia Purpurea.
Salt, common …………………
...
Scilla Maritima.....
Scrophularia Marilandica...
Scutellaria Lateriflora...
Scullcap
Senega..
Seven Barks…………………..
..... ...
...241
...226
.....215
..227
....
....227
..........228
...228
.....
15
.....348
229
229
..229
..230
231
231
118
231, 407
...130
.232
232
..233
......233
82, 40?
.........163
166
....233
...242
...236
....236
237
..237
206
.....155
Secale Cornutum.....
Sedation, Theory of.....
Selection of Remedies.....
Senna......
••*-
..237
44
13
......102
INDEX.
429
Sedum Acre
Sempervivum Tectorum.
Serpentaria.........
Sepia Officinalis……...
Senecio Aureus
Sheep Sorrel...
Sheep Laurel.....
Similia Similibus
....
...239
..239
...238
...239
...240
....227
..163
21
Single Remedy....
.......16, 294
Silica.....
240
Silkweed...
83
Silphium Gumniferum……………..
...241
•
it Perfoliatum...
Skunk Cabbage ...
Smartweed......
Small Pox.........
Sodii Chloridum....
241
..256
207
....345
แ
Sulphas...
242
.243
แ
Sulphis.....
Nitras....
Phosphas.
Solomon's Seal....
Solanum Dulcamara.
Nigrum.....
Solidago Odora...
Sophora Speciosa.
Spanish Needles...
Spilanthes Oleracea.
Spanish Fly....
Spirea Ulmaria….........
Spider's Web..
Spongia Usta....
243
...190
..201
..198
...........246
.........246
.....246
…………………...247
92
...247
.99
...247
77, 257
........247
.:...181
Spearmint......
Specific Medication......
.277
""
Theory of............
9
""
Study of.......
of..............
.270
66
((
Some Phases of.......
.273
"L
Use of the Word.....
Specific Diagnosis.....
10
14
430
SPECIFIC MEDICINES.
Squill......
Strength of fluid Remedies......
Staphysagria...……………
Staphylea Trifoliata.
Statice Caroliniana
Stillingia Sylvatica
Sticta Pulmonaria…………….
Stone Crop.......
Stone Root.
Stramonium
Stone Crop.......
....
Strychnos Nux Vomica.....
Sundew....
Sulphur...
Sumbul.....
Sulphate of Zinc..
Substitution, doctrine of..
Sulphite of Soda
Sulphate of Soda.....
Sulphurous Acid..
Sweet Spirits Nitre..
Sweet Guin
Sweet Clover.......
Symplocarpus Fœtidus.
Symphitum......
Tag Alder....
..236
•
33
• •
123
....248
249
...249
250, 406
238
...116
•
251
197
.... 252
..125
...
254
...255
268
..289
243
243
.....
...
.244, 409
190
..169
178
……..256
...256
67
Tanacetum Vulgare......
256
Tansy...
....256
Taraxacum
257
Tartar Emetic........
74
Taxus Baccata....
257
Tela Aranea.....
Teucrium Canadense......
Temperature....
Theory of Specific Medication....
((
Sedation...
Thuja Occidentalis.......
Tilea Europea...
Tobacco......
257
...258
46
9
44
258
....
...258
…………..186
i
INDEX.
431
Trifolium Pratense
Trillium Pendulum……..
Triticum Repens...
Treatment of Pain......
Triosteum Perfoliatum.
Tussilago Farfara
Twinleaf.........
Typhoid Fever
Urtica dioica
Ustilago Maidis...
Uva Ursi......
Uvedalia
Unicorn Root…....
..258
259
.259
388
.....259
.260
163
..341
..260
...260
.261
.404
.....153
10
... 283
...261
..261
.345
50
261
.264
....265
.265
..265
....265
...266
Use of the word Specific.........
Uncertainty in Medicine..
Valeriana Officinalis.....
Valerian.....
Variola.
Vegetative Processes..
Veratrum Viride.
Verbascum Thapsus...
Verbena Hastata.......
Vernonia Fasciculata..
Veronica Beccabunga.
Viburnum Opulus ....
Viburnum Prunifolium..
Viola Pedata……..
Virginia Snake Root.........
Virgin's Bower............
Want of Vital Power......
Waste and Excretion....
Water Avens........
Wafer Ash…………..
Water Pepper
Water Plantain ...
Water Hemlock…………..
Wahoo......
Water Eryngo....
...
....
....... 266
77, 239
.114
་
42
.48-51
..144
...215
..207
..204
..192
.131
...131
432
SPECIFIC MEDICINES.
White Cohosh.......
White Pond Lily.....
White Snakeroot...
White Balsam……..
Wild Cherry...
Wind Flower.
Wild Indigo
Wild Yam..........
...
Wild Hoarhound......
Wild Ipecac......
Wintergreen
Witch Hazel……………..
....
58
..191
.........131
....146
214
73
........ 88
125
...
...132
134
...
.141
..150
Wood Sage.........
Wormseed.....
..258
82
Yerba Santa.......
Xanthium Spinosum..
Xanthoxylum Fraxineun.....………. …….
Yarrow......
Yellow Poplar.......
Yellow Pond Lily...
Yellow Dock....
Yellow Jessamine...............
Yellow Parilla……………….
Yew.........
Zinci Chloridum....
...266
.267
54
......129
.....169
...191
.227
142
181
..257
......267
Zinci Oxidum......
..268
Zinci Phosphidum....
.268
Zinci Sulphas…………………..
..268
Zymotic Causes of Disease......
47
UNIV OF MICHIGAN,
FEB 24 1918

UNIVERSITY OF MICHIGAN
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3 9015 06555 3383
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