I Ii
I







THE
H O M (E O P ALH
THEORY AND PRACTICE
O F
MEDICINE.
BY E.CE.MIARCY, M.D.
%mflifa sfmlfIbus cuttantur.
NEW-YORK:
WILLIAMI RADDE, 322 BROADWAY.
1 8 5 0.




ENTERED
According to the Act of Congress, in the year 1850, by
WILLIAM RADDE,
In the Clerk's Office of the District Court for the Southern District
of New-York.
H. Lawin anud Co. PricrS N.Y.




PREFACE.
THE profession of the art and science of renewing and; preserving
health has, in all periods and in all nations, been held to be of the
highest dignity, for the devotion and bravery necessary in those
who adopt it, as well as for its association, as ameliorator, with
almost every form of human suffering. In its widest and justest
acceptation, it may be said to be the sum of' logic, since nearly all
knowledge, in metaphysics as well as in physics, is necessary to
the thorough understanding and the illustration of its various principles and phenomena.
In an age preeminently distinguished' for intellectual as well, as
for physical activity, the theories of disease and cure have shared
the general advancement, and the new doctrines that have obtained,
for their elucidation and practical application, demand a new literature. Since the discoveries of the Newton of Medicine, old treatises, founded upon erroneous and soon to be obsolete hypotheses,
are, for the most part, comparatively valueless, except for purposes
of history. Everything is to be reconstructed. Much has indeed
been done in Europe and in this country, since the announcement
of the true laws of cure, yet so little in proportion to the necessity, that no apology will be required for this attempt to occupy
one of the chief places of dethroned but still unsilenced Error.
At the beginning of a system of Theory and Practice, produced
under such circumstances, and for such purposes, it is appropriate
to disclose briefly its leading characteristics, and especially the
positions it occupies in relation to points which may be considered
still unsettled and debateable. The grand proposition, similia
similibus curantur, is not only the basis of the homreopathic method, but is also, yve believe, the hitherto unknown law of the most
successful treatment by the allopathists. Whether we advocate
the use of high or low attenuations, or believe in the topical and
material, or the dynamical and immaterial action of drugs, are




i v                      PREFACE.
matters of proportionably little importance, while we abide by this
fundamental doctrine in the practical application of remedies. The
physician of the old school, who cures delirium tremens with a
large dose of opium, acts as strictly in accordance with the theory
of Hahnemann, as he who cures it with a high attenuation of the
same drug, but with this difference-that the treatment of the
former is attended with danger, and the restoration is slow, tedious,
and defective, while the primary specific impression by the philosophical process is slight, and the curative reaction of the organism
speedy, complete, and permanent.
Although the question of doses is of considerable importance in
individual cases, yet too much stress has been laid upon it by the
advocates of both high and low attenuations. We are constantly
presented with well-authenticated cures by the undiluted tinctures
and low dilutions, and have also as thoroughly understood and
successfully practised the high attenuations. We occasionally
see, too, that strong preparations afford prompt relief where the
weaker have failed, and vice versa. Some constitutions may be
powerfully acted on by a thirtieth, while others will not respond to
any weaker than a first dilution. The different conditions of the
tissues likewise offer the most varied and important modifications
with reference to the effects of agents. How absurd, then, to fix
upon this or that attenuation, and to make use of the term high or
low dilutionist, when we have to deal with organisms of every
possible grade of delicacy and susceptibility, and with morbid conditions which, in some instances, may be modified by even a mental emotion, and in others only by the strongest tinctures.
We say, therefore, to the true hommaopathist, let the grand maxim  of HAHNEMANN, similia similibus curantur, be our prime and
constant rule of medical faith and practice; but never attempt to
confine our doses within the narrow limits of the ultraists of either
party, for the unanswerable reason, that the susceptibilities of the
tissues to medicinal impressions vary in precise accordance with
the degrees of inflammation and nervous erethism. From a condition of health, or a slight irritation of the textures, up to a high
point of inflammatory action, or nervous excitability, there are
almost innumerable gradations of impressibility; and he who would
prescribe wisely and successfully, must select his attenuations, and
order his repetitions with strict regard to these degrees. Of this
subject we have treated at some length in chapter VII.
In our observations on general pathology and therapeutics, we
have endeavoured to explain what we believe to be the true nature
of inflammation, and have pointed out some of the more general
means of avoiding and counteracting the causes of inflammatory




PREFACE.                        V
action. In forming many of our inferences, we have been indebted
to the recent labours of Liebig, Miller, Matteucci, Flourens, Majendie, and Philip. Although the views advanced have no material
bearing upon the homeopathic doctrine of cure, yet if they illustrate this most important of the subjects connected with the morbid conditions of the economy, we shall have done well for medical
science. We are aware that Liehig has carried some of his chemical hypotheses farther than facts or logic warrant, but admit
that many of his positions, as to the production of animal heat, the
metamorphoses of the tissues, the supply and waste of the constituents of the structures, and the phenomena of inflammation,
are in the main correct. If he errs in supposing that all the phenomena of life are attributable to chemical action, that the human
body is subject to the same laws as inert matter, and that the mass
of blood may be contaminated by contact with substances in decomposition with a similar kind of degeneration, he has also
shown truly that chemical action has at least an important influence
in the operations of the functions. Let not, therefore, his mistakes
prevent a rigid scrutiny of his opinions, that we may reject the
untenable, and appropriate the true.
Believing and advocating the doctrine of absorption and the
topical action of drugs, we have derived numerous arguments
for our views from the recent experiments of Matteucci, Flourens, Rau, Muller, Blake, and Majendie. These profound investigators have demonstrated that most medicinal substances possess well defined specific properties, and that it is necessary to
their legitimate effects, that they be absorbed and conveyed by the
blood-as a medium merely-to the tissues for which they have
affinity, there to operate (probably upon the sentient nerves), by
actual contact. The very numerous and accurate experiments with
almost every known drug, instituted by these physiologists upon
animals, are quite conclusive as to the point of the absorption and
topical action of remedies. We have repeated many of their experiments, and have made a great variety of new ones for the
therapeutical illustration of the subject, and have thus formed from
facts alone, the conclusions we have here announced, as to the manner in which remedial agents operate. The scope and design of
this treatise will not permit a detail of these interesting experiments and their results, but we hope hereafter to submit them to
the public. In the meanwhile, attention is invited to the chapter
in which we have treated of this subject.
There is another doctrine now entertained by a majority of the
physicians of both schools, but in no way connected with our
theory of cure, to which we have  devoted. special attention; we
AX




~VI                      PREFACIE.
mean that so often advanced respecting what are called "vital
properties " of parts-a nervous fluid-a dynamic influence, different -from the soul. We object to these terms because they are
merely arbitrary, and are used to designate properties which have
no real existence; because, as Matteucci well observes, they may
have no meaning, or may mean everything. The vitalists define
disease to consist in an alteration of the vital properties of parts.
But what are these vital properties. Are they material or spiritual.
something or nothing. What is the nature and what are the processes of their influence. We are told that miasmata act dynamically or spiritually upon the vital properties of the tissues; but what are
miasmata but minute particles of vegetable matter, subdivided by
heat and moisture, and so diffused in imponderable forms through
the air    Have these atoms really lost their material form or
weight, and become annihilated? Can a material substance, by any
means, be reduced into an immaterial nothing, and retain its identity or individuality. In other words, can matter be transformed
into spirit? Surely, no; but we may subdivide substances so
minutely as not to be able, by our most delicate tests, to detect
them; yet they may have affinities, and be capable of combinations with other atoms, and of producing other material effects
when brought into contact with certain tissues of the organism.
When these material (not dynamic or spiritual) particles have
reached the structures to which they have specific relations, they
impress the sentient extremities of the nerves, so that the capillaries and other parts over which these nerves preside, respond to
their impression, and there are chills, followed by inflammations.
It is evident, then, in this and other analogous instances, that a
material agent operates topically upon the tissues, thus impairing
the normal integrity of the parts, but not dynamically upon certain
(assumed) vital properties.
The general principles of allopathy we have briefly considered
and compared with those of homceopathy; but want of space has
prevented such elaborate discussion of these subjects as was demanded by their interest and importance. We trust, however,
that what we have written may attract attention, particularly to
the real points at issue between the schools, and that the shafts of
ourantagonists may hereafter be directed against our distinctive
principle of cure, rather than against our doses, and the exhibition
of our remedies.
Hahnemann, and some other writers of eminence, have expressed doubts respecting the utility of the common classifications
of diseases, since descriptions must necessarily be general and
imperfect. In a therapeutical point of- view, this distrust of clas



PREFACE.                        Vii
sifications is reasonable, and it has probably arisen from the custom
with the old school, of bringing the symptoms of every disease
under some one general head, and prescribing for the congeries,
however diverse the separate elements, under a particular name.
For example, the allopathist called to a patient with febrile symptoms, finds a rapid pulse, a hot and dry skin, headache, pains in
the back and loins, oppression at the praecordia, restlessness and
irritabilility, foul tongue, thirst, scanty and high-coloured urine,
confusion of ideas, and nightly delirium. He is now to arrange
these symptoms under one of the general heads of his classification,
but is at a loss whether to call it typhus, bilious, or inflammatory,
sthenic or asthenic. The case, however, admits of no delay, and
he arbitrarily decides that it is bilious, and bleeds, vomits, and
purges, well knowing that if it proves a typhus, he can persuade
himself and the patient's friends that it has degenerated from one
type into another. He forgets to make known that copious venesection, emetics, and cathartics, are deemed by many of the most
intelligent of his own school, to be fatal in typhus, and attributes
all evils to the versatile and intractable nature of the malady, while
complacently appropriating to himself whatever credit may chance
to accrue from favourable symptoms. On the other hand, if he
had regarded the disease as a typhus, and pursued the expectant
or tonic treatment sanctioned in his school, and it had proved an
inflammatory fever, lesions might have taken place, and the patient might have succumbed from the inefficiency of his remedies.
Objections of a similar nature apply in a majority of the classifications treated by the allopathist. But while it is unquestionable
that all these are useless as guides in the application of remedies,
it must be conceded that they enable us to concentrate groups of
symptoms under appropriate heads, and thus to arrive more conveniently at just conclusions respecting the nature of diseases.
Accordingly, in this treatise, we have adopted a classification
varying little from those usually employed, which we believe will
facilitate the true apprehension of disordered conditions. We
have described the diseases of the separate systems under the
same head, instead of treating of acute varieties in one part of the
work, and of chronic in another. This course has been deemed
proper on account of the difficulty, in many cases, of fixing the
line of demarcation between acute and chronic affections, and for
convenience of reference to, and of comparison of the different
-diseases of the same system.
In arranging the symptoms which demand particular medicines,
we have adopted the following classification:
- L.EXTERNAL INDICATIONS, or what' have been designated by




VWll                     PREFACE.
Marshall Hall as physical signs of disease..Under this head are
included all those signs which belong to the external or visible
appearance of the patient, and over which he has little or no eontrol, as the expression of countenance, colour and temperature of
the skin, pulsations of the heart and arteries, respiration, breath,
condition of the digestive and genito-urinary organs, attitude, appearance of the eyes, and of the nose, lips, tongue, mouth, and
throat, the secretions, excretions, surface of the body, swellings,
(in relation to size, hardness, softness, elasticity, fluctuation, &c.,)
the condition of the muscles, (in relation to contractility, strength,
debility, and motion,) the voice, mode of expression, and appearance of discharges from the stomach, intestines, bladder, uterus,
vagina, nose, ears, eyes, mouth, and from abscesses, ulcers, &c.
These phenomena may always be observed without any descriptions by the patient or his friends, and, in many instances, without
the patient's consciousness; and, as we have elsewhere shown,
they often indicate with much certainty the character of a malady.
In infants and children, and adults, who, from injury or disease,
become incapable of communicating their sufferings, they are of
the utmost importance, and will frequently be sufficient for our
direction in the exhibition of remedies.
II. PHYSIOAL SENSATIONS, including most of those symptoms
which are commonly described as rational signs of disease. These
comprise pains of all descriptions, weaknesses, irritations, oppressions, obstructions, and all other uneasy or unnatural feelings,
and all circumstances connected with the approach, continuance,
aggravation, or remission of the patient's sufferings. For a knowledge of them, we must rely for the most part upon verbal descriptions; for the best method of procuring which, with truth and
exactness, we refer to IHahnemann's Organon, pages 125 to 133,
where our venerated teacher has pointed out with great minuteness
the necessary directions upon the whole subject of such investigations.
III. MENTAL AND MORAL SYMPTOMS, including the condition of
the mental faculties, the disposition, temper, and all variations of
the intellectual and moral sentiments, from the normal standard.
This arrangement has been adopted with reference to convenience
in investigation, and in the selection of remedies. As some diseases are characterized by manifestations of one or more of the external indications, and others by internal pains, or a perversion of
the mental and moral faculties, so different drugs develope correspondences in the organism. As it is an object that our remedies
should have as exact an affinity as possible to the.symptoms, and
to these alone, the advantage of this plassification of symptoms
will be readily perceived.




PREFACE.                        ix
In descriptions of special symptoms created by different remedies, and presumed to indicate their therapeutical properties, we
have drawn freely from all reputable sources, whether European
or American. In some instances, we have not hesitated to rely
upon drug-symptoms as described by accurate practitioners of the
other school, in cases of poisoning. Although little confidence can
be placed in their ordinary observations upon the diseased organism in relation to this point, yet symptoms are occasionally recorded during the operation of poisonous doses upon the healthy,
which could not well be obtained in any other manner, and which
undoubtedly form an important addition to our knowledge of pure
drug-symptoms.
A difference of opinion exists in the philosophical school respecting the most suitable form for the exhibition of remedies.
Some, entertaining a dread of medicinal aggravations, and believing that the minutest quantity of an appropriate medicine is
sufficient to induce a curative reaction, employ, for the most part,
pellets that have been saturated with the drug. Others, having
less fear of these aggravations, and preferring to know with certainty the precise quality and quantity of their doses, make use of
triturations, given dry, in small powders, and dilutions, either
mixed with pure water or dropped on sugar.
We have preferred powders and dilutions for the following
reasons:
I. A large number of medicinal substances evaporate so quickly,
that, after a time, many of their active particles must necessarily
escape.
II. Very small quantities of many drugs, when exposed a few
weeks to the action of the oxygen of the air, either become entirely neutralized, or so altered in their properties as to be no more
identical with the original drug. On this account, it is better to
impregnate larger quantities of the medium that less surface may
be exposed to the air, and thus to render it certain that a portion
of it retains particles of the drug unimpaired.
III. The importance of using our medicines in a form that shall
be certain to produce the requisite impressions upon the disordered
structures. We deem it an evil of much less magnitude to risk
the occasional induction of some temporary medicinal symptoms,thus being sure that the remedy has reached the affected tissue,than to administer it in such a form as to produce no visible effects,
leaving us in doubt for a time whether an impression has or has
not been made upon the affected parts. We do not deny that pellets, in many instances, may prove entirely efficient and satisfactory, and for non-professional use, perhaps they are the safest;




X                        PREFACE.
but since we have it in our power to select formns which arc certain
to contain. the active properties of drugs, and. which enables us to
prescribe with: greater exactness, we think that such forms should
be generally adopted by the profession. We are compelled, therefore, with deference to many distinguished. cotemporaries, to regard
the ideas which have so often been promulgated respecting medicinal aggravations; as altogether exaggerated and unworthy that
serious consideration with which they have often been received.
For further observation upon this subject, we refer to the chapter
on "Attenuations of Drugs and Repetitions of Doses," page 111.
Finally, if some of our opinions clash with. those of our homoeopathic brethren, we have only to assure them that our only objects
have been to ascertain truth, and: advance our science, and that we
shall always, be willing to investigate facts,. and to listen candidly
to arguments,. and: whenever convinced of errors, to acknowledge
and renounce them.




ERRATA.
On page 22!, tenth line from the bottom, for " Inclination is also present,"
&c,,read — " Inclination. to vomit is also present," &c.
On page 239, Section XIi., heading: —for"' PoruL-AR;'  -Teada —"  PAP uLA."
In-ite Table of Conteatts, en page.13, -Chapter XV.isoamitte4, and Chapter
XVI is substituted.'Chapter XVII-should read'Chaptr X-VI.
On page 25,.second line.from bottom, read medendi for modedi.
On page 93, -sixteenth ine -from top,'read  tesetime N  for, tenations.
On page 94, first -line, read Berzelius for -Beryeli.us.
On page 200, tenth line'from top, comma -for p-riod, and nsmall w for
capital W.
On page SOS, t24th, 27th,'29t hth, 2th,, afterfirstseon d,:third, fourth,
and -fifth, small letters for capitals.




HOM(EOPATHIC MEDICINES.
WM. RADDz, 322 Broadway, New-York, respectfully informs the Homcedpathic Physicians, and the friends of the System, that he is the sole Agent
for the Leipzig Central Homceopathic Pharmacy, and that he has always on
hand a good assortment of the best Homceopathic Medicineis in complete
sets or by single vials, in Tinctures, Dilutions and Triturations; also,
Pocket Cases of Jledicines; Physicians' and Family JMedicine Chests to
Laurie's Domestic (60 to 82 Remedies)-EPP'S (58 Remedies)-HERING'S
(82 Remedies).-Small Pocket-Cases, at $3, with Family Guide and 27
Remedies. —Cases containing 415 Vials with Tinctures and Triturations for
Physicians.-Cases with 260 Vials of Tinctures and Triturations to Jahr's
New Manual, or Symptomen-Codex.-Physicians' Pocket Cases with 60 Vials
of Tinctures and Triturations.-Cases from 200 to 300 Vials with low and
high dilutions of medicated pellets.-Cases from 50 to 80 Vials of low and
high dilutions, etc., etc. Homceopathic Chocolate. Refined Sugar of Milk,
pure Globules, etc. Arnica Tincture, the best specific remedy for bruises,
sprains, wounds, etc. Arnmica Plaster, the best application for Corns, Urtica
urens, the best specific remedy for Burns. Also, Books, Pamphlets, and
Standard Works on the System, in the English, French, and German lan'
guages.




CONTENTS.
PAGZ
Preface,.....        iii
CHAPTER I.
A glance at some of the prominent medical doctrines of the past
and present,...           1
CHAPTER  II.
General observations on pathology,....
CHAPTER III.
Doctrines respecting a vital principle, nervous fluid, dynamic influence, etc.,......       22
CHAPTER IV.
Therapeutics,.......       86
CHAPTER V.
Specific effects of morbific and remedial agents,..       40
CHAPTER VI.
Primary and secondary action of drugs,...       49
CHAPTER VIL
Susceptibilities of organs and tissues to the influence of remedial
agents, vastly greater in disease than in health,.       64
CHAPTER VII.
Allopathy,......       61
CHAPTER IX.
Homeopathy,..       86
CHAPTER X.
Attenuations of drugs and repetitions of doses,                111
CHAPTER XI.
General diagnosis,.                       122
CHAPTER XII.
Fevers,.......      132
CHAPTER XIII.
Causes of fever,.                                 136
CHAPTER XIV.
Intermittent fever,...                           141
CHAPTER XVI.
Yellow fever,                                                  159
CHAPTER XVII.
Infantile remittent,.....      168
CHAPTER XVII.
Continued fever,                                               172
CHAPTER XVIII.                         176
CHAPTER XIX.,IHectic fever;.....      196




Xiv                          CONTENTS.
CHAPTER XX.
Of the febrile cutaneous diseases,.,.              198
SECTION 1. Scarlatina.-Scarlet fever,.                 198
"   2. Rubeola.-Measles,...              207
"   3. Variola.-Small pox,...          212
"i  4. Varicella.-Chicken pow,..          217
"   5. Miliaria.-Miliary feVer,..                218'   6. Roseola,...                     220
"   7. Urticaria.-Nettle rash,                             221
8. Erysipelas,....              227
"   9. The Plague,...                  235
CHAPTER XXI.
Of the Chronic Cutaneous Diseases.
SECTION 10. Herpes.-Tetter,..                 236
"   11. Pemphigus,....             238
"   12. Lichen,....                 239
"   13. Scabies, Psora, Itch,...             240
"   14. Ecthyma,....                 242
"   15. Impetigo,.....      243
"   16. Porrigo,.....         244
"   17. Squamous diseases.-Lepra,..          245
Psoriasis,...                 246
Pityriasis,....          246
CHAPTER XXII.
Diseases of the Organs and Tissues connected with the Digestive
System.
SECTION 1. Glossitis.-Inflammation of the tonguc,.      247
"    2. Tonsilitis.-Quinsy,...         249
3. Parotitis.-Mumps,....      252
"    4. Gastritis, acute.-Inflammation of the stomach,     253
5". Gastritis, chronic.-Chronic inflammation of the
stomach....         257
"    6. Dyspepsia — Indigestion,...       258
"    7. Heematemesis.-Vomiting of blood,.          266
8. Gastralgia, Cardialgia.-Neuralgia of the stomach,   267
"    9. Enteritis.-Imflammation of the intestines,         268
"   10. Acute mucous enteritis.-Dysentery,..       270
"   11. Peritonitis.-Inflammation of the peritoneum,       278
12. Colic.....       280
Flatulent colic,....          281
Colica Pictonum.-Painter's colic,..       282
"    13. Cholera asphyxia.-Asiatic cholera,.          286
14. Cholera morbus,..,.       295
"   15. Diarrhcea,....          297
16. Hmemorrhoids. —Piles,....       299
"   17. Acute he0atitie.flInm mation of the liver,         302
Chronic  "         ~...              3833




CONTENTS.                           X V
CHAPTER XXIII.
Diseases of the Respiratory Organs.
General observations,....                 304
SECTION 1. Catarrh, or Cold,..                    306
Influenza,.....      307
"    2. Cynanche Trachealis.-Croup,..          308
3. Bronchitis,.....       316
"   4. Pneumonia.-Lung fever,..             322
"    5. Pleuritis.-Pleurisy,....       328
"   6. Pertussis.-Whooping cough,..          334
"   7. Asthma,....              336
"    8. Phthisis pulmonalis.-Consumption,                341
" 9. Cough,..,..       357
CHAPTER XXIV.
Diseases of the Heart and its Appendages.
SECTION 1. Angina pectoris,..             359
t"      Carditis and Pericarditis,                       361
CHAPTER XXV.
Diseases of the Brain and Nervous System.
SECTION 1. General observations,...      364
"    2. Encephalitis.-Inflammation of the brain, &c.,    371
"   3. Ramollissement du cerveau.-Softening of the brain, 380
"   4. Hydrocephalus.-Dropsy of the brain,.      381
" 5. Epilepsy,.....      383
"' 6. Apoplexy,....          387
"    7. Paralysis.-Palsy,....      392
"    8. Mania & potu.-Delirium tremens,.          394
9. Insanity,.                                   397
Mania,.....         399
Monomania,.....      401
Dementia,...                402
10. Inflammation of the spinal marrow and its membranes,.....      410
Tetanus,.....         410
Hydrophobia,..                 414
"  11. Ch6rea,.....          419
"  12. Hysteria.-Hysterics,...      421
13. Neuralgia,....          424
CHAPTER XXVI.
Diseases of the Urinary and Genital Organs.
SECTION 1. Nephritis.-Inflammation of the kidneys,.     432
"    2. Cystitis-.-Inflammation of the bladder,.      435
"    3. Diabetes.....      436
"   4. Enuresis.-Incontinence of urine,.         442
~'  5. Suppression and retention of urine,..      443
"   6. Dysuria,.....         454




XVI                         CONTENTS.
SECTION 7. Urinary Calculi,...          454
"   8. Urethritis.-Inflammation of the urethra,         465
"    9. Syphilis,.....       482
"   10. Leucorrhcea.-Fluor albus.-Whites,.           496
"  11. Amenorrhea,....        03
12. Dysmenorrhoea.-Painful menstruation,.          513
"  13. Menorrhagia.-Uterine hemorrhage,..       517
CHAPTER XXVII.
Diseases of the Fibrous and Muscular System.
SECTION 1. Acute rheumatism,....      524
"   2. Arthritis.-Gout,..28
CHAPTER XXVIII.
SECTION 1. Hydrops. —Dropsy,....      530
"   1. Anasarca.-Cellular dropsy,..          538
"   2. Ascites.-Abdominal dropsy,.             539
"    3. Hydrothorax.-Dropsy of the chest,.         542
"   4. Ovarian dropsy,....      543
"    5. Hydrocele.-Dropsy of the testicle,.          544
6. Hydrocephalus.-Dropsy of the brain,.       381
CHAPTER XXIX.
Chlorosis,......       555
CHAPTER XXX.
Scrofula,                                                       566
CHAPTER XXXI.
SECTION 1. Affections of the eye and its appendages,.   578
"    2. Affections of the tunica conjunctiva.-Acute ophthalmia,....          580
"    3. Chronic ophthalmia,...             58.7
"   4. Purulent    "...          590
"    5. Gonorrhceal "....      591
"    6. Scrofulous  "...          592
"    7. Granulated lids,....       599
"    8. Opacity of the cornea,...          600
"    9. Affections of the deeper seated structures of the
eye.-Inflammation of the cornea,..      601
"   10. Iritis,.....         602
"  11. Amaurosis,.....       605
"  12. Hydropthalmia.-Dropsy of the eye,.            611
"  13. Cataract,.....       614
"  14. Fungus haematodes, and cancer of the eye,         617
"  15. Affections of the appendages of the eye.-Hordeolum. —Stye,....       621
"  16. Entropium and ectropium.-Inversion and eversion
of the eyelids,....          622
17. Fistula Lachrymalis,...             623




HOM (E OPATHIC
THEORY AN) PRACTICE OF'MEDICINE.
CHAPTER I.
A GLANCE AT SOME OF THE PROMINENIT MEDICAL DOCTRINES OF THE PAST AND PRESENT.
IN tracing the history and philosophy of medical science, from the earliest periods to the present time, we
are presented with a singular spectacle. Commencing
with those pioneers in medical art, the Asclepiades,
we find that there has been a constant series of revolutions, in both the theory and practice of their noble
profession, down to the present day. Hypotheses have
been advanced and theories established by one generation, to be admired and followed for a time, only-to be
overthrown and superseded by others, which, in their
turn, were doomed to a similar fate. Each generation
has looked upon the generations which have passed,
commiserating their errors and delusions, while the
present doctrines have been complacently regarded
as correct, and destined to stand unchanged before
the investigations and discoveries of all future ages.
The grand cause of all this may be found in the
fact that these theories have been based upon conjecture. Certain conditions have been assumed, and
1




2        GLANCE AT THE PROMINENT MEDICAL
certain states of the system supposed to exist, without
any real grounds for such assumptions or suppositions.
Instead of bringing facts to bear-facts susceptible of
demonstration —and raising thus their theories on a solid
foundation, each writer has given himself to subtle
and abstruse reasonings, taking for his data conjectural agencies and false positions in relation to the
structures and functions of the economy.
Notwithstanding, however, the great errors which
most of these doctrines have contained, the world has
derived, from their promulgation, many useful hints and
valuable suggestions. Indeed, as far as close and accurate observation of the phenomena of disease is concerned, the ancients were by no means inferior to the
moderns. Nor should posterity depreciate their labours
or detract from their fame: for when we bear in mind
the paucity of anatomical and chemical knowledge,
and the numerous disadvantages under which the earlier writers laboured, we cannot but admire their persevering industry, and behold with astonishment the
amount of real truth which they discovered. Whether the moderns, with all their improvements in
other sciences, have done as much for the advancement of medicine, is a question which we shall leave
for others to decide.
In contemplating the earlier history of medical doctrines, we shall not fail to observe that many of the
pathological opinions of Hippocrates have prevailed
down to a very late period. Although the "father of
medicine" drew largely upon his imagination, in establishing the humoral pathology, instead of trusting
exclusively to known truths, yet so great was the influence which he acquired in the medical world, that
almost implicit reliance was placed on his views, both
pathological and therapeutical, for many centuries.
Unfortunately for mankind, many of his most valuable
ideas upon these subjects have been unappreciated
and almost entirely neglected. During the time of
Hippocrates, and even preceding his day, the importance of physical education was much dwelt upon, not
only as a means essential for the perfect development
and health of the body, but for the strength and activity
of the intellect. To Herodicls, who appears to have




DOCTRINES OF THIE PAST AND PRESENT.   3
been the inventor of the gymnastic treatment, ancient
Greece was indebted for the superior physical culture
which her sons enjoyed, and which conduced so materially to her glory. The principals of these gymnastic schools were men skilled in medicine, and their
efforts were exerted to secure for their pupils the
highest possible state of physical and mental vigour.
Let us endeavour to emulate the practice of these
wise men, in this now unappreciated branch of education, and thus, by perfecting the development of the
body, in accordance with the dictates of nature, secure
to mankind more uninterrupted health and a higher
degree of intellectual power.
For some centuries subsequent to the death of Hippocrates, few real discoveries were made in medical
science. Although several men like Praxagoras of
Cos, Chrysippus, Herophilus, and Asclepiades, advanced new hypotheses, and introduced, from time to
time, many innovations in practice, yet, in the main,
they were all advocates of the humoral pathology.
About a century before Christ, however, Themison,
the founder of the methodic sect, made his appearance. Discarding the doctrines of Hippocrates, he advanced the opinion that all diseases arise from two
morbid states of the system, which are contrary to
each other-a state of constriction and a state of relaxation. To these he afterwards added a third state,
compounded of the two former, which he termed the
mixed state. The remedies which he considered applicable to these different conditions were relaxants
and astringents.
After Themison came the classic Celsus. Without
wedding himself to any particular theory, he made judicious selections from the doctrines of his predecessors, and thus instituted his method of practice. He
conceived that diseases have a direct tendency to cure
themselves, and that the measures of the physician
should be so directed that the efforts of nature are not
interfered with, and that the remedies applied shall be
those which experience has shown to have a tendency
to aid the operations of nature. He classified the different species of fever, and discarded the doctrine of
Hippocrates in regard to critical days; and by clearing




4       GLANCE AT THE PROMINENT MEDICAL
away many of the absurdities of his predecessors, contributed much to simplify and correct the prevailing
doctrines. The expectant method of practice owes its
origin to this distinguished man.
After Celsus, a few bright stars shone out in the
medical firmament, shedding their rays of knowledge
over the world, until the second century after Christ,
when all were extinguished; and medicine, in common
with the other sciences, slumbered through the dark
ages. Amongst those who were most conspicuous
in this earlier period, may be mentioned Aretaeus,
Musa, Scribonius Largus, Andromachus, Rufus the
Ephesian, and, finally, Galen. These were all advocates of the humoral pathology, but to the latter must
be awarded the palm, not only for the able manner in
which he amplified and explained the doctrines of
Hippocrates, but for the immense number of practical
facts which he gave to science.
At the commencement of the sixteenth century, the
attention of physicians began to be more particularly
directed to the study of anatomy and chemistry, for
the purpose of elucidating the phenomena of disease,
and the operations of medicines. About this time
appeared Paracelsus, who boldly denounced all previous theories, and ushered into the world a new doctrine, founded upon chemical views. This celebrated
person taught that all living bodies were composed of
the same elements as other kinds of matter, and were
subject to the same chemical laws. These elements
were supposed to be sulphur, mercury, and salts; upon
a due proportion of which the health of the body was
believed to depend, and any variation from this proportion to constitute a cause of disease. He supposed
that a certain intelligence which he calls " archeus,"
located in the stomach, presides over these elements,
and causes their good qualities to be assimilated to the
body, and the noxious principles to be rejected. This
"archeus," like the "phusis" of Hippocrates, served
an excellent purpose in filling the gap whenever no
plausible explanation could be found for the establishment of his absurd propositions.
To Paracelsus, however, is due the credit of having
first suggested the true therapeutical principle, to give




DOCTRINES OF THE PAST AND PRESENT.   5
those drugs for the cure of disease, which in health
give rise to a train of symptoms similar to those of
the malady.  But the numerous erroneous notions
which he entertained respecting physiology, pathology,
and the specific effects of medicines, prevented the
practical development of the magnificent idea which
his mind had conceived.
The next reformer of note is Sydenham, who flourished about the middle of the seventeeth century. He also
was a humoralist, and indulged largely in hypotheses;
but he contributed much to the advancement of science.
Until this period, the idea had prevailed that disease
consisted in an altered state of the fluids. Whether
disciples of Hippocrates and Galen, chemists, mechanicians, or metaphysicians, all believed in the humoral
pathology. After Sydenham, however, Baglivi and
Hoffman appeared, and effected a change of an important character. With Baglivi originated the doctrine
that all morbid changes commenced in the solids, and
that the fluids were acted upon secondarily. Hoffman
embraced the views of Baglivi, but enlarged upon
them, and introduced the hypothesis that the " muscular fibre is endowed with a certain degree of tone,
which constitutes its healthy state; but from various
circumstances, this action may be morbidly impaired,
or increased, on the one hand, so as to generate spasm,
or morbidly diminished, until it arrives at the opposite
condition of atony."
Contemporary with Hoffman, was Stahl, who advanced the idea of the existence of an independent
principle, which pervades the body, affording to it its
vital energies, and upon which the operations of the
economy depend. Not having acquired an accurate
knowledge of the chemical operations which are constantly going forward in the body, or any just ideas in
regard to the phenomena of life, it is not surprising
that this great man confounded the operations of the
intelligence with the vital principle. But however
erroneous may have been many of the ideas of Stahl,
his writings contain some entirely new and very valuable truths.
Stahl supposed that the superintending principle,
the " anima," presides over the operations of the living




6      GLANCE AT THE PROMINENT MEDICAL, ETC.
organism, having no exclusive location, but- pervading every part of the body, causing motion in the organs of motion, sensation in the organs of sense, and
all the phenomena of life, by a direct operation or influence upon each particular part. Had he not been
imbued with the prevailing absurdities respecting a
"vital principle," a "nervous fluid," a "dynamic influence," &c., this idea might have led to splendid results; but instead of recognising in this anima, the
soul, or intelligence, he confounded it with certain supposed spiritual or vital properties which pertained
alone to the body, and which he supposed were annihilated on the death of the body. Elsewhere we shall
again allude to this subject.
The brilliant intellect of Stahl also distinctly recogniset the truth of similia similibus curantur, and pointed out its advantages over the then universal law of
cure, contraria contrariis opponenda. Had he, or Paracelsus before him, adopted the course of Hahnemann
in experimenting with drugs, in health and in disease,
and by this means accumulated a sufficiency of factsthe incontrovertible arguments in sustaining any theory
-homoeopathy would long since have been the only
system of medicine. Both these reformers were possessed of gigantic intellects —genius, indeed, of the highest order-and the most exalted moral courage, which
enabled them to disregard the ex-cathedra dogmas
of antiquity; but they lacked that patient and selfsacrificing devotion in pursuit of facts, and that unbounded benevolence and love of mankind, which so
essentially characterized the career of Hahnemann.
To the latter therefore should be rendered all the
credit which attaches to this school of medicine.
Since the time of Stahl, physicians have formed
their therapeutical opinions mostly by observation of
phenomena, both in regard to the action of the organs
and the effects of remedies. The rapid advancement in
the knowledge of anatomy, physiology, pathology and
chemistry, has conduced much to call into existence
better ideas in the entire science, and to do away with
the mass of hypothetical rubbish which had been
accumulating for so many centuries. From the age
of Stahl each man began to rely more upon his own




GENERAL OBSERVATIONS ON PATHOLOGY.   7
observation in forming his views; and the influence
of ancient names and ancient doctrines became less
powerful. In the list of innovators m~y be placed
the names of Haller, Sauvages, the " father of Nosology," Brown, Darwin, Bichat, Morgagni, Broussais,
and many other writers with whose doctrines we are
all familiar.
We have thus briefly alluded to a few of the more
eminent men of the past, not to enter into an exposition
of their peculiar doctrines, but to illustrate the numerous
changes which have occurred in the theory and practice of physic. And how few of the views of all
these great men are at this day deemed worthy of consideration! How little have modern writers been able
to profit by this labour of centuries, in erecting a true
and uniform system of pathology and therapeutics!
Indeed, Allopathy at this moment, is entirely destitute
of any recognised theory. Her followers, for the most
part, are eclectics; each man, like Celsus of old,
selecting one idea here and another there, as best suits
his taste. Better far would it be for mankind, if they
would follow their illustrious examplar still further,
and trust more to the efforts of nature, and less to
the violent and uncertain effects of their applications.
CHAPTER II.
GENERAL OBSERVATIONS ON PATHOLOGY.
We shall now lay before our readers some views in
regard to general pathology and inflammation, which
we trust may conduce somewhat to the advancement
of our science.  In offering these opinions to the
public, we have not the presumption to suppose that
we are about establishing any new theory; but if we
succeed in throwing some new light upon the complicated operations of the human economy, our end
will be attained.
We hold that it is the province of the physician not
only to cure diseases, but to point out the surest methods of preventing them. In order to do this suc



8              GENERAL OBSERVATIONS
cessfully, it is necessary that he appreciate those
conditions which constitute health, so as to guard
against the numerous causes of its disturbance. In all
living bodies, certain states are essential to this
condition. The most' important of these states are1st, a soundness of the organs and tissues; 2d, an
adequate supply of nutritious food; 3d, pure air, that
the blood in the lungs may be oxygenated; 4th, a
calm activity of mind, so that the requisite stimulus of
the intelligence shall produce its peculiar effects
upon all parts of the body; 5th, an avoidance of the
various causes which debilitate, overtask, or in any way
impair the integrity of the nervous or muscular systems; 6th, the practice of those means which are calculated to ensure the due performance of all the
functions, as exercise, amusements, the cultivation of
a cheerful temper, bathing, and moderation and regularity in all the habits of life.  Thus the functions
will be performed in a certain definite and uniform
manner, the requisite equilibrium between the supply
and waste of the body be retained, and that state secured by which health is constituted.
It should be firmly impressed upon the mind,
that the important offices of respiration, circulation,
digestion, assimilation, absorption, secretion, &c.,
are dependent upon the chemical action which is constantly going forward within the body, between the
elements of the tissues and the inspired oxygen on
one hand, and a uniform supply, through the nerves,
of spiritual stimuli on the other.  When these elements are supplied in due proportion, from the food
and the air, and no unnatural or injurious cause acts
on the system, health must result.
But if the quantity of oxygen absorbed to unite
with the elements of the tissues, is insufficient to generate the natural amount of animal heat and motion, or
if the strength of one or more of the tissues becomes,
from any cause, so impaired as to be incapable of
offering the requisite resistance to the oxygen of the
blood, disease ensues. In the latter case, the impaired
state of the diseased structure does not offer sufficient
contractile power to prevent the intromission of red
globules into those parts which, in the normal state,




ON PATHOLOGY.                9
contain only the ordinary products of the transformations of the tissues. The result is, that the pores art
obstructed, the sweat is retained in the system-thus
affording additional fuel for combustion, with the oxygen of the blood, and from the unnatural irritation
which it causes, giving rise to accelerated respiration,
circulation, and the other phenomena of fever. If the
resisting power of the tissues continues impaired for a
length of time, and the oxygen continues to act as
usual, disorganization must follow.
It has been proved that 322 ounces of oxygen enter
the system of an adult daily, the whole of which
goes into combination with the elements of the food,
and is thrown off through the lungs and skin in the
form of carbonic acid and watery vapour.
The same quantity of carbon and nitrogen is supplied to the blood from the elements of the fopd, to
reproduce the organs, which is lost by the waste or
exercise of the functions. According to Liebig, "the
quantity of oxygen absorbed determines the amount
of food necessary to be assimilated."
If then the food be properly digested and assimilated, a due quantity of pure air be respired, and the
normal integrity of the organs remain unimpaired,
all the structures will act with uniformity, and a
healthy equilibrium will result. To ensure a continuance of such a condition, it is not only necessary
to avoid all of those causes which are directly
capable of disturbing this complicated series of functions, but to make use of those means which tend to
invigorate the system, and aid nature in her operations. In civilized life, these sources of disturbance
are almost innumerable; but in the progress of this
work, we shall endeavour to point out some of the
more prominent, and show in what manner they
operate in causing disease.
In the healthy state of the system, certain structures
possess the power of effectually excluding the red
globules of the blood; thus preventing a too great
change of matter, which an event -of this kind would
inevitably produce. This power is dependent, for its
normal action, upon the presence of two conditions,
viz., an adequate amount of resisting power in the
1*




10            GENERAL OBSERVATIONS
muscular fibres, which modern writers term contractfility, and an unimpaired state of the nerves, in order
that the intelligence may communicate with the extreme parts, and thus afford the muscular fibres an
additional stimulus or power of resistance. This stimulus, of which the nerves are the conductors, is an
agent of immense importance in modifying and altering
the functions of the structures. In the normal state,
its effects are apparent during the various perceptions
and emotions which are constantly agitating us.
When these two properties remain unimpaired, every
office must be duly performed.
It is true that the muscular or the nervous systems
may be tasked, for a short period, without detriment;
provided, that a corresponding degree of rest be
allowed, for the weakened energies to be restored to
theirj.atural state. This is witnessed in severe bodily
or mental labour; the immediate effects of which are,
fatigue, lassitude, and diminished muscular and
nervous energy. If this be succeeded by a due allowance'of sleep, the waste of force is repaired, and
the body resumes its healthy tone. If, however, this
labour be continued beyond a certain point, and the
requisite quantity of rest be withheld, the capillaries
lose their vitality, become incapable of resisting the
entrance of red blood, and inflammation, with fever,
is the consequence.
Indeed, it may be laid down as a general rule, that
most of those causes which are capable of producing
disease, act by impairing' the muscular and nervous
force of the tissues to such an extent as to render them
incapable of excluding the red globules. We know
that these globules are charged with oxygen, and
that this gas, when in contact with parts of which the
elements consist of, carbon and hydrogen, must effect
chemical changes.  It matters not whether these
changes are produced within the body or in the air;
the results are in both instances the same.
It has been proved by the experiments of Bichat,
Buniva, and Philip, that the capillaries of a healthy
living animal effectually resist the introduction of
fluids, even when a powerful syringe is used; but as
the energies of the animal sink, they gradually lose




ON PATHOLOGY.               11
their power of resistance, and allow the fluid to pass
into them like " passive and yielding tubes." From
these experiments it is evident that the capillaries are
the first to lose their vitality, since the large arteries
have been observed to retain their contractile power
some hours after death.  Thus it is that the first
manifestations of disturbing causes are upon the
surface, in the condition of chills, succeeded in a short
time by unnatural heat and inflammation.  "Push
into the aorta of a living animal, by means of a syringe, different fine fluids, and you will never see them
fill the capillary system, or issue by the exhalents;
but when the experiment is performed soon after the
death of the animal, the fluid will pass readily into
the serous capillaries, and pass out by the exhalents,
excretory ducts, &c."-(Bichat.)
From the above facts it is evident, that whenever
the integrity of the extreme parts becomes impaired,
the introduction of the red globules is permitted,
which, according to chemical laws, must give rise to
increased evolution of heat, inflammation and thickening of the capillaries, and consequent obstruction to
the passage of the excretions. The retention of the
products of the combustion of the oxygen of the blood
and the elements of the food, is an additional source
of disturbance.  These irritating substances induce
accelerated respirations, in order that sufficient oxygen
may be absorbed to neutralize them, and thus cause
exaltation of temperature, increased activity of the
organs, and the phenomena of fever.
In all our pathological inquiries, it is of the first
importance that we have a distinct appreciation of
the laws which produce and regulate the phenomena
of life, and, as far as practicable, of the influence of
external agents in modifying these phenomena.
First, the primary source of animal heat and motion, is the chemical action which takes place in the
lungs. Secondly, when the blood arrives at the extreme vessels, other and important chemical changes
occur between the oxygen of the blood and the elements of the tissues, giving rise to a great amount of
caloric and motion. Now as the combustion at the
lungs is the principal cause of propelling the blood




12           GENERAL OBSERVATIONS
through the arteries into the capillaries-so it is probable that the combustion which occurs between the
oxygen of the red globules, and the elements of the
changed tissues at the extreme vessels, is the principal source of the motive power which forces the
blood back through the veins to the heart and lungs.
There can be no chemical change without the evolution of heat, no heat without expansion, and no expansion without developing motive power. We are
obliged to reject the doctrine that the blood is brought
back through the veins to the heart, by a kind of suction, which this organ exercises on account of the
vacuum which constantly occurs within its walls; for
if this motive force is all located at the heart, there
is no way of accounting for the expenditure of the
large amount of motive power constantly generated at
the extreme points. We see two parts of the body
where combustion is constantly occurring, viz., the
lungs and the extreme vessels; and when we remember
that the laws which govern chemical action, whether
in the body or the air, are similar, we can appreciate
the probable force which must be produced at these
extremities.
Since then the animal heat, motive force, &c., are
generated principally at the lungs, and in the capillaries, it is evident that any cause which can disturb
the healthy operation of either of these important
parts must produce immediate and serious disturbance
throughout the whole system.
The agents capable of inducing disease here, are
numerous and dissimilar.
In hot climates, the atmosphere being highly rarefied, a less volume of oxygen is absorbed at each inspiration, and consequently a less quantity afforded to
enter into combination with the carbon of the system.
On this account we observe a greater prevalence of
liver and bilious affections in torrid than in temperate
latitudes. Unless extreme care be taken to avoid
animal food, liquors, and other articles which produce
a large amount of carbon, this element will so abound,
that the rarefied air which is inhaled will be wholly
inadequate to effect those changes which serve to retain the equilibrium between the supply and waste.




ON PATHOLOGY.               13
from the transformations of tissues. Here, a greater
quantity of the elements of nutrition are usually assimilated than the inspired oxygen can'decompose.
This excess of carbon and hydrogen being retained,
the nervous and muscular force of the tissues become
relaxed and enfeebled, so that from slight exciting
causes, diseases of a bilious or congestive character
are engendered.
We have said that the same quantity of carbon
and hydrogen should be supplied to the blood from
the elements of the food, to reproduce the organs,
which is lost by the waste or exercise of the functions.
That which is not acted upon by the oxygen in the
lungs and at the skin, is taken up by the veins, and
carried to the liver, which separates those substances
(carbon, soda, &c.,) incapable of reproducing the
tissues, and finally depositing them in the gall-bladder in the form of bile. When the amount of bile
exceeds the retentive capacity of the gall-bladder,
the surplus must run over, and a large portion of it
be conveyed into the system, thus impairing the integrity of the tissues, and laying the foundation of those
diseases incident to equinoctial latitudes.
In cold climates, a state of things the reverse of
this ensues.  Here, the air being highly condensed, a large volume of oxygen is absorbed at each
inspiration, to combine with the carbon of the
system, and thus generate sufficient caloric to compensate for that which is abstracted by external cold.
For this condition, all causes which can impair the
normal state of the digestive organs must be avoided,
in order that a sufficient amount of carbon, &c., may be
assimilated, to combine with the oxygen and secure
the healthy equilibrium. The greater the exposure
to external cold, the larger must be the supply of
food and oxygen to make up for the loss of heat.
Cold, acting unduly upon the external parts of the
body, produces a train of symptoms similar to those
caused by miasmata and other noxious exhalations when
inhaled. The first effects in either instance, are to impair the energy of the extreme vessels, inducing constriction and chills, to be succeeded by diminished resisting




14            GENERAL OBSERVATIONS
power, and other phenomena which characterize inflammation.
The increased action of the circulatory vessels
which usually follows the chills, has been referred by
some writers to the stimulus of a greater volume of
blood being thrown upon these organs than is natural,
and the increased heat which accompanies this exaltation as a result of the action itself. No greater
error than this could be promulgated, for the entire
source of animal heat is chemical action, and all of
the involuntary motions must bear a direct ratio to
this evolution of heat. If the skin, lungs, brain, or
any other part, becomes from any cause incapable of affording the normal resistance to the oxygen
which is constantly brought into contact with it,
an augmented chemical action must occur in it,
with the invariable concomitants, increased heat, congestion, and fever.
" If a given part of the body is acted upon by continued and intense cold, while the other parts retain
their natural temperature, there occurs, after a time,
in consequence of the loss of heat, an accelerated
change of matter in the cooled parts. The momentum of the force of the vitality, in the parts which
are not cooled, is expended, as before, in mechanical
motion; but the whole action of the inspired oxygen
is exerted on the cooled part. In the cooled part
of the body, the living tissues offer a less resistance
to the chemical action of the inspired oxygen: the
power of the oxygen to unite with the elements of
the tissues, is, at this part, exalted. Itr the cooled
part, the change of matter, and with it the disengagement of heat, increases; while in other parts of the
body, the change of matter and the liberation of heat,
decrease. But when the cooled part, by the union of
the oxygen with the elements of the metamorphosed tissues, has recovered its original temperature, the resistance of its living parts to the oxygen
conveyed to them again increases, and as the resistance of other parts is now diminished, a more rapid
change of matter now occurs in them, their temperature rises, and along with this, if the cause of the
change of matter continues to operate, a larger




ON PATHOLOGY.               15
amount of vital force becomes available for mechanical purposes. If the heat is abstracted from the
whole surface of the body, the whole action of the
oxygen will be directed to the skin, sand in a short
time the change of matter must increase throughout
the body."-(Liebig.)
From these facts we are led to conclude, that a
large amount of those articles which abound in carbon
and hydrogen should be consumed in cold climates, in
order that sufficient materials may be constantly furnished to the tissues, to afford the requisite amount of
resistance to the inspired oxygen. This is the only
means by which the animal temperature can be kept
up sufficiently to counteract the loss of heat which is
constantly occasioned by external cold.  Disease
must always occur, when cold so intense and protracted as to impair the normal resisting force of the tissues, is applied to the body, in such a manner as to
induce atony in the capillary vessels, chills, lassitude,
pain, and other symptoms of inflammation. One of
the most prolific causes of disease, in cold climates,
is generally active from without, in the form of sudden changes of temperature, excessive exposure to
cold when the body is enfeebled, and in going from
heated rooms into the cold while perspiring. In these
instances the effects produced are, debility and constriction of the extreme vessels, (chills,) lassitude, and
pains in the limbs and head, followed, as soon as reaction comes on, by accelerated respiration, circulation, and other symptoms which constitute fever. In
regard to the part or organ affected, much will depend
upon the predispositions and constitution of the patient.
As a general rule, however, the greatest impression
is usually made, and the force of the disease expended,
upon the most enfeebled part. If the lungs are predisposed to disease, the exciting cause will develop
pneumonia. If the brain or digestive organs have
been debilitated by excessive exercise, phrenitis or
gastritis will ensue. The same principle holds true with
regard to the other organs and structures of the
economy. If the whole system be in a normal and
sound state, atmospheric vicissitudes will commonly merely predispose the organs to a disordered




16            GENERAL OBSERVATIONS
action from whatever farther exciting cause may occur.
But repeated exposure to sudden changes of temperature, even in a sound state of the organs, may produce
actual diseases
The immediate effect of the above enumerated, as
well as of almost all other causes of disease, is to
impair the integrity of the  capillaries to such
an extent as to render them incapable of excluding
the red globules. The intromission of these "carriers of oxygen," must of necessity give rise to
an increased and unnatural change of matter, with its
concomitants, augmented heat and motion. This inflammation of parts produces obstruction to the passage of the excretions, causing them to be retained
within the system to serve as an additional source of
disturbance. The nature and activity of the exciting
cause, the part affected, and the constitution of the
patient, will determine the violence and danger of the
disease.
It may then be assumed with safety, that the chief
influences which predispose to disease in all countries,
are extremes of heat and cold, and abrupt changes of
temperature.
In cold latitudes, those affections prevail which are
induced by undue exposure to cold, and from the condensed state of the air respired. Hence pneumonic
and other diseases of a purely inflammatory character.
In hot regions, where the respired air is highly
rarefied, we observe those disorders which proceed
from a deficiency of oxygen to neutralize the elements of the food, and from exposure to the burning
rays of a torrid sun. Liver complaints, yellow and
congestive fevers, and those diseases which an excess
of carbon, circulating in the blood, would produce, are
here found in abundance.
The diseases of moderate latitudes are of a more
mixed character, milder, and more subservient to the
power of remedies. Here frequent and sudden atmospheric changes exert the- greatest influence in
disturbing the healthy equilibrium, and in inducing
disease.
Every living body possesses a certain definite and




ON PATHOLOGY.                7
limited capacity of resistance.  This capacity can
only be taxed to a fixed point, without deranging
some of the functions and causing disease. We have
seen that the first and most essential requisite to ensure health, is a due proportion between the elements
of the food and the inspired oxygen. Now, if moderation and regularity be exercised in all the duties and
habits of life, a sound state of the organs and a due
performance of all the functions will follow.
Among the parts of which the normal action is highly
essential to the well-being of the individual, and upon
which disturbing causes usually act, are the digestive
and respiratory organs, the skin, and nervous system.
Of these, the lungs and skin are by far the most frequently affected.  Exposed incessantly to noxious
exhalations, impure air, extremes of heat and cold,
and sudden changes of temperature, it is not a
matter of surprise that most exciting causes operate
primarily upon one or both of these important parts.
Almost all inflammations of important organs are
ushered in with feelings of general lassitude, pains in
different parts of the body, irregular respirations, and
chills. It matters not whether the first impression has
been made by atmospheric changes-extremes of heat
or cold-or undue mental or corporeal exertion: one
important phenomenon is witnessed in nearly all instances, that is, a spasmodic or constricted state of the
extreme vessels. This constriction of the capillaries
is always attended with more or less debility, which
prevents them, when re-action comes on, from resisting the intromission of red blood. Thus result obstruction to the excretions, accelerated change of
matter in these parts, and the other phenomena of
inflammation and fever. Now, whatever organ or
structure is most predisposed to diseased action, must
receive the greatest detriment from the retained secretions, and the exalted and unnatural action which
pervades the system.
According to many authors, the causes of inflammation may be either predisposing or exciting. If two individuals, one robust, and regular in his habits, and the
other delicate, and irregular, be exposed to the same
morbific influence, the formerwill escape, while the lat



18             GENERAL OBSERVATIONS
ter will receive injury; or, if the exciting cause be still
more active, an impression will be made upon the
first, which will predispose his system to disordered action, while in the latter, the same influence
will cause actual disease. If the morbific agent be
very virulent, actual disease may be induced in both
instances, but in different degrees of severity.
If this is true, it may be asked why it is that in hot
climates the robust are more liable to be attacked
with fevers, than those of a feeble appearance? The
reason is obvious. The system of the vigorous man
abounds with those elements which, when properly
decomposed by oxygen, generate the vital activity,
and produce strength and health.  Now, if he indulges his appetite as usual, while he inhales a highly
rarefied atmosphere, disease must of necessity result;
for unless the amount of oxygen absorbed into the
system be proportionate to the elements of the food
assimilated, much of the latter must remain unacted
upon, and thus serve to contaminate the blood, and
derange the functions of the organs. Here, a cause
of disease exists, to which the feeble man is but little
exposed. His system is characterized by a deficiency
rather than an excess of carbon; his digestive organs being so weak that no more of the elements of
nutrition are assimilated than the inspired oxygen can
neutralize. Thus, in his case, the equilibrium between
the supply and waste of matter is retained, and the
organs remain healthy.
In the first example, a strict abstinence from animal food, liquors, and other articles abounding in carbon, with care that the healthy function of the skin be
not disturbed, will secure as great freedom from disease as in the other instance. It is not that the robust
man is necessarily more prone to disease than the other,
but because, either from ignorance or imprudence, he
often exposes himself uselessly to an exciting cause to
which the latter is not liable.
We contend that the man of stout frame and vigorous constitution is better able to resist diseases in all
climates than one of a more feeble organization, provided, that he adapts himself by his habits and dietetic
regulations, to the climate in which he resides. The




ON PATHOLOGY.               19
grand essential consists in keeping up a due proportion between the elements of the food and the inspired
oxygen. So long as this proportion is preserved, a vast
amount of exposure can be sustained in any climate,
without detriment.
In northern latitudes, those who are feebly organized, or of nervous or sanguine temperaments, suffer
-far more than the robust and bilious. In such cases
it is necessary that the amount of carbon and hydrogen assimilated to repair the waste of the tissues, be
very large, in order to supply the system with sufficient
material to resist the action of the absorbed oxygen.
Let it be remembered, that disease ensues whenever
any part of the body becomes incapable of affording a definite amount of resistance to the action of
this gas. The principal source of this resistance is the
carbon and hydrogen of the changed tissues; and if
no unusual or deleterious causes operate to depress
the system, all will be well. If, however, the digestive
organs become disordered, and assimilation checkedthe body being at the same time exposed to excessive
cold-the oxygen will act upon the debilitated structures themselves, in order to find sufficient fuel for
combustion, so that the animal temperature may be
retained.
The phenomena of life depend upon the constant
operation of two antagonistic elements. Their presence and activity, in suitable proportions, impart
heat, strength, and life, while the absence of one
makes the other an active agent in causing disorganization and death.  According to Lavoisier,
a quantity of oxygen is constantly being inspired
by the healthy adult, equal to 321 oz., or 46,037
cubic inches, daily, the tendency of which is to
neutralize and destroy the elements of the body. To
counteract this destructive agent, the elements of the
food are constantly being assimilated, and are finally
brought into contact with it. In this manner, so long
as the proportion between these agents is equal, those
chemical changes take place which generate the animal heat, corporeal vigour, and motive power, serving
to keep in operation the whole machine and ensure the
normal action of every organ. The immense import



20             GENERAL OBSERVATIONS
ance, then, of fully comprehending and appreciating the
mutual influence, and dependence upon each other, of
the respiratory and digestive organs, will be understood by all.
Extreme cold produces disease by permitting more
oxygen to be absorbed by the blood than can be decomposed by the products of the metamorphosed tissues. Those parts of the body possessing the. least
vitality must then be acted upon, and inflammation,
and perhaps disorganization, ensue.
Extreme heat generates disease from causes directly the opposite, viz., a deficiency of oxygen, to neutralize the assimilated carbon and hydrogen. In both
instances the nervous and muscular force of the capillaries is so impaired as to render them incapable of
excluding from their structure the red globules. Obstruction is thus caused, a large amount of heat is
evolved, and the redness, swelling, and pain, which
characterize inflammation, is present.
The primary cause of most inflammations is a disproportion between the action of the oxygen of the
blood and the elements of the changed tissues.
The cause of this disproportion-acting upon those
parts of the body most susceptible to its influencegives rise immediately to an impaired state of the
nerves and muscular fibres of the extreme vessels,
rendering them incapable of preventing the intromission of the red blood. The first effect upon these vessels is stimulant; indicated by contraction, or spasm, and
chills. This is soon followed by the secondary or atonic
stage, which is indicated by distention or congestion
of the capillaries with red blood, heat, redness, and
other symptoms, which show that the small vessels
have lost their power of resisting the entrance of the
destructive " carriers of oxygen."  The immediate
cause of the disturbance and disorganization which
results in inflamed parts, is dependent solely upon the
chemical action of the oxygen of the red globules, upon
the elements of the affected structure. If this is the
case, it will be asked why, then, disturbance and inflammation do not take place from the red globules in
the act of blushing, or from friction? Because, in these
instances, the nervous and muscular force of the capil



ON PATHOLOGY.                21
laries remains unimpaired, and they are thus enabled
speedily to throw off this temporary accession of red
blood, and resume their normal resistance to its further
entrance. It is only by impairing the resisting force of
these vessels, in such a manner that the arterial blood
continues to enter them, that inflammation can occur.
Even in the act of blushing, a perceptible increase
of heat is apparent, and when the emotion acts intensely, and for a considerable period, phenomena similar
to those which occur in very slight superficial inflammations, are observed; as uneasy sensations, fulness,
perspiration, &c.
The virulence of the morbific influence acting upon
the extreme vessels, and the extent to which their resisting power is impaired, will determine the violence and danger of the inflammation.
It has been ascertained by Wilson Philip and others,
"that where the inflammation of a part is greatest, the
vessels are more distended, and the motion of the
blood is slowest." This is owing, undoubtedly, to the
diminished contractile power of the capillaries; and it
is probable, in inflammations of a congestive character, that this contractile or resisting power is almost
entirely destroyed. This fact is important, in a therapeutical point of view, inasmuch as it directs us to
apply our remedies in such a manner as to restore the
loss of tone of the extreme vessels, as the most direct
method of cure. We shall hereafter take occasion to
advert to this subject again, when we shall dilate upon
it more fully.




22
CHAPTER III.
DOCTRINES RESPECTING A VITAL PRINCIPLE, NERVOUS
FLUID, DYNAMIC INFLUENCE, &c.
All authors upon physiology and medicine, have
written much about a "vital principle," a "nervous
force," &c. They speak of them as immaterial and
mysterious agents, which perform all of the most wonderful offices in the human economy. They are supposed to be distinct from the intelligence, or soul, and
to possess a kind of subtle and mysterious power,
which accomplishes all those difficult operations, in
the phenomena of life, which physiologists are unable
to understand or explain.
" There is not," says Paine, " in the whole range of
medical literature, one author, however devoted to
the physical and chemical views of life, who does
not evince the necessity of admitting a governing
vitalprinciple, as a distinct entity, distinct from all
other things in nature. I say, there cannot be produced one author of any consideration, who does not
summon to the aid of his discussion a vital principle,
whenever he touches upon the abstract phenomena
of life."
But what proof have we that such a principle
actuates the body? What good reason is there for
assuming the existence of a peculiar, immaterial
power, independent of the soul? " To speak of the
vital forces, to give them a. definition, to interpret
phenomena by their aid, and yet to be ignorant of the
laws which govern them, is doing nothing, or rather
is doing what is worse than nothing. It is to attempt
an impossibility, it is to content the mind to no purpose, to stop the search after truth. To state that the
liver separates the elements of the bile from the blood
by means of the vital force, is merely to assert that
the bile is formed in the liver. By thus varying the
expression, a dangerous illusion is established."(Matteucci on Living Beings, p. 29.)
We know that every part of the organism has its




DOCTRINES RESPECTING A "; VITAL PRINCIPLE," ETC. 23
own special function, the physical operation of which
we can fully comprehend; but superadded to all of
these parts, there is, undoubtedly, a subtle and mysterious agency, the soul. Shall we now add to the
system a power which was never disclosed by the
Creator-an assumed, vague, and indefinite principle,
concerning which we are entirely ignorant, arid which
can serve no purpose but to cover up ignorance, and
securely conceal absurd hypotheses? Shall we pretend that when God created man from clay, and
" breathed into his nostrils the breath of life, and he
became a living soul," he also infused another principle, similar to but distinct and independent of the
soul?
We are of opinion that much error has arisen
from the general idea, that the intelligence is established exclusively in the brain, and that it possesses
only certain limited powers. That its highest and
most important manifestations proceed from this organ,
there is no doubt, because the special senses are located here. Sight, hearing, smell, &c., are all recognised and appreciated here, because the organs through
which we are sensible of these phenomena, are in this
vicinity; but in other parts it exercises its influence
directly and often independently of the brain and spinal cord.
In regard to the nature of the intelligence, or soul,
and how it acts upon the material parts, to aid in producing the phenomena of life, can never be known.
We are able to see its results and appreciate its wonderful influences, but the mode of its operation is absolutely inexplicable.  It pervades every part of the
body, acting as a stimulus to each organ, giving rise
to sensation in the organs of sense, motion in the organs of motion, digestion, absorption, assimilation,
respiration, circulation, &c., in the organs provided for
these functions.
All modifications or derangements of structure,
alter the peculiar effects of this spiritual stimulus;
for it acts only through the medium of the organs as
they actually exist. All deviations therefore from
the normal organization of parts, induces corres



24  DOCTRINES RESPECTING A " VITAL PRINCIPLE," ETC.
ponding alterations in the manifestations of the intelligence.
The soul has no particular location, but pervades
every portion of the nervous system, exercising a constant and direct influence over every organ and tissue.,
This is clearly apparent from the experiments of
Philip, Stilling, Hall, and others, which prove "that
the power of the heart and vessels of circulation is
independent of the brain and spinal marrow," and
"that the power of the muscles of voluntary motion,
vessels of secretion, and peristaltic motion of the
stomach and intestines, are independent of the nervous system, and that their relation to this system is
of the same nature with that of the heart and vessels
of circulation-the nervous power influencing them in
no other way than as other stimuli and sedatives do."
From these and other experiments, Dr. Philip supposes
that the vessels possess " a principle of motion independent of their elasticity," and identical with galvanism.
The experiments of Majendie have shown, "that
the hemispheres of the brain and cerebellum may be
removed in a mammiferous animal, and it will continue
to experience sensation, odours, sounds, and sapid impressions. Vision, however, is abolished."
Dr. Dowler, of New Orleans, has very recently instituted a series of experiments on the alligator,
which demonstrate in the clearest manner the position
which we have advanced, respecting the peculiar operation of the soul, or intelligence, upon the organism.
In one experiment, Dr. D. divided the muscles of the
neck, the cervical vertebrae, and the spinal cord, also
the spinal cord between the shoulders and hips, destroyed the sympathetic nerve, and removed the intestinal viscera, "yet, for a period of more than two
hours, the alligator exhibited complete intelligence,
volition, and voluntary motion in each and all divisions
of the body. It saw, felt, and defended itself; showed
anger, fear, and even friendly attentions to its keeper,
a black boy." In another experiment, "the upper portion of the skull, including a horizontal stratum of
brain, was removed. The animal performed a series
of voluntary motions, intelligibly directed, to ward off




DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.  25
injuries.  The entire brain and the medulla oblongata
were now removed, without diminishing its power to
direct its limbs to any part that was pained by the
slightest touch of a pin or knife.  A metallic rod was
passed many times within the spinal cord, completely
destroying the spinal marrow beyond the hips. It was
still found that both voluntary motion and sensation
remained, though their manifestations were greatly
impaired." Dr. D. concludes from these and numerous other experiments of a similar nature, " that voluntary motion is neither directly communicated from
nor regulated by the brain, or the cerebellum; that
the muscles, in connection with the spinal marrow,
perform voluntary motions for hours after having
been severed from the brain; that these motions are
not only entirely independent of the brain, but may
take place, though imperfectly, after the destruction
of the cord itself; that the trunk, as well as the brain,
thinks, feels and wills, or displays psychological phenomena; that the sensorium  is not restricted to a single
point, but is diffused, though unequally, or in a diminished degree, in the periphery of the body; and that actions which take place after decapitation, as described
above, are in absolute contrast to REFLEX ACTIONS, being
sensational, consentaneous, voluntary, and in other respects dissimilar." Is it any more wonderful that the,
soul conduces to the phenomena of digestion, assimilation and appropriation, when the natural stimuli of
these organs are presented to them, than that sight
is appreciated when the natural stimuli of the eye,
the rays of light, are applied to this organ? Is it any
more singular that this spiritual stimulus should endow
each structure with power to exclude all noxious
substances, and select each its natural excitant, than
that the sense of hearing should only appreciate one
-voice, in the midst of a hundred other voices and instruments, whenever the will so directs?
In order to acquire a correct idea of the functions
of life, it is necessary, in the first instance, to contemplate the body as a perfect machine-adapted in every
part by a definite and special organization, to receive
different impressions according to the nature of the
substances or excitalnts presented, and the offices




26 DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
which they are destined to perform. Without doubt
chemical and mechanical forces exercise an important
influence in the operations of this machine. The combustion of oxygen with the carbon at the lungs, and
in other parts of the system, must develop heat, expansion and motive power, and mechanical causes
may operate somewhat in adding to this force, yet all
of these influences are wholly inadequate to accomplish and perpetuate the more complicated phenomena
of life. It is: then essential that another important
agency should be every where present, in order to
enable the organs to respond properly to their special
stimuli.  Consequently we have " superadded to the
body" an intelligence which affords a specific stimulus
to every part;: acting solely through each particular
structure as it exists, and modified in its operation
according to the modifications or alterations in the
organs themselves.  If the structure of the eye is
injured, an imperfect image will be formed upon the
retina, the intelligence will manifest itself through,
this injured structure, and this sense altogether impaired. If the structure of other organs be altered, so
that their natural stimuli cannot be brought to bear as
usual, the operation of the spiritual stimulus will be
modified in proportion, and disordered function result.
This stimulus acts at each particular part, specifically, and in a measure independently of other parts,
causing irritability of different grades in the muscular
fibres, and exercising those peculiar properties every
where, which have been erroneously attributed to a
different and independent principle, the vital force.
The influence likewise which it exercises upon the
body as a cause of disease has never yet been properly
appreciated. This is due, first, to the erroneous supposition that the operations of the soul are confined
to simple conception, judgment, comparison, and other
intellectual phenomena; and, secondly, to the beforementioned arbitrary custom, derived from antiquity,
of attributing all other phenomena connected with
the organism, which cannot be explained by the known
laws of matter, to the agency of another influence, to
which Hippocrates gave the name of phlusis, Paracelsus and Van Helmont of aracheus, and Stahl of' anima.




DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.  27
but which medical men of the present day designate
as tile "vital principle," " vital properties," " vis vitae,"
" vis insita," &c.
But what reason is there for limitino the influence
of the spul to the mere intellectual operations? What
good reason for supposing that the soul is located
exclusively in the brain, and that the rest of the body
is only acted upon indirectly and secondarily by this
subtle and immaterial power?
In the ordinary waking state, the operations of the
soul are manifested directly through the media of
all the physical structures, and these manifestations
are limited in extent and variety, and subject to certain fixed laws, having reference to the structures and
the stimuli acting upon them. Thus, the power and
extent of vision is determined by the physical condition of the eyes, and the brain (which furnishes them
with bloodvessels and nerves), and the number and intensity of the rays of light which strike the retina.
Light, in this instance, is the material stimulus, which
passes through the structure of' the eye in the same
manner as it passes through an optical instrument,
producing the reflection of images upon the retina in
a manner analogous to images formed in a camera obscura. The soul takes immediate cognizance of these
images upon the retina, in precisely the same manner
that it recognises the images in the camera obscura. It
is worthy of note, that these images may be formed
upon the retina, and yet the soul be entirely unconscious of them: so may an absent-minded man look
into a camera obscura, filled with reflected figures, and
derive no impressions from them. Without this invisible, incomprehensible, and eternal soul, the eye
would be but a mere optical instrument, perhaps
taking the first rank amongst such instruments, but
entirely on a par with them, and subject to similar
laws. No material agent, like electricity, magnetism,
galvanism, or what has been termed animal fluid,
could ever enable it to appreciate impressions, or perform a single act of intelligence.
Every structure of the organism, whether situated
within the cranium, chest, abdomen, or in any other
part, is in a similar condition in relalion to the soul.




28  DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
and, without its presence and influence, is subject
only to the ordinary laws of matter. Let those chemical theorists who suppose that the organism is actuated by electricity, galvanism, magnetism or caloric,
instead of by an immaterial and incomprehensible
spirit, adduce a single example in which the former
agents have acted on matter in such a manner as to
produce an idea, or anything analogous to reason, and
we will then allow that such doctrines are worthy of
consideration.
It is the office of the soul to preside over the necessities of the physical man —to guard against and ward
off injurious influences, and to respond to all impressions made upon the textures. So long as the normal
physical condition exists, and no undue influence is
exerted upon the mind, a spiritual, or, (as others will
have it,) a vital equilibrium, is maintained throughout
the system; but it' a part be attacked by an enemy in
the form of inflammation, or if an undue impression
is made upon the mind, this equilibrium is disturbedthe spiritual force is unequally distributed, and disordered action follows.
We append a few examples to illustrate the influence of mental impressions in modifying the action
of the tissues: An individual in perfect health, and
undisturbed by any external influence, finds himself
in a gallery of paintings. At one point a devoted
daughter is seen braving the horrors of a foul dungeon, to offer from her own breast sustenance to an
aged and starving father, and while we look, the lachrymal glands are excited, and unbidden tears flow
freely. At another point, an inhuman monster has
seized an innocent child, and is in the act of dashing
out its brains against the wall, and while we gaze, the
blood mounts to the brain, the cheeks glow with indignation, and the heart throbs violently at the bare
contemplation of the outrage. Another tableau meets
the view, and we see the executioners in the act of'
casting a struggling criminal into a den of poisonous
serpents, and, as we behold the reptiles coiled up for
a deadly spring, with fiery eyes and forked tongues,
the blood forsakes the surface, the stomach sickens,
the heart sinks, and a. cold shudder steals over the




DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.  29
whole system. Another scene presents itself: we behold a table loaded with the most tempting viands
and fruits, and an immediate change occurs in the
salivary glands, the mouth fills with saliva, the stomach indicates its want, and a general perturbation of
the digestive system ensues. The mere sight of an
epileptic often induces a corresponding complaint in
others; the indulgence of bad habits in one member
of a family, like snuffling, distortion of the mouth,
eyes, &c., frequently bring about the same habits in
other members of the family. Violent emotions from
sudden intelligence, whether good or bad, often induce
diarrhaeas, syncope, catalepsy, apoplexy, mania, &c.;
fear and apprehension are most powerful predisposing
causes of disease, and when excessive, often act as
exciting causes, particularly during the prevalence of
epidemic and contagious affections, as cholera asphyxia, small-pox, yellow and typhus fevers, &c. Protracted grief is a common cause of chronic diseases,
like dyspepsia, jaundice, neuralgia, hypochondria, phthisis pulmonalis, &c. Intense and exclusive application
to any given subject, eventually causes disease of the
brain and nervous system, and mental derangement.
The hypochondriac, who suffers under the effects of
some morbid fancy, continues to feed his malady by
pondering over his imaginary ailments; the monomaniac, as he dwells upon his delusion, fans the flame
which is consuming him. If an individual in the most
perfect health be told by several different persons that
he looks pale, haggard, and sick, it is more than probable that the impression will exercise so powerful an
influence, that he will actually feel sick, and take to
his bed: we have witnessed more than one example
of this kind. In disease, also, the manner, bearing
and expression of the physician, often exert the most
surprising effects upon the patient, either in ameliorating or aggravating his malady. Most diseases are
attended with an exalted state of the nervous system,
and with a highly sensitive and irritable condition of
the mental faculties. In this condition, a doleful expression of countenance, or words of doubt, discouragement and sadness, are often capable of plunging
the patient into the most profound state of mental




30  DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
and physical depression, and thus aggravating, to
a serious extent, his malady,; while on the other
hand, a cheerful face, a lively and agreeable manner,
and words of hope and encouragement, usually exercise an influence of the most favourable character,
and conduce very materially in bringing about a curative reaction of the organism. It should never be forgotten, that courage, hope, confidence, and a cheerfll
state of mind, are powerful tonics, and often enable
the healthy system to resist the influence of contagious, epidemic, and other noxious impressions, and
the sick organism to combat successfully the destructive effects of disease; while fear, apprehension, grief,
despair of recovery, sadness, and depression of spirits,
by impairing the resisting powers of the economy,
become both predisposing and exciting causes of disease. Showme a physician who has attained a high
reputation in the treatment of difficult and dangerous
cases of disease, and I will have confidence that he
is one who carries a cheerful face; who delights in
dwelling upon the bright and pleasant things of life,
rather than upon those which are gloomy and dismal;
and who does not fail to infuse into his patients, and
all around him, confidence, hope, and comfort. The
expression and bearing of such a man always act as a
beacon of hope, to arouse the sinking energies of the
patient, and to encourage him to strive against the
depressing influence of his malady. In these, and
other analogous instances, it is the intelligence alone
which is operated on, and which diffuses its influence,
not over any vital properties of the organism, but
upon the respiratory, circulatory, digestive, and nervous systems.
We have, then, constantly operating upon the machine, first, what may be termed the material, or natural stimuli, and second, the immaterial, or spiritual
stimuli, both of which are absolutely essential to the
continued performance of the functions. In some
parts of the organism, these material excitants must
be constantly present, in order that the system may
be kept in operation. The heart and blood-vessels,
and the respiratory organs, must be incessantly acted
upon by the blood and atmospheric air, in order to




DOCTRINES RESPECTING A VITAL PRINCIPLES ETC.  3 I
ensure life. Other parts, like the stomach, lacteals,
capillaries, &c., may be deprived of their natural
stimuli for a length of time without causing death,
but not without inducing derangement of functions
and disease. These material stimuli not only exercise
a highly important influence in the phenomena of life,
but it is upon them that morbific and other noxious
impressions are often made in causing disease. According to Liebig, " the slightest action of a chemicai
agent upon the blood, exercises an injurious influence."
Any material deviation, then, from the natural properties of the inspired air, or the other stimulants of the
organism, must constitute a source of disease.
The other agency exerts a not less important influence over all parts of the body, and gives rise to its
manifestations in accordance with the peculiar organization and modification of each structure. This
property, which has been attributed to the'"vital
principle," or " nervous force," is due solely to an immaterial, or spiritual agency-the intelligence, or soul.
The operation of this intelligence upon the organs,
produces that peculiar state which enables them, when
supplied with their material stimuli, to accomplish
their functions. It manifests its power in the capillary system in enabling these vessels to exclude the red
globules; over the lacteals, in enabling them to exclude all but the nutritious portions of food; over the
organs of involuntary motion, in enabling them to
respond with uniformity and regularity to their material excitants; over the nerves of sensation and motion, in enabling them to take cognizance of injurious
foreign impressions, and to exercise voluntary motions; over the organs of the special senses, in enabling them to appreciate sight, hearing, smell, taste,
and touch.  This spiritual influence operates only
through the medium of these organs and tissues, developing specific and harmonious manifestations, according to the peculiar use and structure of each part.
Under its guidance the molecules are appropriated, and
become a part of the organism. Through the same
influence the system is enabled to resist, to a certain
extent, morbific and other injurious impressions. It is
this stimulus which endows each tissue with its spe



32  DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
cific irritability, causing each part to recognise and
respond to its own natural material excitant, and offer
resistance to the application of' all disturbing agencies.
The soul does not leave the body, until the structures are so much injured, that the functions all cease
operation. Many organs may be destroyed, or rendered incapable of transmitting mental or spiritual
impressions, yet the intelligence, entire and unaltered
of itself, will still pervade the remaining portions of
the organism. It will still manifest itself just so far
as it finds normal organs and tissues to operate
through or manifest an influence upon. The material
parts alone may be impaired or obliterated, but so
long as there is life, the immaterial part must pervade
the body, unaltered, although its manifestations may
be entirely changed.
The objections which we have advanced in relation to a vital principle, apply with equal force to
the arbitrary and improper use of what is termed
dynamic influence. Hahnemann, when alluding, in
his Materia Medica, to the therapeutic power of the
sixtieth potency of thuja, remarks in a note as follows: " The discovery that trituration and succussion
develop the medicinal properties of drugs, in proportion as these processes are carried on further, until
the material substance shall have been transformed,
as it were, into medicinal spirit, is of inexpressible
value, and so undeniable, that those who, from a
want of'knowledge of the resources of Nature, consider homeopathic attenuations as mere mechanical
divisions of the original drug, must be struck dumb
whenever they consult experience."
We regret that the great Hahnemann has fallen
into the fatal and universal error of the allopaths,
since the days of Hippocrates, of calling things by
their wrong names, and of endeavouring to explain
phenomena which cannot be explained in the existing
state of science.
Experience teaches, that minute atoms of certain
drugs possess more power to impress the structures
of the organism, than larger quantities of the same
drug in a crude state.




DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.   33
Hahnemann, carrying his trituration and succussion
to a great extent, and still finding powerful remedial
effects, hastily and quite arbitrarily concludes, that
"the material substance has been transformed into a
medicinal spirit."  This inference, in our humble
opinion, is altogether absurd and unwarrantable.
Who supposes it possible, that a material substance
can be transformed into a spiritual one? Who supposes that matter can be reduced, by any process,
into any thing but matter, in a different state of attenuation? MIedicinal spirit, and dynamic properties, are vague, and as we believe, absurd expressions, calculated to lend an air of mystery to explicable phenomena, and lead to erroneous views respecting homeopathy.  We unhesitatingly assert,
from positive observation in many instances, that high
attenuations of drugs possess the power to impress
the human organism, under certain circumstances;
but what reason has Hahnemann, who made this important discovery, to assert that such drugs have been
transformed, by trituration and succussion, into a
spirit, or an immaterial nothing? Because the present
knowledge of chemistry does not enable us to analyze
and detect minute atoms of matter, has any man a
right, for this reason, to declare that a material substance can be reduced into a spiritual and immaterial
one? Because our scales are not sufficiently delicate
to weigh the medicinal atoms existing in high attenuations, - or our optical instruments sufficiently
powerful to see them, shall we say that they absolutely have no weight, or that matter has been annihilated?
Are there any who suppose, that the miasmatic
particles which arise from vegetable decomposition
and produce fevers, or the contagious effluvium which
arises from smallpox, scarlet fever, or measles, or the
vapours which arise from ether, chloroform, hydrocyanic acid, &c., have become obliterated, annihilated, and extinct, so that they possess no form,
weight or substantial existence whatever, as soon as
they escape into the air in imponderable atoms, though
becoming capable of impressing the structures of the
body so violently? Are there any who doubt, that in
2*




34   DOCTRINES RESP-ECTING A VITAL PRINCIPLE, ET'C.
all these instances, something material is introduced
into the blood, and conveyed to certain textures to
produce an impression by contact?  Let us rather
acknowledge that the still imperfect state of science
does not enable us to analyze and detect these minutely attenuated atoms, rather than resort to an
absurdity, to cover our want of knowledge, by calling
them spiritual, vital, or dynamic.
The great stumbling-block which has always been
in the way of real advancement in medical knowledge, is the propensity which has existed to explain
things which were difficult, or perhaps not at all
susceptible, of explanation, by vague and unmeaning
terms, instead of acknowledging our ignorance, and
awaiting farther developments in science. Shall we
say of atmospheric air, azote, oxygen, hydrogen, carbonic acid, and other gases, that they are spiritual
and immaterial, and exercise their effects upon the
organism dynamically, simply because we cannot
weigh or behold the precise form and size of the minute molecules of which these gases are composed?
Is it supposed, when air is introduced into the lungs,
that an immaterial substance enters into chemical combination with the carbon of the blood, changing it
from a dark to a bright red colour, and giving rise
to the legitimate effects of chemical action between
two material substances, viz., caloric and expansion?
When wve pour a heavier into a lighter gas, as for
example, carbonic acid gas into common air, is it supposed that the former falls to the bottom and usurps
the place of the latter, by some vital, spiritual, or dynamic influence, or simply by the force of gravity or
weight? Or when the balloon, inflated with hydrogen,
rises into the clouds, does the phenomenon occur
through some immaterial agency, or because hydrogen
is lighter than oxygen and nitrogen, and is consequently
forced upwards by the pressure of these two combined
gases? And yet the atomic molecules, composing
these gases, are as much attenuated as the higher attenuations of a homceopathic medicine.  Science is
even progressed so far, that we can now compress certain gases, like the carbonic acid gas, &c., into an
actual solid -body.




DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.  35
Spallanzani, Prevost and Dumas have proved, that
if three grains of the fecundating fluid of a frog be
dissolved in a pound of water, a single drop of this
solution is sufficient to vivify many thousands of eggs
by simple contact, and yet this globule of water only
contains 2,994,687,500th part of a grain! Inthis case
an infinitesimal quantity of matter has impressed
other crude substances by contact, in such a manner
as to produce visible changes in these substances,-a
new action, and one the most wonderful in naturelife. And the vitalist of the old and the dynamist of
the new school, would attribute this phenomenon to
some mysterious vital or dynamic influence: but can
these minute atoms of fluid be annihilated or termed
vital, dynamic, spiritual or immaterial properties of
the fluid, and the effects resulting from their contact
with the eggs, vital, dynamic or spiritual effects?
Because we cannot handle, smell or taste the atoms
dissolved in the globule of water, shall we assert that
some mysterious change has been wrought upon this
material substance, and that therefore it is not subject to the ordinary laws of matter, but must operate
in a spiritual manner? Common sense forbids.
If we take the thousandth part of a grain of an organized substance and submit it to the lens of a powerful microscope, we behold all the separate parts of
its organization, and containing within itself innumerable distinct nuclei, which may be again subdivided
into perfectly organized molecules, until the microscope can no longer appreciate the separate particles;
and yet no one supposes that tl substance ever becomes annihilated or spiritualized. Even one part in
ten thousand of chloroform, may be detected in the
blood, by converting it at a red heat into chlorine
and hydrochloric acid. How true then the axiom of
Lavoisieur, Nothing is lost, nothing is created.
Away then with all unmeaning expressions, like
medicinal spirit, vital power; dynaminzation; let us own
our ignorance respecting the precise changes which
drugs undergo by trituration and succussion, and their
exact methodus modendi, and no longer imitate allopathy, by resorting to spiritual subterfuges, in order to




36               THERAPEUTICS.
give some explanation of the great facts which Hahnemann has discovered, but which cannot yet be fully
explained or understood.
CHAPTER IV.
THERAPEUTICS.
At the present time, there exists no uniform or general system of therapeutics, because there is no theory of disease in which universal confidence is reposed. The medical world being divided into several
distinct schools, each inculcating different doctrines
concerning pathology and the methods of cure, and
all endeavouring to sustain their favourite systems,
without much regard to accuracy respecting facts, or
to logic in their inductions, it is not surprising that the
science of medicine is so often looked upon by the
public with distrust and disrespect. We behold the
vitalist, denouncing the doctrines of the chemist and
mechanician, as inconsistent and highly dangerous in
practical operation, while all agree in ridiculing that
system which is alone founded on accurate observation of facts, homceopathia.
It is doubtless true that many new and valuable
ideas may be derived from each of these conflicting
schools by the medical philosopher, whose sole object
is truth. Indeed, the coincidence of opinion between
the father of homaeopathia and many of the most
prominent advocates of the vital theory, like Paine,
Bichat, Philip, &c., in regard to physiology and pathology, is remarkable. These eminent authors not
only agree respecting the "properties and laws of
healthy beings," but they concur as to the changes and
modifications which take place in diseased states of
the organism. Although they entertain totally different views concerning the practical application of re



THERAPEUTICS.               37
medies, it will be observed that the allopath often
adopts the precept "similia similibus," in effecting
his cures.
Nor are there men wanting,-men who stand high
in the ranks of allopathy, —,ho unhesitatingly place
the pathological and therapeutical doctrines of homwopathy, far above those of either the chemical or
physical schools.
Thus, Paine, in his "Institutes of Medicine," observes, "It is due to truth (fiat justitia ruat coelun),
that the physiologist concede to the homoeopath that
his hypothetical views may be directed by an enlightened understanding of the properties and laws
of healthy beings. Upon this ground, indeed, his
hopes can alone repose; and even his doctrines in
pathology and therapeutics are a thousandfold better,
more rational, more consistent, more conducive to
health and to life, than any or all of the tenets of the
chemical or physical schools."
We shall not be surprised at this concession, when
the opinions of Hahnemann are contrasted with those
of many allopathic authors who have written since
his day.
The vitalists hold, "that all disease consists in a
modification of the vital properties and a consequent
change of function, and is, therefore, only a variation
of the natural states; that the artificial cure consists
in a restoration of these properties and functions by
making upon the former certain impressions which
enable them to obey their natural tendency to a state
of health; that remedial agents of positive virtues
operate like the truly morbific, but less profoundly in
their therapeutical doses, and that the philosophy of
their cure consists in establishing, in a direct manner,
certain morbid alterations in the already diseased properties and actions of life, which are more conducive
to the natural tendency that exists in the vital properties to return from a morbid to their natural states."
(Paine.)
Hahnemann and many of his disciples also suppose
that " it is solely the morbidly affected vital principle
* Hahnemann's Organon.




38                THERAPEUTICS.
which brings forth diseases; that in disease this spontaneous and immaterial vital principle, pervading the
physical organism, is primarily deranged by the dynamic influence of a morbific agent, which is inimical
to like. Only this principle, thus disturbed, can give
to the organism its abnformal'sensations and incline it
to the irregular actions which we call disease."
So also of the operation of remedies, Hahnemann
has it, " that the brief operation of the artificial morbific powers, which are denominated medicinal, although they are stronger than natural diseases, renders it possible that they may, nevertheless, be more
easily overcome by the vital energies, than the latter,
which are weaker. Natural diseases, simply because
of their more tedious and burdensome operation, cannot be overcome by the unaided vital energies, until
they are more strongly aroused by the physician,
through the medium of a very similar, yet more powerful morbific agent-(a homeopathist medicine).
Such an agent, upon its administration, urges, as it
were, the instinctive vital energies, and is substituted
for the natural morbid affection hitherto existing.
The vital energies now become affected by the medicine alone, yet transiently; because the medicinal
disease is of a short duration."
The vitalists of both schools also suppose that natural,
morbific and remedial agents, possess certain peculiar
and distinct properties which enable them to exercise
an influence only on particular parts of the system,
through the means of particular nerves; "passing
over, in the fulfilment of this law, various intermediate
nerves of more direct anatomical connection."  (Paine).
Although we are not advocates of the vital theory,
yet it must be conceded that this principle of elective
affinity is so universal, as applied to the operation of
morbific and remedial agents, that the influence which
any substance of either class exerts upon the organism, may, with propriety, be denominated its specific
effect. The miasms of plague, of intermittent, yellow,
and certain other fevers; the infection  of contagious diseases; the virus of hydrophobia, syphilis,
gonorrhea, &c., all produce peculiar and specific
effects upon the system. Each of these substances




THERAPEUTICS.               39
possesses the property of selecting that tissue for
which it has an affinity, and of expending its entire
primary action upon the particular part selected.
It is owing to this specific law, that medical men
have been able to classify diseases; to predict.with
certainty, that exposure to the influence of particular
morbific agents, under certain  circumstances, will
give rise to abnormal action in certain parts, attended
with a definite and uniform train of symptoms.
It is also in virtue of this specific law, that medicines may be administered which operate with certainty upon particular tissues and orgahs, and effect
those primary and sympathetic modifications in diseased states of the organism, which enable nature to
bring about safe and speedy cures.
One of the chief objections urged against the therapeutical doctrines of homeopathia, is the supposed
"fallacy of reasoning from  the effects of remedial
agents, upon healthy to morbid conditions." *  The
reason adduced for this opinion, is the fact that diseased parts become modified in their action, and far
more susceptible to the operation of remedies, than
when healthy. This last statement is doubtless true,
and it stands, as we shall endeavour to show, at the
foundation of the homceopathic method of administering m'edicines.
Although the axiom, " contraria contrariis opponenda," is almost universal among the different schools of
allopathia, so far as theory is concerned, yet in practice, the principle " similia similibus curantur,"'' is, as
we have before observed, not unfrequently adopted.
In order that a clear understanding may be acquired of the manner in which medicines operate, as exhibited by the old and new schools, we shall attempt
to demonstrate:
Ist. That most morbific and remedial agents operate
specifically and with much uniformity, both in health
and disease, as causative and curative agents.
2d. That all drugs produce upon the human body
primary and secondary effects, the first of which appear speedily, and when the dose has not been exces* Paine's Institutes of-Medicine.




40             SPECTFIC EFFECTS OF
sive, are of short duration, and are then succeeded by
the second, which are of an opposite character, and
permanent.
3d. That in disease, the susceptibility of the affected parts to the action of remedies, is vastly greater
than of the same parts when in health.
4th. That medicines, when administered in a crude
form and in large doses, according to the doctrines and
ordinary practice of the old school, whether applied
directly to the diseased organ or tissue, or to a healthy structure remote from the diseased part, are not
only incompetent to eradicate disease in a safe and
speedy manner, but generally serve to aggravate the
already existing symptoms, and by superinducing additional medicinal disease, complicate, to a serious extent, the original natural affection.
5th. That when a curable natural disease has been
excited in the organism, attended with a definite train
of morbid symptoms, a medicine capable of causing
(in large doses) a similar series of symptoms, in
health, will become speedily curative of such natural
disease, if administered in the attenuated doses of
homoeopathy.
CHAPTER V.
SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL
AGENTS.
All are aware that the naturalpoisons of certain animals; the virus of hydrophobia, syphilis, gonorrhcea and
sycosis; the miasms of plague, and of yellow, typhus
and intermittent fevers; the infection of contagious
diseases, &c., exercise, when introduced into the circulation, specific effects upon the human system, and
give rise to definite and easily recognised symptoms.
There are other morbific agents, like intense and
protracted heat and cold, atmospheric vicissitudes,
excessive physical and mental exertion, violent emotions, &c., that operate in a more general, but not less




MORBIFIC AND REMEDIAL AGENTS.       41
specific manner. Their operation, when carried so far
as to become morbific, induces debility of the nervous
system; loss of irritability in the capillary vessels,
which makes them incapable of excluding the red globules, and as a consequence, developing augmented
heat, swelling, redness, and pain.
Eberle, in his Practice of Medicine, asserts that
"the influence of almost every agent, whether morbific or medicinal, appears to possess a kind of elective
affinity for some particular organ or structure of the
organization."'This fact is so apparent, in regard to
morbific agents, that it scarcely requires notice; but
there are many authors -who still entertain doubts respecting the specific action of medicines. An attentive
examination of the following facts, must, however, settle the question satisfactorily in the minds of all imnpartial inquirers.
Remedial agents operate in the same specific manner, both in health and in disease; but with the difference that in the latter condition, only a very minute
quantity of the specific agent is requisite to produce a
salutary impression, on account of the augmented susceptibility to remedial impressions, which diseased
parts acquire.
1. " A medicine administered in certain doses, and
during a certain period of time, can produce pathological lesions analagous to those that characterize certain diseases."
2. " This same medicine, given to a healthy individual, on the same principles, produces the characteristic symptoms of the diseases whose pathological lesions it gives rise to."
3. " This medicine is a specific of these same diseases."
4. "Specificity is not therefore an isolated fact, but
the law which should guide medical treatment."[Des Specifiques en M6decine, Paris, 1847; par L. J. J.
Molin.]
The experiments of Majendie, Blake, Pereira, Rau,
Liebig, Mfiller, Orfila, Griesselich, Molin, Matteucci,
and Philip, prove conclusively, that most mnorbific and
remedial agents produce their effects after having
been absorbed into the blood. It has also been proved




42              SPECIFIC EFFECTS OF
with equal certainty, that foreign substances, when
absorbed into the circulation, are conveyed to those
structures for which they have a special affinity, and
there make a specific impression, which modifies the
function of the part, according to the nature of the
agent and predisposition of the individual. The blood
serves as the conducting medium merely, and if the
absorbed substances do not possess the power of exercising an influence upon any tissue, they may continue
to circulate through the lungs until the inspired air
gradually neutralizes them, or they may remain for an
indefinite length oftime,(as sometimes happens in cases
of hydrophobic virus and fever miasms, without affecting the system,) and yet retain their activity. The reason of this may be, that the tissues upon which they act,
are in so perfect a state of vigour, as to be able to resist
the power of the noxious agent, until some cause shall
enfeeble the part to be affected, and thus predispose
it to receive the injurious impression.
It will not be denied, that both in healthy and diseased states of the organism, cantharides, copaibie,
cubebs, the turpentines, juniper, squills, colchicum,
digitalis, apis, mel, cajuputi, and most other diuretics, produce their effects by acting directly, or
specifically, upon the kidneys, as topical irritants;
that the preparations of mercury, nitric acid, iodine,
&c., exercise a direct and specific action upon the
glands, mucous membranes, and skin; that senega,
phosphorus, ipecacuanha, tartarized antimony (whether taken into the stomach or injected into the
veins), and many of the resins, exercise a specific
action upon the lungs; that aloes, gamboge, colocynth, act specifically upon the stomach and rectum,
while senna, rhubarb, scammony, jalap, and certain
other cathartics, spend their effects upon all portions
of the intestinal canal; that ergot, savin, pulsatilla,
madder, tansy, &c., operate specifically upon the
uterus; that belladonna, opium, stramonium, strychnia, hyoscyamus, conia and coffea, impress specifically some portion of the nervous system; and, in a
word, that almost every drug impresses certain tissues in preference to others, and that a knowledge of
the manifestations to which these different impres



MORBIFIC AND REMIEDIAL AGENTS.      43
sions give rise, can alone enable us to combat diseases. That the above enumerated substances are
actually absorbed, and exert a topical effect, is apparent from the fact4that they have often been detected
in the blood, secretions, excretions, and even the solids
of the body.
It'is asserted by Flourens, " that opiuin acts specifically on the cerebral lobes; that belladonna, in a
limited dose, affects the tubercula quadrigemina, and
in a larger dose the cerebral lobes also; that alcohol,
in a limited dose, acts exclusively on the cerebellum,
but in a larger quantity, it affects also neighbouring
parts; and, lastly, that nux vomica more particularly
affects the medulla oblongata."  He also states,
"that in birds it is possible to observe, through the
cranium, changes of colour (some alterations in the
vascular condition of the parts) which these agents
effect in the brain."
Pereira, in his Materia Medica, also declares that
"the  ammoniacal, empyreumatic, and  phosphoric
stimulants, containing ammonia and its salts, the
empyreumatic oils, phosphorus, musk, and castoreum, all agree in producing a primary and specific
effect on the nervous system, the energy and activity
of whose functions they exalt. On account of their
specific influence over the nervous system, they are
administered in various spasmodic or convulsive diseases, especially in hysteria, and also in epilepsy and
chorea. The beneficial influence of some of the vegetable tonics (as, cinchona) in intermittent diseases,
should probably be referred to the specific effects of
these agents on the nervous system. The preparations of arsenic, silver, copper, bismuth, zinc, &c.,
are usually, but, as I think, most improperly, denominated tonics. They are agents which, in small and
repeated doses, as well as in large and poisonous
doses, specifically affect the nervous system."
We are also assured by Liebig, in his work on
animal chemistry, that "we can by iemedial agents
exercise an influence on every part of an organ by
substances possessing a well defined chemical action."
It will be observed that we have adopted, in part.




44               SPECIFIC EFFECTS OF
the views of Miller, in regard to the operation of
morbific and remedial agents. This distinguished
physiologist supposes that the blood is only the " vehicle of introduction," and that as-it passes through
the tissues of different organs, the medicinal particles
with which it is impregnated " act on one or more
parts which are endowed with a peculiar susceptibility to their influence. He also supposes "that a
change is effected in the composition of the organic
matter of the part acted on."
That medicinal substances induce modifications in
the functions of the organs, by topical action, is
proved, as we have before observed, from  the fact
that the medicinal particles are often found in the
excretions of the affected part. The inference must
follow, from a careful consideration of all the facts
bearing upon the subject,* that the functions of the
organism are generally morbidly, altered by the direct
action of noxious substances.
In regard to the mode in which these substances
operate, we suppose that their primary impression is
made upon the sentient extremities of the nerves. impairing their integrity, and rendering them incapable
of conducting the spiritual stimulus (which is an essential condition of irritability) to the extreme vessels.
It must be borne in mind, that in all inflammations,
the capillaries are the " instruments of disease;" that
the primary impressions of all deleterious agents are
made upon these delicate structures, and that all of
our remedies must be directed with reference to the
state of these vessels, in curing disease. " Upon these
vessels all remedial agents exert their curative effects,
whether by their direct action. or through the instrumentality of the nervous power."-(Paine).
The extreme terminations of the nerves are so
highly impressible, that the very minutest quantity of
a specific agent is capable of producing prompt and
decided effects, while the same agent would prove
powerless, if applied to the larger nerves.  Thus it is
* For further proofs respecting the doctrine of absorption and topical
action of drugs, see the experiments of Muiller, Tiedemann, Gmelin,
Majendie, Matteucci, Liebig, Rau, Flourens, Dutrochet, Blake, Herring,
Mayer, Christison, Orfila, and Dumas.




MORBIFIC AND REMEDIAL AGENTS.       45
that imponderable substances and mental emotions
are so often the causes of disease. Here we have one
reason, also, awhy medicines, when administered homeopathically, produce those happy modifications
in the affected parts which dispose them so speedily
to recovery. In connection with this, if we take into
consideration the extreme sensibility which diseased
parts acquire to the operation of medicinal.agents,
we shall be unable to doubt the propriety of administering medicines according to the homceopathic
method.
Miiller supposes that when impressions are made
by specific substances, " changes are effected in the
composition of the organic matter of the parts acted
on."  Of this, however, there is no satisfactory evidence.  On the contrary, we know positively that
very many cases of disease occur without giving
rise to any change whatever in the organic construction of the parts affected.
One of the first indications generally observable in
an abnormal state of an organ or tissue, is a loss of
tone, or irritability and perverted function of the capillary vessels. In the experiments performed upon
the blood, by Philip, Alston, and Gallois, it was observed that the smaller vessels were the first to succumb to foreign influences, and then, if the potency
of the agent were increased, the larger vessels would
become affected.
Now, when we reflect, that irritability is dependent,
ist, upon a normal organization of parts; 2d, a regular
and uniform supply of natural material stimuli, the arterial blood, &c.; and 3d, a healthy action of the
mind, in order that the spiritual stimulus shall make
its due impression, we can readily conceive how slight
a cause, moral or physical, morbific or remedial, may
disturb or impair this irritability, and thus induce disease. " Every part of the organism depends, for the
performance of its proper functions, on the receipt of
arterial blood and of nervous influence; so alterations
in the supply of either of these essentials may modify
or even suspend the functions of a part." *
* Pereira's Mat. Med.




46              SPECIFIC EFFECTS OF
The nerves are simply the conductors of the intelligence, and so long as their integrity, tone, or conducting power, remains unimpaired, this essential condition
of irritability will remain. If, however, any cause acts
upon them in such a manner as to injure or destroy
this important property, the stimulus of the superintending spirit, or as the vitalist would say, the nervous
power, is not transmitted, and, as a consequence, disease must result from the absence of one of the important requisites of irritability or contractility.
Injurious impressions may be made upon the extreme nerves, either by deleterious matters absorbed
into the blood, and brought into direct contact with
them, or by certain external applications, like electricity, magnetism, heat, cold, and exercise.
Inflammation may be excited by the operation of
either of these causes, by a primary effect upon the
sentient extremities of the nerves, which induces loss
of tone and conducting power, and as a consequence,
loss of irritability and resisting power in the capillaries.
This impression is not made, as some theorists would
have it, upon an immaterial principle, but upon something material, tangible, and demonstrable, viz., the
nerves themselves.
Poisons and other noxious substances, when taken
into the blood, are rapidly conveyed to all parts of the
body; and when they arrive at the structures, upon
which they have a specific action, nature makes an
effort to expel them through these particular parts. If
the substance be active in its effects, the impression
which is made upon the minute nerves of the part,
will be in a corresponding manner severe. The length
of time required for foreign substances to produce their
effects, is extremely variable. Some articles, like several of the salts of potash, juniper, the turpentines,
asparagus, indigo, madder, &c., are -expelled through
the urinary organs in a few moments, while other substances may remain in the blood for an indefinite period of time, or until some predisposing cause shall
act upon the system in such a manner as to augment
its susceptibility, and place it in a condition to be affected by the morbific agent. In some instances, the morbific
agent remains harmless in the circulation, for months,




MORBIFIC AND REMEDIAL AGENTS.       47
and even years, when suddenly, some tissue becoming
enfeebled and incapable of resisting the action of the
specific agent, the disease, in all of its violence, bursts
forth. In cases like these, it is quite evident that the
injurious impressions cannot be made upon the vital
properties of parts, for the effects must be sooner propagated and rendered apparent. Neither can we suppose, with the advocates of the chemical hypothesis,
that the constituents of the blood become altered and
contaminated with the peculiar miasms or virus, for
such blood introduced into the circulation of a healthy individual gives rise to nothing like the original
disorder. We again repeat, that the blood is simply
the vehicle which conveys the poison, and that no effects are produced, until the structure for which the
poison has the greatest affinity has become ready, from
some predisposing cause, to receive the impression of
the deleterious agent, and thus is specifically affected.
Why it is that morbific and remedial agents select
particular organs and tissues to exert their action upon,
we do not know; but that such is the fact, all medical
observers will bear witness. Nor is it more surprising than that some of the natural fluids, like the urine,
gastric juice, bile, &c., remain with impunity in some
parts of the body, while if they gain admission to other
parts, as the cellular substance, or peritoneum, they
occasion inflammation, sloughing, and death.
Some writers attribute the operation of medicines to
an electrical influence. "All bodies," says Bischoff,
"' by contact with each other, act as electrics, without,.
however, necessarily undergoing any chemical changes. Therefore, when a medicine is applied to the organism, its action is electrical." The instantaneous
effects of very minute quantities of hydrocyanic acid,
sulphureted hydrogen, and carbonic acid gases, and
of strychnia, conia and morphia, certainly bear a close
resemblance to the overwhelming shock of lightning,
and go far to sustain this opinion.
Whether remedies act as topical stimulants, or as
sedatives, dynamically or electrically, may admit of a
question; but it is quite certain that their primary impressions are made upon some portion of the nervous




48              SPECIFIC EFFE''CTS OF
system, and generally on the extreme nerves of the
parts impressed, and those modifications of irritability
produced, which exert either a salutary or injurious
influence over the part acted on. Even in those instances where the primary influence has been exerted
upon some portion of the cerebro-spinal or ganglionic
systems, the capillaries receive an almost simultaneous
impression through the sympathetic nerves, which at
once gives rise to disordered function in these important vessels.
Absorption may take place in almost every structure of the body-lymphatics, lacteals, blood vessels,
skin, cellular substance, &c.; but many circumstances
exert an influence in deterring the rapidity of the process, as well as the quantity absorbed.
Mfiller asserts that " the more the matters are soluble, divided and fitted for entering into combination
with the organic juices, the more easily are they absorbed."  Absorption also varies according to the
quantity of liquid which exists in the organism, and is
in the inverse ratio of the plethoric state of the animal."
Dutrochet and Edwards have demonstrated that animals absorb water most rapidly after transpiration.
Majendie and Orfila have proved that dogs having
lost large quantities of blood, rapidly absorb strychnia
and die; while those into whose veins large quantities of water had been injected, remained unaffected by
the same amount of the poison. These facts will enable us to understand why diseases are not easily contracted when an individual is in vigorous health, or
after a full meal.
" Within certain limits, absorption is in proportion
to the temperature of the absorbing body, and of the
body absorbed." (Matteucci.) Therefore, inflammations of all kinds, fevers, &c., facilitate absorption.
For this reason it is, that in acute inflammatory diseases,
the higher attenuations prove efficient, which would
be productive of no effect in the ordinary condition-of
the system.
Although, therefore, morbific or medicinal agents
may be absorbed into the mass of blood, on account of
protracted hunger and thirst, or other cause, it does
not follow that any manifestations will be apparent;




PRIMARY AND SECONDARY ACTION OF DRUGS. r 49
for if the whole organism be in a sound and vigorous
condition, it will resist the specific action of the sub,
stance for an indefinite period. Therefore it is that
certain poisons often remain latent in the circulation
for months, and even years, without being able to exercise their specific action, until some part of the sys.
tem becomes disordered in such a manner as to be incapable of longer resisting the noxious influence. In
many cases of absorption of morbific substances, where
the organism is healthy, it is probable, from their con.
stant circulation through the lungs, where they come
in contact with that powerful decomposing agent, the
inspired oxygen, that they become neutralized after a
time, and their noxious qualities destroyed. On the
contrary, if the following conditions are present, viz.,
irritation, inflammation, fever, deranged digestion, debility from loss of fluids, insufficient nutriment, &e.,
the morbific agent will be absorbed with facility, and
speedily produce its specific impression.
CHAPTER VI.
PRIMARY AND SECONDARY ACTION OF DRUGS.
HOMCGOPATHY teaches that the impressions which
drugs produce upon the organism, in health and in
disease, are analogous in their character. But there
is this important difference between healthy and
diseased structures, that large quantities of the drug
are required to produce appreciable impressions upon
the former, while the susceptibility of the latter is so
morbidly augmented that the most minute atoms of
the medicine are instantly effective. Not only so, but
even the natural material stimuli of the structures cannot be tolerated, but become immediate and additional
sources of disease, and if persisted in, of fatal disorganization.
If, then, we desire to know the precise effects of
drugs in disease, it is necessary to prove them by taking large doses in health —doses sufficiently large to
affect the structures sensibly and decidedly. Even if




50           PRIMARY AND SECONDARY
contraria contrariis opponenda be adopted as the law of
practice, this is an important discovery, for we may then
administer the remedies with a full knowledge of the
parts they impress, and of the exact symptoms they
induce, and thus remove allopathy a single step from
empiricism.  Some eminent writers of the old school
have distinctly recognised the importance of this subject: Thus, Dr. Paris, in his Materia Medica, remarks,
that "observation and experiment upon the effects of
medicine are liable to a thousand fallacies, unless they
are carefully repeated under the various circumstances
of health and disease, in different climates, and on different constitutions."
Professor Dunglison, on the seventh page of his
New Remedies, says," To treat disease methodically
and effectively, the nature of the actions of the living
tissues, in both the healthy and morbid conditions,
must be correctly appreciated; the effects, which the
articles of the Materia Medica are capable of exerting
under both those conditions, must be known from accurate observation, and not until then can the practitioner prescribe with any well-founded prospect of
success."
Pereira assures us, " that in order to ascertain the
action of remedial agents on the living body, it is
necessary that we examine their influence both in
healthy and diseased conditions. For, by the first we
learn the positive or actual power of a medicine over
the body; while, by the second. we see how that
power is modified by the presence of disease."(Pereira's Mat. Med. and Ther. Vol. 1, p. 126.)
Other equally distinguished allopathic writers now
entertain the same views upon this point, but without
taking into consideration some very important circumstances connected with the provings. We have reference to the great fact inculcated by Hahnemann,
that all drugs exercise upon the organism two effects, a
primary and a secondary, and that these secondary
effects are always the reverse of the primary.  A
knowledge of this truth will enable us to classify both
the primary and the curative results of medicines, and
thus more clearly to appreciate the phenomena which
should guide us in their application. The primary




ACTION OF DRUGS.               51
symptoms make their appearance soon after the medicine has been taken into the stomach, and continue for
a longer or shorter period, according to the magnitude
of the dose, and the condition ofthe health, after which
they disappear, and the secondary or opposite series
of phenomena manifest themselves, and remain until
the organism recovers its equilibrium. But in a fewv
instances the power of drugs is displayed in such a
manner that these primary and.secondary effects
appear in alternation for a considerable time, when the
primary symptoms yield to the secondary, or serious
organic derangements ensue. The mode of operation
in these instances, is probably analogous to that of the
miasm of intermittent fever, in producing alternate
chills and heat. Medicines of this description are
termed polycrests.
No one who has candidly tested the operation of
drugs with reference to this law, can for an instant
deny its truth and importance; and the law applies
not only to large doses of drugs, but to every other
cause which unduly impresses the structures; that is,
in such a manner as to disturb that healthy balance in
the operations of the organs which constitutes health.
Let us examine the ordinary effects of cathartics in
health: first, the mucous membrane of the intestinal canal is irritated or inflamed, and the natural consequence
of inflammation follows in the form of increased
mucous and serous secretion, increased peristaltic action, and a painful and loose state of the bowels: this
is the primary effect. After several thin discharges
from the bowels, a debility and a depression of the parts
occur (bearing an inverse ratio to the amount of
primary inflammation); the peristaltic action becomes
impaired or suspended, and constipation results as the
secondary effect of the drug.
There is no exception to this rule, unless the cathartic operates so violently as to produce a permanent
inflammation and disorganization of the mucous membrane. in which case the primary symptoms may be
continuous and constitute a permanent affection.
Even in cases of this kind, however, partial reactions
sometimes occur during the course of the malady, and
secondary symptoms are manifested. in the form of




52             PRIMARY AND SECONDARY
constipation alternating with diarrhea. These violent
primary symptoms rarely continue beyond a few days
without resulting in serious structural lesion, or a
healthy and permanent reaction.
The primary effects of opium, in large doses, are to
induce sleep, lessen nervous and muscular sensibility, cause agreeable dreams, and diminish or suspend all of the secretions, with the exception of perspiration, which is augmented. If the quantity taken
has been moderately large, a pleasurable excitement
for a short time precedes the soporific influence, as a
primary symptom. These first results continue from
twelve to forty-eight hours, according to the magnitude of the dose, when the organism reacts; the exhilaration is succeeded by depression, the sopor by
constant and prolonged wakefulness, morbid irritation
of the whole system, a return, in preternatural quantities, of all the secretions which had been suspended,
and a suppression of the cutaneous secretion, which
had been morbidly augmented; and the secondary
effects of the drug are thus manifested.
So long as diuretics continue to irritate the kidneys,
they are forcibly stimulated to pour out an unusual
quantity of urine; but as soon as the specific is
omitted, the organism reacts against the temporary
irritation set up by the medicine, and a corresponding
diminution of the urinary secretion follows, until the
organ recruits from the previous overaction, and the
disturbed equilibrium is restored.
The primary operation of stimulants gives rise to
an exaltation of the mental and physical powers,
while a corresponding depression and abasement invariably result as secondary consequences.
The primary operation of digitalis, in large doses,
is to retard the action of the heart and arteries. The
reaction of the system against the drug, or the secondary effect, is an augmentation of this action.
The primary symptoms caused by aconite, are intenser action of the circulatory vessels; the secondary
consequence consists of a reduction of the pulsations,
in some instances as low as thirty-five in the minute.
The primary effect of intense cold, is to stimulate
and inviforate the whole system; and the secondary




ACTION OF DRUGS.              53
results are loss of muscular and mental energy, stupor,
and death.
This law of primary and secondary action applies
not only to medicinal, but to a large proportion of
morbific agents. On this supposition we may readily
account for the remissions and exacerbations which
are observed in most fevers.  It is only when the
morbific influence has been very active, and the resulting inflammation violent, that no reactions or
remissions occur. It may nevertheless be set down as
a general law, that no structure of the human body
can be called into preternatural action, or stimulated
beyond a given point, without a speedy tendency to
reaction on the part of the organism. In severe forms
of disease, this reaction may not be apparent for
weeks, and perhaps until organic lesion occurs; yet,
sooner or later. some reaction, with secondary symptoms, manifests itself. There is a healthy point in the
functional actions of the organs-an equilibrium, if we
may be allowed the expression, of the respiratory,
circulatory, digestive, absorbent, assimilative, secretory, and excretory functions-which cannot be disturbed with impunity. Stimulate one of these beyond
its natural point, and a corresponding depression must
necessarily ensue before the normal balance is restored. Each tissue possesses only a definite amount
of resisting power, and therefore every undue expenditure of' this power entails future debility. Nature
is constantly striving to maintain the functions in
their natural condition, and this she accomplishes
by inducing in the different parts a reaction the reverse of the disturbing cause, and bearing an inverse
ratio to this cause.  The amount of strength and
resisting power which is acquired from the food, &c.,
is fixed and definite; and this force is expended in
limited and definite quantities throughout the economy, and thus secures the healthy performance of the
functions.
The practical deductions which legitimately arise
from these views of this subject, are of the most interesting character, as regards the application of remedies; for if the ideas which have here been adduced
are correct, it is plain that the antipathic doctrine




54       SUSCEPTIBILITIES OF ORGANS, ETC.
of cure is erroneous, while the truth of the homeopathic becomes equally apparent.
CHAPTER VII.
SUSCEPTIBILITIES OF ORGANS AND TISSUES TO THE INFLUENCE OF REMEDIAL AGENTS, VASTLY GREATER IN
DISEASE THAN IN HEALTH.
ONE of the principal arguments which has been adduced against Hahnemann's system of therapeutics,
is the supposed fallacy of judging of the effects of
medicines in disease, from their operation in health. It
is considered that the modifications which occur in
what are termed the " vital properties" of parts, in a
state of disease, also alter the action of remedial agents
in a corresponding manner.
The fact is incontrovertible, that tissues in a state
of inflammation, do acquire properties very different
from what they possess in the normal state; but respecting the nature of these acquired properties, numerous facts go to prove, firstly, that the parts actually
inflamed, become extremely sensitive to the impressions of specific remedies; and, secondly, that the
facility of absorption is promoted throughout the whole
system. The recent experiments of Mfiller and Matteucci have demonstrated the fact, that in proportion
as the tone of the nervous and muscular systems becomes impaired, or inflammation obtains, up to a certain point, just in the same ratio will absorption be
promoted and foreign agents exercise their influence.
We have seen that inflammation consists in a
" congestion of the capillaries," induced by debility, and
the want of resisting power in these structures, to exclude the arterial blood, and that the effects of inflammation of a particular organ upon the general system,
are lassitude, pains, and other symptoms which indicate diminished nervous and muscular energy. That
condition, therefore, which is termed erethism, is not,
as is sometimes supposed, indicative of increased nervous energy, but results directly from loss of strength.
In health, the capillary vessels possess the power of




SUSCEPTIBILITIES OF ORGANS, ETC.    55
excluding all of those constituents of the blood except
the colourless fluid which is their natural stimulant.
Although the capacity of these minute tubes is sufficiently large to admit the red globules with ease, yet
they are endowed with a peculiar property which
enables them to resist their entrance.
Any cause, therefore, capable of impairing this
natural irritability, becomes a source of debility and
inflammation.
It has been proved that, in health, most medicinal
substances may become absorbed into the blood; but
yunless they possess some peculiarly noxious qualities,
they will act upon those parts for which they have a
specific affinity, and be thrown off in the form of excretions, causing in their passage through the structure
on which they act, only a slight and perhaps unappreciable irritation.
When taken in disease, these same substances' are
absorbed with far greater facility, and exercise the
same specific affinity for particular parts as in health;
but with the difference, that they make impressions
upon the inflamed tissues, far more energetic and
strongly pronounced, than when taken in a healthy
state of the organism. Nor is this augmented susceptibility to the influence of remedies, confined to the
tissues primarily affected, but the whole system becomes far more impressible than during health. It is
a well established law, that no one structure can be
inflamed, without giving rise secondarily to sympathetic symptoms in other parts of the economy. It matters not whether the part primarily affected, be the
lungs, stomach, skin, or any other structure, the whole
system may be ultimately disordered, through remote,
contiguous or continuous sympathy. The connection
between the different parts of the human body, through
the media of the sympathetic nerves, is so close and
direct, that no organ can be acted on by a morbific
agent, without developing secondarily sympathetic
symptoms more or less violent, according to the nature
of the agent, the severity of the primary impression,
and the constitution of the individual. All of the organs are so designed and constructed by the Supreme
Architect, that, in health, a certain harmony of action




56         SUSCEPTIBIL1TIES OF ORGANS, ETC.
prevails throughout every part of the machine, causing every function to be executed with uniformity, so
that no disturbance can accrue to any single part,
without impairing this healthy equilibrium.
Paine advances the following sentiments, which
have a powerful bearing upon this subject. Probably
no allopath has ever written whose theoretical views
coincide so nearly with the doctrines of Hahnemann,
as those of this distinguished author; and we only
wonder that their practical deductions should differ
so materially.
" It appears therefore to be a most important law,
that morbid states call into operation the function of
sympathy among organs, which, in their natural state,
manifest but feeble, and perhaps no direct relations
whatever; and that in consequence of morbid changes,
remedial agents will operate sympathetically through
the stomach, &c., upon remote parts, when they would
have no such effect in the healthy state of the organs.
New vital relations being developed by disease, our
remedies continue to operate through those acquired
relations so long as they exist."
Again, "In proportion, therefore, as the susceptibility of the system at large is increased by morbid
changes, or predisposed by morbific influences, so, in a
general sense, will the alterative action of remedial
agents be felt in a corresponding manner."
Again, "It is one of the most important laws in
medicine, that the susceptibility of tissues and organs
to the action of remedial agents, is more or less affected
by disease. Many agents which operate powerfully
in certain morbid states, and in certain doses, both
locally and sympathetically, may be perfectly inert in
the natural states of the same organs."
Finally, "It is worthy of repetition, that such is the
analogy between morbific and remedial impressions,
that the organs which sustain the former are thus rendered susceptible of the latter, when they might otherwise be insensible to the same remedial agents, in
their appropriate remedial doses. Take many of the
most powerful agents, arsenic, tartarized antimony,
iodine, &c., and when administered in certain small
and repeated alterative doses, they bring about the




SUSCEPTIBILITIES OF ORGANS, ETC..57
cure of the most obstinate and formidable conditions
of disease; while the same doses' may not manifest
any action upon the system, or on any part of it, under
circumstances of health. This manifestly depends
upon an increased susceptibility of the organic properties, in their diseased conditions, to the action of foreign agents, and upon anll increased disposition to undergo changes. This law, which unfolds a principle
latent in health, and by which morbid organic properties acquire susceptibilities to salutary influences from
agents which in health, would either produce no effects, or lead to untoward results, and its ally, the
great recuperative principle, impose the highest obligation upon physicians to become medical philosophers."*
Most of the positions laid down by Dr. Paine, in the
above quotations, are doubtless correct; but in all his
inductions, he is labouring under an important error
insupposing that morbific and remedial agents exercise their influence only upon certain immaterialpr i.nciples or vital properties.
Can it be supposed that when tartarized antimony
or Ipecacuanha are taken into the stomach, in emetic
or diaphoretic doses, they act upon an immaterial property of this viscus, in causing emesis or diaphoresis?
Can it be believed that the diuretics, copaibae, cubebs,
turpentine, &c., operate upon the vital properties of the
urinary apparatus, in producing diuresis, or that belladonnal, stramonium, strychnia, conia, alcohol, and the
vapours of ether, or chloroformn, expend their force upon
thespiritual properties of the brain and nervous system;
or that the preparations of mercury, iodine, &c., exercise their powerful influence upon the organism, by impressing immaterial, imponderable, or vital properties?
We think it is more consistent with known facts and
sound logic, to suppose that all such agents exert their
influence primarily upon the sentient extremities of
the nerves, modifying the functions of those parts which
they supply, increasing their susceptibility to the influence of foreign agents, and thus establishing inflammation or a new action.
* Paine's Institutes of Medicine.
3*




SUSCEPTIBILITY OF ORGANS, ETC.
It has been remarked by Paine and others, that arsenic, antimony, iodine, mercury, etc., given in certain
small and repeated doses, in disease, are productive of
decisive effects, while the same doses in health, would
exert no appreciable influence. For this reason, they
assert and would have us believe, that the conditions
and properties of diseased parts are so modified and
altered in all respects, as to be incapable of responding
to the action of those medicines which operate specifically in health.
It is quite certain that most medicinal substances
may be taken in very small doses during health, without any apparent effect, on account of the power which
the system then possesses ot' resisting the aggressions
of slight foreign agents; but if the same substances
be taken in large doses, most decided, powerful, and
specific results will follow in all states of the system.
If taken in still smaller quantities, the effects are yet
perceptible, but less Strongly marked. These results
will be unequal in point of intensity in normal and abnormal states of the organism, according to the amount
of disease present; but in all instances, their specific
operations will be uniform.
Tartarized antimony and ipecacuanha, in large doses,
both in health and disease, exercise a specific influence upon the stomach, lungs, and skin, as is indicated by vomiting and augmented secretions from the
respiratory organs and skin. In doses of one-sixth or
one-eighth of a grain, no effect is produced upon the
respiratory muscles or stomach, but the influence is
yet visible upon the skin. If the quantity be diminished still farther, even to an attenuation of Hahnemann, the impression may not be perceptible, either
upon the stomach, lungs, or skin, yet we find them
capable of influencing the extreme nerves in a decided manner. It does not follow, because a patient
does not vomit, purge, or sweat, that a medicine has
no effect. On the contrary, we know that morbific
agents give rise to the most virulent diseases without
creating the slightest sensation in the system at the
period when the noxious impression is made. The
direct and sympathetic effects of such causes are,
however, severe and dangerous.




SUSCEPTIBILITIES OF ORGANS, ETC.    59
The experiences of a host of honourable and scientific
men have proved, beyond a doubt, that minute quantities of medicinal agents may produce salutary influences in the same manner; and the law obtains with
regard to all specific medicines. The effects in these
instances may not indeed be sufficient to induce
emesis, catharsis, or other violent effects in any part
of the body; yet from the-great sensibility of the
minute nervous ramifications, they must receive impressions and be modified in their action, when the
trunks, or larger branches of nerves, would remain
unaffected. Who shall decide when the quantity has
become too small to produce an effect upon the most
sensitive parts of the body? Shall the allopath, because he does not witness vomiting, purging, or
sweating; or the homoeopath, who from accurate observation in numerous instances, notes from infinitesimal doses, prompt and decisive curative effects?
To illustrate our meaning more fully, we will suppose a certain medicine possesses the power, when
given in large doses, during health, of affecting a particular tissue. The same substance, administered in
very small doses under the same circumstances, has
no apparent influence. If, now, the tissue for which it
has a specific affinity, becomes inflamed, its suscepti.
bility is so acute, that an extremely minute quantity
of the specific agent is capable of making potent and
salutary impressions.
The other parts of the organism which become disordered through the media of the sympathetic nerves,
also acquire an exalted sensibility which renders them
highly impressible, and capable of being acted upon
by infinitesimal quantities of specific medicinal agents.
Homceopathic remedies, as Paine has well observed
of medicines generally, act only through these "acquired relations," and their power ceases as soon as
these acquired relations have been removed and
health re-established.
We shall appreciate, then, the importance of selecting 4 remedy which shall cover, not only the
symptoms resulting directly from the tissue primarily
affected, but which shall embrace all of the remote




IO        OSUSCEPT1BIIITY OF ORGANS, ETC.
sympathetic effects. In other words, we must prescribe for the "totality of the symptoms."
"It will now be apparent, from what has been said
in the preceding section, how  it is that remedial
agents will call into salutary reacting, sympathies in
various parts of the body not affected by disease, but
whose susceptibilities are increased by morbific sympathies reflected from the seat of absolute disease,
and upon which parts'the remedial agents'might
otherwise be inoperative. Whatever, too, may be the
complexities of disease, the right remedy will be at
least compatible with the whole condition." *'"A particular state of one organ, such as inflammation, or a secreting action in it, often causes the production of a similar state in other parts."  And, "the
principle of the balance of sympathy teaches us how
we must avoid aggravating the morbid condition of
one organ by the means which we apply to another."t
An adherence in all cases to Hahnemann's axiom,'" similia similibus," in our remedial measures, is the
only means by which this last objection can be obviated with any certainty or success.
It is proper to remark, before concluding this chap.
ter, that there are a few apparent, though not real
exceptions to the principles which we have advanced.
A most remarkable one is observed in the case of
tetanus, where enormous quantities of opium, both in
a crude form and in tincture, may be administered by
the stomach or rectum, without producing any marked effect. This fact, however, by no means proves
that the susceptibility of the parts for which opium
is a specific, is diminished; but it proves only that absorption is prevented. If opium is injected into the
veins, under these circumstances, it has been found
by Majendie, Orfila, and Mfiller, that it exerts its
influence in the same manner and degree as when
taken during health.
We suppose, therefore, that in tetanus, the lacteals
and other absorbents, are in a state of spasm, and thus
mechanically exclude the entrance of all substances
* Paine's Institutes of Medicine.
Miiller's Physiology




ALLOPATHY.                 61
from their structure. In this manner, opiates and
other drugs are shut out of the circulation, and, consequently, cannot be brought into contact with those
parts of the nervous system upon which they exert
their specific force, and where alone- they possess the
power of producing their legitimate effects..
All cases of this description, are simply apparent
exceptions to the general rule, and do not in the
slightest degree invalidate the general principles
which we have advanced.
CHAPTER VIII.
ALLOPATHY.
It would be very difficult at the present time, to
give an accurate definition of the above term. The
axiom which is adopted by a portion of the disciples
of the allopathic school, and upon which their hypothetical doctrines are founded, is " contraria contrariis
opponenda."  Although distinctions are recognised
between the antipathic or palliative, the allopathic or
heteropathic, and the chemical, methods of practice,
yet in point of fact, they may all, with propriety, be
resolved into one and the same school. All employ
venesection, emetics, purgatives, diaphoretics, and
alteratives, to reduce inflammations; opium to allay
pain and suppress unnatural discharges; bark, iron,
brandy, &c., as tonics; blisters, setons, moxas, issues
and esecharotics to produce counter-irritation; revulsives, derivatives, and indeed all of those means which
are termed allopathic.
Allopathists do not, however, uniformly adhere to
any of the above doctrines, but often unconsciously
encroach upon homaeopathic ground, and by practising according to the law of "similia similibus," effect
their speediest and safest cures.
Thus, rhubarb and calomel, when administered in
large doses during health, cause irritation or inflam



62                  ALLOPATHY.
mation-of the membranous tissue of the bowels, as is
indicated by griping pains, and discharges of watery
or mucous fluids; yet these are favourite allopathic remedies for diarrhwea and dysentery: copaibm, cubebs,
turpentine, and cantharides, when given in large and
repeated doses in health, induce inflammation of the
mucous membranes of the urino-genital apparatus;
yet these specific medicines are almost invariably
prescribed in the acute and chronic affections of
these parts: ipecacuanha in doses of twenty to thirty
grains, is the most common emetic of the old school;
yet this same school are constantly in the habit of administering this drug in doses of one-twelfth or onesixteenth of a grain, in cases of obstinate nausea and
vomiting, with the most happy results: inhalations
also of the particles of ipecacuanha, cause asthma,
cough, dyspncea, &c.; yet it is a common remedy in
small quantities for the cure of these complaints:
excessive use of alcoholic liquors or opiates, often induces mania a potu; yet opium and brandy, which
exercise the same specific effect upon the brain, are
the principal allopathic cures of this dangerous malady: the preparations of mercury, when given in
considerable quantities, cause ulceration and sometimes gangrene and sloughing of the mouth and
throat, pains in the muscles and bones, eruptions upon
the skin, and inflammation of the bowels, attended
with tenesmus, and mucous and bloody stools; yet for
syphilitic and other ulcerations of the throat, pains in
the limbs, eruptions, and bowel affections, the use of
small doses of this mineral, in some form, is deemed
indispensable by the allopath. Sir Astley Cooper, in
his Lectures, observes,* "Children often contract syphilis in utero, and within twenty-four hours after
their entrance into the world, have the palms of their
hands, the soles of their feet, and the nates, covered
with copper-coloured eruptions; and the nails begin
to peel off, and if care be not taken, the little patient
will sink under the effects of the disease. In these
cases, you give the mother a quantity of mercury, the
influence of which is communicated to the child,
* Cooper's Manual of Surgery, by Castle,




ALLOPATHY.                  63
through the medium of the milk, and it becomes
cured of the syphilitic disease."  This is excellent
homceopathic treatment: the mercury in this instance is attenuated in the mother's milk to a very
great extent-probably to such a degree that no analysis can detect it, or any scales weigh it, and yet Sir
Astley Cooper assures us that the infinitesimal quantity of mercury which finds its way to the milk of the
mother, is sufficient to effect a speedy cure upon the
child. In this instance nature, instead of art, attenuates the drug. Tartarized antimony exercises a specific effect upon the lungs, stomach, and secretory
organs, causing, according to Majendie, an inflammation or engorgement of the two first named organs,
whether taken into the stomach or injected into the
veins; yet this is the sheet-anchor of allopathy in
pneumonia, pleurisy, and in the first stages of gastric
or bilious fevers. Arsenic has a specific influence when
taken in large doses, in health, upon the nervous
system, heart, skin. and alimentary canal; and this is
an important old-school remedy in neuralgia, epilepsy, chorea, angina-pectoris, cutaneous affections,
and intermittent fevers. When nitrate of silver is absorbed in health, it makes a specific impression upon
the nervous system and the corium; allopathists employ it in epilepsy, chorea, and in morbid sensibility
of the gastric and intestinal nerves. Large and repeated doses of nux vomica or strychnia, taken in
health, produce "rigidity  and convulsive contractions" ot the muscles; yet in cases of traumatic tetanus, strychnia has effected cures in the hands of allopathic physicians, in doses of J- to -I- of a grain:*
its specific action under all circumstances, is upon the
cerebro-spinal system, and thus its efficacy when
properly exhibited in tetanus, epilepsy, chorea and hysteria. Belladonna, taken in health, gives rise to inflammation of the throat and a scarlet eruption upon the
skin; and yet this remedy is highly extolled and extensively used by many leading men opposed to homceopathy, as a prophylactic against scarlatina. An
* See report of tetanus cured with strychnia, by Dr. Fell. 8th number
of N. Y. Med. and Surg. Reporter.




64                  ALLOPATHY.
eruption resembling psora is often produced by an
excessive use of sulphur and iodine; still these are
the grand remedies in cutaneous affections of this
kind. Pereira prescribed prussic acid to a lady who
had been suffering for months from gastrodynia; in
a few hours, to the astonishment of every one, she
was quite well. "It can hardly be imagined," says
Pereira, "that irritation of the stomach can be rapidly removed by a substance which is itself an irritant." The direct application of blisters to surfaces
affected with rheumatic, erysipelatous, and other natural cutaneous inflammations, is constantly recommended at the present time by the Hippocratics.
"Erysipelas and other cutaneous inflammations may
be removed by the direct action of cantharides upon
the part inflamed.  The remedial agent, in these
cases,' varies the mode of inflammation, and thus introduces a modification in which the properties of
life are brought into recuperative action" (Paine's
Institutes of Medicine); yet they affect a superlative
contempt for the law of" similia similibus curantur!"
It is from experience alone that the old school physicians have learned that ipecac., in doses of 2~ to ov
of a grain, arrests nausea and vomiting, and imparts
tone and vigour to the stomach; that calomel, in doses of -l of a grain, is invaluable for the cure of inflammation of the mucous membranes of the bowels:
" in cases of inflammation of the mucous tissue of the
intestines attended with frequent watery discharges,
there is nothing comparable with calomel, in doses
varying from the twentieth to the eighth of a grain,
once in four to twelve hours:" —(Paine's Institutes of
Medicine.)  That quinia, in doses of J-'J or J6 of a
grain, is more efficient in removing remittent and intermittent fevers, and as a general tonic in diseased
states of the system, than when exhibited in quantities of from one to ten grains at a dose: "quinia in the
dose of 5 or 10 grains, may speedily arrest an intermittent fever by its febrifuge virtue; but this is bad
practice, since, by its associate tonic virtue, it is
likely to increase or to induce local congestions; thus
leaving the patient imperfectly cured, and subject to
relapses: I have seen, in my own family, the most




ALLOPATIHY.                65
formidable grade of remittent fever, of long duration
and attended with the foregoing complications, ardent heat, thread-like pulse, loss of mind, &c., and
where hope of recovery had been abandoned, yield to
less than a grain of quinine, divided into sixteen doses"-(Paine's Institutes of lMedicine); that strychnia,
in very minute quantities, will cure tetanus; that the
class of remedies denominated alteratives, are capable
of producing powerful effects upon the organism, and
that too, in a manner altogether unknown and imperceptible.
But how do these physicians know that the virtues of these medicines cease at these points? Have
they ever made honest trials of them in a pure form,
and in doses of al, T, or a still smaller proportion
of a grain, and learned from  actual observation that
they have then lost their power of impressing diseased
structures? We venture to affirm, never, or they
would long since have deserted the standard of allopathy.
This leaning towards the modern theory is not
altogether confined to the few practical cases which
we have cited, but some of their most eminent writers have approached so near to the views of Hahnemann, that we are at a loss whether to rank their
theoretical doctrines as homeopathic or allopathic.
The distinguished Pereira, in his Materia Medica
and Therapeutics, writes as follows: " Unguents and
lotions are used in cutaneous diseases, ulcers, &c.;
gargles in affections of the mouth and throat; collyria in opthalmic diseases; and injections into the
vagina and uterus in affections of the urino-genital
organs. In all such cases, we can explain the therapeutical effect in no other way than by assuming that the
medicine sets up a neztkind of action in the part affected,
and that the new action subsides when the use of the
medicine is suspended or desisted from."
This explanation is the true one. The medicines
in these cases, as well as in all other instances where
appropriate specific remedies are used, do "set up a
new kind of action in the part affected," creating a medicinal disease which supersedes the natural one.
The only fault we have to urge against allopathists




66                   ALLOPATIIY.
in the treatment of these and analogous cases, is,
that they give much too large doses, and thus create
a far more violent medicinal disease than is necessary.
to bring about their cures. Notwithstanding, however, their errors in exhibiting medicines in a crude
and impure form, and in unnecessarily large doses,
we must give them  the credit, (fiat justitia ruat
coelum,) of occasionally curing disease (although unwittingly) in a " rational and consistent" manner.
Paine, in his Institutes of Medicine, remarks, " that
when the intestinal mucous tissue is affected with
that condition of disease which results in a preternatural watery secretion, and consequent evacuations,
which is called diarrhea, and rhubarb is administered
in a certain dose, this substance first impresses the
membrane in such a way as to determine an increase
of the peristaltic movement; but it simultaneously
alters the morbid state of the intestinal mucous tissue in
such a way that the natural secretion is arrested.
Whether, therefore, the rhubarb purge, or prove astringent, or tonic, a common principle, and common
laws are concerned throughout; and all the sensible
results depend upon certain alterations which the agent
effects in the vital properties and actions of the vessels
or tissues which are the seat of the morbid conditions,
or in which the various phenomena may take place."
The same principle directs the practitioners of the
old school in the treatment of many other diseases,
and yet they sneer at homeopathy, and hold up their
own inconsistent and uncertain doctrines as philosophical and correct! Gentlemen of the old school,
your practice too often belies your profession: you
pretend to be allopathists and antipathists, while constantly administering medicines after the manner of
the homceopathist. Instead of tbiding by the theoretical doctrines which have come to you from rude
and (lark ages-doctrines which have received seals
of approbation from the alchemist, the astrologer, and
the sorcerer-you have stealthily, and, doubtless, in
many instances, unwittingly, abandoned your legitimate ground, and practised upon the principles of our
modern heresy! Where is your pride, where your
consistency?  You have the boast of antiquity, you




ALLOPATHY.                67
have received your "bundle of ideas" from Hippocrates and Galen, to whom you pay reverence and
allegiance; you disdain innovations, and despise discoveries and improvements; you have withstood the
changes of more than two thousand years, and, by
your powerful dicta, have continually discouraged all
original induction, and endeavoured to crush in the
bud every advancement in medical knowledge.
Where is now your former pride, that you so often
practically abandon your time-sacred axiom, "contraria contrariis," and adopt the new heresy, "similia
similibus?" Perhaps the light of modern science and
discovery breaks, against your will, through the crevices of your unjointed and heterogeneous theories, or
you are startled from your propriety by the whelming
accumulations of fact which Hahnemann and his disciples have displayed so bravely before the world;
or, possibly, the disrespect and abuse of some of the
most eminent and able of your caste, has impaired all
confidence in, and respect for, your own dogmas and
their applications, and you are at sea in search of a
system. Are we wrong? If so, we have excuse in
the following, from  the distinguished editor of the
British and Foreign Medical Review, Dr. Forbes,
who asserts:
"' 1. That in a large proportion of the cases treated
by allopathic physicians, the disease is cured by nature, and not by them.' 2. That in a less, but still not in a small proportion, the disease is cured by nature in spite of them;
in other words, their interference opposing instead of
assisting the cure.
" 3. That, consequently, in a considerable proportion of diseases, it would fare as well or better with
patients, in the actual condition of the medical art,
as more generally practised, if all remedies, at least
all active remedies, especially drugs, were abandoned.
We repeat our readiness to admit these inferences as
just, and to abide the consequences of their adoption."
Beware, then, most ancient goddess, survivor of all
thine earlier contemporaries-of alchemy, and astrology-lest thou fall, and thy doctrines, handed down
througah the dark ages, through the juggling temples




68                 ALLOPATIIY.
of idolatrous priests, be swallowed up ill the deluge
of new facts and discoveries which the nineteenth
century is pouring upon the world. But, seriously, it
is a matter of no little surprise, that while anatomy
has made most rapid strides, unfolding the secrets
pertaining to the most minute structures of the animal organism; while botany and mineralogy have
displayed before our eyes the wonders of the vegetable and mineral kingdoms, and pointed out the laws
of their formation, development, and even of their
very existence; while chcmistry has grasped some of
the most subtle agents in nature, and developed improvements in the arts and sciences which have continually startled and astonished the world, as well for
useful as for purely scientific results,-medicine, until
the time of Hahnemann, has been crushed under the
weight of antiquated doctrines, and the legalized
power and oppression of the schools.
We have thus far made allusion to that part only
of the allopathic practice which bears some approximation to the correct method. In most of the instances enumerated, specific medicines are employedmedicines that produce a similar state when given in
health, to that which they are to cure. Although
large quantities of crude and impure drugs are used
in these instances, and the medicinal diseases are
thus rendered violent and complicated, still it must be
admitted that occasional cures are accomplished.
But we come now to a more interesting and momentous part of our subject. It becomes our duty to lay
before our readers the doctrines and practice of allopathy, as they actually exist; to note their many inconsistencies, and to point out some of the innumerable
evils which they entail upon mankind.
We have seen that in the treatment of disease, the
old school physicians make an indiscriminate use of
the palliative, heteropathic, and in a few instances, the
homceopathic methods of practice.
A general idea prevails, that all diseases consist in
"local determinations of blood," and that no two affections of any consequence, can exist in different parts
of the same organism, at once. On this account it is,
that new diseases are created in healthy parts, for the
purpose of removing the primary natural one.




ALLOPATHY.                 69
Physicians have been led to adopt this mode of reasoning from observing that the spontaneous appearance of cutaneous eruptions, discharges of blood, profuse perspirations, &c., occasionally afford relief to
morbidly affected internal organs. Without reflecting that these results are merely symptoms of the internal disorders, and that the causes upon which these
signs depend are located in the blood, they attempt to
annihilate diseases, by imitating artificially these symptoms.
In regard to the first position, we affirm that their
premises are untrue. There are no facts which warrant the statement, that "no two excessive determinations of blood can exist in the same individual at
the same time." Neither is it true, that the appearance of cutaneous eruptions, spontaneous sweats,
diarrhzea, and discharges of blood. are invariably,
or even generally, indications that the affected organ
is in process of restoration, or that the system at large
is recovering its lost energy and vigour; since it often
occurs that the symptoms of the complaint are all aggravated, upon the supervention of either of the above
occurrences.
Dr. WVilson observes, that " there is often a remarkable tendency to the worst species of hemorrhages
from the bowels, towards the termination of fatal cases
of phrenitis."
Dr. Eberle, in his Practice of Physic, remarks, " On
the day preceding the fatal termination of a case of
phrenitis which came under my own observation, an
exceedingly copious discharge of dissolved blood took
place from the bowels, and on the following morning
the heemorrhage occurred also from the mouth and
gums."
Let us suppose a case of phrenitis. We have here
an inflammation, or a congested state of the capillaries of the brain. To relieve this inflammation, and
withdraw a portion of the fluid which is concerned in
the congestion, blood-letting, both general and local,
is resorted to as a primary and indispensable process
of cure. By this means, the general strength is reduced, the pulse increased or diminished in frequency,
and the temperature of the skin altered, but the con



70                   ALLOPAt11Y.
gestion still continues, and the morbid and debilitated
state of the extreme vessels (in which the disorder
alone resides) remains the same as before.
A resort is then made to revulsives and counter-irritants, in order that new inflammations may be created in healthy structures, which shall supersede that
already existing in the brain. To effect this object,
purgatives of the drastic kind are exhibited, and blisters applied to the head, neck, and lower extremities,
in order that the intestinal canal, and portions of the
skin, shall be placed in a state of artificial inflammation.
Let us understand the case clearly. We have a
disease consisting solely in a loss of tone and irritability of the serous vessels of the brain, which prevents
them from excluding the red blood, and of performing
properly their functions. To obviate this condition, a
quantity of blood is abstracted, and artificial or medicinal inflammations are caused in the intestinal
canal, and upon different parts of the surface of the
body.
We now  inquire in what manner these violent
means can, by any possibility, reach the seat of the
malady, and impart tone and vigour to the weakened
capillaries, so as to enable them to exclude from their
structure the red globules, and resume their healthy
function?
All will concede that inflammation consists in loss
of tone and irritability in these vessels, and that no
cure can take place, until this impaired irritability is
restored. In inflammation, according to Philip, Hastings, Eberle, Wilson, and Allan, the capillaries of the
part are in a state of debility, and passive relaxation.
The immediate exciting cause of inflammation may
be either stimulant or sedative. In both instances the
impression is made upon the nervous filaments of- the
capillaries, and if the cause acts as a stimulant, the
reaction which must follow this augmented action,
will leave these delicate nerves in a state of debility
proportionate to the amount of the previous excitement.
If the primary cause is directly sedative, no reaction
will occur, but a similar state of relaxation will obtain
as in the former instance.




ALLOPATHY.                 7 1
How, then, we repeat, can venesection, cathartics
and blisters affect the necessary object? They do not
certainly prevent the red blood from still entering the
relaxed capillary tubes, for the whole remaining mass
must continue to circulate through the brain, as well
as other parts of the organism, every few minutes.
By lessening the quantity of blood, we also abstract
a portion of that natural stimulus of the organism,
which is one of the essential conditions of irritability.
" Every part of the organism depends, for the performance of its proper functions, on the receipt of arterial
blood and of nervous influence; so alterations in the supply of either of these essentials, may modify or even suspend the functions of a part."*
How absurd and pernicious then, in inflammations,
the very essence of which is debility and loss of tone,
to detract from one of those conditions upon which
this very tone and vigour depends! As well might you
remedy the breach through which the waters of a
raging torrent are madly rushing, by turning off from
its course a small quantity of this element. As well
attempt to suppress the leak of a storm-tossed vessel,
by diverting a portion of the stream on which she
floats, from its natural channel.
It is not the blood which is at fault; but a portion
of the organism. Correct therefore the cause of the
disturbance by direct and appropriate specifics, and
you may then, and not until then, effect cures, safely
and philosophically. Seek not to deprive the system
of that fluid which is so essential to the organism, and
on whose integrity its functions depend; for by so doing, the cause of the malady will remain untouched.
It is very true, that when a large quantity of blood
is abstracted, during inflammation, there will seem to
be in some instances an apparent amelioration of all
the symptoms, but this effect is only temporary; for
as soon as reaction comes on, the enfeebled capillaries
again admit the destructive " carriers of oxygen" as
before; the state of congestion and inflammation remains, while the system at large has lost a portion of
that stimulus which conduces so materially, not only
* Pereira's Mat,. Med




72                  ALLOPATHY.
to sustain the normal integrity of the functions in
health, but to aid in the restoration of enfeebled and
diseased parts.
The remedies which stand next in importance in the
old school method of treating phrenitis, are revulsives
and counter-irritants. It is supposed that by exciting
the intestinal exhalents, inflaming the membrane of
the bowels, and portions of the skin, the circulation is
diverted from the brain and directed especially to
these parts.
But by this means is the brain in reality relieved?
Is the whole mass of blood thus prevented from circulating as usual through this organ once in three or
four minutes, or the character of its red globules
changed?  By exhausting the energies and resisting
force of distant healthy structures, and creating sympathetic symptoms throughout the body-thus complicating the already existing disease, and impairing the en.
tire nervous and muscular energies-are the inflamed
capillaries of the brain placed in a more favourable
condition to recover their impaired tone and irritability? Every man who has a correct idea of the
laws which govern the organism in health and disease,
and who is willing to banish prejudice and be guided
by common sense and true philosophy, must answer
in the negative.
We object to these remedies, however, not only because they are incompetent to produce salutary impressions upon inflamed parts, but because of the
evils of a positive character to which they give rise.
The chief remedies of the old school, are the preparations of mercury, opium, antimony, and bark. In
a vast majority of all the cases treated by the practitioners of this school, one or more of these articles is
made use of. Indeed, scarcely a single malady of any
moment can be named, in which one of these medicines is not considered indispensable.
Let us then examine some of their effects, in allopathic doses, upon the healthy and diseased organism.
1. MERCURY.
This mineral is more uncertain in its action, in all
states of the system, than any other article in use. It




ALLOPATHY.                  73
possesses the power in different constitutions, and under certain circumstances, of affecting nearly every
organ and tissue of the body; and it is not in the
power of the most judicious physician to say beforehand, where or in what manner, it will exert its force.
Some of the more common deleterious effects of the
use of mercury, are, excessive salivation, ulceration,
gangrene and sloughing of the gums, mouth, sand throat,
gastro-enteritis, mercurial erethism, dysentery, cutaneous
eruptions, inflammation of the periosteum  and bones,
nodes, excessive derangement of the nervous system, paralysis, tremors, necroses of the maxillary and other bones,
rheumatism and opthalmia.
When mercury is administered, even in a moderate
quantity, no human being can be at all certain that
one or more of these evil consequences will not result.
Indeed, it is the direct object, oftentimes, to produce
some of them, to operate as counter-irritants.
Whether it is employed in large or small quantities,
solid, or in the form of vapour, is of little importance,
so far as its power of affecting the system is concerned.
The following, from the Ed. Med. and Surg. Journal,
illustrates the baneful influence of the vapour when inhaled: "' In 1810, the Triumph man-of-war, and Phipps
schooner, received on board several tons of quicksilver,
saved from the wreck of a vessel near Cadiz. In consequence of the rotting of the bags the mercury escaped, (and the whole of the crews became more or less
affected. In the space of three weeks 200 men were
salivated, two died, and all the animals, cats, dogs,
sheep, fowls, a canary bird,-nav, even the rats, mice
and cockroaches, were destroyed."
The following cases resulting from the employment
of calomel, have come under my own observation, viz.,
three cases of necrosis of the inferior maxillarv bones,
requiring the removal of portions of the jaw; several
cases of gangrene and sloughing of the mouth and
throat, which have terminated fatally; a number of
cases of mercurial palsy; numerous instances of ulceration of the nose, throat, &c.; skin diseases, affections of the bones, nodes, rheumatic affections, &c., &c.
Professor Chapman, after descanting upon the woful effects which have so often been produced by cal



74                  ALLOPATI*Y.
omel, and referring to many disgusting cases of mercurial disease which have come under his own observation, thus concludes: " Who is it that can stop the
career of mercury, at will, after it has taken the reins
in its own destructive and ungovernable hands? He
who, for an ordinary cause, resigns the fate of his patient to mercury, is a vile enemy to the sick; and if
he is tolerably popular, will, in one successful season,
have paved the way for the business of life; for he
has enough to do ever afterwards to stop the mercurial
breach of the constitutions of his dilapidated patients.
He has thrown himself in fearful proximity to death,
and has now to fight him  at arm's length as long as
the patient maintains a miserable existence."
And this dreadful poison is the most common,-yes,
the daily remedy of allopathy, for almost every disorder, whether mild or severe, acute or chronic. This
is the agent with which artificial diseases are created
in healthy parts, to cure primary or natural ones 
This is the substance with which unfortunate mortals
are drugged, from the time they come into the world,
until their wretched and too often premature departure, with its well-known and generally admitted evils
and dangers,-from the contemplation of which the
well-instructed and experienced allopath shrinks with
instinctive dread, —and its questionable value in most
instances of its prescription, it may justly detain our
attention. Calomel and opium are the common remedies in the traditional practice. We shall see to
what degree they may be used in a practice that is
philosophical.
By glancing at the standard works on the practice
of medicine, it will be observed that there is scarcely
a single malady, either acute or chronic, in which one
or both of these articles is not recommended as an important if not indispensable means of cure. Taking
Eberle's Practice of Medicine- an approved allopathic work-as a fair illustration of their views and
practice, it will be seen that of the one hundred and
thirty-nine diseases, upon which these two volumes
treat, there are only ten, in which calomel or opium in
sonme form is not recommended. The following are
the names of these exempt diseases, viz: mumps,
ring-worm, nettle. rash, scurvy, chronic cystitis, hysteri



ALLOPATIIY.                 75
tis, asphyxia, roseola, hmmatemesis, and nose-bleeding.
Nor are these remedies advised simply as auxiliaries
in the treatment, but in a large majority of cases, they
constitute the principal means of cure.
The allopath is taught to believe that mercury excites the functions of all the organs-acts specifically
upon the liver, salivary glands, heart, lungs, and nervous system —and therefore that it may be administered
almost universally. Regardless of the secondary sympathetic affections to which it usually gives rise, he
attributes all of these symptoms to the natural disorder, and if the patient succumbs before the combined
attacks of the primary disease and the medicinal one,
he consoles himself with the reflection that he has followed his authorities and prescribed as his predecessors
have done for centuries before him.
Ask him what are his views concerning inflamlation, and he answers that it consists in a debilitated
and congested state of the capillaries of the part affected. Ask him what is the modus medendi of mercury
in the cure of inflammation,-how any of its effects
can reach the seat of the malady, the congested capillaries, and restore to them their impaired tone and
healthy functions, —and he either avows his ignorance
or offers an unsatisfactory explanation.
2. oPIUM.
If we except calomel, this drug and its preparations
are more frequently used by the medical men of the
old school, than any other article in the Materia Medica. Possessing the power, as it does in an eminent
degree, when exhibited in large doses, of covering
(not curing) symptoms, and of shutting the mouths
of clamorous and inquiring patients, it is used constantly and indiscriminately in nearly all protracted
maladies.
Let us then briefly examine the effects of opium in
health and disease, and see if it possesses the wonderful property of reaching every structure, and of counteracting so many diverse and contradictory symptoms.
Its effects upon the human system, in medium doses,
are in the first instance stimulating, succeeded in a
short time by diminished sensibility and desire to sleep.




76                 ALLOPATHY,
"This continues from eight to twelve hours, and is
followed by nausea, headache, tremors, and other
symptoms of diminished and irregular nervous energy.
All of the secretions, with the exception of that from the
skin, are either suspended or diminished."* These effects, with a very few exceptions, are uniform under
all circumstances, so far as we can judge.
How, then, is this substance applicable to the
treatment of so many diseases?
We have remarked that in all maladies, there exists
an inflammation of an acute or sub-acute character,
in some part of the organism, and it is the presence of
this inflammation which maintains and perpetuates
them.
We have also observed that all inflammations consist in a congested state of the capillaries of the part
affected, caused and kept up by a loss of tone, resisting power, or irritability, which disables them from
resisting the intromission of red blood.
It is apparent, then, that in order to prove efficient,
such remedies should be exhibited as are capable of
acting upon the seat of the complaint, and of restoring the delicate capillary nerves to their normal state
of integrity. Opium cannot accomplish this, for its
operation tends to impair the nervous energy, instead
of adding vigour, to dry up most of the secretions, instead of aiding nature to give vent to the poisonous and
pent up fluids, it induces nausea, headache, tremors,
and many other medicinal symptoms of sufficient severity to make a healthy man sick, or to complicate
to a serious extent any existing natural affection.
If it be urged that opiates have the power of allaying pain, while other more efficient measures are
pursued to effect the cures, we reply, that by covering
up the pain, the real state of the case is concealed;
other new symptoms set in, which will be unnoticed
by: the benumbed patient, while secondary sympathetic affections will be propagated to every part of
the body, aggravating and complicating the original
disorder.
Opium is also highly extolled in low forms of fever,
* Wood and Bache, U. S. Dispen.




ALLOPATHtY.                 77
and other complaints, where the powers of the system
are in an exhausted condition. But let it be remembered, that the stimulating effect of this drug is of short
duration, and that the corresponding reaction or depression will bear an exact ratio to the previous exaltation. This law is fundamental; for the system
possesses but a definite and limited amount of vital
power, and is capable of resisting only a limited degree of unnatural action or disease, so that we can
readily perceive how opiates, and other stimulants,
must ultimately prove deleterious.
It is true that perspiration is promoted by the use of
this narcotic, but this does not cure.  Sweating is
merely a symptom, and it may be favourable or otherwise. When excited artificially by medicine, it is not
productive of benefit, because this adds nothing towards invigorating the weakened capillaries.
"Perspiration induced by medicine is of little moment, unless the remedy simultaneously impresses,
directly or indirectly, the parts diseased; and then the
salutary results, so far as the surface is concerned,
depend upon special vital influences exerted by the
remedy upon the skin and reacting sympathies. This
is exemplified by the profound effects of tartarized
antimony and ipecacuanha, the uselessness of hot
water, and the frequent pernicious results of the compoundpowder of ipecacuanha, when free perspiration
may follow the administration of either. The effect,
therefore, depends but very little upon the evacuation
from the skin, as produced by what are called sudorifics." *
It is proper to observe that opium may, and sometimes does, effect cures in the hands of allopathists,
when given as a specific. Its curative virtues in mania a potu and intoxication, even in large doses, are
well known. In these instances, the remedy impresses
directly the part diseased, and cures hcmaeop'athically.
It is quite true that an infinitesimal quantity of the
drug, properly prepared, will always prove more efficient, speedy, and safe, in accomplishing the object,
and will not give rise to the unpleasant medicinal
* Paine's Inst. of Med.




78                 ALLOPATHY.
symptoms which necessarily attend the employment
of large doses; yet the fact must be conceded, that
clumsy and unscientific cures are occasionally effected
by the course alluded to.
An interesting case is related by Pereira, illustrative of this.  "Opium  is sometimes employed by
drunkards to relieve intoxication. I knew a medical
man addicted to drinking, and who for many years
was accustomed to take a large dose of laudanum
whenever he was intoxicated, and was called to see a
patient."  The specZfic effects of the alcoholic stimulants and opium, given during health, are exerted as
remarked at page 43, upon the same organ; and we
should therefore expect that a malady caused by the
excessive use of the one, might be cured by the specific
action of the other.
TARTARIZED ANTIMONY.
This salt has been several times formally banished
from the Materia Medica, on account of its dangerous
qualities, and as often revived again.
The Faculty of Medicine, at Paris, in 1566 and
1615, passed solemn decrees against it, as a virulent
poison, and these decrees were even sanctioned by
parliament, though afterwards formally reversed.*
Since this period, some have loudly extolled its virtues in the treatment of a great variety of diseases,
while others have as earnestly condemned its use, as
deleterious in all cases.
The celebrated Professor Nathan Smith, in his
Essay on Typhus Fever, remarks, " I have seen many
cases in which persons in the early stages of this
disease were moping about, not very sick, but far
from being well, and who, upon taking a dose of tartarate of antimony, with the intention of breaking up
the disease, have been immediately confined to their beds."
He arrives at the conclusion, after much experience,
that " tartar emetic should not be used in this affection, even at its commencement; and in the latter
stages of the disease, that it is sometimes followed by
fatal consequences."
* Vale.




ALLOPATHY.                 79
In emetic doses, tartarized antimony irritates the
stomach, causes congestion, and sometimes inflammation of the lungs, attended with more or less constitutional disturbance. When it fails to produce emesis
speedily, it often acts violently upon the bowels, giving rise to severe griping pains and watery evacuations. The tenderness of the stomach and intestines,
and the constitutional disturbance which succeeds its
emetic and cathartic operation, indicates the injury
which these delicate structures have sustained.
The primary impression of antimony is not the only
objection against its employment; for, like calomel
and opium, it gives rise to numerous secondary-symptoms in remote parts, which tend to aggravate in a
serious manner any natural affection which may be
present. One of the most important of these secondary
evils, is dilatation of the ventricles of the heart. Having witnessed this result in several instances, one of
which occurred in my own family, my attention has
been particularly directed to the subject, and I am
fully of opinion that cases of this description, from the
use of antimony, are by no means unfrequent.
CINCHONA.
In intermittent fevers, general debility, and in certain stages of most other affections, Peruvian bark and
its preparations are usually employed by the old
school. For the cure of the former, especially, quinine
is the remedy upon which universal reliance is placed;
possessing the property, when used in large and repeated doses, of speedily arresting the chills and fever,
it is constantly prescribed for this malady, without
the slightest knowledge of its processes, and without
any regard to the dangerous medicinal disorders which
it superinduces.
All allopathists who have had much experience in
the treatment of fever and ague, are aware that the
mere suppression of the paroxysms by no means restores the patient to health; for in a great majority
of instances, he lingers for months or even years in a
diseased and miserable condition. In these cases it is




80                   ALLOPATHY.
probable that a medicinal affection is induced by the
remedy, so serious in its character, as to supersede
temporarily the primary one. This is evident, from
the fact that after the effects of the medicine have
somewhat subsided, the original disorder again generally makes its appearance. In some instances, however, the medicinal affection is so severe as to constitute a permanent disease, and thus entirely usurp the
place of the fever.
" Experience shows that, though bark,and its alkaloids, in large doses, will often arrest intermittent fever suddenly, such doses are liable either to induce
some congestion, especially of the liver or of the mucous tissue of the stomach, or will aggravate and establish some co-existing congestion; and thus while
the patient is for the present relieved of the fever, he
is dismissed with an insidious local complaint that not
only renders him a permanent invalid, (resulting often
in indurated enlargements,) but which local malady may,
and often does become, in process of time, the exciting
cause of another attack offever. In respect to relapses,
it is not unfrequent that, when intermittents are suddenly stopped by a large dose of quinine, the paroxysms return as soon as the patient begins to exercise
much, or to take his ordinary food."*
We should naturally suppose that these untoward
results would deter practitioners from using so frequently these dangerous remedies; or at all events,
as rarely and in as small quantities as possible.
On tihe contrary, it seems to be peculiar to allopathy,
that her advocates take credit to themselves, when
ih'ey succeed in administering this, as well as other
medicines, in larger doses than any of their contemporaries, without destroying their patients. Indeed, so far
has this destructive system been carried, of experimenting upon disease, that the enormous quantity of a
scruple and even half a dram of quinine has been exhibited at a dose, and repeated several times a day.
These monstrous quantities create t gastro-enteritic
irritation, nausea, griping, purging, head-ache, giddi* Paine's Inst. of Medicine.  % Wood and Bache.




ALLOPATHY.                  1
ness, fever, somnolency, in some cases delirium, in
others stupor," &c. Paine asserts that he has witnessed many of these effects " from five grains only;"
yet, as patients sometimes live in spite of this treatment, many persist in adopting these desperate innovations.
There are many other medicines employed by allopathy in the treatment of disease, besides those to
which we have alluded, but in general they serve only as auxiliaries. In this list may be ranked diaphoretics, diuretics, expectorants, refrigerants, emmenagogues, emollients, errhines, &c., but the articles belonging to each of these classes, in a crude state and in
large doses, are liable to important objections.
The fault of those medicines which operate specifically, like diuretics, emmenagogues, &c., in the
hands of allopathists, is the aggravation which they
must necessarily cause, if the part acted upon be irritated or inflamed. This objection will be clearly appreciated, when it is remembered how extremely sensitive to specific remedial impressions, organs and tissues become during inflammation.
The evils resulting from the use of those medicines
which are not specifics, are, first, their inability to
reach the seat of the complaint, and secondly, the
sympathetic derangements to which they give rise in
various parts of the body, the direct tendency of
which, is to retard and counteract the recuperative efforts of nature.
As an example of the first class, let us take the diuretic copaibae, as a remedy for gonorrhcea. In this
example, the remedy doubtless impresses directly the
inflamed membrane of the urethra, but the impression
is so violent that either a decided increase of the inflammation ensues, or the discharge is suddenly suppressed, and some other organ, as the bladder, kidneys,
testicles, or lungs, takes on diseased action. Indeed we
are decidedly of opinion, that not one genuine case of
virulent gonorrhea can be adduced where a safe and
permanent cure has been effected by large doses of
this balsam.
A not unfrequent effect of copiabme in moderate quan4*




82                  ALLOPATHY.
tities, is to excite serious disorder of the lungs. This
consequence I have often witnessed, and I have a patient at this time, who assures me that he is unable to
take a single dose of it, without being afflicted with a
pain in his chest, and cough.
Gastric and intestinal disturbance, also, usually result from its use. In some instances, a troublesome
eruption makes its appearance, rendering it necessary
to discontinue its employment for a time. And yet
with all of these artificial consequences, the disease is
very rarely, if ever, cured by this nauseous substance.
Diaphoretics were introduced into practice by the
advocates of the humoral pathology, under the supposition that their sweating qualities would aid nature
in throwing off the morbid humours. When the hypothesis universally obtained that fevers were %aused
by an excess of one of the four humours, blood, phlegm,
and yellow and black bile, and that this superabundance must be expelled through the pores of the skin,
kidneys, &c., it was a rational deduction that the employment of diaphoretics and diuretics should conduce
essentially to aid nature in the cure.
But when more correct ideas in regard to the nature
and seat of diseases were introduced, and medical men
had learned that spontaneous sweating, diuresis, discharges of blood, diarrhma, &c., in the latter stages of
diseases, occurred in consequence of a natural amendment or a sudden prostration in the powers of the affected parts, and not as an effect of the medicines, it is
a matter of surprise that these uncertain remedies
should have been retained.
The late Professor Nathan Smith, makes use of the
following language, replete with good sense: "As
there is more or less sweating in the decline of most
febrile diseases, and as a general perspiration is often
accompanied with other symptoms of amendment, it
has been looked upon as the natural cure of the disease.
Under this impression, it has been a pretty universal
practice to encourage sweating; but with respect to
the grounds upon which this practice is founded. it is
a question whether the effect has not, in this case, been
mistaken for the cause; that is, whether the sweating
is not the effect of the amendment, rather than the




ALLOPATHY.                 83
cause of it; and if so, it is still more questionable,
whether sweating, produced by art in the beginning
of the disease, would be attended with good effects.
In all cases, zWhere I have seen this sweating regimen
adopted, the practice has been obviously injurious."
Many other eminent professors, as may be readily
proved, entertain similar views in regard to this
subject.
Physiology teaches us that no unusual disturbance,
no inflammation, and no functional derangement, can
accrue to any part of the body, whether by a moral,
physical, morbific, or medicinal agent, without being
followed by secondary sympathetic symptoms in remote parts, more or less severe according to the violence of the exciting cause. The stomach and bowels,
more especially, being the grand centre of junction of
the ganglionic system of nerves, are so intimately
connected with all parts of the economy, that disturbances at either of these points are reflected
through the sympathetic nerves upon remote healthy
structures, thus complicating to a serious and often
fatal extent, any disorder which may already be present.
There is scarcely any part of the machine which is
not called into morbid sympathetic action, by derangements of the stomach and intestines. Even the
presence of' bile, or acid, in unusual quantities, causes
pains in the head and limbs, nausea, and other affections of a distressing nature, until the offending substances are removed.
All of the organs and tissues are so closely connected by the nervous system, that it may be laid
down as a general rule, that no disorder can happen
to one part without implicating, more or less, other
parts, whether diseased or healthy.*  "A particular
state of one organ, such as inflammation, or a secreting action in it, often causes the production of a
similar state in other parts. The principle of the
balance of sympathvy teaches us how we must -avoid
aggravating the morbid condition of one organ by the
means which we apply to another."
iMaller's Physiology.




84                  ALLOPATHY.
How reasonable, then, to expect that artificial medicinal inflammations of the sensitive structures of
the economy, should give rise to secondary affections
of a grave and permanent character.
In conclusion, the theoretical and practical doctrines of allopathy may be briefly summed up as follows:
1. In the rude ages of the world, when the-arts and
sciences were in their infancy,-when vague, indefinite and absurd notions were entertained respecting
diseases,-when anatomy, chemistry, physiology, pathology, botany, and even correct methods of induction, were entirely unknown,-when the imaginations
of men, instead of ascertained facts, were appealed to
in establishing theories, —and when systems of practice
were founded upon merely fanciful conjectures; then
it was that blood-letting, cathartics, diaphoretics,
diuretics, refrigerants, revulsives, derivatives, counterirritants, and most of the other remedies of allopathy,
made their first appearance. As the pathological doctrines of this period were all entirely erroneous, it is
but fair to conclude that their therapeutical inferences
must have been equally incorrect.
2. Whatever may have been the changes in respect
to the theory of disease, from age to age, long established customs, the force of habit, education, prejudice, &c., have served to retain until our own period,
most of the violent, unnatural and pernicious methods
of treatment, invented and adopted by the founders of
medicine.
3. At the present time, everything pertaining to
the theory and practice of the old school is indefinite,
obscure, and uncertain. Scarcely two different allopathists entertain the same views in regard to pathology, and not one can determine beforehand, with any
kind of certainty, precisely what effects his medicine
will produce; yet, in the treatment of nearly all cases,
venesection, calomel, opium and antimony are empyrically, and, we might almost say,universally employed.
In those cases where refrigerants, diuretics, expectorants, &c., are used, they can only be looked upon as
auxiliaries, and are usually administered without any




ALLOPATHY.                 85
accurate knowledge as to whether they promote or
retard the designs of nature.
4. Owing to the absence of any generally received
or consistent theory of disease, allopathists are obliged
to prescribe at random. They strike at the- name, and
not at the seat of maladies, where alone remedies can
prove efficient. Thus it is that patients are so often
reduced to the lowest point, by medicines, while the
disease continues its progress, unchecked.
5. Lastly, there is every reason to believe, that the
production of violent artificial diseases in healthy
structures, for the suppression of natural maladies, is,
upon the whole, far more productive of deleterious
than of beneficial consequences.
In view, therefore, of the present condition of the
medical art, we most earnestly request the allopath
to pause, and reflect deeply and seriously, before persisting in the use of venesection, revulsives, derivatives,
alteratives, and counter-irritants. Let him remember
that a high responsibility attaches to his position,that the welfare, happiness, and lives of his patients
hang upon his judgment and decision,-and that an
improper exhibition of remedies may so complicate
and aggravate the natural disease, as to consign his
patient to a premature grave. Let him look about,
candidly and impartially, and see if there are really
no improvements in the practice of the healing art,
since the times of Hippocrates and Galen. Let him
submit new discoveries and new doctrines to a rigid
practical test, and decide from the results —from the
cures effected-what system is most correct and best
calculated to promote the welfare of the human race.
Let him no longer reverence ancient doctrines and
ancient names, simply on account of their antiquity,
but seek after truth alone, whether of ancient or modern discovery, and found his practice only upon this
certain basis.




86
CHAPTER IX.
HOMCEOPATHY.
When Hahnemann first promulgated to the world
his pathological and therapeutical views, their novelty, their entire variance from all preconceived opinions, and their alleged superiority over all other
systems, when applied to the practice of the healing
art, induced physicians to suppose the man mad, and
his ideas the offspring of a disordered imagination.
It was difficult to conceive that acute maladies
could be cured without venesection, emetics, cathartics, sudorifics, refrigerants, alteratives, and counterirritants, and on this account the great discoveries of
the father of homeopathy were for many years coldly
received, and his arguments answered only by impudent sneers, or senseless ridicule.
Like the illustrious Fulton, who-when he announced to his countrymen the powers of steam, and
first applied this agent to the propulsion of a vesselwas declared, even by his nearest friends, insane, and
his projects visionary; like Harvey, the discoverer
of the circulation of the blood, who was bitterly attacked " by the bigoted abettors of old established
systems, with whispers, inuendoes, and controversial
writings," and himself pronounced a reckless innovator, and unworthy of public confidence as a practitioner; like Galileo, who, after demonstrating the
truth of the Copernican system, was persecuted byhis
rivals, and twice compelled by the inquisition to abjure a system which he knew to be correct; like
Columbus, Newton, Locke, Jenner, and many other
benefactors of the human race, Hahnemann has been
aspersed. and his doctrines, like theirs, have been ridiculed, misrepresented, and contemned; but time has
cast all the calumniators of Columbus, of Galileo, of
Newton, of Locke, of Harvey, of Jenner, of Fulton,
into a deserved oblivion, while the names of these
eminent persons stand high on the roll of fame, and
their discoveries remain to benefit the world.
The public of Europe and America are fast ren



IOMCEOPATHY.              87
dering the same justice to Hahnemann and his doctrines, and the time will ere long arrive, when the
united world will rank him by the side of those great
men to whom we have just alluded. It is even now
conceded by many eminent allopathic writers, that
the hypothetical doctrines of homeopathy are correct.
By referring to page 65, it will be observed that the
pathological views of Hahnemann, and some of the
professors of the old school, coincide in a very striking
manner. Indeed, it is a matter of doubt whether there
can be found in the medical ranks, two more staunch
advocates of the " vital theory," than Samuel Hahnemann, the homoeopathist, and Martyn Paine, the allopathist.
But when we come to the therapeutical inferences
deduced from these opinions, we find a wide and essential difference. The latter, in summing up his
method of treatment, has retained all of the violent
and barbarous remedies of antiquity, with very little
knowledge of their mode of operation upon the human
system, and with as little certainty as to whether they
will ameliorate or aggravate disease.
The former has pursued a different course. In consideration of the facts, that the action of no two medicines upon the economy is the same, —that almost
every agent exercises a peculiar and specific influence
upon certain structures only, and that this specific
effect obtains both in health and disease, he instituted
a series of accurate experiments during health, in
order to arrive at the pure effects of different medicinal substances. The illustrious founder of homceopathy not only tested the operation of medicines upon
his own person, but he induced others-men of science
and undoubted integrity in different parts of Europeto make trials of the same substances, without informing them of the results of his own experiments;
and when their observations were completed, he instituted comparisons, and found that the effects of the
medicines upon the different individuals were almost
uniformly the same. Having now ascertained with
certainty the pure effects of a number of articles
during health, he commenced exhibiting them for the
cure of diseases, in accordance with the principle




88                HOMCEOPATHY.
which he had conceived to be philosophical and true,
similia similibus curantur. We need not repeat, that
the results of these experiments were in the highest
degree satisfactory.
In the early part of his career, Hahnemann made
use of the pure mother tinctures, in ordinary doses,
but he observed that the primary effects were too active,-there usually occurring a temporary augmentation of the symptoms. This induced him to reduce
his doses until he came to make use of attenuations
and dilutions; and he found, that when the medicines
were properly prepared, they still had their specific
action, and that disease was more speedily removed
than when stronger preparations were employed.
But the principal objection which was formerly,
and which still, to a considerable extent, is raised
against the system of homceopathy, is the supposed
inefficiency of infinitesimal quantities of medicines
when administered as curative agents. Nor is this at
all surprising, for it has been customary for three
thousand years, when disturbance prevails in the human citadel, to storm it with agents of destruction.
Blood is made to flow, the delicate membranes of the
stomach and intestines are raked with broadsides of
emetics and drastics, the nervous system is shattered
by narcotics and stimulants, and the functions of every
organ deranged by the showers of destructive allopathic missiles with which the enfeebled body is constantly assailed. By these summary means the disturbance is smothered, but the citadel is in decay,
its resources exhausted, its foundations impaired, and
its strength forever diminished.
Homoeopathy, however, resorts to a different mode
of procedure. In her remedial measures, she uses no
unnatural violence, nor seriously disturbs the function
of any organ; but her remedies are exhibited with a
definite object; the affected organ or tissue is acted
upon with almost mathematical certainty, and that
too without creating disease in healthy parts, or in
any way complicating the natural affection. But she
usually administers her medicaments in infinitesimal
doses, and we now come to the question whether such
minute quantities of matter are capable of producing




HOMCEOPATHY.                 89
salutary impressions upon the organism when labouring under disease?
No one will deny that the human body during health
is constantly being acted upon and disturbed by influences or agents so subtle, that neither the chemist
nor physiologist can analyze or even detect them.
The simple application of substances to the surface
of the body is sufficient to produce decided and permanent effects. Turnbull says, that " so small a portion as the one hundredth part of a grain of aconite,
made into an ointment, and rubbed upon the skin, has
produced a sensation of heat, pricking, and numbness,
that has continued a whole day."
A leaf of tobacco applied to the wrist or sole of the
foot, will excite the action of the respiratory muscles,
blood-vessels, glands, and skin, causing nausea, vomiting, &c.
If the leaves of hyoscyamus or belladonna be applied to the eye, an effect will be produced which will
remain for several weeks. It is asserted by Pereira
and Sigmond, that "a dilatation of the- pupils may be
produced by only approximating the leaves of hyoscyamus or belladonna to the eyes."
It is also well known,* that "violent erysipelatous
inflammation over the whole surface of the body, is
often induced from approaching within a few yards of
several species of rhus."
The wild buffalo scents the hunter for a distance
of more than a mile, and hastens from the vicinity of
danger.
The carnivorous bird recognises the odoriferous particles arising from a dead carcass, miles distant in the
air, and with hasty wing, pounces upon the prey.
The medicinal quality of cod liver oil (ol. jec.
aselli) consists of iodine distributed in infinitesimal
quantities throughout the oil. According to an analysis made by Falker, the iodine forms only the oneforty-thousandth part of the oil, being about equal to
a third or fourth hommeopathic attenuation of iodine.
The value of this naturally attenuated medicine in the
treatment of scrofula and consumption, is at the pres* Paine's Inst. of Med.




90                 HCiMCMOPATI Y.
ent time generally conceded. The analyses of Stein,
De Jongh, and Balard, fully confirm that of Falker.
The very minutest quantity of the natural poison
of certain animals, the virus of hydrophobia, smallpox, kine-pox, syphilis, and gonorrhmea, is sufficient,
when placed in contact with an abraded or delicate
surface, or otherwise introduced into the system, to
give rise to all of their corresponding maladies. Other
diseases, like scabies, leprosy, &c., may be communicated by the mere touch, or from inhaling the breath of
an infected person.
Miasmata, animal exhalations, electricity, magnetism, heat, light, and even mental emotions, are all,
under certain circumstances, capable of disturbing the
organism and causing dangerous maladies, and yet, as
Liebig, in his Animal Chemistry, truly observes, " with
all our discoveries, we shall never know what light,
electricity, and magnetism are in their essence. We
can ascertain, however, the laws which regulate their
motion and rest, because these are manifested in phenomena. In like manner the laws of vitality, and of
all that disturbs, promotes, or alters it, may certainly
be discovered, although we shall never learn what life
is."
Let it be ever borne in mind, that most substances,
both in the organic and inorganic kingdoms, possess certain active principles which are latent and unappreciable
in the natural state, and are only called forth and developed by the influence of some agent or process, which
effects a transformation or metamorphosis of the crude
material.
Heat, electricity, and magnetism, become apparent
when certain physical substances operate upon each
other in such a manner as to disturb or change the
original state of cohesion of particles.
Caloric is a property common to all material substances. In the natural state of these substances, this
active principle is latent, and cannot be appreciated
by the senses; but iffriction be used, this agent is set
free, and its power becomes manifest.
Electricity also, pervades all material bodies, and
only becomes sensible when the natural state of these
bodies is disturbed by friction.




HOM(EOPATHY.               91
It is probable, likewise, that iron and other substances contain magnetism in a latent state, and only
require the operation of certain influences, to develop in them the phenomena of magnetism. This is
evident from the fact, that "the same magnet may
successively magnetize any number of steel bars,
without losing any portion of its original virtue;
from which it follows, that the magnet communicates
nothing to the bars, but only develops, by its influence, some hidden principle." 
Large quantities of vegetable, animal, or mineral
substances, may be taken into the stomach in a crude
state, with impunity; but if their elementary
particles become separated by decomposition, or
otherwise, and then introduced into the system, they
give rise to the most baneful results. It is a matter
of little consequence. whether this minute subdivision
of particles is effected by the action of solar heat
and moisture, by trituration, or succussion; the ultimate effects are the same: The elements of the
substance are separated, the essence or medicinal
part is set free from the crude, material, and non-medicinal portions, and reduced to such a state of attenuation as to become readily absorbed, and yet
retain all the specific qualities pertaining to the original agent.
Indeed, so minute and subtle are the miasms from
vegetable and animal decomposition, the exhalations
arising from contagious disorders, &c., that no one
has yet been able to appreciate their physical or
chemical properties, by the most accurate tests of
chemistry or optics. Who, however, for this reason,
will presume to deny or doubt their tremendous, although mysterious, power upon the human system?
When ether or chloroform evaporates, the cohesion
between the particles of the liquid is destroyed; its
elements float in the air, and are capable of impressing the organism in a much more powerful, and in a
totally different manner, from any impression which
could be produced by these constituents in a less attenuated state-as, for example, that of the original
* Beck's Chemistry.




02                HOMCEOPATnY.
liquid. If a large quantity of ether be swallowed,
but slight effects will result; but if an imponderable
quantity be introduced into the blood through the
lungs, in the form of vapour, it is immediately brought
into contact with the brain and nervous system, and
the most astonishing effects speedily ensue.
"If the 10,240th of a grain of tartrate of mercury
be diffused through the substance of a mere hard
sweet-pea, the beautiful germ of a graceful flowering
herb, which lies folded up in its horny pericarp, shall
never come out and be expanded, though you imbed
it in the softest mould, and solicit it by every art."
(Leuchs.)
Professor Doppler, of the Royal Institute of Prague,
in speaking of the modus operandi of infinitesimal
particles, writes thus: " From the moment in which
the substance of the atoms succumbs to the influence
of their surfaces, and apparently independent of the
law of gravitation, they move with the greatest facility in every direction, and, as it were, become alive;
from that moment only, in my opinion, drugs acquire
the capacity of penetrating the organism, and of exciting there a curative effect. For if drugs, prepared
in this manner, be brought in contact with the invisible extremities of nerves, their hyper-microscopical atoms will enter the organism at the same time
with their superficial electricity, and will, if the nerves
be in a perfectly natural state, be thrown out of the
system without impediment, after having penetrated
it in every direction.  But if a body in a state of
health be accompanied by an activity of the nervous
system, perfectly unimpeded and equally free in every
direction, we cannot, on the other side, but presume,
that in a state of imperfect health the power of conduction, proper to the nervous substance, will be materially diminished, partially and in individual organs, either in consequence of a chemical change, or
for some other reasons. But to use rather a material, but, nevertheless, by no means unfit comparison,
as streams deposit the sand and pebbles they carry
along, on those spots only where their currents meet
with an impediment, and their rapidity seems broken
by obstructions, so in a similar manner, in the dis



nOMCEOPATHY.                93
eased organism, may the electric currents, however
feeble, leave the atoms of drugs at the diseased spots,
where they, according to their individual properties,
exert either a curative or detrimental influence."
If, then, imponderable substances possess powers so
unequivocal and potent upon the healthy subject,
when the organs are in a high state of vigour, and
consequently in a good condition to resist the influence of foreign impressions, why may we not
infer, with perfect propriety, that medicinal substances, equally imponderable, are capable of impressing the organism during disease, when the affected structures are unusually susceptible to extraneous influences?
Homoeopathists suppos'e that the mode in which their
tenuations operate is analogous to that of infection by
miasms; that the inert matter of the substance is
destroyed, and the active principle set free; and that
the smallest quantity of this active principle, triturated with sugar of milk, or diffused in water or
alcohol, is capable of communicating to the vehicles
its properties, and thus to the organism its peculiar
action.
The essential principles of all vegetable substances constitute but a very small proportion of the original crude article, and the more perfectly we separate these active from.the inactive portions, the more
pure and powerful will the remedy become. Like caloric, electricity, and magnetism, the strength remains
latent in the crude state of the substance, and can
only be developed by the important agency of heat,
friction, or trituration.
Peach-blossoms, the bark of mountain-ash, the
kernels of peaches, cherries, and plums, bitter almonds, &c., contain, in a latent condition, the active
poison known as prussic acid, which may readily
be obtained from either of these articles by a chemical process.
Ipecacuanha is indebted for its virtues, to a principle called emetia. Pelletier found, upon analysis,
that the brown ipecacuanha bark contains only sixteen per cent. of impure emetia; and the red bark




94                HOMCEOPATHY.
fourteen per cent. According to Bergelius, the impure emetia possesses only one-third the strength of
the pure. We therefore find, that of one hundred
parts of crude ipecacuanha, only five parts possess
the medicinal virtues of the drug. Nor is it at all
improbable, that farther researches will enable the
chemist to free this principle from other impurities,
and thus develop a still more potent medicine.
Opium contains but a very small per cent. of its
narcotic principle, morphia.  The crude substance
contains, in addition to morphia, at least fourteen
other ingredients, all of which are destitute of any
particular virtues. Only about eight or nine per cent.
of morphia is obtained from Turkey opium, and this
is quite impure and unfit for use, containing narcotina, &c.
Cinchona is composed of ten or twelve ingredients
of which, all but quinia and cinchonia, are inert.
Even these last, as usually obtained, are highly adulterated, and do not by any means represent the active
principle of bark in its purity.
The same rule obtains in relation to most other
substances. The essential properties are distributed
but sparingly throughout ligneous, resinous, and
other matters, and it is only by the utmost care and
nicety, that we call separate and develop these properties.
Indeed, there are many instances where the skill of
the chemist is unable, not only to develop artificially
certain principles of vegetable and animal substances,
but even to analyze them when they become spontaneously disclosed by the action of heat and moisture.
Miasmata and other noxious exhalations are examples of this kind.
It is a fundamental law of therapeutics, that the active properties of all medicinal substances can only be
manifested from their surfaces; and it follows as a
consequence, if we would develop the full powers of
drugs, that they must be made to occupy as great a
surface as possible.
If a compact piece of wood be ignited, but a small
blaze can be produced; while if the same wood be cut
into small portions, so as to expose a large surface, and




IIOMCEOPATIHY.              95
then ignited, a large and powerful flame will appear.
Only a limited amount of electricity can be drawn
from a given surface of glass; but if the same glass
be made to occupy double the space, an additional
amount of the fluid may be set free.
If a hole be rapidly bored through an ordinary piece
of iron, the surface of each chip so detached will be
found to possess magnetic properties; and a singular
circumstance connected with this, is the fact, that
when the boring is accomplished in a perpendicular direction, the chips are more highly magnetized than
when it is effected horizontally. Here, again, is an
instance where'friction has developed properties entirely unappreciable in the natural state.
A single grain of matter may be made by trituration
to pervade every part of one hundred grains of sugar
of milk, and each molecule thus separated may be
still farther subdivided into corpuscules, which in their
turn may be diffused intimately through additional
quantities of the medium. In this manner only, can
we call forth all of the latent properties of drugs, and
reduce them to that state of attenuation which is compatible with absorption, and which enables them to
exert those salutary specific influences which the
homoeopathic practitioner so uniformly observes.
Each atom thus minutely separated, retains the
power of exercising its specific influence upon the organism. Quantity is of but little consequence, provided that the substance is properly prepared; for an
imponderable quantity in its highest state of development, is quite as capable of producing its peculiar
effects in certain conditions of the body, as a much
larger amount.
It is undoubtedly true that an atom, either morbific
or medicinal, which possesses an affinity for a particular structure, is capable of communicating to such
structure its peculiar action, the influence being propagated from one molecule to another, and each acquiring the properties of the original atom, until the
influence is expended.
Examples of this kind of action are constantly presented to the physician in the form of continuous sympathy.




96                 1HOMCEOPATHY.
One inhalation of a noxious miasm, under favourable
circumstances, is as capable of causing its specific contagion, as a thousand, or more. One thousandth part
of a grain of a natural or morbid virus. is as capable
of imparting the peculiar action of the poison to all
parts of the organism susceptible to its influence, as a
larger quantity.
So also, when an atom of a medicine is absorbed
into the system and comes in contact with an organ or
tissue already diseased, upon which it exercises a specific influence, it communicates to the surrounding
atoms its peculiar action until the whole tissue is involved, and thus, if the remedy be homceopathic to
the malady, it will supersede the primary affection.
La Place and Berthollet have advanced the opinion,
that " a molecule, being put in motion, can communicate its motion to others, if in contact with them."
This law is applicable to both animate and inanimate matter, under certain circumstances. Thus, the
smallest point of decayed vegetable or animal matter, if placed in contact with healthy vegetable or animal substances for which it has an affinity, will communicate to the latter its own morbid action.
The smallest point'of decay in a tooth, continually
propagates its peculiar action to the surrounding parts
until the whole tooth is destroyed, or the diseased portion is removed.
The slightest spark of fire, put in contact with a comnbustible material, communicates its action to all parts
susceptible of combustion.
A minute nucleus being once formed in the mineral
kingdom, possesses the power of attracting to itself in
a regular and uniform arrangement. all of those particles near it, for which it has an affinity, and the different varieties of minerals communicate to these particles their own peculiar action and arrangement.
It is asserted by the supporters of the chemical hypothesis, "that substances in a state of putrefaction, by entering the blood, impart their peculiar action
to the constituents of that fluid, and all the substances of the body are induced to undergo a modified
putrefaction."* Liebig affirms that " a body, the atoms
* Paris Pharmacologia.




HOMEOPATHY.                97
of which are in a state of transformation, may impart
its peculiar condition to compounds with which it may
happen to communicate."
These assertions, however, are not sustained by
facts. There is no proof that the blood becomes contaminated by the atoms which enter it in a state of
transformation; nor is there any proof that such
atoms are capable of " imparting their peculiar conditions," indifferently to other "compounds with
which they may happen to communicate."
Every substance in nature, whether morbific or
medicinal, possesses its own characteristic and distinct mode of action, and is only able to exercise or
communicate this action, in a specific manner, to
particular structures. Thus, the contagion of scarlatina imparts its peculiar action to the throat and skin.
The contagion of scabies acts exclusively upon the
skin. The miasms which occasion many kinds of
fever, appear to expend their effects upon the nervous
system. The virus of gonorrhea is specific and uniform in its results upon the mucous membrane of the
urethra. The virus of syphilis, although more general in its operation, affects only a certain class of
structures. All of these poisonous matters are incapable of imparting their peculiar influence, unless they are
brought into contact with those tissues for which they
possess a "kind of elective affinity."  There is no reason to suppose, that in any instance we have named, the
blood itself is contaminated, but it serves merely as
the vehicle which conveys the morbid particles to the
different parts of the body.
What we have advanced in regard to the modus
operandi of morbific, is equally true of medicinal
agents. We have before shown that most drugs possess well-defined specific actions, which can only be
manifested after having been conveyed by the blood
to their destined structures.
It will be perceived that the views here advanced
in regard to the mode of operation of morbific and
medicinal agents, differ essentially, not only from
those of the chemical school, but also from those of
most writers who have hitherto appeared as advo-'




98                HOM(COPATHY.
cates of homeopathy.  From  quotations made at
page 22, it will be observed that Hahnemann himself
is a firm advocate of the " vital theory.", In common
with many distinguished writers of the old school, he
supposes all diseases to consist of certain alterations
of the' vital properties " of parts, and that medicines
cure these diseases by acting upon these (supposed)
immaterial properties in such a manner as to restore
them to a norlnal state. In advocating these doctrines, Hahnemann has virtually rejected the theory
of absorption, the truth of which has been so amply
verified by Muiiller, Pereira, Blake, &c., and thus has
marred a portion of his beautiful system.
It may seem impossible, at a first view, that attenuated
drugs can be absorbed into the system, and exert their
influence topically on the different structures; but in
support of this opinion we beg leave to submit the
following ideas.
Medicines, as has been previously remarked, are
often detected in those structures on which they have
exerted their effects. Mercury, iodine, sulphur, nitrate
of silver, the salts of lead, iron, bismuth, copper, &c.,
have all been found in different tissues of the economy; and even Liebig himself advises us that many
of these substances often form " permanent compounds with the different tissues." The same author
also remarks, "-if by the introduction of a substance
certain abnormal conditions are rendered normal, it
will be impossible to reject the opinion, that this phenomena depends on a change. in the composition of
the constituents of the diseased organism, a change in
which the elements of the remedy take a share."
The elements of the remedy do most certainly take
a share in this change, but only so far as the disordered organ or tissue is concerned. It matters not whether the specific agent be imponderable in quantity,
administered through the lungs, stomach, or skin, or injected into the veins; it seeks that part for which it
has an affinity, and there manifests its force.
I have known persons to become salivated by the
use of less than one-half of a grain of the first trituration of corrosive sublimate, given in divided doses.
This can be explained in no other way than  by




HOMCEOPATHY.                99
supposing that the remedy is rendered innoxious to
the absorbent vessels by the peculiar mode of preparation; for so small a quantity of the crude article
has never, to our knowledge, been known to produce
this result. By trituration, the crude particles of the
mineral are  so  minutely separated  and diffused
through the vehicle, that the delicate absorbents admit them into the circulation with facility, while in
an unprepared state the remedy would be recognised
as an irritant, and consequently excluded.
When salivation is produced by large doses of calomel, or blue-mass, it is highly probable that evaporation occurs from the heat of the stomach and intestines, and that this vapour, impregnating the chyle, is
absorbed. It has been said by the opponents of absorption, that the preparations of mercury cannot be
absorbed on account of their insoluble nature, and
therefore that salivation is caused by an impression
which is made upon the "vital properties" of the
stomach, and that this impression is reflected to the
salivary glands, through the sympathetic nerves. But
if the advocates of this doctrine will reflect that mercury evaporates at a common temperature, and that
this vapour, when inhaled, exerts all the specific effects of the mineral, they must admit that when submitted to the higher temperature of the stomach and
bowels, this evaporation and absorption will be augmented.'I believe," says Pereira, "with Buchan,
Orfila, and others, that metallic mercury, in the finely
divided state in which it must exist as vapour, is itself
poisonous.,,
An argument which we deem conclusive upon this
point, is from the fact that traces of mercury itself have
often been detected in the secretions, excretions, and
solids of the body; and if any "vital properties"
have reflected the influence, they must have conveyed
the solid substance along bodily to the affected glands,
etc.
In considering the subject of absorption and the
topical action of attenuated drugs, it must be remembered that the absorbing structures are very delicate
and sensitive, so that they are enabled to exclude all
crude and irritating substances; and also that the ex



100                HOMCEOPATHY.
treme terminations of the nerves, in all parts of the
body, are exquisitely susceptible to the influence of
specific foreign agents; and a cause capable of
affecting powerfully these minute filaments, would be
entirely without energy and unappreciated, if brought
to bear upon the trunk or larger branches of the same
nerve.
Another fact illustrative of the truth of absorption
and topical action is, that substances always exercise
their specific effects more promptly and potently when
introduced directly into the mass of the blood, than
when taken by the stomach. "Medicinal or poisonous agents, injected into the blood-vessels, exert the
same kind of specific influence over the functions of
certain organs, as when they are administered in the
usual way, but that their influence is more potent."*
Liebig also assures us, that'" we can by remedial
agents exercise an influence on every part of an organ
by substances possessing a well-defined chemical action."
Here is a distinct recognition of the principle of
the topical or specific action of remedial agents, although the character of this action is supposed to be
chemical. Without entering into any discussion upon
this point, or attempting to explain how morbific or
remedial agents produce their peculiar effects, we
shall remain satisfied with the positions we have before laid down. and 4 simply refer our readers to the
numerous instances, within their own knowledge, of
the topical action of substances, both ponderable and
imponderable, with the addition of a few examples of
the latter, which can be understood and appreciated
by all.
1st. Odours. When odoriferous particles are brought
into contact with a certain nasal structure, (the schneiderian membrane,) the minute and sensitive nerves of
the part take cognizance of the stimulus, a decided
impression is made upon the whole membrane, and
an odour, agreeable or otherwise, according to the
nature of the exciting cause, is the result. In this
instance, physical, but imponderable particles, operate
*.Pereira, AMt. Med. and Ther.




HOMEOPATHY.               101
upon the nasal tissue by absolute contact, and impart
that peculiar action which enables us to appreciate
odours.
2d, Light. According to Sir Isaac Newton, light is
a physical, but imponderable compound, and can only
manifest its power when its atoms are in contact with
the organ of sight. These particles of light are the
natural stimulus of the eye,-material, imponderable,
specific. When this compound is separated into the
different primary rays, each particular ray, when
brought into contact with the eye, exercises a special
and distinct influence, giving rise to the p(rfect appreciation of the different colours of the prism. Here
again we are presented with an example of the specific influence of imponderable atoms upon a certain
part of the system.
3d, Caloric. Newton also maintained that caloric is
" a distinct material substance, the particles of which
repel one another, and are attracted by all other substances."
When caloric is given off by a heated body, its
atoms impart to all other atoms with which it comes
in contact, its own peculiar action, and the sensation
of heat, with its attendant phenomena, expansion,
&c., is the consequence. Here we are afforded with
a still more striking instance of the power of an imponderable substance in altering and modifying the
character and properties of all substances upon which
it exercises its action. This active principle, present
in all bodies, hidden and unappreciable except when
set free by friction, percussion, mixture, electricity, or
combustion, possesses properties when thus liberated,
surpassing in power and influence every other substance in nature; yet it is more subtle and imponderable than the most attenuated medicines of homaeopathy.
4th. Electricity, galvanism, magnetism, and the various gases, are all material substances, and manifest
their influence physically by contact with the body.
It must not be supposed that light, heat, electricity,
magnetism, etc.,- are immaterial nothings-mere properties of matter-because they cannot be weighed
handled, and made subservient to all of those




102               HOM(EOPATHY.
which govern more crude substances. Nor must it
be supposed of drugs, that they possess no qualities
except those which are apparent in the crude state,
and can be fully appreciated by their nauseousness
of taste, rankness of smell, or power of raking the
stomach and intestines,
Modern science has demonstrated, that by friction,
percussion, mixture, &c., some of the most powerful
principles known may be liberated from substances,
which, in a crude state, are entirely harmless. It
has shown, that the more perfectly we can disencumber these principles from their inactive envelopes, the
more potent they become.  It has shown that the
mass of ligneous, resinous, starchy, fatty, extractive,
and colouring matters, which surround and enclose
the active portions of vegetable substances, instead
of possessing medicinal properties, serve only to nauseate and oppress the stomach and bowels, and thus
complicate any existing malady.
Pereira, and other authors opposed to our system,
have endeavoured to cover it with ridicule by entering
into a computation respecting the weight and strength
of the different attenuations. They have displayed
before us tabular views showing the strength of each
attenuation, and then assured us, without the trouble
of testing the question practically, that such exceedingly small doses of medicines can produce no effect
upon the system, but " that the supposed homeopathic
cures are referable to a natural and spontaneous cure,
aided, in many cases, by a strict attention to diet and
regimen."* This is the principal argument urged
against the therapeutical doctrines of Hahnemann.
We beg leave, however, to request those gentlemen
who judge of the potency of substances by their
weight and dimensions, tot enter into a still further calculation, and inform us which possesses the greatest
weight, the medicinal particles pertaining to a drop of
a thirtieth attenuation of homceopathy, or the charge
of electricity, which lays prostrate and senseless the
strongest man-or the quantity of sulphuretted hydrogen, or carbonic acid gas, requisite to cause immediate
* Pereira's Mat. Med. and Ther.




HOMEOBPATHY.              103
death, when inhaled? Which can be most readily
detected and appreciated by analysis, the atoms of a
high attenuation of Hahnemann, or the deleterious
miasms which arise -from vegetable or animal decomposition?
Which present the greatest difficulties in examination and description, the physical structure of the particles of a homeopathic medicament, or that of. caloric, or light?
Will the respectable Hippocratic, who cannot recognise power in any-material substance, unless it can
be weighed or handled, enter into a computation, and
inform us how much a poisonous dose of the vapour of
hydrocyanic acid, mercury, or lead, weighs?
Let it be remembered, that not one atom of matter
in the whole universe can be annihilated: transformations may be effected-the cohesion of particles
may be changed*-atoms in their ultimate state of
chemical combination may be physically divided into
molecules, and again subdivided into lesser atoms to
such an extent as to baffle detection from the most
perfect tests of chemistry or optics-new powers may
be developed in these atoms, the exact operation of
which we may not at present be able to understand,
but in no instance can we destroy one single particle
of matter. We may effect an entire metamorphosis
of almost any solid substance, and diffuse its elements
in such a manner as to occupy and affect a very large
amount of space. The elements of a few grains of
gunpowder may be made with the aid of a few imponderable particles of caloric, to change their form,
and impregnate every portion of the atmosphere of a
large room. In like manner, a single- grain of a vegetable or mineral substance may be transformed, and
its atoms diffused throughout large quantities of inert
materials, in such a manner as to impregnate them
in every part with medicinal properties, but in no instance can a single atom be annihilated. Until we
arrive at more accurate knowledge in relation to the
laws which govern the chemical and physical action
of the minute atoms of substances than we at present
* See Atomic Theories.




104              HnO103COPATHY.
possess, let us not deny that they may be endowed
with properties and powers, (although their modus
medendi is a mystery to us,) capable of exercising an
important influence upon the human organism.
In regard to the preparation of medicines, there are
several points of difference worthy of particular notice, between the old and new schools.
1. Allopathy employs her drugs in a crude and
consequently inactive form; while homceopathy makes
use only of their pure essential principles, unencumbered by foreign matters.
2. Allopathy employs so great an amount of artificial heat in her pharmaceutical operations, that a
large proportion of the active properties of her drugs
is expended in evaporation; while hommeopathy
makes use only of expression, trituration, and succussion, and thus not only retains all of the virtues inherent in the drug, but actually develops powers
which would have remained latent under other circumstances.
3. On account of the peculiar mode of preparation, the remedies of allopathy are offensive to the
taste, nauseous to the stomach, and by their indigestible and irritating qualities, serve directly to induce
gastric and intestinal derangements, and other serious
medicinal symptoms. The medicines of homceopathy
are liable to none of these objections.
4. For the reasons above enumerated, many of
the remedies of the old school are excluded by the
sensitive absorbents, on account of their irritating
qualities, and are thrown off with the frecal matters
as foreign substances; having failed, in their passage
through the intestinal canal, of producing any other
effect than an irritation of the gastro-intestinal
membrane. The attenuated remedies of homceopathy,
being innocuous to the lacteals and absorbents, are
readily admitted into the circulation and conveyed to
those parts upon which they exert a specific action,
thus impressing directly the organs or tissues actually
diseased. "No substances," says MartynPaine, in his
Institutes of Medicine, " but such as exist in a fluid or
very attenuated state, are taken up by the lacteals and
absorbents."




IIOM(EOPATHY.              105
So, also, in the' therapeutical application of remedies, we claim, as far as accurate scientific principles
and sound philosophy are concerned, that homceopathy is vastly superior to  allopathy.  We shall
briefly reiterate some of the more prominent points
of difference in the practice of the two schools.
The system of homceopathy is founded upon rational and scientific principles, inasmuch as its
remedies are exhibited with a definite object, and the
results can in most cases be predicted with mathematical certainty..
The practice of allopathy must always be indirect,
uncertain, and empirical. The violence of the remedies employed, necessarily induces medicinal and
sympathetic affections, which, mingling with the
symptoms of the natural disease. render it impossible
to distinguish between the two classes of symptoms,
or to judge whether the malady, or the medicine, or
both combined, are killing the patient.  The fact,
that so few allopathic practitioners coincide precisely
in regard to the treatment of very many diseases,
proves conclusively that their system is one of guessing, rather than one founded on scientific knowledge
and ascertained facts.
Hommopathic remedies being specific and certain
in their effects, operate only upon those parts which
are actually diseased. Without inflaming healthy
structures, debilitating the system, or disturbing the
function of any organ, they induce, when judiciously
exhibited, a new or alterative action in the part affected, of just sufficient severity to banish the natural
malady, while the new or medicinal action subsides
speedily and spontaneously.
According to the doctrines of homeopathy, no two
diseases or kinds of inflammation can exist in the
same structure at the same time; for whenever two
exciting causes act upon the same part, the one possessing the most powerful action, must necessarily
banish and supersede the weaker. Therefore, in accordance with the rules of our system, remedial impressions are always made directly upon the organ
or tissue affected, and a new kind of action set up
5*k




106               HOMCEOPATHY.
which abolishes the disease and usurps temporarily
its place.
According to the strict tenets of the old school,
remedies should be exhibited in such a manner as to
impress structures which are healthy and remote from
the organ or tissue diseased, in order that revulsive,
derivative, or counter-irritating effects may be produced, and thus serve to attract the fluids from the
natural affection to the artificial one. This plan of
treatment originated, as we have seen, from the supposition that no two maladies of consequence could
exist in diferent parts of the same organism  at the
same time. As this idea is at present universally conceded to be erroneous, we assert that a mode of practice deduced from such false data, must of necessity
be unscientific and empirical.
By operating on healthy structures, the allopath accomplishes little or nothing towards restoring the impaired capillaries of the affected part to their original condition of strength and resistance, and consequently his system must be entirely inadequate to
effect cures. We are, for this reason, forced to the
conclusion that the modern Celsus, Dr. Forbes, is correct when he asserts, that " in a large proportion of
the cases treated by allopathic physicians, the disease
is cured by nature, and not by them."
It is a fundamental law of medicine, that no inflammation can be created in any part of the body,
without giving rise to secondary sympathetic affections in other and distant parts. It is evident, therefore, that the greater the number of structures
affected with inflammation, whether natural or artificial, the greater will be the number of sympathetic
symptoms, and consequently the more serious and
complicated the malady. Thus we perceive the
force of Dr. Forbes' remark, "that in not a small proportion of the cases treated by the physicians of the
old school, the disease is cured by nature, in spite of
them; in other words, their interference opposing,
instead of assisting, the cure."
We have before shown that organs and tissues become morbidly susceptible to the impressions of specific remedial agents during inflammation; therefore it




nOM(EUPAT'Y.,              107
is that extremely minute quantities of specific medicaments are capable of exercising powerful influences
during disease, which, under circumstances of health,
would be productive of no effects whatsoever. This
is a truth of vast importance in the administration of
medicines, and should be thoroughly appreciated by,
the practitioner who regards the welfare of his patients. Let him remember that these acquired susceptibilities are so great, that even the natural stimuli,
food, gastric juice, bile, light, &c., cannot be tolerated;
and from this fact, take warning lest he inflicts injury
and counteracts the efforts of nature, by too active
medicines.
But as we have so frequently observed, it is not so
much our principle of cure, at which the shafts of the
old school are directed, as to the doctrine of small
doses. It is not because the adherents of allopathy
cannot make themselves acquainted with the powers
of attenuated drugs, but it is because their inveterate
prejudices will not allow them to investigate the facts
which are involved. They prefer to die of vomiting,
purging, and sweating, as their predecessors have done
for two thousand years, rather than to be cured quietly
under a new system. These individuals are not satisfied
unless theyfeel and see the poor body writhe and suffer
for the sin of being sick. What care they for any
interior or invisible action of a medicine, when they
can be cut. racked, and tortured, by the lancet, emetics,
cathartics, blisters and moxas, and that too, secundeem
artem? To be sure, they were not aware of any visible
effects when the morbid agent operated upon their systems to produce the disease, but the curative part is in
their own hands, and they are determined to exercise
their privilege of a full and continual appreciation of
the whole modus operandi of the remedial. process.
This part, nature has no power to cheat them of, but
Hippocrates now reigns, and they are resolved to exercise their ancient reserved rights, and bleed, puke,
purge, sweat and blister, ad libitum.
But why have our opponents dwelt so much upon
our doses? Does not every homceopath aim and intend
to give a sufficient quantity of the medicine at a time,
to effect a speedy cure; and is not this quantity deter,




108               HOMMOPATHIY.
mined by experience of simple facts? We have different strengths or attenuations of each medicine, from
the strongest tincture up to the most minute attenuations, and every homeopath selects that strength or
attenuation of the drug which most speedily and safely
cures his patient. The great point with him is, to select such a medicine as shall be homeoopathic to the
symptoms of the disease, and then to administer just
enough of it to effect his object in the most safe and
speedy manner. He findsby experience-by a mass of
facts-that the tinctures and- alkaloids, although often
capable of subduing disease, are less prompt, less efficient, and less safe than weaker preparations of the
drug. This easily demonstrated truth, was not the result of theory or hypothesis, but originated with Hahnemann, as we have already seen, through necessity,
on discovering that the tinctures which were first employed by him, in accordance with his principle, often
produced too violent impressions upon the affected structures. What cared Hahnemann-what care his disciples-whether they use one or twenty drops of a tincture,
or one grain of a twentieth attenuation? Were twenty drops of a tincture, or twenty grains of a crude substance, more efficient in curing sickness than one drop
or one grain of an attenuation, is there any man who
supposes that Hahnemann or his followers would not
have administered them in this form, in preference to
any other? The chief glory of the founder of homoeopathy does not consist in the discovery of the efficacy
of small doses, but in the demonstration and practical
introduction of the great doctrine of curing maladies
by impressing diseased tissues with medicines which
operate specifically upon these tissues themselves, rather than on distant parts.
It matters not, therefore, in regard to the homceopathic law of cure, whether we use this or that strength,
provided the remedy is homceopathic to the disease,
and exactly the requisite impression is produced upon
the affected parts. The man who cures a belladonna
headache with ten drops of the tincture, adheres to similia similibus as much as he who cures with the thirtieth attenuation of the medicine. The only question
to be decided is, which strength cures most safely and




UOl0MCOPATHY.              109
quickly; and if facts prove, as all homeopaths believe,
that a preparation weaker than the tincture is by far the
most safe and efficient, then it is our duty to give these
preparations the preference. It is found, for example,
when repeated doses of tincture of belladonna are
given in acute inflammation of the brain, that-the primary symptoms from the drug manifest themselves too
violently-that it causes dangerous and protracted medicinal aggravation, and a tardy re-action of the organism; while a dilution of the remedy impresses mildly the
diseased structure, causing scarcely perceptible primary symptoms, and is speedily followed by its secondary or curative effects.
We shall conclude this chapter by quoting a few
observations of the distinguished modern chemist (an
allopathist) Kane, respecting the divisibility of matter,
and some of the phenomena witnessed when a very
high state of attenuation has been arrived at. We make
these extracts for the benefit of those whose " bundles
of ideas " are not already made up, trusting at least,
that they may have the effect of demonstrating to such
persons, that, not only morbific and medicinal power
may exist in infinitesimal atoms of matter, but even
life itself.
"It has been proved that gold may be divided into
particles of at least'1,400   of a square inch, and yet
possess the colour and all other characters of the
largest mass. If a grain of copper be dissolved in nitric acid, and then in water of ammonia, it will give a
decided violet colour to 392 cubic inches of water.
Even supposing that each portion of the liquor of the
size of a grain of sand, and of which there are a million in a cubic inch, contains only one particle of copper, the grain must have divided itself into 392 million
parts. A single drop of a strong solution of indigo,
wherein at least 500,000 distinctly visible portions can
be shown, colours 1,000 cubic inches of water; and as
this mass of water contains certainly 500,000 times
the bulk of the drop of the indigo solution, the particles of indigo must be smaller than,,       the
twenty-five hundred millionth of a cubic inch. A rather more distinct experiment is the following: if we
dissolve a fragment of silver, of 0.01 of a cubic line in




1 10              HOMEOPATHY.
size, in nitric acid, it will render distinctly milky, 500
cubic inches of a clear solution of common salt.
Hence the magnitude of each particle of silver cannot
exceed, but must rather fall far short of a billionth of
a cubic line. To render the idea of this degree of division more distinct than the mere mention of so imperfectly conceivable a number as a billion could affect, it may be added, that a man, to reckon with a
watch, counting day and night, a single billion of seconds, would require 31,675 years."
According to Doppler, a cubic inch of brimstone,
broken into a million equal pieces, a sand grain each
in size, is magnified in sensible surface from six square
inches to more than six square feet. It is calculable
in this way, that, if each trituration of the homoeopathist diminishes his drug a hundred times (an extremely moderate allowance), the sensible surface of a
single inch of sulphur, or any other drug, shall be two
square miles at the third trituration.
" In the organized kingdoms of nature, even this excessive tenuity of matter is far surpassed. An Irish
girl has spun linen yarn of which a pound was 1,432
English miles in length, and of which, consequently,
17 lbs. 13 ounces would have girt the globe; a distinctly visible portion of such thread could not have
weighed more than,,,of a grain. Cotton has been
spun so that a pound of thread was 203,000 yards in
length, and wool 168 yards. And yet these, so far from
being ultimate particles of matter, must have contained more than one vegetable or animal fibre; that
fibre being of itself of complex organization, and built
up of an indefinitely great number of more simple
forms of matter.
" The microscope has, however, revealed to us still
greater wonders as to the degree of minuteness which
even complex bodies are capable of possessing. Each
new improvement in our instruments displays to us
new races of animals, too minute to be observed before, and of which it would require the heaping together of millions upon millions to be visible to the naked
eye. And yet these animals live and feed, and have
their organs for locomotion and prehension, their appetites to gratify, their dangers to avoid. They possess




ATTENUATIONS OF DRUGS, ETC.     111
circulating systems often highly complex, and blood,
with globules bearing to them, by analogy, the same
proportion in size, that our blood globules do to us;
and yet these globules, themselves organized, possessed
of definite structure, lead us merely to a point where
all power of distinct conception ceases; where we
discover that nothing is great or small but by comparison; and that presented by nature on the one hand
with magnitudes infinitely great, and on the other with
as inconceivable minuteness, it only remains to bow
down before the omnipotence of Nature's Lord, and
own our inability to understand him."  (Kane's Chemistry, by Draper, p. 19.)
CHAPTER X.
ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES.
In selecting our attenuations for the cure of disease,
the following circumstances are to be taken into consideration: 1, the age, sex, temperament, constitution,
and habits of life; 2, the condition of the disordered
textures; 3, the character of the drug to be employed.
(a) Age. Infants and children of tender years,
whose organisms have not become blunted by exposure to the ordinary stimuli of life, by improper food
and drinks, and by abuse of cathartics and opiates,
are in the most eminent degree impressible, and require the highest attenuations. It is at this period
that the circulation is most active, the nervous system
most delicate, and the tissues most sensitive to the
influence of external agencies.
At the middle period of life, when the body has arrived at maturity, and all of the organs have acquired
their full strength and vigour, the resisting power
against both medicinal and morbific agencies is at its
maximum. The action of the circulatory vessels is
now moderate and stable, the nerves are strong, the
structures have become accustomed to all kinds of




112        ATTENUATIONS OF DRUGS, ETC.
stimuli, and the mind, which exercises so powerful an
influence over the body, acts calmly and judiciously.
At this period, our lower attenuations will often serve
us more efficiently than the higher.
During the decline of life, many circumstances
which have a tendency to modify the operation of
medicines, are to' be considered. Individuals who
have passed their lives in intemperance, who have
been afflicted with frequent attacks of disease, and
whose systems are loaded with the cumulative poisons of drugs, usually acquire a remarkable obtuseness and inactivity of the whole organism, so that the
very lowest attenuations are requisite to effect suitable impressions. On the other hand, many old people, upon the verge of second childhood, become
sensitive, irritable, and so intensely impressible, that
the higher preparations respond promptly and effectively.
(b) Sex. Females are more easily acted upon by
medicines than males, for several reasons. Perhaps
the most prominent one consists in their superior delicacy of organization: their circulation is more active,
their nervous systems more irritable, and their mental
powers more acute and quick, although less strong,
logical and independent than those of men. J. J.
Rousseau asserts, that a woman will leap to a conclusion which would require a man hours of severe
thought to arrive at. It is this susceptibility and de.
licacy of organization which render the female more
impressible than the male sex, and which should
always have no inconsiderable weight in the selection
of attenuations.
(c) Temperament. The temperament also has an
important influence in the operation of medicines.
As most morbific and remedial agents produce their
effects upon the sentient extremities of the nerves, it
follows that a highly susceptible condition of the nervous system is most favourable to the prompt operation of these causes. We therefore infer, that the
higher attenuations are better adapted to the nervous,
than to either of the other temperaments.
Next to the nervous temperament, in point of susceptibility, may be ranked the sanguine. Individuals




ATTENUATIONS OF DRUGS, ETC.      113
of this temperament are characterized by great activity and energy, and by prominent development and
vigour of the vascular system.
The temperaments which are the least susceptible
to remedial impressions, are the bilious and lymphatic.
The former is characterized by large muscular developments, tendency to biliary -derangements, frequent
turns of melancholy, and great powers of endurance.
The latter is distinguished by a predominant activity
of the glandular system, by a flabby and relaxed condition of the muscles, and by a feeble and rather obtuse state of the nervous system. These temperaments sometimes require our lowuest attenuations, especially in chronic diseases.
Two or more of these temperaments often unite in
the same person, when we have what is termed a
mixed temperament. This variety may be considered,
upon the whole, the most favourable to health and
longevity, since no quality predominates, and the
functions of the organism are more equalized.
(d) Constitution. Attenuations must also be selected with a due regard to the constitutional peculiarities of each particular case. We know of several
persons who cannot take a blue pill, or a pill in
which calomel is a constituent, without being violently salivated. There are others in whom opium
produces furious and protracted delirium, and catharsis, as primary effects; others cannot carry ipecacacuanha about their persons, or inhale the smallest
quantity of it, without attacks of asthma; others
cannot approach the rhus plant without being poisoned; others cannot use shell fish, and certain other
sorts of food, without being afflicted with urticaria;
the smell of hay causes asthma in some, and the delicate fragrance of the rose, syncope, in others. On
the other hand, there are some organisms which can
scarcely be impressed with even large and continued
doses of medicines. Constitutions which have been
impaired by abuse of stimulants, drugs, tobacco, and
licentiousness, and in which there is an abasement
of the nervous and physical power, demand low attenuations. In a word, it will be found on rigid examination, that each individual possesses some pecu



114        ATTENUATIONS OF DRUGS, ETC.
liarities which it will be necessary to take into consideration, when we decide respecting the strength or
repetition of a remedy.
(e) Habits of life. We have read of persons who
were "music mad," but we have often seen those who
were- medicine mad. The world is full of this class
of monomaniacs, who "pass away their time in descanting on their own" diseases, and in filling their
bodies with all sorts of injurious and nauseous drugs.
After pursuing this course a long time, the system, by
habit, tolerates enormous quantities of the poisons
swallowed, and the structures lose, in a measure,
their susceptibility to medicinal impressions.  It is
for this reason that the homceopathist experiences so
much difficulty in the management of cases of dyspepsia, hypochondria, and constipation, which have
been induced by long continued abuse of cathartics;
also in the affections of confirmed opium eaters, habitual drunkards, and gourmands. Individuals of these
classes, require low attenuations. In the same category may be ranked those operatives who make a
free use of mercury, the salts of lead, the strong acids,
and other poisonous substances which evaporate at
the ordinary temperature.
Robust persons, who pass much time in active
exercise in the open air, will require stronger doses
than those of delicate organization and of studious
and sedentary habits.
2. The condition of the disordered textures. Those
parts of the system which are most amply supplied
with nerves, are, all other things being equal, most
susceptible to the operation of medicines. Thus the
eye is more readily impressed than the arm; the
lungs, stomach and intestines, than the limbs and
joints, &c. Much, also, depends upon whether the
specific employed, is positive and decided in its operation.
But there is another circumstance of vast moment
to be taken into consideration in the choice of our
attenuations, and to which we have elsewhere called
particular attention. We refer to the augmented susceptibility to medicinal impressions which inflamed
structures acquire.  We have shown that the con



ATTENUATIONS OF DRUGS, ETC.       115
dition of inflamed tissues becomes entirely changed,
and that their acquired susceptibilities become so
morbidly increased, that even their natural stimuli
cannot be tolerated, but when allowed to operate, become additional and powerful sources of disease.
The natural and healthy material stimuli of the eye,
the ear, the lungs, the stomach, the bladder, &c., are
grateful during the normal state of these organs; but
let inflammation occur, and the smallest pencil of
light becomes intensely painful to the eye, as noises to
the ear, air to the lungs, food and drinks to the stomach, and urine to the bladder.
Nor is this augmented susceptibility confined to the
operation of the natural stimuli, but it applies with
still greater force to the action of specific medicines,
up to that point of inflammatory action when the sensitive extremities of the nerves succumb from intensity of excitement, and a condition bordering on paralysis or gangrene obtains. It is sometimes difficult
to decide when this morbid erethism has arrived at its
maximum, and the atonic state commences; but the
gradual subsidence of pain, appearances of effusion
or ulceration, and diminished sensibility of the affected part, will afford us the best indications upon this
point.  This fundamental law of homeopathy, not
only serves to explain in the clearest possible manner
the astonishing effects of infinitesimal doses, but it
teaches an important practical fact, at present unappreciated, but incontrovertible, and which stands at
the foundation of our therapeutical applications, viz.,
to ascend in our scale of attenuations in proportion to
the violence of the inflammation, until we arrive at that
point where the nerves of the diseased part have attained
their maximum qf erethism, after which we must again
descend the scale in the same ratio.
This same law applies with equal force to all irritations of the nervous system, even when entirely unattended with the usual phenomena of inflammation,
redness, swelling, heat, and pain. We have often
seen this nervous erethism- so strongly pronounced —
and where there were no signs of vascular excitement-that a, single grain of ipecacuanha, or the twentieth part of a grain of tartarized antimony, would




116         ATTENUATION OF DRUGS, ETC.
produce copious vomiting and purging; or a drop of
the first dilution of nux vomica, induce involuntary
contractions of the muscles, especially of those parts
which were unusually irritable; or a single grain of
jalap, rheum, calomel, or even a mental emotion, imrhediately cause diarrhoea; or a cup of tea or coffee
taken in the evening, prevent sleep for a whole night;
or the inhalation of a few imponderable particles of
ipecacuanha, give rise to both its primary and secondary specific effects upon the pulmonary organs.
There may be a few apparent exceptions to this
rule, as in the example already referred to respecting
the inefficiency of large quantities of opium and laudanum in tetanus; but these exceptions are susceptible of ready explanation. In this disease there exists
a peculiar preternatural excitement of the nerves,
which preside over the voluntary motions, and the
contractility of the tissues, which induces a spasmodic occlusion of those textures of the digestive canal
which, in the normal state, permit the absorption of
opiates. This is evident from the fact, that if laudanum be injected into the veins during tetanus, the usual
effects are manifested. In this exception, therefore,
the drug is not absorbed, and of course cannot exercise
its specific effects upon the economy.
It is evident, then, that in the selection of attenuations for chronic diseases, the precise condition of
the nerves of the affected parts must always be taken
into consideration, since some chronic maladies- are
characterized by a highly exalted nervous susceptibility, and call for the use of high attenuations; while
in other cases, this susceptibility or impressibility remains at a low  grade, and consequently will only
respond to low attenuations.
Dr. Lobethal, in alluding to this subject, makes use
of the following language:-" God be praised, the
times are passed when we adhere without examination to the prescriptions of Hahnemann, and when we
administered the thirtieth dilution in every case, without any regard either to the species of the medicine, or
the individuality of the patient. The idea of greatness
or littleness is but relative; we cannot say in a general manner, that some drops of the mother tincture




ATTENUATION OF DRUGS, ETC.          117
of a certain medicine will be a strong dose; nor yet,
perhaps, that the twenty-fourth or thirtieth dynamization of every medicine shall be regarded as a feeble
dose.  The dose of each medicine should be strong
enough to provoke the necessary reaction of the organism, and, provided we are careful not to administer
a too heavy one, agreeable to take, and without danger, we should always give a sufficient one.
"I am decidedly convinced, that in order to apply
the homoeopathic treatment with success,the physician
should take cognizance of the whole scale at his disposal, from the actual dose of the old school, up to the
highest dilutions of which any medicine is susceptible.
"' We may establish it as a principle, that the administration of large or small doses is in inverse proportion to the richness in nerves of the individual organism, and the species of diseased organ; that is to
say, the more the sentient sphere of the organism, in a
given case, shows itself predominant, the more the
dose of the indicated specific medicine should be
feeble, and that the more the individual organism, or,
in a local affection, the diseased organ, is poor in
nerves, the more the doses should be large."-(Revue
Critique et Retrospective de la Matiedre Medicale Specifique. Vol. iii., 1841).
Dr. G. H. Gross, of Germany, also observes, that
"' homceopathia, as now accepted, has determined the
point, that the physician must exercise his judgment as
to the dose, varying it from the HIGHEST DILUTION down
to ONE OR MORE DROPS OF THE UNDILUTED TINCTURE, as
individual cases may demand." *
"In the Vienna Homweopathic Hospital, where a
chronic case is rarely seen, the dilutions usually given
by Dr. Fleischmann, range from the first to the sixth
of the decimal scale. At the Linz Hospital, Dr. Reiss,
though convinced of the efficacy of the highest dilutions, and occasionally prescribing them, treats the
majority of his patients with the same dilutions as
those employed by Fleischmann. In looking over the
* Dr. Gross wrote this in 1840; but during several years preceding his
death, he was a most decided advocate of the highest dilutions.




118        ATTENUATION OF DRUGS, ETC.
records of homceopathic practice, we cannot help perceiving that of late years there has been a constant
downward tendency with respect to the dilutions (the
high potency novelty being left out of view). Not
only is this true with respect to the generality of
cases recorded, but also with respect to the practice
of individuals.  The majority of those statistics to
which we so triumphantly appeal, are undoubtedly
derived from the employment of the lower dilutions."
(British Jour. of Hornm. No. xxiii, p. 25,)
Dr. E. F. Ruckert, of Germany, also writes as follows: " I am satisfied that the system (homceopathia)
is still progressive, and has by no means attained its
perfection. In respect to doses, most generally, I make
use of the first dilutions, and never exceed the twelfth,
giving them in increased volume and repeating them
frequently. I have been more successful in this course
of treatment than formerly in the use of the smaller
doses.". Similar views have recently been promulgated upon
this subject, by G. Schmid, Trinks, Griesselich. Watzke,
Madden, Bigel, Drysdale, Russell, and indeed by a majority of our school, both in Europe and America.
We have not unfrequently been able to cure disease
with a high attenuation, after having failed with the
first and second dilutions of the same remedy; but it
has been a much more common occurrence with us, to
effect cures with the first attenuation after having
been unsuccessful with the higher preparations. No
definite rules, therefore, can be given which will apply
in all cases, but every circumstance connected with
each particular case must be duly investigated, and
the physician then exercise his own best judgment.
3. The character of the medicine to be employed.-Certain substances which are very feeble or even inert,
in their natural crude state, appear to acquire new
and potent qualities on trituration. Whether these
new properties are communicated to the minutely divided particles by a chemical combination with the
oxygen of the air, for which several, like carbon, graphite, sulphur, lime, &c., possess a very strong affinity, or whether they arise from the simple subdivision
of the atoms of the drug, we are unable to determine.
But these are the medicines which have been found




ATTENUATION OF DRUGS, ETC.       119
especially serviceable when employed in high attenuations.
On the other hand, there is a class of medicines
so volatile in their nature, that trituration and exposure to the air and moisture, deprive them of their active principles. Amongst these articles may be ranked camphor, ammonia, bromine, nit. argenti, the
ethers, the volatile salts, &c. Medicines of this kind
should always be exhibited in the lower attenuations.
We must also be governed somewhat by the positive or negative character of the specific employed.
Some medicines are very marked and prompt in their
specific operation,like tartarized antimony, phosphorus,
ipecacuanha, belladonna, aconite, hyoscyamus, stramonium, opium, &c., and may ordinarily be used at
rather higher attenuations than those whose primary
effects are less prompt and'strongly pronounced.
The advantages which we obtain from a minute
subdivision of crude substances, are as follows:
1st. We develop every part of the active principle
pertaining to the substance, by breaking up all natural organization or arrangement between its molecules,
and thus exposing a large amount of active surface
which would otherwise have remained latent.
2d. By distributing these molecules intimately
throughout an inert vehicle, (sugar or water,) they are
far more readily absorbed by the delicate lacteals and
absorbents, than coarse and irritating particles of matter.
3d. When these minute atoms have been conveyed
by the blood to those parts with which they have an
affinity, they penetrate the smallest vessels, impress
the minutest sentient nerves, and become productive
of results entirely unattainable by drugs in a crude
form.
4th. During the act of subdivision, it is not improbable that the atoms of drugs sometimes become oxydized, and thus acquire new and increased powers.
Finally, we infer, that no new properties are developed by the homoeopathic method of preparing drugs,
except such as arise from the mere subdivision of their
particles; and that all ideas respecting spiritualization,
dynamization, and magnetism, in the preparation of
medicines, are erroneous and untenable.




120          ATTENUATION OF DRUGS, ETC.
In regard to the repetition of doses, we are- to be
guided by the acute or chronic nature of the malady,
the urgency and danger of the symptoms, and the effects produced by the medicine.
In violent and dangerous acute diseases, like choleraasphyxia, convulsions, phrenitis, pleuritis, gastritis,
&c., the remedies should be repeated as often as
every fifteen, twenty, or thirty minutes-until an aggravation of the symptoms, (that is, some primary
effect of the drug), appears, or a perceptible amelioration of the symptoms is apparent, when the medicine
should be omitted, in the first case, until the secondary
or curative symptoms have come on, and expended
themselves; and in the latter, so long as amendment
continues. If the case demands it, recourse may again
be had to the same medicine; or if new symptoms
have made their appearance, another appropriate
remedy may be selected.
In less -urgent cases of acute disease, it will be sufficient to repeat the remedy every four, six, or eight
hours, until primary symptoms (aggravation) occur,
or amelioration of the symptoms evinces the secondary
or curative effects, when we may rest tranquil until
the amendment ceases, and the medicine has expended
its curative effect.
In chronic maladies, the remedy may be repeated
once in twelve or twenty-four hours, until an impression is perceptible, either in the form of primary drug
symptoms, or of amelioration of the morbid condition.
When this result obtains. we may with great propriety
wait until the full effects of the medicine have subsided, before we repeat the dose. In these cases it is
far better to make use of doses sufficiently strong, and
repeat them sufficiently often to induce decided primary medicinal symptoms-even if we are obliged now
and then to give antidotes-rather than to remain for
weeks in doubt as to whether a suitable impression
has been produced by a single dose. It is very rare
that moderate drug symptoms are productive of unpleasant consequences in chronic diseases, while the
reaction thus induced in the diseased tissue, usually
has the effect to bring about a much more speedy cure.
Indeed, we believe it may be set down as a general




ATTENUATION OF DRUGS, ETC.         121
rule, that the sooner we can produce a moderate, but
decided medicinal action in a structure suffering from
chronic inflammation, the sooner will a curative reaction follow, and health result.
",It would therefore appear that experience has confirmed the opinion of Hahnemann, that a certain
amount of aggravation is essential to the therapeutic
process; in the vast majority of cases this does not
make itself known in any perceptible degree, but it
does occur in a certain, though small amount of cases,
sufficient to confirm its existence as an essential phenomenon. The cases in which it occurs with infinitesimal doses are probably only those of excessive or
even idiosyncratic susceptibility, and even with these
it is a phenomenon of no danger, and only slight inconvenience. Hence we may conclude, that a normal
dose of homeopathic medicines, sufficiently small to
avoid the liability to aggravation in a certain amount
of cases, and yet sufficient to cure best and quickest in
the majority of cases, is a mere chimera, and ought
not to be sought for; but in seeking for doses the best
for the majority of cases, we must lay our account for
meeting with a certain number of aggravations, but
practically these latter are of no importance.
Likewise in the case of collateral symptoms, it is
affirmed by Hahnemann, that " we cannot arrange our
doses so as to escape the liability to them in a small
and practically unimportant degree."-(Dr. Drysdale:
British Jour. of Hornm., No. xxiii., p. 22.)
In all cases of urgent acute disease, in which we can
find no single remedy which corresponds to the prominent symptoms, it is necessary to select a second remedy which shall cover the remaining symptoms, and administer it in alternation with the first. Pneumonia
is often accompanied by cerebral inflammation; typhus
fever, with serious disorder of the intestinal canal, the
lungs, the brain and nervous system; intermittent.fever, with enlargement of the liver, jaundice, cough,
&c.; and other maladies with affections in other parts
of the body, which are not strictly connected with the
original complaint.  In examples of this kind, the alternation of remedies is both proper and necessary; at
the same time it must be remembered, that it is far
6




122             GEMNERAL DIAGNOSIS.
more desirable that a single medicine should be chosen
which covers all the symptoms of the disease.
The same rule holds good with respect to giving
medicines in succession. Whenever the first remedy
fails in producing the required impression, or whenever
important new symptoms arise to which the original
drug does not correspond, we may resort to another
which accords with the totality of the symptoms.
A large proportion of homneopathic physicians, both
of Europe and America, now advocate a frequent repetition of doses in acute diseases, and in many in:
stances give alternations of the remedies. Some of
those who have expressed themselves decidedly upon
this point, are, Drs. Gross, Schmid, Rau, Fleischmann,
Reiss, Ruckert, Lobeth al, Hartmann, Russel, Hull, Neidhard, Gray, Currie, Trinks, Griesselich, Madden, Dudgeon, and Quin.
The erroneous ideas which were formerly entertained respecting the alternate employment of remedies, are at present nearly abandoned. So long as the
absurdity prevailed that our medicines operated in a
kind of spiritual manner, upon certain mysterious appendages of the organism, termed " vital properties,"
it was deemed unsafe to administer two remedies in
alternation, for fear of creating confusion among these
dynamic influences; but since the laws of absorption,
and the specific topical action of drugs, have become
so fully established, there is no longer hesitation in
alternating medicines whenever symptoms appear to
require it.
CHAPTER XI.
GENE RAL  D IAGNO S IS.
IT is a matter of the highest importance that the
homeopath should be perfectly familiar with the most
approved methods of diagnosis, in order that he may
take advantage of every possible circumstance which
may facilitate his investigations of disease. Although




GENERAL DIAGNOSIS.           123
a patient may be competent in general to indicate the
exact seat of his pain, and thus enable the physician
to determine what organ or tissue is affected, this is
by no means true in all cases.
There are many maladies which are entirely unattended with pain, or any other local sign, by which
the physician can detect the suffering organ. In cases
of infants and young children, who are unable to indicate the locality of their sufferings, and in some
chronic affections, a knowledge of the external signs
is of vast importance. In all such cases a proper skill
in diagnosis will prepare the medical man to penetrate the innnermost recesses of the organism, and to
understand its most profound secrets.
It is a singular and highly interesting fact, that the
pains of the different parts of the body impart to the
countenance certain characteristic and easily understood expressions. As these signs are involuntary,
and almost uniformly present, all will recognise their
importance as diagnostic phenomena.
In forming our diagnosis, it is essential in the first
instance to notice accurately every circumstance connected with the patient which is at all peculiar or
unnatural. The general expression of' countenance,
the tone of voice and manner of speaking, the
figure, attitude, movements, etc., should be attentively
marked. At the same time, age, sex, temperament,
hereditary predisposition, occupation, habits of life,
whether labouring under the effects of any previous
malady or of mercury, and whether accustomed to the
constant use of opium, should all be duly considered.
The patient should then be permitted to detail his
symptoms after the mannerpointed out by Hahnemann,
in his Organon, (pages 126-7). In cases of inability on
the part of the patient to enter into a description of
the case, the friends should be called upon to give all
of the information in their power, in regard to the rise
and progress of the disorder. An attentive perusal of
Hahnemann's advice upon this subject, is of the utmost importance to the acquisition of a perfect portraiture of every complaint.
Since, however, there are some instances in which
neither the patient nor friends are able to afford any




124             GENERAL DIAGNOSIS.
information respecting the nature or seat of the affection, it is indispensable to acquire a knowledge of all
external and involuntary signs which can in any way
illustrate the character of the malady.
Allopathic writers have divided diagnostic signs
into those exhibited by the countenance; the attitude;
the nervous system; the digestive organs; the circulatory system; the respiratory organs; the skin; the
lymphatic system; the secretions.
As the countenance is an excellent index of what is
occurring in distant parts of the organism, we should
note attentively the expression of the eyes, nose,
mouth, and forehead, and also whether sadness, moroseness, peevishness, despair, fear, grief, or joy, is
evinced. By heeding carefully these indications, we
shall be greatly assisted toward accurate opinions in
obscure and complicated cases.
Thus, contraction of the features, rapid dilatation
and contraction of the nostrils, dyspncea, with expression of anxiety, indicate acute inflammation of the respiratory organs.
Sharp features, and expression of anguish, " forehead wrinkled, brows knit," eyes sunken, countenance pale, hollow cheeks, lips dry and bluish, indicate pain and severe inflammation of the abdominal
viscera.
General expression of countenance flushed and excited, or dull and stupid; eyes red and brilliant, or
dull and heavy; pupils contracted or dilated; protrusion of' the eyes, with a wild expression; mouth
drawn to one side; twitchings of the eyelids and
muscles of the face, indicate inflammation of the cerebral organs.
Expression anxious; respiration difficult and rapid
during inspiration, while expiration is comparatively
easy; symptoms worse after assuming the recumbent
posture; face swollen and livid; indicate hydrothorax.
Face flushed and swollen; lips blue; eyes prominent and unnatural; face cold; sudden startings in
sleep; anxious expression; indicate organic disease of
the heart.
Cheeks pale and blanched; lips white, and puffy; a




GENERAL DIAGNOSIS.            125
dark circle around the eye-lids; expression of languor
and debility, indicate chlorosis.
Paleness and puffiness of the upper lip indicate
scrofula and verminous affections.
" Eyes and face red; rapid respiration; motions of
the nostrils rapid;" indicate simple acute fevers.
FIGURE AND ATTITUDE.
Before alluding to the different attitudes assumed
by the body during disease, as diagnostic signs, we
shall take the liberty of digressing for a moment, in
order to touch upon the importance of a proper cultivation of the physical powers, as a means for securing
the most perfect corporeal development and symmetry.
In order that the organs may perform their functions
in a proper manner, it is absolutely indispensable that
the body should retain its normal structure and shape,
and remain unincumnbered by any artificial appliances
which tend to impede the circulation or check the
free action of the muscles. Unfortunately for mankind, it has been customary both in barbarous and
civilized countries, to distort artificially certain parts
of the body, under the absurd notion that they were
improving upon nature, and enhancing the beauty of
the figure which the Supreme Architect had formed in
his own image.
Amongst the savage tribes of the Rocky Mountains,
it is customary, and we suppose fashionable, for the
natives to flatten the forehead by long-continued artificial pressure. This constitutes the ideal of savage
beauty, and is the common method of improving upon the works of the Creator.
In other barbarous countries it is customary to slit
the ears and nose, and hang from them large quantities of tin, brass, and other cheap ornaments. This,
with the requisite amount of tattooing and painting,
illustrates their notions of what the human figure
should be.
In China, the semi-barbarous inhabitants compress
the feet of their females, from birth, in such a manner
as to prevent their growth and development; and in




126            GENERAL DIAGNOSIS.
this abominable distortion consists their idea of female
beauty. This is the Chinese improvement upon nature.
The Turks cram their women with "pillau," after
the manner of stuffing geese, to cause enlargement of
the liver, for "pate de foi gras,"-that they may become enormously fleshy, and thus present to the admiring eyes of their lords, figures of uniform dimensions in all directions. This is the Moslem's style of
female beauty.
In the highly civilized countries of Europe and
America, it is not customary to make use of artificial
contrivances to flatten the head, prevent the growth
and development of the feet, to slit the ears and nose,
or cram their women; but, through the instrumentality of those " infernal machines," corsets and stays,
the sex deem it indispensable, in order to be genteel, to
compress entirely from its natural shape the most important and vital part of the organism. These unnatural efforts at distortion are usually commenced at
an early period, and continued with perseverance,
until the figure has lost its natural symmetry, the
lungs are forced upwards, out of their just position,
and the abdominal viscera made to accommodate
themselves in the new situation to which they have
been reduced by art.
The civilized females of the present day, affect to
contemn the symmetrical figures which the Creator originally formed, and which the ancient sculptors delighted to represent in marble, and have chosen to
"' improve" on these old-fashioned notions, by partially
cutting off the connection between the upper and lower parts of the body; thus reducing it from the shape
of those models of perfection, the Venus di Medici, and
the Venus of Milo, to that of a wasp or an hour-glass.
We have not only the authority of the ancients in
all those master-pieces of art in which they have illustrated their ideas of beauty, but the greatest of
modern sculptors, our illustrious countryman, Powers,
in a MS. letter before us, declines a suggestion that his
exquisite statue of Eve should be exhibited, because
his sense of harmonious proportion, as well as of
physical necessity, compelled him to present the moth



GENERAL DIAGNOSIS.            127
er of mankind in the shape which the Creator approved as the ultimate. product and most perfect fruit of
divine intelligence and energy. "Eve," the sculptor
says, with satirical humour, "is an old-fashioned body,
and not so well formed and attractive as are her
grand-daughters,-at least some of them. She wears
her hair in a natural and most primitive manner,
drawn back from the temples, and hanging loose behind, thus exposing those very ugly features in women.
Her waist is quite too large for our modern notions of
beauty, and her feet, they are so very broad and large!
And did ever one see such long toes! they have never
been wedged into form by the nice and pretty little
shoes worn by her lovely descendants. But Eve is
very stiff and unyielding in her disposition: she will not
allow her waist to be reduced by bandaging, because she
isfar more comfortable as she is, and besides, she has
some regard for her health, which might suffer from such
restraints upon her lungs, heart, liver, 4c., (4c., 4c. I
could never prevail upon her to wear modern shoes,
for she dreads corns, which, she says, are neither convenient nor ornamental. But some allowance ought
to be made for these crude notions of hers,-founded
as they are in the prejudices and absurdities of primitive days. Taking all these things into consideration,
I think it best that she should not be exhibited, as it
might subject me to censure, and severe criticisms, and
these, too, without pecuniary reward."
Singular perversion of taste! wonderful and alt
powerful influence of fashion, which can induce
so many intelligent beings to suffer torture like savages, for the purpose of distorting their bodies, and
bringing them into those artificial shapes which civilized nations denominate genteel and graceful!
Suppose a fashionable woman should apply corsets
and stays to a favourite monkey, or a pet lap-dog, and
so compress its body out of shape, would not the attempt be pronounced heartless, and its author, perhaps,
be indicted for cruelty to animals? but when the same
barbarity is perpetrated upon a human being, it is
tolerated, because it is genteel and fashionable!
Were females the only sufferers from these cruel
practices, the sin would not be so great; but their




128              GEN ERAL DIAGNOSIS.
posterity participates deeply in the consequences which
result from their criminal perversity. The flat and narrow chests, the stooping gaits, and the pale or sallow
faces which greet us at every step, demonstrate the
extent of our physical degeneration.
But the female sex are not alone censurable. Too
great a proportion of the men, —of this country especially,-become round-shouldered, crooked, and deformed, from a want of free muscular exercise, and too
close an application to business, in constrained, bent,
and unnatural positions.
Physical education in latter times, has been quite
overlooked. Parents have commenced sending their
children to school in infancy, and their embryo minds
have been tasked with all kinds of mental exercise,
while their physical powers have been suffered to languish in heated and ill-ventilated rooms. Thus they
have grown up with improved minds, but feeble, undeveloped, and perhaps crooked, or mis-shaped bodies.
Let it ever be remembered, that the mind and body
exercise an influence upon each other, and if we would
secure to the former its highest development, we must
cultivate and perfect the latter. In this respect we
may with advantage go back to antiquity, and copy
after Herodicus, in advancing physical education.
But to return to our subject: As in health the attitude is erect, and those positions are assumed by the
body and limbs which indicate muscular strength, so
departures from the normal standard, induce corresponding alterations in the position and appearance
of the body.
Thus, tremors; position upon the back, with a constant disposition to sink down towards the foot of the
bed, indicate extreme muscular debility.
Distressing dyspncea, and sense of suffocation when
lying down; constant desire to assume the erect posture; general agitation, cough, and appearance of
anxiety, indicate hydrothorax.
Common position upon the back; rigidity and morbid involuntary contractions of the flexor muscles,
usually of the upper extremities, indicate softening
of the brain.
Position upon the back. " with the knees drawn up;




GENERAL DIAGNOSIS.            129
head and shoulders a little elevated; dread of motion,
indicate abdominal inflammation with acute pain.
Position upon the belly; pressure of the abdomen
affording relief; and very restless, indicate spasmodic
abdominalpains.
Rigidity, and involuntary contraction of the muscles
of the neck, back, and limbs, indicate inflammation or
irritation of the spinal cord.
In the advanced stages of acute diseases, position
upon the back, with the legs drawn up, indicate retention of urine.
THE TONGUE.
Much information may be gained, in many instances,
from an examination of the tongue. The following
are a few of the diagnostic signs presented by this organ:
A clean, smooth, and bright red tongue, indicate inflammation of the gastric or intestinal mucous membrane.
A clean, and red tongue, with papilla prominent; or
a furred tongue, with red papilla appearing through
the fur, indicate scarlatina.
A reddish, and tremulous tongue, indicates mania 4
potu.
A thick and yellow fur covering the tongue, with
bitter taste, indicate biliary derangement.
A white fur upon the tongue, indicates slight simple
fever.
Acute symptomatic fevers, effect but little change in
the appearance of the tongue.
A relaxed, dilated, and tremulous tongue, indicates
congestive or nervous fevers.
A pale and flabby tongue, " with large papilla," indicate gastric debility-met with in chlorosis.
A sharp and pointed tongue, is often observed in
irritation and inflammation of the brain.
THE NERVOUS SYSTEM.
Tearing, throbbing, and aching pains —aggravated
by contact, pressure, or movement, indicate inflammatory action.
Twitchings of the limbs; jerkings and shocks of the
6*




130            GENERAL DIAGNOSIS.
tendons; cramps; convulsive movements; violent
contortion of the body; pains relieved by pressure;
unattended with fever, indicate spasmodic pains.
Sharp and darting pains, unaccompanied by swelling, heat, or redness, indicate neuralgic pains.
Vague and wandering pains about the ancle often
indicate inflammation of the knee.
Pains also in other healthy parts, sometimes indicate inflammations in remote structures.
Wakefulness, indicates irritation of the nervous system.
Irresistible inclination to sleep, with stertorous
breathing, indicates compression, or serious disturbance of the brain.
Twitching of the muscles during sleep, and frequent waking from frightful dreams, indicate organic
disease of the heart; also characteristic of verminous
irritation.
Sudden, rapid, and jerking movements of the head
and limbs, indicate cerebral irritation, mania 4 potu,
and someforms of insanity.
THE ALIMENTARY CANAL.
The alvine discharges will afford many useful hints
to the observing physician.
Thus, light or clay-coloured evacuations denote a
lack of bile.
Mucous and bloody stools indicate intestinal inflammation: if accompanied with tenesmus, and redness
or protrusion of the rectum, we may conclude that
the lower part of the canal is affected.
Watery stools, with slight pain, indicate irritation
of the bowels.
"Glairy, dark green evacuations, like chopped spinage, are characteristic of hydrocephalus."
Very dry and hard faces indicate a relaxed and torpid state of the mucous membrane of the bowels.
THE RESPIRATORY ORGANS.
Using the abdominal muscles principally in respiration, indicates inflammation of the lungs.
Using the intercostal muscles alone, indicates abdominal inflammation.




GENERAL DIAGNOSIS.            131
Irregular respiration, with stertorous breathing, indicates compression of the brain.
Inspiration difficult, anxious and rapid, while expiration is comparatively easy, is peculiar to hydrothorax.
Wheezing, short, panting and anxious respiration,
with contraction of the larynx, indicate asthma.
Paroxysms of rapid, short, suffocating and spasmodic
cough, indicate pertussis.
White, tenacious sputa, indicate chronic bronchitis.
Very thick, yellow, or greenish sputa, which sinks
in water, indicative of disorganization of the lungs.
THE SKIN.
A yellow skin indicates disordered liver.
A sallow skin occurs in chlorosis, and afew chronic
ills.
A pale and waxen skin denotes a deficiency of blood.
A blue or livid skin, in infants, indicates a pervious
foramen ovale.
A hot and dry skin denote inflammaction.
A cold skin, with internal heat, indicate internal
congestion.
THE URINE.
Urine red and scanty denotes inflammation.
Urine clear, limpid, and abundant, in nervous affections.
Urine depositing a sediment indicates biliary derangement.
The above are only a few of the more common and
well known diagnostic signs. Our only object is to
direct the attention of physicians to this subject, for
there are often many things about the general appearance of a patient which are slight and indescribable in themselves, but which will aid him materially
in forming his opinions.
In order, then, to arrive at a correct diagnosis, it is
necessary1. To note all external signs.
2. To ascertain the age, occupation, previous
habits, predispositions, and peculiarities of the patient.




132                  FEVERS.
3. To procure from the patient a spontaneous and
minute detail of his sufferings in his own language.
When the patient is unable or incompetent to afford
this information, get as accurate a description as possible from those best acquainted with the history of
the case.
4. Ask such questions, and make such examinations
by the touch, pressure, sight, hearing, percussion, auscultation, &c., as may be necessary to perfect the
diagnosis.CHAPTER XII.
FEVERS.
Much has been written, and many hypotheses have
been advanced, from time to time, concerning the
pathology of this important class of diseases. Within
the two past centuries, the changes of opinion in
regard to the nature and seat of fevers, have been
almost innumerable; and yet. with all that has been
written, and the numerous bitter controversies which
have taken place, we are at the present moment but
little farther advanced as to any definite knowledge
upon the subject, than we were centuries ago. Indeed,
the opinions of the medical world at the present time,
are so.much at variance, that it would not be difficult
to find men of distinction who advocate almost every
doctrine which has ever been promulgated.
The old dogma that fevers arise from a concoction
of something injurious to the system, has even its advocates; thus, "substances in a state of putrefaction, by entering the blood, impart their peculiar action to the constituents of that fluid, and all the substances of the body are induced to undergo a modified
putrefaction."*  Again, Dr. Burne says, " that the adynamic or typhoid fever has no local seat; that its nature is a morbid condition of the blood, produced by the
* Paris Pharmacologia




FEVERS.                  133
operation of a primary cause, the respiration of a contaminated or tainted atmosphere."
Dr. Clancy and other authors believe the proximate
cause of fevers to be " a want of power in the system
to form blood."
Others still, like Clutterbuck and Broussais, have
contended that fevers of every denomination and degree, are the result of inflammation. They are supposed by these gentlemen to be topical affections, " the
general disorder of the system being only secondary
and sympathetic."  The former located the seat of
fevers in the bralin, the latter in the gastro-intestinal
mucous membrane.
The vitalists suppose that fevers, in common with
many other diseases, are owing to a morbid alteration
of what are termed the vital properties of the textures
affected.
Professor Mackintosh, of Edinburg, has advanced
the opinion, " that the effects of outward causes, and
inward irritations, in'producing irregular determinations of blood, are the great agents in exciting diseases,
and especially fevers."  He supposes " that the functions of almost all organs are embarrassed in fever
from the very beginning; that internal determinations
of blood take place, which rouses the system to reaction, and thus causes fevers; that inflammations of all
parts of the body will give rise to fever; that.inflammation may supervene during fever, without being the
primary cause of the febrile commotion; that the
-nervous system is involved as well as the vascular;
and that the blood itself must be in a diseased condition."
A majority of the profession at the present day,
however, suppose with Cullen, that the prime causes
which produce them, act directly upon the nervous
system, and thus produce their pernicious results.
Our own opinion is, that fever is a combination of
symptoms that may arise from a disturbance -of any
one or more parts of the body; that the primary impression is made upon the extreme nerves of the part
acted on; and that the whole system is affected to a
greater or less extent, secondarily, thus giving rise to
that congeries of symptoms which constitute fever.




134                  FEVERS.
The skin, the nervous system, the circulation, the respiration, the secretions, and indeed the whole body
partakes more or less in the general disturbance.
We suppose that the causes which produce fevers,
are specific agents which operate by being absorbed
into the circulation, and conveyed to those structures
for which they have an affinity or attraction, there imparting those peculiar and specific actions which induce fevers.
The miasm which causes intermittent fever evidently impresses a different part of the organism from
that which induces typhus. So also the miasms of
yellow fever, the contagion of plague, smallpox, scarlet fever, &c., are all peculiar and specific morbific
agents, which exercise their influences upon the system in different ways and in a manner analogous to
medicinal agents. Whether this morbific influence is
exerted upon the brain, the nervous system, the blood,
the stomach, or the arterial coats, of one thing we are
quite certain, that the miasm of intermittent fever can
never cause plague, yellow, scarlet, or typhus fevers,
nor can the poison of either of these maladies give
rise to any disease except that of its own peculiar
type.
It is probable that the contagion arising from human
effluvia-of ship, jail, and hospital fevers, scarlatina,
smallpox, plague, and the different kinds of malariaare all distinct substances, composed of minute particles of matter, each possessing its own peculiar properties, and each exercising its own specific influence
when introduced into the human organism. Unless
this were true, we should see either of these affections
constantly giving rise to any of the others indiscriminately.
In a perfectly healthy and vigorous state of the,sys.
tem, neither miasms nor contagious matters are capable of producing their peculiar effects, and they may
continue to circulate harmlessly in the blood for
months, until the system is debilitated from some cause
and thus predisposed to their influence, or until their
noxious qualities shall have been neutralized by frequent contact with the air respired at the lungs. The
fact that physicians and other healthy pemrons so often




FEVERS.                   1:35
expose themselves with impunity to all of the noxious
agents, proves conclusively that a certain state of preparation is an essential condition to their operation.
At present the pathology of fever is so little understood, that all opinions respecting its nature and seat
must be, to a considerable extent, vague and conjectural. In treating upon the different forms of fever,
therefore, we shall adopt the classification of Mackintosh, on account of its simplicity and the superior facilities it affords for diagnosis. The following is the
arrangement:
1st. Intermittent fever.
2d. Remittent or yellow fever: infantile remittent.
3d. Continued fever, subdivided into four orders,
viz.:Fever from functional derangement.
" from inflammation.
" from congestion.
A mixed form of fever between these three last, but
in which congestion predominates, commonly denominated typhus or synochus.
4th. Hectic fever.
5th. Fevers attended with eruptions, subdivided as
follows:        Scarlet fever.
Measles.
Smallpox.
"'  "  modified.
Chickenpox.
Miliary fever.
Roseola.
Urticaria.
Erysipelas.
6th. The plague.
In all of these fevers there are certain peculiar
characteristics which serve to distinguish them from
each other, and from all other maladies. Notwithstanding this, however, we scarcely ever find two
cases of the same type running precisely the same
course, or presenting precisely the same symptoms.
So many circumstances connected with the exciting
cause, as climate, age, sex, temperament, predispositions, habits, &c., tend to modify the character of each
particular.case, that all instances of the same malady




136                   VEVERS.
must necessarily present different trains of symptoms.
It will readily be perceived, therefore, how impossible it is to prescribe for the name of a disease instead
of symptoms. We also take this occasion to express
our opinion, that any classification of diseases whatever, is valuable as an aid in diagnosis rather than in
the exhibition of remedies.
The course of a fever sometimes varies during its
progress from its commencement to its termination,
and on this account divisions are made into1. The forming stage.
2. The cold stage.
3. The hot stage.
4. The sweating stage.
5. Collapse.
This is a mere arbitrary division, which can by no
means be relied upon, for many fevers run their course
without the supervention of these stages. Let it ever
be impressed upon the mind, then, that these classifications and divisions are entirely arbitrary and artificial, and can only be used for the purpose of facilitating our diagnostic examinations.
CHAPTER XIII.
CAUSES OF FEVER.
The causes of fever are either predisposing or exciting. Anything which debilitates the organism, or
impairs the tone and resisting power of the nervous
or muscular system, may be denominated a predisposing cause of disease. Under this head may be ranked,
excessive physical or mental exertion, protracted
grief, anxiety, fear, chagrin and disappointment, deprivation of well ventilated dwellings, proper food,
clothing and exercise, over-indulgence in the pleasures of the table, stimulating drinks, licentiousness,
want of cleanliness, and, finally, congenital causes,
and those connected with some hereditary predisposition.




CAUSES OF FEVER.            137
Those causes which induce fever by a direct impression, are termed exciting causes.  Miasmata,
contagious and epidemic effluvia, noxious gases, extreme and protracted heat or cold, and sudden changes
of temperature, are examples of this class.
All of the causes, however, which we have ranked
under the head of predisposing, may, and often do become, under favourable circumstances, actual exciting
causes of' fever.
It is equally true, also, as we have before observed,
that what are called exciting causes, do not usually
operate so as to produce fever, unless the system is
prepared or rendered susceptible to their influence by
debility, or some other predisposing cause.
The powers of the body may be taxed up to a certain point, by moral or physical, morbific or remedial
agencies, without exciting actual disease; but if the
influence be carried beyond this point, an impaired
condition of the capillaries acted on will ensue, with
the usual concomitants, inflammation and fever. Even
the natural maladies, scarlet fever, measles, smallpox,
chickenpox, and hooping cough, seldom malke their
attacks unless the system is predisposed to receive
their impressions.  Therefore, these disorders will
often attack one member of a family, while all of the
rest, who are equally exposed to the contagion, will
escape.
The same rule holds good in regard to the operation
of morbific, as of remedial agents, viz.: in proportion
to the departure of the organs and tissues from their
healthy standard, so will be the acquired susceptibilities of these structures to the influence of morbific
agents.
The importance, then, of a constant and regular
system of physical culture, and a rigid avoidance of
all those things which can in any way impair the
normal integrity of the organism, will be recognised.
Indeed, we believe that such a course might be pursued, as would secure an individual against disease
until his system should succumb from old age. Such
a course would involve a herculean task in our present state of physical degeneracy, yet it is not beyond
the bounds of possibility.




138              CAUSES OF FEVER.
A few of the means which we should recommend
to accomplish this object would be,
1st. A proper system of physical education.
The first and most essential condition for the enjoyment of perfect health, consists in a symmetrical and
well developed organization. In looking around upon
the world, how few do we behold who can boast of
unexceptionable physical conformations-how  few
who have not some imperfection which might have
been avoided by an early and proper attention to physical culture!
But how shall this bodily perfection be attained?
We reply, by the universal establishment of free
public gymnasiums, where those athletic exercises can
be pursued which shall systematically develop and
strengthen every part of the body. We repeat, let
there be established, athletic sports, games, &c., suitable for all ages and conditions; where the man of mature years may occupy agreeably an occasional leisure
hour with physical and mental benefit; where the
growing youth can correct all incipient bodily defects,
and acquire that development and expansion in every
part, which will enable all of the organs to act in a
free and healthy manner. Let us abolish "infant
schools" for the education of infant intellects, and establish in their place infant gymnasiums for the culture
of their infant bodies. Let us see no more intellectual
" infant prodigies," with their pale, sickly faces, and
their feeble and half-developed forms, but show us in
their stead, physical prodigies with their rosy cheeks,
their plump, firm, and well-grown muscles, and with
elasticity and buoyancy reminding us constantly of perfect health. Show us your children of six, eight, or ten
years of age, wild, bouncing, and overflowing with animal spirits, rather than your prim, well-mannered, delicate sickly, hot-house, and band-box specimens.
All physiologists agree as to the vast importance to
the young, of a great amount of exercise —free, spontaneous, and unrestrained. It is a principle of their
natures, absolutely essential to their well-being, and
we must not permit the artificial customs or restraints
of society to prevent it.
Our remarks apply with more force to cities than




CA.USES OF FEVER.              139
to the country, for in the former everything is forced
and unnatural: children are born into hot-houses, and
reared in dwellings heated with Lehigh coal, to the
temperature of 75 or 80 degrees Fahrenheit. Here do
these unfortunates pass the best part of their existence,
encompassed by everything which is unnatural and
artificial, and inhaling an atmosphere deprived of a
portion of' its oxygen, and impregnated with carbonic
and other noxious gases, until, while yet young in
years, they arrive at the conditions of old age, satiated
with the displays and luxuries of life, and reduced to
a miserable state of physical inefficiency.
It has been well remarked by physiologists, that if
the large cities were not constantly supplied with
healthy recruits from the country, they would soon become desert wastes. This remark is, beyond question,
true, and it is only necessary to look into any of our
large towns and behold the numerous worn-out and
impotent wrecks of the wealthy families who have
been inhabitants for two or three generations, to be
convinced of the fact.
The second means which we should advise to secure health would be, a correct system of dietetics.
The use of all kinds of animal and vegetable substances which are perfectly pure, digestible, and
healthy, should be rigidly prohibited. In order to accomplish this object, we do not believe that better
rules could be adopted, than those instituted and commanded by Moses for the Jews. Amongst the articles
forbidden in the dietetic regulations of the great Hebrew lawgiver, we find pork excluded, from the supposition that the swine is unclean and unhealthy.
When we consider how frequently the animal is affected with that dreadful malady, scrofula, and also
how filthy and disgusting are its habits, it is not surprising that any person who is at all particular as to
the quality of the food he consumes, and who possesses
ordinary powers of observation, should denounce this
nasty, offensive, an(l diseased animal, as unfit for food.
But this abominable stuff in all its different forms, is
consumed by christians everywhere. Lard constitutes
the culinary expletive which serves to connect the ingredients of almost every dish in one greasy union.




140              CAUSES OF FEVER.
Whether the uses of pork and its preparations, have
any agency in causing scrofula, we leave for others to
determine. An argument, however, which tends to
establish the affirmative, is in the fact, that amongst the
strict Jews, and all of those nations where the animal
is not used as food, this malady is scarcely known,
while in every country where it constitutes an article
of diet, scrotula abounds.
In a word, care in regard to the selection of proper
articles of food, suitable methods of cookery, avoidance
of fat and condiments, stimulant, narcotic, and hot
drinks, and regularity in partaking of meals, will enable mankind to preserve the integrity and health of
those organs which are concerned in digestion and
assimilation, and thus avoid the numerous evils which
accrue from errors in diet.
Finally, we would recommend the establishment of
such a state of society as should recognise no pursuit
or custom as legal or respectable, except such as should
conduce directly to the health, morals, and general
welfare of the community.
MIASMATA, &C.
Numerous experiments have been made for the purpose of arriving at the chemical and physical properties of miasmata, and contagious and epidemic effluvia,
but as yet, all investigations upon this subject have
proved futile. We only know that when animal or
vegetable substances undergo decomposition, a principle is set free which diffuses itself in the atmosphere,
and which possesses the power when absorbed into the
system, of producing certain specific effects upon the
extreme nerves, which generate fever. The portion
which is thus liberated by the aid of heat and moisture,
constitutes, without doubt, the active principle of the
original crude substance, in its purest form and most
perfect state of development. This active principle is
as imponderable and attenuated as the preparations of
homeopathy, and a few inhalations under favourable
circumstances are capable of causing fever: it is also
as specific and- uniform in its operation and effects upon
the economy, as remedial agents themselves.




141
CHAPTER XIV.
INTERMITTENT FEVER.
We have observed-that each type of fever is marked
by certain symptoms which distinguish it from all
other varieties. The type under consideration presents its characteristics in a very striking manner.
Indeed, so great is the difference between intermittent
and other fevers, that some writers have withdrawn it
from the list of febrile diseases, and ranked it with
those connected with derangement of the cerebrospinal system. The regularity and distinctness of the
paroxysms, and the complete state of apyrexia between
the periods of attack, certainly offer some reason for
this course; but, on the other hand, as the combination of symptoms termed fever, is universally present
during the paroxysms, and since upon the whole it
bears a closer resemblance to febrile than neuralgic,
or ganglionic affections, we shall continue to adopt the
old classification.
In the different forms of intermittent fever, the interval which elapses between the commencement of
one paroxysm and another, varies; some cases having an interval of 24, some 48, and others 72 hours
from one attack to another. From this circumstance
the different types have been designated-quotidian.
or:4 hour type; tertian, or 48 hour type; quartan, or
72 hour type. These have also been subdivided into
double quartan, double tertian, &c.
DIAGNOSIS. A paroxysm of intermittent fever is
composed of three stages, viz.: first, the cold; second the hot; third, the sweating stages.
Preceding the cold stage, there usually occur general feelings of lassitude, debility, uneasiness, and
pains in the head, back, or loins, and sometimes slight
sensations of external or internal cold. There is also
a loss of appetite, disinclination to bodily or mental
exertion, and a constant disposition to stretch or yawn.




142            INTERMITTENT FEVER.
As the cold stage actually commences, the extremities feel cold and contracted; the surface becomes
pale, shrunken, rough, with diminished sensibility; a
sensation of cold along the spine, extending into the
thorax and abdomen; the coldness soon diffuses itself
throughout the whole body; universal tremors, external and internal; chattering of the teeth; respiration
laborious, rapid, and imperfect'; oppression at the
praecordia; countenance pale, leaden, earthy, or livid,
shrunken, and expressive of anguish; eyes dull and
sunken; lips livid; general sense of physical and mental prostration.
The pulse is variable: it may be slow, rapid, weak,
oppressed, or intermitting.
The temperature of the body is usually natural, with
the exception of the extremities.
The duration of this stage is exceedingly various;
sometimes terminating in ten minutes, at other times,
lasting four or five hours.
Paroxysms occasionally occur without any well
marked cold stage, a slight trembling only being experienced previous to the hot stage; at other times
neuralgic or rheumatic pains, or coma, precede the,
second stage.
Hot Stage. As soon as the chills begin to abate,
flushes of heat commence passing over the body, until,
in a short time, the hot stage is fully developed.
This stage is characterized by hot and dry skin;
countenance flushed and full; mouth dry, tongue
parched; urgent thirst; headache; respiration rapid
and anxious; general restlessness; pains in different
parts of the body; more or less disturbance of the
mind; pulse usually rapid, sharp, and bounding.
This stage also varies very much in duration, it
rarely terminating in less than four, and often continuing twelve, and sixteen hours. In some instances
the hot stage even continues several days, when it becomes a continued fever; or it may assume the remittent form.
Sweating Stage. After the hot stage has run its
course, a perspiration makes its appearance upon the
forehead and extremities, which is soon diffused over
the whole body. As the sweating becomes more and




INTERMITTENT FEVER.            143
more profuse, the febrile symptoms, with the pains and
uneasy sensations, gradually subside, until the paroxysm terminates in a perfect state of apyrexia or convalescence.
The above is a general description of the ordinary
course of an intermittent paroxysm; but in some instances these stages are reversed, or one or more of
them may be absent, or if present, only a few of the
symptoms enumerated will be recognised.
Writers have divided intermittents into four varieties, viz., first, the inflammatory; second, the congestive; third, the gastric; fourth, the malignant intermittents.
This division is made from the fact that the different types, under certain circumstances, partake of
the general character which these terms indicate.
Thus, the inflammatory variety generally occurs during the winter and spring.  Quotidians are more
prone to partake of this modification than tertians or
quartans.  Patients labouring  under this variety,
rarely enjoy perfect intermissions between the paroxysms, and they are often left with permanent disorders of the liver, lungs, &c.
The congestive variety is very uncommon. It seldom attacks any except those of feeble, relaxed, and
exhausted constitutions, in whom there is not sufficient vigour to accomplish a perfect reaction. The
brain is the organ which usually suffers most, and
coma often supervenes during the cold stage, which
ends in death.
The gastric variety presents prominent symptoms
of gastric derangement from the first, a superabundance of the biliary secretion, furred and bitter
tongue, with nausea and vomiting. It is peculiar to
temperate latitudes, and usually occurs in the autumn.  In this variety the liver is much affected,
and therefore we find chronic enlargements of this
organ often remaining after the paroxysms have been
subdued.
The malignant intermittents are peculiar to hot latitudes.  They are attended with extreme debility
from the onset; respiration is feebly and imperfectly
performed, the blood is only partially oxygenated,
diarrhea now and then ensues, and a rapid prostra



144           INTERMITTENT FEVER.
tion of the powers of the system usually occurs, which,
in many instances, speedily proves fatal.
It has been noticed that chronic enlargements and
indurations of the liver and spleen, affections of the
lungs, dyspepsia, scirrhous indurations, &c., often succeed fever and ague.  These affections have been
looked upon as secondary consequences of the fever,
while, in point of fact, they are medicinal diseases,
superinduced by the abuse of mercury and bark.
These drugs are empyrically employed by the allopath, for the cure of this malady in all its various
forms: Whether inflammatory symptoms predominate, whether there is congestion of the brain, lungs,
or liver, or whether the system is exhausted by previous debilitating causes, quinine and calomel in large
doses are the grand, and we might almost say, the
only remedies of allopathy.  But do these violent
drugs actually cure the malady? When the paroxysms are arrested by the use of these herculean
doses, are the seeds of the disease eradicated, and is
there no danger of a relapse? Let the candid practitioner of the old school answer.
It is the opinion even of some eminent allopaths,
that large doses of quinine  often suspend chills
and fever, by superinducing in the liver or some other
important viscus, a serious medicinal inflammation or
congestion which usurps, temporarily, the place of
the intermittent. The effect of this truly allopathic
measure is, however, only of short duration, for the
paroxysms return again as soon as the artificial disease has somewhat abated, or from some slight exciting cause. Thus will the paroxysms repeatedly
return, and be as often temporarily suspended, until
finally some permanent chronic malady will become
fastened upon the system and thus supersede the original affection.
Is there a man in existence sufficiently robust to
swallow with impunity the quantities of antimony,
calomel, bark and quinine, which are usually prescribed by the old school in fever and ague? Must
not some part of the organism necessarily succumb
before such formidable quantities of powerful medicines? Let the stoutest allopath presume to try the




INTERMITTENT FEVER.           145
experiment upon his own person, and if he escapes
without inflammation of the stomach and intestines,
serious disease of the liver, lungs, spleen, or some
other organ, we will confess our error, and say that
large doses of quinine are innocent and harmless, and
that the preparations of mercury are manageable,
mild, and safe, when admitted into the human stomach.
Causes. The most common cause of intermittent fever
is a peculiar miasm which arises during the progress
of vegetable decomposition, and which some authors
have termed koino miasmata. The term marsh miasm
is often used, but we deem it improper, as the miasms
generated in elevated locations, are as capable of
causing the disease, as those formed in low and
marshy ground.  The decomposition of vegetable
matters, by the aid of solar heat and moisture, is the
only condition requisite to develop the morbific principle.
Other causes occasionally give rise to fever and
ague, as intestinal irritation from indigestible -food,
and worms, sudden suppression of old discharges, and
atmospheric vicissitudes.
Therapeutics.-The remedies most commonly made
use of in this malady, are china and arsenicunz. The
following will also be found appropriate in many instances:-ipecacuanha, bryonia, eupatorium, perfoliatum, nux vomica, veratrum alb., belladonna, carbo
veg., pulsatilla, antimonium crud., ignatia, cocculus, lachesis, sabadilla, sulphur, cina, natrum  mur., capsicum.
China.-External indications. -Yellowish colour of
the skin and face; during the chill and heat, redness
of the face, and distention of the veins of the face and
head. "During the chill, bilious vomiting; palpitation of the heart; short cough."-(Hartlaub). "During the intermission, yellowish, clay-coloured countenance; weak eyes; fulness of the abdomen; cough;
anasarca. In tertian fever, with thick, brown, yellowcoated tongue: countenance palish yellow during
the paroxysm and intermission; swelling in the region of the spleen; eyes red and sensitive." —(Knorre.)
Quotidian fevers, with pale countenance: cold and
7




146           INTERMITTENT FEVER..
pale hands and feet, and retching up of mucus during
the chill; while during the fever there are, red face,
full quick pulse, dry spasmodic cough.
Physical Sensations.-Paroxysm preceded by palpitation of the heart, sneezing, anguish, nausea, thirst,
bulimia, headache and colic. Thirst before and after
the shiverings, or during the sweating stage; coldness
-of the body, with congestion to the head; soreness in
the region of the liver; easy perspiration during sleep,
or when moving; short cough; for the most part no
thirst during the cold  or hot stages.  Hartlaub
has cured chills, external or internal, without thirst,
followed by heat with thirst; and followed, or not,
by sweat; or chills in some parts of the body, with
shuddering and heat in the head, terminating in
fever, intermingled with chills, attended with thirst
and followed by sweat; or no chills, but fever with
urgent thirst, and afterwards with perspiration. Hartmann advises china, when we have during the paroxysm  throbbing pain in the head, extending to
the orbits; vertigo; nausea; pain in the region of
the liver; sharp pain in the chest; short cough;
aching pain in the abdomen during the chill; pains
in the loins and legs. During the intermission, confusion of the head; transient vertigo; variable appetite; thirst; drowsiness after meals; uneasy sensation in the pit of the stomach; nausea; constipation;
general debility.  Knorre has cured the quotidian
type, with vertigo; pale and cold hands and feet,
and retching of mucus, during the chill; and pains
in the head, both sides, and pit of the stomach; dry
and jarring cough, and drowsiness during the fever,
which is protracted and violent. Also, tertian fevers,
with violent chills, heat, and thirst, followed by perspiration. During the paroxysm and intermission,
there were bitter taste, eructations, and vomiting;
aching pains in the pit of the stomach, and in the region of the spleen; yellow and sickly aspect. Also
in tertian fever, when the chill is short and slight, but
followed by violent aching pain in the forehead, in
the right temple, and around the right eye; general
heat; intense.thirst; eyes hot, painful, and sensitive
to the light; paroxysm commences in the forenoon.




INTERMITTENT FEVER.           147
lasts until evening, and is succeeded by perspiration
during the night.
M}[ental and moral symptoms.-Confusion of ideas
and drowsiness during the paroxysm and intermission;
anxiety; discouragement; great activity of the mind;
sometimes delirium.
Administration. —One drop of the third dilution in a
teaspoonful of water, may be given' previous to the
chill, and during the forming stage.  Should this
prove insufficient to remove the symptoms, the dose
may be repeated every four hours during the intermissions.
Arsenicum. —External indications.-Face puffed and
earthy; or countenance anxious, sunken, and of a yellow tint; pendiculations and drawing in the limbs
during the cold stage; pungent and burning feel of
the skin during the fever; dropsical swellings; trembling of the limbs during the sweating stage; pulse
irregular, or quick, weak, small, and frequent, or suppressed and trembling; tongue bluish, white, or
bright red; diminished urine; night-sweats; face
red during the fever, but pale and sunken during the
intermission.
Physical sensations.-Aggravation of existing symptoms just previous to, or during the attack; paroxysms
imperfectly developed; chills and heat alternating;
periods of attack regular, and generally in the morning or evening; burning thirst, or adypsia; fever of
either type; burning in the stomach, sharp pains in
the limbs, chest, back and head, during the heat, with
difficulty of breathing; during the sweating stage,
heaviness of the head, buzzing and ringing in the
ears; between the cold and hot stage, drowsiness,
languor, thirst, nausea, vomiting and hiccup; sweats
during sleep, or on waking in the morning.  Dr.
Watzke has cured chills and thirst, followed by high
fever, urgent thirst, dizziness, confusion in the head,
and, finally, profuse perspiration without thirst.
During the apyrexia, pains in the chest and head;
weakness and faintness; small appetite; abdomen
swollen, and affected with occasional colic pains. Dr.
Hartlaub has cured chills without thirst, followed by
fever with or without thirst, and then by perspiration:




148           INTERMITTENT FEVER.
before the chill, vertigo; fainting; pains in the side,
chest, abdomen and back; stretching and yawning:
during the chill, anxiety; pains in the head, back,
limbs, and pit of the stomach; stretching and yawning; prostration; nausea; vomiting; coldness of the
abdomen, oppression of the chest: during the fever,
delirium; pain in the head; vertigo on rising; nausea;
bitter taste; aching pain in the region of the liver;
aching and burning, extending from the pit of the
stomach to the left hypochondrium; oppression of the
chest: during the intermission, pale countenance;
white tongue; swelling of the hypochondrium and
abdomen; cold, clammy sweat; throbbing pain in the
forehead; thirst; no appetite; nausea; extreme debility; pains in the head, chest, back, and limbs.
Mental and moral symptoms.-Depression of spirits,
and irritability previous to the attack; anxiety, uneasiness, confusion of ideas, which gradually increase
until the sweating commences; occasionally delirium
during the hot stage.
Administration. —Two drops of the sixth dilution in
an ounce of water,-a dessert spoonful once in six
hours during the apyrexia, until the symptoms have
disappeared. One dose of this remedy will often
prove successful where allopathic doses of crude cinchona, and other articles, have produced no effect.
I have, in two instances, succeeded in curing cases
which have resisted the old school method for months,
with a single drop of the thirtieth attenuation.
Remarks.-Arsenicum is appropriate in any type of
fever and ague, provided the symptoms correspond,
although several authors especially commend it in the
tertian and quartan forms. Fleischmann employs
from the third to the sixth attenuation; Watzke
generally gives the second, third and fourth dilutions.
Unless the patient is unusually susceptible, we prefer
the third to the sixth.
Ipecacuanha. —External indications.-Before the
shiverings, uneasiness, stretching and lassitude, with
cold sweat on the forehead; tongue clean or loaded;
during the apyrexia, countenance pale or yellowish.
Physical sensations.-Slight chills, followed by much
heat; or, severe chills with little heat; aggravation




INTERMITTENT FEVER.            149
of the rigours from external heat; thirst only during
the chill; nausea, vomiting, and other signs of gastric disturbance, manifest during the heat; also, constriction of the chest. Watzke advises ipecac., when
the chills are attended with thirst, confusion of ideas,
and dull pains in the head; the hot stage, with thirst,
and sharp pains in the head; the sweating stage, with
but little or no thirst; the apyrexia, with want of appetite, bitter taste, oppression at stomach, and pale
face. Hartlaub has cured slight and short chills,
without thirst, followed with violent fever with thirst,
and succeeded by profuse perspiration, or without
perspiration. Before the chill, pain in the back:
during the paroxysm, headache, dulness of intellect,
gastric derangement, nausea and vomiting, oppression,
contraction, pain in the chest, and cough: during the
intermission, bitter taste of food, much saliva, loss of
appetite, vomiting after eating, lassitude, sleeplessness.
Mental and moral symptoms. —Before the chill, dul —
ness of intellect and sleeplessness: during the chill,
confusion of ideas, irritability, impatience, and indisposition to mental effort.
Administration.-Same as china.
Remarks.-This remedy has been most frequently
used in fevers of the quotidian and tertian types. Lobethal, Hartmann, Boenninghausen, Schmid, Fleischmann, Watzke, Madden, Trinks, Elwert and Rummel,
have expressed themselves strongly in favour of the
low dilutions of ipecac. in this disease.
Bryonia.-External indications.-During the shiverings, trembling and redness of the face: during the
heat, nausea, and tendency to keep the recumbent
posture: during the sweating period, frequent sighing
and cough.
Physical sensations.-Preceding the cold stage, vertigo, headache, and lassitude; first stage, ushered in
with severe chills and trembling, with heat in the
head; chilly stage, more violent than the hot, or,
slight but protracted chills, and some thirst; second
stage, ushered in with flushes of heat and slight chills,
in alternation in the first instance, afterwards burning heat and thirst; universal dry heat, external and




150           INTERMITTENT FEVER.
internal; spasmodic cough; vertigo and headache
during the fever; shooting pains in the side and abdomen; after the heat, profuse sweat; oppression in
the chest, with dry cough; tendency to sweat night
and morning; during the apyrexia, constipation, thirst,
unhealthy yellowish complexion, and night sweats.
Mental and moral symptoms.-Irascibility, and dis.
position to look on the dark side of affairs.
Administration.-Two drops of the third dilution in
an ounce of water, —a dessert spoonful two or three
times during the apyrexy.
Eupatorium perfoliatum.-This is a remedy which
we have found highly serviceable in many cases
which have been complicated by the abuse of calomel and quinine. It is particularly indicated when
the liver is much implicated. An intelligent friend of
mine, who resides at the West, in a fever and ague
district, informs me that he has for many years past
made use of a very small quantity of an exceedingly
weak infusion of this agent, as a prophylactic against
the disease, in his own family, and with complete
success. He also assures me, that he has often cured
with astonishing facility, cases which had baffled for
months the ordinary treatment, with a dose or two of
an infusion very slightly bitter.
The external indications are, yellow tinge of the
skin and eyes; eyes dull, heavy and sunken; lips
pale or bluish, dry and cracked.
Physical sensations.-Irregular development of the
paroxysms; frequent slight chills previous to the commencement of the first stage; partial chills in the back
and extremities; dizziness, heaviness and ringing in
the head, during the cold stage; hot stage ushered in
with slight chills, alternating with flushes of heat, until in a short time the heat becomes general, attended
with headache, nausea, vomiting, pains in the chest
and stomach; pains in the bones; tenderness of the abdomen on pressure; loss of appetite; sensation of fatigue, languor and debility; constant inclination to
sleep; nocturnal sweats.
Dr. Williamson advises eupatorium in the quotidiin
and tertian types, when the following symptoms are present: paroxysm commencing in the morning; thirst




INTERMITTENT FEVER.            151
several hours before the chill, continuing during the
chill and heat; stiffness of the fingers during the chill;
soreness in the bones; aching pain with moaning,
throughout the cold stage; a greater amount of shivering during the chill than is warranted by the degree of coldness; retching and vomiting of bile from
drinking; vomiting after every draught; vomiting at
the conclusion of the chill; distressing pain in the
scorbiculus cordis throughout the chill and heat; chill
beginning at nine o'clock in the morning; throbbing
headache during the chill and heat; violent pain in
the head and back before the chill; inconsiderable
perspiration, or none at all; fever in the forenoon, preceded by thirst early in the morning, but no chill; attended by fatiguing cough and not followed by sweat;
loose cough in the intermission; cough in the night
previous to the paroxysm; yellowness of the skin.
Mental and moral symptoms.-During the paroxysm,
confusion of ideas and ringing in the ears; discouragement; indifference to life; dull of conception, and
discontented during the apyrexy.
Administration.-One drop of the first dilution in a
spoonful of water, during the apyrexy. As a prophylactic against intermittents, one drop of the tincture
two or three times a week.
Nux vomica.-External indications.- During the
chills, skin, hands, feet, face and nails are cold and
bluish; redness of one or both cheeks; spasmodic contractions in the limbs; yawnings and stretchings.
Sweat profuse, sometimes with a disagreeable acid
smell; partial or one-sided sweat; pulse hard, full and
frequent, or small, quick, or feeble, or intermittent;
dryness of the lips; tongue coated white or yellow.
Physical sensations.-First stage preceded by external and internal cold and yawning; chills usually at
night, or in the morning; aggravated by motion, drinking, or excitement; pain and heat in the head; thirst
for beer; pains in the back and loins; during the hot
stage, headache, vertigo, thirst, nausea, pains in the
chest; shivering on motion; debility; during the
sweating stage the symptoms are mitigated; sweat
and chills alternately.
Watzke gives us the following indications: chills




152            INTERMITTENT FEVER.
with thirst; headache, loss of consciousness, or delirium, painful and inflexible limbs, contracted feel of
the muscles. Chills last four or five hours, and not
followed by heat or perspiration. After the chill, exhaustion; pains in the hypochondria from distention;
thirst and want of' appetite; tongue white; feet swollen; sensation of heaviness when walking. Or, chills
followed by heat and sweats; with thirst; anxiety;
headache; slight cough, with burning sensation in the
chest, worse during the chills and heat; constipated
bowels; loss of appetite; craving for beer; weakness
and faintness.  Hartlaub has cured chills with or
without external coldness, and without thirst; followed by fever with thirst, and succeeded or not by perspiration. The chill may be slight and short, or violent and protracted, with shaking and chattering of
the teeth, and blue nails; fever attended with perspiration about the head and neck. Or, shaking chills
with thirst, followed by fever with thirst, and by perspiation,; chill preceded by thirst, coldness increased
by drinking. Or, alternating chill and fever; motion
during the fever or sweat causes chills; during the
chi, pain in the back (sacrum); during the fever,
headache, vertigo, red face, pain in the chest, vomiting of water, bile, slime and food; red urine; during
tab intermission, headache; vertigo; trembling of the
head on motion; pain in the forehead; acid eructations; bad taste in the mouth, loss of appetite, disgust
for food'; much thirst; pain in the pit of the stomach
after eating; distention and pain of the belly; constipation; pressing at the neck of the bladder after urinating; drawing in the limbs; weakness. Hartmann
employs it when, at the commencement of the paroxysm, there are paralytic weakness of the limbs; disordered stomach; vertigo, and sudden prostration of
strength.
Mental and moral symptoms.-During the chills, stupid or delirious; during the fever, anxious, melancholy,
sad, timid, apprehensive of death. Occasionally monomania during the progress of the disease.
Administration.-Two drops of the twelfth dilution
in an ounce of water-a dessert spoonful each night.
If a cure is not effected at the end of a week, give a




INTERMITTENT FEVER.            1 53
drop of the first dilution once in six hours, until the
symptoms disappear.
Remarks.-Nux is particularly applicable to the quotidian and tertian types. If the individual has been a
hard drinker, or luxurious and sedentary in his habits,
the indications are still stronger.
Arnica.-External indications.- Inclination to remain quiet.
Physical sensations.-Chills occur in the evening;
thirst; contraction of the features. In the hot stage,
pain in the back and limbs; shiverings from the
slightest exposure; the hot and sweating stages slight
and of short duration. In the apyrexia, pain in the
stomach; loss of appetite and general appearance of
wretchedness and debility.
Mental and moral symptoms.-Obstinate; reckless;
quarrelsome.
Administration.-My friend Dr. Shue, has been accustomed to exhibit this remedy in alternation with
ipecacuanha, with marked benefit. It may be given
at the first attenuation-a few drops every four hours
during the apyrexy.
Veratrum album.-External indications.-Cold and
clammy perspirations on the forehead; shuddering.
In the hot stage, coma and red or purplish cheeks;
pulse slow, and almost extinct, or small, quick, and intermittent; tongue red and dry.
Physical sensations.-General coldness of the whole
body; cold stage of short duration, and attended with
shivering; vertigo; nausea; pains in the back and
loins; thirst for cold water; the second stage more
protracted, and accompanied with headache; short
dry cough; fever with external coldness; urine dark
coloured; diarrhcea or constipation; coma; in the
third stage, profuse perspiration, with thirst and drowsiness.
Hermann prescribes veratrum, when the chills are
followed by sweat, and afterwards coldness. Or, chills
alternating with fever, with thirst; vertigo; nausea,
and pain in the back, succeeded by fever with delirium; flushed face, and tendency to sleep. After the
paroxysm, morbid appetite. Or, cold stage, without
the hot or sweating stage.
7*




154           INTERMITTENT FEVER.
Mental and moral symptoms.-In the cold stage, confusion of ideas; in the hot stage, coma; during the
apyrexy, restlessness, and sometimes mental alienation.
Administration.-One drop of the first dilution in an
ounce of water-a table spoonful two or three times
between the paroxysms.
Belladonna.-External indications.-Face pale and
bloated during the cold fit: eyes red and injected;
face red; pulsations of the carotids; veins of the forehead swollen; and some perspiration during the heat.
Physical sensations.-Shiverings and heat alternating; rigours followed by heat; during the fever, burning thirst; headache; shootings in the temples; great
sensibility to impressions; delirium; sweat of the
parts covered only; stitches in the chest; dimness of
sight.
Mental and moral symptoms.  Quarrelsome and
passionate during the paroxysm; or, great agitation;
mistrustful; constant dread of evil; visions of frightful or ludicrous objects; delirium.
Administration.-A  drop of the third dilution in
water, every four hours between the paroxysms.
Carbo veg. —External indications: Before the chill,
pale face; cold feet and hands; during the fever, red
face; during the intermission, nocturnal sweat; cold
sweat on the, face and limbs.
Physical sensations. — Tertian type, kept up by
roused psora; rigours,. preceded by throbbing of the
temples; rending in the teeth and bones; and attended with thirst and sense of prostration; hot stage,
attended with thirst, or absence of thirst; headache;
vertigo; impaired vision; nausea; pains in the stomach and chest-; acid sweats in the morning: in
the intermission, paleness; emaciation; distention of
the stomach; headache; loss of appetite; lassitude
and disturbed sleep.
Mental and moral symptoms.-Anxiety and fear in
the evening; intellect dull.
Administration.-One grain of the third trituration
in two ounces of water, a tablespoonful once in four
hours during the apyrexia.




INTERMITTENT FEVER.          155
Remarks.-This remedy was supposed by Hahnemann to be of especial service, in those old and obstinate cases of intermittent fever, which appeared to
be connected with a psoric miasm lurking in the
system. Hartlaub has found it curative in similar
cases. It is adapted to the tertian type.
Pulsatilla.-External indications.-Face pale during the cold stage; face red and bloated in the hot
stage, sometimes with sweat on the face; swelling of
the veins; anxious and rapid respiration; eyes dull,
and cloudy; inclination to remain in the recumbent
posture; pulse quick and small, or full and slow, or
feeble and suppressed; tongue coated, whitish, grayish, or yellowish.
Physical sensations.-Chills in the evening or afternoon; vertigo, pain and heaviness in the head;
sensation of cold from slight exposure; irregular diffusion of heat, chiefly in the face, or on one side;
absence of thirst: after the paroxysm, headache, oppression of the chest, moist cough, bitter taste.
Or, according to Lobethal, Hartmann and Watzke,
chills without thirst; fever, with thirst, and dull
headache; sweating very slight.  Or, chills commencing with vomiting, with slight thirst during the
cold, hot and sweating stages; diarrhma; loss of appetite.
Mental and moral symptoms. —During the paroxysm,
anxiety; sadness; taciturn; apprehension; dread of
sudden death: great depression of spirits during the
apyrexia.
Administration.-Two drops of' the first dilution in
an ounce of water,-a dessert spoonful three or four
times during the apyrexi-.
Remarks.-When the attacks leave been incited by
abuse of fat and indigestible food, or are connected
with any derangement of tile menstrual function, pulsatilla is appropriate. it has been most frequently
employed in the quartan type.
Antimonium crudum.-External indications.-Face
and eyes of a yellowish hue; yellow or whitish fur
upon the tongue; pulse quick or slow.
Physical sensations.-Tertian type; short chills,
followed by fever, with pain in the chest and pit of




-af1 ~IINTERMITTENT FEVER.
the stomach; predominance of gastric or bilious
symptoms; frequent nausea and vomiting; bitter
taste in the mouth; thirst; diarrhcea; distention of
the stomach.
Mental and moral symptoms.-During the apyrexy,
indifference to life; during the paroxysm, peevish;
dread of misfortune; out of humour.
Administration.-Two drops of the third dilution in
an ounce of water,-a tablespoonful once in six hours
during the intermission.
Ignatia. —External indications.-During the chill,
pale or sunken face; bilious vomiting: during the
second stage, pale face, or one cheek red and the
other pale: during the intermission, lips dry and
cracked; countenance pale; hard, dry stools; nettlerash; pulse variable; tongue white.
Physical sensations.-Rigours, with thirst for cold
water; nausea and vomiting; pain in the back and
limbs; oppression at the chest; loose, short cough;
coldness, relieved by external heat; heat general
during the second stage; vertigo; headache; pain in
the back and limbs; drowsy; absence of thirst during
the hot and sweating period; during the intermission,
pressing and shooting pains in the head, back, and
limbs; loss of appetite.
Mental and moral symptoms.-Occasionally delirious
during the fever; suppressed grief, with sighing;
timid, sad, irresolute, and inclined to weep during the
apyrexy.
Administration. -Same as belladonna.
Cocculus.-External indications.-Trembling during
the first stage; redness of the cheeks during the heat;
pulse full, hard and frequent; tongue clean or loaded.
Physical sensations.-Transient chills; skin hot to
the touch, in the first stage; burning heat in the
cheeks; cramps in the loins and stomach, and but
slight fever in the second stage; apyrexy, accompanied with vertigo; dull pain in the head, and general
debility.
Mental and moral symptoms.-Apprehension of approaching evil; fear of death, during the paroxysm;
sadness and discouragement during the apyrexy.
Administration.-Two drops of the third dilution, in




INTERMITTENT FEVER.             157
an ounce of water-a tablespoonful every four hours
between the paroxysms.
Lachesis.-External indications.-Face pale, or leaden, discoloured or yellowish, during the cold stage and
the intermission; red spots on the cheeks while the
fever is on; blue circle round the eyes; red swelling
of the face; agitation and tossing in the cold and hot
stages; pulse intermittent, or feeble and frequent;
tongue dry in the second stage.
Physical sensations. —Most of the time, icy coldness
of the limbs; rigours only partial; pains in the limbs;
fever at night or in the evening, with headache and
great debility; oppression at the chest; severe pains
in the limbs; thirst, and sometimes bilious vomiting.
Mental and moral symptoms.-In the apyrexy, melancholy, violent jealousy; weakness of memory: during
the paroxysm, delirium; loquacity; irritability.
Administrati6n.-One grain of the third trituration
in two ounces of water-a dessert spoonful every
twelve hours until the desired effect is obtained.
Sabadilla.-External indications.-In the cold stage,
trembling of the limbs, spasmodic cough: in the hot
stage, yawning and stretching; pulse variable;
tongue natural.
Physical sensations.-The different stages imperfectly developed; external coldness with shivering;
dry cough, pains in the chest, limbs and bones in the
first stage: during the apyrexia, dull pains, with sense
of fatigue.
Mental and moral symptoms.-During the paroxysm,
inability to collect or arrange the thoughts; delusions
of the imagination with respect to oneself; delirium.
Remarks.-This remedy is useful when the malady
has been preceded for some time by gastric derangement, or in cases complicated by abuse of quinine.
Administration.-Same as veratrumrn.
Sulphur.-External indications.-Countenance pale
or hot during the first stage; circumscribed redness
of the cheeks during the second stage; sweat upon the
head, face, and hands; eruptions or scabs upon the
face, hands, or limbs; pulse hard, full and quick;
tongue natural.
Physical sensations.-Previous to the first stage,




158             INTERMITTENT FEVER.
thirst and lassitude; chilliness in the evening or at
night, and sometimes in the afternoon; shiverings in
the back, chest and arms, with coldness of the hands,
feet and nose; heat attended with thirst; burning
sensation in the hands and feet; bruised and tired
feelings in the limbs; palpitation of the heart; perspiration easily excited in the head, neck, hands, &c.
Mental and moral symptoms.-In the apyrexy, sadness, with frequent inclination to weep; during the
paroxysm, irritable and peevish; thoughts incline to
religious subjects.
Administration.-One grain of the first trituration in
four parts —a powder every twelve or twenty-four
hours until decided amendment or aggravation of
symptoms ensue.
Remarks.-Sulphur has most often been employed
in the quotidian type. In many cases of fever and
ague occurring in psoric subjects, it will also prove
eminently serviceable.
Cina. Hermann and Gross have found cina curative when during the paroxysm there are, pale countenance; canine appetite; headache; nausea; foul
breath: during the intermission, cold surface; morbid
appetite; lassitude; occasional sweats.
Hartlaub advises capsicltm in chills with thirst;
headache; mucous vomiting; flow of saliva; great and
painful swelling of the spleen; rending pains in the
back, loins, and knees; yawning and stretching; fever,
with or without thirst; headache; bad taste; cutting
pains in the belly; pains in the chest, back, and legs;
after the fever, slight or profuse sweat; in the intermission, ash-coloured countenance; swelling of the
spleen and the feet; constant chilliness and coldness;
drawing pains in different parts when in the air;
useful in relapses after' abuse of quinine.
The same writer commends natrum mur, in chills
with little or no thirst; sharp pains in the forehead,
back, and bones; short breath; yawning and sleepiness, followed by fever, with great thirst; severe
rending or throbbing pains in the head and forehead;
in the intermission, yellowish face; white tongue;
hard and scanty stools; swollen stomach; headache;
weak eyes; bitter taste; no appetite; great thirst;




YELLOW FEVER.                159
pit of the stomach painful to the touch; sleepy in the
day time, but sleepless at night; lassitude and debility. It also cures tertian and quotidian types, with
chills only.
Administration.-A drop of the first dilution once in
four hours between the paroxysms.
CHAPTER XVI.
YELLOW FEVER.
This fever is exceedingly uncertain in its course, violence, and duration. It may strike its victim suddenly
prostrate, overwhelming in its severity the whole system, and thus preventing a single rally of the circulatory vessels; or it may advance mildly, differing but
little from an ordinary attack of remitting fever. In
some instances it bears a strong resemblance to the
higher grades of bilious fever. Much depends upon
the peculiar circumstances of the individual attacked.
If he is recently from a temperate climate, and unaccustomed to hot regions, he will be more susceptible
to the action of the poison than if he had been previously acclimated.
Medical men have supposed that after a certain
period of exposure, the system becomes so completely
accustomed to the miasm, that it loses all susceptibility to its influence, and in this manner the process
of acclimation is accomplished. There is doubtless
some truth in this idea, but there are other causes
which exercise quite as important an influence in this
process. Those persons who abandon a temperate for
a residence in a tropical climate, do so in that physical condition which the requirements, habits, and regimen of the former naturally generate. In a previous
chapter we have seen, that in cold regions, where the
atmosphere is highly condensed, a large amount of
animal food is requisite to supply the system with sufficient carbon and hydrogen to resist and neutralize the




160                YELLOW FEVER.
action of the inspired oxygen. With these habits,
appropriate only where a condensed atmosphere is respired, individuals seek the tropics, with bodies abounding in carbon, and continuing, in most instances, their
accustomed regimen of animal food and stimulants,
thus burdening their systems with an amount of the
elements of nutrition far greater than the oxygen contained in the rarefied air which they inhale can decompose.
It is probable, therefore, that one of the chief predisposing causes of yellow fever, is the presence of a
greater amount of carbon in the system than the inspired air can properly act upon. The exact equilibrium between the supply of the elements of the food
and the absorbed oxygen, is disturbed; the carbon predominates, and all of those derangements which proceed from a superabundance of this agent, necessarily
ensue.
The inhabitants of tropical latitudes have comparatively but little desire for animal food, but prefer farinaceous diet, vegetables and fruits: in this manner
naturally securing to themselves a due proportion between the elements assimilated and the oxygen absorbed; while the inhabitants of the north find it necessary to consume large quantities of meat and other
articles abounding in the elements of nutrition, in order
to preserve a healthy equilibrium. We therefore most
strongly urge it upon those who remove from cold to
hot climates, to adapt their systems by appropriate
regimen, and strict temperance in all things, for the
change, and we confidently predict that they will enjoy as great an immunity from this dreadful scourge,
as the natives themselves.
Diagnosis. The premonitory symptoms of yellow
fever are giddiness, wandering pains in the back and
limbs, slight chills, nausea, and frequent sensations of
faintness.
After these symptoms have continued a few hours, a
decided reaction occurs: the circulation becomes
excited, the face flushed, the eyes red,'there are violent pains in the head, back, loins, and extremities,
distress of stomach, and vomiting of acid bilious matters, the surface becomes dry and burning hot, mouth




YELLOW FEVER.               161
and throat dry, with intense thirst, and sometimes delirium.
The duration of this paroxysm is usually about
twenty-four hours, although occasionally it continues
two or three days, after which there is a remission of
all the symptoms, except a distressed sensation in the
stomach, with nausea and vomiting. The patient remains in this state with a considerable degree of comfort for a few hours, when there is a recurrence of
many of the former symptoms in an aggravated form.
The stomach now becomes extremely painful and sensitive, vomiting is violent and incessant, the fluids
ejected are of a darker colour, the skin and eyes acquire a yellow tinge, and the mind becomes confused
and wandering.
The duration of this second stage varies from twelve
to forty-eight hours, with sometimes slight remissions
towards the termination of the paroxysm, when the
third or last stage sets in. This stage is characterized by the complete development of the dreaded
" black vomit." At this period, the powers of the system all sink rapidly; the pulse flags, and perhaps intermits; the tongue becomes dry, black and shrivelled;
the breathing irregular and laborious; cramps seize
the calves of the legs and the bowels; the whole countenance loses its natural, lifelike expression; the extremities become cold; colliquative sweats, diarrhea,haemorrhages, and loss of intellect occur, and, finally,
dissolution ends the scene.
This is only a brief outline of the more ordinary
symptoms and course of the malady, and will, we
trust, serve to aid the inexperienced practitioner in
his diagnosis. Each case, however, must necessarily
present modifications according to the predisposition,
habits, and peculiar circumstances of the individual
attacked.
Causes.-When animal and vegetable matters are
submitted, for a considerable length of time, to the
daily influence of intense solar heat, and a certain
amount of moisture in the crowded and filthy streets
of cities, or other confined places, a miasm is generated, which, under favourable circumstances, will
cause yellow fever. Concerning the nature of this




162               YELLOW FEVER.
miasm we know nothing; but it is evident, that the
continued high degree of temperature to which these
substances are exposed, and the confinement of their
noxious emanations within the walls of crowded cities
developes a more virulent morbific agent than is the
case when the same matters are exposed in the open
country, or to a more irregular and less intense heat,
such as usually occurs in more temperate localities.
There are several other causes which act as povwerful predisposing influences, one of the most important of which, as before mentioned, is the too free use
of animal food and stimulants. We may also include
in this category, irregular habits, mental anxiety, depression ~of spirits, fear, grief, exposure to night air
or to a burning sun, and, indeed, whatever else tends
to debilitate the organism.
Therapeutics.-The remedies most commonly applicable to the treatment of this affection are, ipecacuanha. belladonna, bryonia, rhus, arsenicum, and aconite.
The other medicines likely to prove serviceable are,
nux vomica, mercurius, veratruin, china, sulphur, cantharides, carbo veg., and crotalus. The late and much
lamented Dr. Taft, of New Orleans, was eminently
successful in his treatment of the yellow fever as it
occurred in that city. Sometime since, we had the
pleasure of perusing a letter from a highly intelligent
gentleman of New Orleans, in which he states, that
the success of Dr. T. was so great in this malady, as
to attract the marked attention of a large number of
citizens; and the writer expresses a deliberate opinion, that a new and favourable era would soon have
occurred in the management of this formidable affection, if the able and accomplished Taft had survived.
The remedies which this physician found most successful, and upon which he chiefly relied, were
aconite, ipecacuanha, belladonna, and bryonia, in the.first, and sometimes second stages; in the second and
third stages, in addition to the above, rhus tox., arsenicurn, iveratrum, cantharides, carbo veg., nux vom. These
medicines were usually employed at the first attenuation, and frequently repeated, either singly or in alternation, as the circumstances of each case appeared
to require.




YELLOW FEVER.             163
When the first symptoms declare themselves, as
dizziness, slight chills, pains in the back and limbs,
uneasy sensations at the epigastrium, with nausea,
vomiting, and sensation of faintness, ipecacuanha, at
the third attenuation, should be immediately exhibited.
This remedy may also be found serviceable during the
second and third stages, in alternation with some
other article. Should the malady continue to progress, the following medicines should be considered,
and, in proper cases, promptly administered.
Belladonna.-External indications.-Glowing redness and bloated appearance of the face; eyes red
and sparkling, or fixed, glistening, and prominent;
tongue loaded with whitish mucus, or yellowish, or
brownish; pulse variable.
Physical sensations.-Dry burning heat; sharp, darting and shooting pains in the head; violent throbbings
in the head; burning thirst; painful heaviness and
cramp-like pains in the back, loins, and legs; pressure,
cramp-like, and contractive pains in the stomach; inclination to vomit, or violent vomitings.
Mental and moral symptoms.-During the remission,
melancholy; dejection: when reaction comes on,
great agitation, with continual tossing and anguish.
Administration.-Belladonna is for the most part applicable to the first stage of yellow fever. One drop
of the third potency may be given once in one, two,
three, or four hours, according to the violence of the
symptoms.
Bryonia.-External indications. —Skin yellow; eyes
red, or dull and glassy, or sparkling and filled with
tears; tongue dry, and loaded with a white or yellow
coating; pulse rapid, and full, or weak and rapid.
Physical sensations.-Severe pain and burning sensation in the stomach; vomiting, particularly after
drinking; burning thirst; pains in the back and
limbs; headache aggravated by movement; eyes
painful on motion; sense of fulness and oppression in
the stomach and intestines.
Mental and moral symptoms.-Anxiety, with dread
and apprehension respecting the future; loss of memory; delirium.
Administration.-Two drops of the first dilution in




164               YELLOW FEVER.
an ounce of water,-a dessert spoonful every two
hours until an impression is produced.
Rhus.-External indications.-Surface of a dirty yellow colour; eyes glazed and sunken; tongue dry and
black; lips dry and brownish; pulse quick and small;
loquacious delirium, or coma with stertorous breathing; constant moaning.
Physical sensations. —Distressing pain and burning
in the stomach; nausea and vomiting; paralysis of
the lower extremities; spasms in the abdomen; want
of power over the abdominal muscles; colic; diarrhmea; difficulty in deglutition, and pain on swallowing.
Mental and moral symptoms.-Intellect dull and
clouded; constant uneasiness; delirium.
Administration.-Two drops of the third dilution in
an ounce of water,-a dessert spoonful at a dose, and
repeated as the symptoms require. In cases where
this dilution is not sufficiently prompt or active, the
first dilution may be substituted in drop doses.
Arsenicum.-External indications. —Face of a yellowish or bluish colour; eyes dull and sunken, with a
dark mark under them; sclerotica yellow; nose
pointed; coldness of the.body, with cold and clammy
sweat; lips and tongue brown or black; colliquative
sweats; pulse irregular, or quick, weak, small and
frequent, or suppressed and trembling.
Physical sensations.-Sense of extreme debility;
dull, throbbing, stunning, or shooting pains in the
head; burning or sharp and darting in the epigastrium,
or in the region of the liver-; limbs feel stiff and useless; frequent evacuations, with tenesmus. or painless
and involuntary; oppression at the chest, with rapid
and anxious respiration; cramps in the calves of the
legs; great oppression at the stomach, with violent
vomiting, especially after drinking; drawing and
cramp-like pains in the abdomen; sensation as if a
weight was pressing upon the abdomen.
M'ental and moral symptoms. —Indifference; weakness of memory; stupidity; delirium, with great flow
of ideas; loss of consciousness and of sense; raving.
Administration. —In urgent cases, a drop of the third
dilution may be exhibited every half hour, until some
change is produced in the symptoms. In less danger



YELLOW FEVER.              165
ous instances, the intervals of administration may be
lengthened as circumstances require.
Aconite.-External indications.-Suitable in the first
and Second stages, when there are burning and dry
skin; red cheeks; full and rapid pulse; red and sensitive eyes; tongue natural or covered with a whitish
slimy coat; lips and mouth dry; vomiting of mucus
and bile; urine dark red.
Physical sensations.-Violent febrile reaction; sensation of intense heat; great thirst; acute pains in
the temples, forehead, or on one side of the head; vertigo on rising, eyes weak and sensitive to light; pains
and soreness in the back and limbs; nausea; general
sense of debility; great heat and irritability of the
stomach; short and anxious respiration.
Mental and moral symptoms.-When the fever is on,
great anguish, anxiety, and restlessness; for the most
part nightly delirium.
Administration.-A drop of the first dilution may be
given in water every two hours, until the active febrile
symptoms abate. Aconite and belladonna may sometimes be alternated with benefit in the first period of
the disease.
Remarks.-In a majority of cases, a few doses of
this remedy will be found indispensable, during the
first reaction. This corresponds with the experience
of several physicians with whom we have communicated upon the subject, and whose opportunities of
observation have been ample. Dr. Hempel thinks it
probable that aconite is the only specific for this disease.
Nux vomica.-External indications.-Skin yellow;
face pale or yellowish, especially round the nose and
mouth; lower part of the sclerotica yellow; eyes inflamed with redness of the conjunctiva; eyes surrounded with a dark circle and full of tears; tongue with a
thick white or yellow fur, or dry, cracked, and brown,
with red edges; pulse variable.
Physical sensations.-Burning pains in the stomach;
pressure or cramp-like pains in the epigastrium; vomiting of acid, bilious, or mucous matters; frequent and
violent hiccough; eyes sensitive to light; vertigo, or
pains in the head; tremours of the limbs; cramps in




166               YELLOW FEVER.
different parts; thirst for beer, brandy, or some stimulant; contraction of the abdominal muscles; loose discharges of slimy or bilious matters or blood; burning
pains at the neck of the bladder, with difficulty in
urinating; coldness, paralysis, and cramps in the legs;
feet benumnbed and cramped.
Mental and moral symptoms.-Excessive anxiety, uneasiness, fear of death; despair, or loss of consciousness and delirium, with moaning or muttering.
Administration.-Two drops of the third dilution in
an ounce of water,-a dessert spoonful once in from
two to six hours.
Mercurius.-External indications.-Yellow  colour
of the skin; eyes red, blood vessels of sclerotica injected; eyes sensitive to light; paralysis of one or more
limbs; tongue with moist thick white fur, or dry and
brown mucus; faces variable; pulse irregular, or
quick, strong, and intermittent, or weak and trembling.
Physical sensations.-Excessive inclination to sleep,
or restlessness from nervous irritation; sense of fatigue
and debility; rapid loss of strength; dizziness, or violent pain in the head; violent convulsive vomiting of
mucous and bilious matters; burning pain and tenderness of the stomach; constipation, or diarrhcea with
discharges of mucus, bile, or blood; coldness of the
arms and legs, with cramps; excitability and sensibility of all the organs.
Mental and moral symptoms.-A.nguish and agitation; weakness of memory; apprehensions; discouragement; moroseness; raving.
Administration.-A grain of the third trituration in
an ounce of water-a dessert spoonful every two, four
or six hours.
Veratrum alb. External indications.-Face of a yellowish or bluish colour, cold and covered with cold
perspiration; eyes dull, clouded, yellowish and watery; lips and tongue dry, brown, and cracked; hiccough; coldness of the hands and feet; trembling and
cramps of the feet, hands, and legs; evacuations loose,
blackish or yellowish; pulse slow and almost extinct,
or small, quick, and intermittent.
Physical sensations.-General prostration of strength;




YELLOW FEVER.               167
confusion of head, or vertigo; deafness; difficult deglutition; intense thirst; violent vomiting of green bile
and mucus, or black bile and blood; burning in the
stomach; great exhaustion; cramps in the stomach,
abdomen, and limbs; diarrhcea.
Mental and moral symptoms.-Timid; despondent;
restless; loss of sense; coma or violent delirium.
Administr'ation.-A drop of the third dilution in an
ounce of water; a dessert spoonful frequently repeated, until an effect is apparent.
Sulphur.-External indications.-Face pale, or yellowish; eyes red, or yellowish; aphthee in the mouth;
tongue dry, rough, and reddish, or with white or
brownish coat; pulse hard, quick, and full; faeces
whitish, greenish, or brownish, bloody or purulent.
Physical sensations.-Dizziness, or sharp pains in
the head; itching and burning pain in the eyes; roaring in the ears; nausea, with trembling and weakness; vomiting of bilious, acid, bloody, or blackish
matters; pressure and pain in the stomach; pains in
the back and loins.
Mental and moral symptoms.-Melancholy; sad;
timid; undecided; wandering.
Administration.-A grain of the third trituration in
an ounce of water; a dessert spoonful every four
or six hours, extending or diminishing the intervals
according to the exigencies of the case.
Cantharides is sometimes indicated in the third
stage with complete insensibility, cramps in the abdominal muscles and legs, suppression of urine, heemorrhages from the stomach and bowels, and cold
sweat on the hands and feet. It may be employed at
the first dilution, a drop every half hour, until a decided impression is produced.
Carbo veg. and crotalus, have both proved curative in the third stage of yellow fever, and should
always receive due attention in grave cases.




168
CHAPTER XVII.
INFANTILE  REMITTENT.
THis is a disease peculiar to childhood, and is usually caused by the use of unhealthy and indigestible
food, the irritation of teething, worms, repelled eruptions, sudden drying up of ulcers, discharges, &c.
The affection is characterized by prominent disorder
of the stomach and intestines, in most instances, but
occasionally the brain or lungs seem to be chiefly
affected. In all cases, however, whichever part the
disease may seize upon, there occur regular remissions
and exacerbations.
Diagnosis — The malady under consideration makes
its appearance with the premonitory symptoms of
ordinary fever, as slight chills, restlessness, thirst, and
wandering pains in -the back, bowels, and limbs.
When the hot stage is fully developed, the patient refers most of his sufferings to the stomach and intestines: they become painful, tender upon pressure, and
there is either obstinate constipation or diarrhea. The
evacuations are usually darkish, offensive, and indicative of a deficiency of bile. When the disease is
concentrated in the stomach, there is burning thirst,
with vomiting of liquids as soon as swallowed; the
tongue is usually covered with a moist, whitish fur,
and red at the edges. If the inflammation be not
promptly arrested, but is permitted to progress without the aid of appropriate remedies, lesions will occur
in the digestive tube, or disorder of the brain or lungs
will be very likely to supervene.
Causes.-Undue exposure to cold, sudden changes
of temperature, improper food, worms, teething, repelled eruptions, abrupt suppression of accustomed
discharges, and the injudicious use of irritating medicines.
Therapeutics.-The remedies suitable for the treatment of this affection, are, in the first instance, the
higher dilutions of aconite, followed by those medi



ISFAINTILE RYMFTTENT.          169
cines which accord with the peculiar symptoms of
each case. As soon as the fever has been sufficiently
subdued by the former medicine, some of the following
articles may be resorted to with advantage: ipecacuanha, cina, chamomila, mercurius, belladonna, arsenicum,
pulsatilla, nux vomica, spigelia, sulphur.
Since in most instances the gastro-intestinal mucous membrane is the seat of the malady, it will be
necessary to make a free use of ipecac., mere., puls.,
nux, cham., dulc. Should the brain or lungs become
involved, belladonna, bryon., nux, opium, and stramon.,
will prove efficient remedies.
Dr. Drysdale has found this fever, as it occurs in
England, exceedingly intractable, notwithstanding the
most assiduous care and attention on the part of both
physician and friends. In children of scrofulous constitutions, Dr. D. has known the disease to persist for
months, in spite of every remedial measure. In cases
of this description, he advises sulphur, calcarea, arsenicum, and silicea.
In highly impressible and irritable children, we have
often witnessed an almost constant tendency to febrile
attacks, during dentition. The alimentary canal, the
brain, and the nervous system, appear to remain in
such a condition of erethism, that the slightest exciting
causes, as errors in diet, worms, suddenly checked perspiration, &c., serve to develop the affection. In instances of this kind, aconite, belladonna, and chamomela
are peculiarly appropriate, and will generally, enable
us to subdue permanently this morbid excitability.
These remedies should be given in drop doses of the
twelfth to the sixteenth dilution, once in twelve hours,
until every sign of undue irritability has disappeared.
Hartmann commends a few doses of coffea cruda, or of
cal. carb. when this erethism is obstinate, and has continued for a long time.
If the febrile attack has already made considerable
progress, with excessive irritability of the stomach,
and immediate ejection of every thing which enters it,
however simple; distention, pain, and tenderness of
the stomach and bowels upon pressure; hot and dry
skin; burning thirst; tongue covered with a whitish
fiur and red at the edges; great restlessness and irri8




170           INFANTILE REMITTEN'.
tability; loathing of food; dark, yellow, slimy, or green
diarrhea, we may give a grain of the third trituration
of ipecacuanha, or a drop of the sixth dilution of chamomela, once in two hours, as long as is deemed necessary.
If the disease is still farther advanced, and the countenance has assumed a pale, or dingy, sunken and
cadaverous aspect; dark and puffy appearance under
the eyes; coldness and dryness of the skin, or cold
clammy sweat; burning pains in the stomach and intestines; thirst; constant nausea; the smallest quantity of food or drink, increasing the burning and distress, until they are rejected; watery diarrhea, with
smarting and tenesmus; great prostration; frightful
dreams, anguish and uneasiness, especially at night;
dark, dry and trembling tongue; black and dry lips;
grinding of the teeth, we should employ arsenicum at
the twelfth dilution-a drop in a teaspoonful of water
every two hours, until the requisite effect is produced.
When in addition to the symptoms enumerated
above, the child is exceedingly restless, and sensitive
to light on the slightest noise; with flushed cheeks;
red, glistening and protruded eyes; hot head; constant raising of the hands to the head; rolling of the
head from side to side; sudden starts from sleep, with
screams; spasmodic twitches in different parts; dilated or contracted pupils; short and oppressed respiration, we should administer belladonna at the twelfth
dilution-a drop in water, every two hours, until a
decided impression is evident.
When the fever is accompanied by obstinate constipation; frequent desire to urinate; burning heat of the
whole body; morning exacerbations; rigidity of the
limbs; or drawing, contractive sensations through the
body; occasional spasms; frequent trembling both
sleeping and after an exertion; shudderings and chills
from the least contact of cold air; great sensitiveness
of the whole body; unpleasant symptoms often excited by motion or contact; and indications of gastric
or bilious disorder, we may employ nux vom. at the
twelfth dilution-a drop in water, every two, three, or
four hours, as circumstances require.
When the malady has been caused by the irritation




INFANTILE REMITTENT.           171
of worms, it will be necessary to use cina or spigelia.
These medicines may be employed at the third attenuation, and a dose given three or four times daily until
the morbid disposition of the alimentary canal is corrected.
Bryonia is applicable in cases attended with disorder of the pulmonary tissues. In addition to biliary
and gastric derangement, there should be dry racking
cough; stitches in the chest and sides; painful, anxious,
and hurried respiration; bruised pains, and soreness
in the limbs; pains aggravated by motion or contact;
hot skin; thirst; alternating heat and chills; nightly
delirium; irritable and quarrelsome. This remedy
may be used at the sixth dilution —a drop once in two
to four hours.
Dulcamara is the specific when the fever can be
traced to exposure to wet and cold, which has caused
a sudden check to the perspiration. In these cases,
the force of the disease is expended upon the mucous
membranes of the digestive and respiratory organs, as
is indicated by watery diarrhaea, pains in the stomach
and bowels, oppression at the chest, dry coryza, cough,
and difficult respiration. Its administration is the
same as bryonia.
if the attack is attributable to abuse of fat, crude
and indigestible food, and is accompanied with prominent gastric derangement, pulsatilla should be employed at the sixth dilution-a drop every four hours
until the disturbance is corrected.




172
CHAPTER XVII.
CONTINUED FEVER.
In this class of fevers may be included those arising from functional derangement, from inflammation,
from congestion, and typhus.
FEVER FROM FUNCTIONAL DERANGEMENT.
Diagnosis.-This is generally the mildest and least
dangerous of all the continued fevers. It commences
with slight chills, alternating with flushes of heat,
lassitude, restless nights, wandering pains in the head,
back and limbs, which are soon succeeded by increased action of the heart and arteries, dry and hot
skin, thirst, furred tongue, scanty and high-coloured
urine, and moderate derangement of almost every
function.  If the malady is met at the onset with
suitable remedies, its progress is cut short, and immediate convalescence ensues; but if it be allowed to
continue unopposed, although it occasionally subsides
spontaneously, it generally terminates in one of the
other forms of continued fever.
Causes. —Overloading the stomach with fat, crude,
and indigestible food, insufficient clothing, irregular
habits, dwelling in damp and ill-ventilated houses,
and the habitual and intemperate use of coffee, tea,
and tobacco.
Therapeutics.-Aconite, from the first to the third dilution, if administered early, is sufficient to cure most
cases of this form of fever; but if the disorder is
neglected until inflammation or congestion occurs in
some structure, then those medicines which operate
specifically upon the parts affected, are to be employed, selecting those, of course, the pathogenetic
symptoms of which cover the most perfectly those of
the malady.




CONTINUED FEVER.             173
FEVER FROM INFLAMMATION. (Synocha.)
Diagnosis.-In this form of fever the general symptoms, as hot and dry skin, rapid and full pulse, dyspncea, thirst, nausea, oppression at the epigastrium,
restlessness, furred and dry tongue, are present; but
the symptoms which more particularly characterize
the disease, are determined by the organ which is
prominently affected.
When the inflammation is located in the membranes of the brain, the face becomes flushed, the
eyes red and sparkling or protruded, staring, and distorted, the carotids throb violently, pupils contracted
or dilated, expression unnatural, furious delirium,
pulse full, rapid, and bounding, and finally if the disorder progresses, sopor, muttering delirium, subsultus
tendinum, and convulsions.
If the disease attacks the lungs, we shall have rapid, anxious, and oppressed respiration, shooting pains
in the thorax. troublesome cough, with difficult expectoration, pain and soreness during inspiration, and
perhaps other symptoms pertaining to inflammation
of the pulmonic structures.
If the gastro-intestinal membrane be affected, we
shall have the signs peculiar to inflammation of this
tissue, as nausea and vomiting, pains in the bowels,
increased on pressure, tongue red, countenance expressive of anguish, thirst, bowels hot and swollen.
Causes. —Atmospheric vicissitudes, extremes of cold
or heat, errors in diet, and over-exertion. Inflammatory fever often-succeeds neglected or mismanaged
fevers from functional derangement, especially in
cases where some organ has been previously debilitated, and in this manner rendered susceptible to inflammatory action. Indeed, it is probable that inflammations seldom occur in parts which are perfectly
healthy and vigorous, but that when the exciting
causes of fever operate in these cases, they merely
give rise to slight and easily remedied functional derangements. Whenever, therefore, any structure of
the organism is in a state of unnatural irritation or
debility, this constitutes a powerful predisposing
cause of inflammatory fever, which only requires




174              CONTINUED FEVER.
some farther morbific influence to ensure its full development.
Therapeutics.-As in this form of fever there is an
exaltation of most of the functions, and particularly
of the circulatory vessels, aconite is an indispensable
remedy, always in the onset and frequently during
the course of the malady. This remedy, as all are
aware, exerts a peculiar power over the action of
the heart and arteries, and is, therefore, particularly
appropriate in those cases distinguished from the
first, by full and rapid pulse, hot and  dry skin,
thirst, &c.
In those instances where cerebral disorder predominates, belladonna, opium, and stramon.0 will be found
essential in the treatment, either alone, or in alternation with aconite.
If' the pulmonary tissues are inflamed, suitable remedies may be found in bryon., tart. ant., ipecac., and
phosphorus.
For gastro-enteritic inflammation, recourse must
be had to one or more of the following medicines,
viz.: merc., nux, ipecac., puls., dulc., cham., ars., and
verat.
Administration. —In the selection of remedies, much
depends upon the age, sex, temperament, as well as
the peculiarities of each particular case. For children and adults who are very impressible, we advise
the higher potencies; while in cases of vigorous and
unsusceptible persons, the very lowest attenuations
will prove most efficient.
In regard to the repetition of doses, no definite rules
can be prescribed beforehand; everything must of
necessity depend upon the nature and violence of the
disease, and the effect which each particular dose
produces.
FEVER FROM CONGESTION.
Diagnosis.-The precursory stage  of congestive
fever is characterized by restlessness, irritability, indisposition to mental or bodily exertion, fatigue from
the slightest exercise, vertigo, giddiness, apprehension,
pulse often below the natural standard. This stage
continues from a few hours to six or seven davys, when
the second period fully developes itself.




CONTINUED FEVER.             175
The symptoms will now be modified in accordance
with the organ which sustains the violence of the
attack. If the brain be the suffering structure, the
patient will complain of headache, oppression or
tightness in the head, pupils contracted or dilated, the
ideas confused, the pulse slow and labouring, and,
finally, coma, paralysis, and convulsions may supervene.
When the bowels are the seat of the congestion,
we shall observe an anxious and distressed expression
of countenance, eyes sunken and glazed, more or less
nausea and vomiting, bowels burning hot, and tender
on pressure, while the extremities are cold; tongue
slightly coated with a whitish or reddish fur; uneasiness, with constant desire to change position; frequent
sighing; bowels constipated or relaxed; and, finally,
spasms and stupor, with stertorous breathing.
If the disease concentrates in the lungs, there will
be rapid, laborious; and obstructed respiration; pulse
irregular or intermitting; cough; face and skin purple from imperfect decarbonization of the blood; surface cold, and pains in the chest.
In all of these varieties of congestion, the physical
and mental energies of the system are below the
natural standard, the pulse is generally unusuallyslow
and feeble, the function of the lungs is imperfectly
executed, there is an unequal distribution of heat, and
diminution of sensibility throughout the body.
Causes.-Excessive cold, atmospheric changes,
drllinking large quantities of cold water when the body
is heated, insufficient clothing, improper food, severe
mental or physical exertion, sudden news, grief, fear,
depression, disappointment, mortification, &c.
Therapeutics. —Tlhe remedies which have been used
with most success in congestive fever, are, for the
cerebral form, bell., acon., op., stram., hyos., conium
mac., coff., mosch., and camph.
For the abdominal form, ipecac., verat., ars., nux,
cuprum, merc., phos., carb. v., secale cor.
For the pulmonary form, bryon., acon., phos., lach.,
seneg., rhus tox., tart. em., hyos., ammon. carb.
Administration.-Congestive fevers often attack the
organism suddenly and violently, and if not promptly




176                 TYPIUS.
arrested, run on to a speedy and fatal termination.
In severe cases, therefore, as soon as the remedy has
been selected which is homoeopathic to the malady,
it should be repeated at short intervals until a decided
impression is made upon the symptoms. After a reasonable time, if no effects are apparent, give a still
stronger dose, or change the medicine.
Let it be remembered, in all violent maladies,
that our object is, to produce a specific effect upon
the diseased structure as soon as possible, in order
that we may supersede the morbid by a healthy medicinal action. We need have no fear in this fever of
creating too great a medicinal aggravation, for there
is a low grade of erethism  and impressibility of the
whole organism, and we can readily apply an antidote to any over-action which may be excited, and
thus control its influence, while, if we permit the
natural affection to make progress from a too timid
and sparing an exhibition of remedies, disorganization
will be likely to ensue.
In this form of fever, we generally employ the first,
second, and third attenuations,-the dilutions in drop,
and the triturations in grain doses.
CHAPTER XVIII.
kTYPHUS.
Few diseases have attracted more attention and
been the cause of more bitter controversies in the
medical world, than typhus fever. While some have
maintained that it is a malady peculiar to the cold
seasons of temperate latitudes, and caused by exhalations of animal or vegetable matters in a state of putrefaction,* others assert with equal confidence that it
occurs in -all climates, at all seasons, at every period
from infancy to old age; and that it does not arise
* Dewees, Bainorft, &e.




TYPHUS.                   177
from any specific cause (sui generis), but may proceed
from marsh miasms, animal exhalations, intense cold,
errors in diet, over-exercise, and a variety of other
causes.*  Some suppose it contagious, and others noncontagious.
Respecting its nature and seat, it has had the honour of being located by different medical writers in
every part of the body, from the crown of the head
to the soles of the feet.  At one time the whole
world placed it in the blood: then another generation
of theorists arose who seated it in the solids: at
another period all the world, of France, made the discovery that its place was the gastro-intestinal mucous membrane, and that Hippocrates, Galen, Celsus,
Stahl, Boerhaave, Cullen, Hoffman, Brown, et omne
id genus, had been labouring under a succession of errors upon the subject for more than two thousand years.
Still later, some theorists have found out that its position is in the brain and nervous system, while a few
very sensible persons have arrived at the conclusion
that the exact nature and seat of typhus is yet involved
in obscurity.
At the present moment there are a great variety of
opinions respecting it. One class of medical men suppose it to be a disease affecting principally the brain
and ganglionic system of nerves. Another class suppose its action to be in " the mucous membranes and
lymphatic glands, especially those of the ileum,
whence it has been termed typhus abdominalis."t
Others still suppose it to be a disease of a dynamic
character, or an affection of the " vital properties" of
the system. In regard to this last supposition, it cannot be refuted, because it means nothing at all. It is
as senseless and absurd as it would be to attribute it
to a derangement of the electric, magnetic, galvanic,
or any other " properties" which we may assume that
the organism possesses.
The malady assumes different characteristics according to the predisposition of the individual when
exposed to the influence of the contagion. If his sys* Natham Smith, Macintosh, &c.  t Hartmann.




178                  TYPHUS.
tem has been debilitated by over-exertion of body or
mind, by grief, care, misfortune, disappointment or
shame, the brain and nervous system will be prominently affected, and we shall be presented with that
variety termed cerebral typhus.
Should the stomach and intestines happen to be in
a state of irritation and debility, when the contagion
is absorbed, they will receive the impression, and we
shall have what is denominated abdominal typhus.
If the organ predisposed be the lungs, the morbific
agent will spend its effects at this point, and pneumo
typhus be the result.
So long, however, as the whole organism remains
in a perfectly sound and vigorous condition, with the
mind cheerful and moderately active, it will be able
to resist the influence of the miasm, and in all probability escape the malady. The law is fundamental,
and cannot be too often inculcated, that just in proportion as the organism, or any part of it, diverges from
the normal standard, in the same ratio will the susceptibility of such affected structures to morbific or
remedial influences, be increased.
Diagnosis.-The symptoms which appear at the
commencement of typhus, are, lassitude, debility,
sense of fatigue, impaired memory, slight chills, alternating with flushes of heat, dull pains in the head,
back and limbs, loss of appetite, and melancholy.
These symptoms often continue one or two weeks, the
patient not feeling sick enough to take his bed, or
sufficiently well to attend to his occupation, when he
becomes more restless during the night, delirium sets
in, he is obliged to keep his bed from debility, his
tongue, which was at first coated with a thin, white
fur, becomes dark, dry, and cracked, and as the disease
advances, the old fur passes off, leaving the surface
red, glazed, and dry. As the disease progresses, the
eyes become suffused, the countenance loses its natural expression, the muscles are weak and tremulous,
a viscid saliva is secreted, which collects and dries
upon the lips and teeth, the surface acquires a dingy
colour, there are subsultus tendinum, defective vision,
partial loss of hearing, a tendency to slide down to
the foot of the bed, involuntary discharges from the




TYPHUS.                179
bowels and bladder, picking at the bedclothes, low
muttering delirium, and, finally, coma, convulsions
and death.
The symptoms and course of the complaint will, of
course, be modified in accordance with the severity of
the attack, the part affected, and the plan of treatment pursued.
If we may be allowed to judge from the opinions
which have from time to time been expressed by some
of the eldest, most experienced, and distinguished
members of the old school, upon this subject, we
will say, that the course of treatment ordinarily recommended and pursued by allopathists, is productive
of far more injury than benefit, in typhus. In proof
of this, we quote from a monograph upon typhus
fever, by the late Professor Nathan Smith, of Yale
College, published in 1831.
After commenting upon the various contradictory
methods of treatment advised by different authors, as
the antiphlogistic, stimulant, tonic, derivative, &c., he
asserts: " I am clearly of opinion, that we had better
leave the disease (typhus) to cure itself, as remedies,
especially powerful ones, are more likely to do harm
than good."
In another place he declares: that "the use of powerful means, with a view of curing this disease, is
liable to do great mischief."
These are not the hasty opinions of a mere theoretical man of books, but they are the matured sentiments of one -who enjoyed an immense practice in
several of the different New England states, for a
period of more than forty years. Many other more
recent authors have not hesitated to avow similar
views, and, although they do not yet admit the truths
of the new law of cure, they entertain an entire lack
of confidence in the therapeutical doctrines of the old
system, so far as typhus, and many other maladies, are
concerned.
It may, then, with much propriety be affirmed, that
serious injury is often inflicted in typhus by allopathic
treatment, and that many'of the symptoms above
enumerated are aggravated, if not actually superinduced, by blood-letting, counter-irritants, and powerful drugs.




ISO                 TYPHUS.
Causes.-The presumption is very strong, that the
cause of typhus is a specific agent, sui generis, and
that it is set free from the animal body during the
course of a fever, or when a number of individuals
are crowded together in close, filthy, and ill-ventilated
apartments. This specific poison rarely, if ever,
makes a serious impression, unless the organism is
previously predisposed to its influence. When all of
the organs are in a normal condition, and operate in
a healthy manner, an equilibrium is maintained
throughout the system which enables it to resist the
action of noxious agents. The ideas which we have
here advanced in regard to the specific nature of typhus contagion, were maintained by a number of
medical men many years ago, amongst whom may be
named the distinguished gentleman to whom we have
before alluded, Dr. Nathan Smith.
The reasons adduced by this careful observer of
nature in support of his opinion, are as follows: "On
the Connecticut river, for two hundred miles from
north to south, and on all its tributary streams on both
sides, for an hundred miles in width, there has been
no instance of any person's having contracted the intermitting fever, from the first settlement of the country to the present time; and yet the typhus fever has
prevailed, more or less, in every township within that
tract of country."
If, as many writers assert, the miasms of intermittent, yellow, and typhus fevers are analogous, should
we not constantly witness these maladies running into
each other, or assuming indiscriminately these different forms in the same location?
But a still stronger reason is brought forward by
Dr. Smith to sustain his position: he asserts that
"there is a remarkable odour arising from a person
affected with this disease, so peculiar, that I feel assured, that upon entering a room blindfolded, where a
person has been confined for some length of time, I
should be able to distinguish it from all other febrile
affections.  This is an additional circumstance in
favour of the existence of the specific cause assigned
above, as several other diseases which arise from contagion are attended by an odour peculiar to each,




TYPHUS.                 181
which, when once fixed in the mind, enables a person
to recognise their presence ever after. This is strongly evinced in smallpox, measles, malignant sore throat,
&c."
It is also a fact worthy of note, and one which bears
strongly upon this point, that typhus fever was entirely unknown to the savage tribes of America, previous
to the settlement of the whites; and, even at the present time, those bands which have not been contaminated by the civilizing aggressions of the usurpers of
the soil, but continue their wild, roving, active and
simple modes of life, are not at all subject to this
fever. The moment, however, they forsake their simple and primitive customs, and adopt our dissipated
and enervating habits, enclosing themselves in close,
ill-ventilated, and heated apartments, and stuffing
themselves with spirits, greasy and indigestible food,
coffee, tea, condiments, and tobacco, they become
affected with contagious and miasmatic disorders, and
often die in great numbers. This fact goes to prove
that typhus is a disease pertaining exclusively to
civilized life, and that it requires the unnatural and
artificial customs and habits of the white race to ensure
its generation.
But as the constituents of animal and vegetable
substances are so nearly identical, it is highly probable that the typhus poison may also arise from vegetable decomposition in close and heated apartments.
Of one thing we may be assured, respecting both animal and vegetable matters: that when decomposition
occurs in dark, damp, and confined places, a far more
active and virulent miasm is generated, than when
the same substances undergo transformations in the
open air.
Therapeutics.-In the management of inflammatory
typhus, the liberal use of cold water, both internally and
externally, will be found highly beneficial. This important agent has been hitherto quite too much overlooked in the treatment of fevers, for there is no
doubt of its immense power as a curative agent,
when judiciously employed. This is by no means a
modern remedy, as many suppose, but its frequent use
was strenuously recommended and actually adopted




TYPHUS.
for many years, by one of the most eminent and successful * physicians of New England, as long ago as
1796. The following quotations will show the views
then entertained respecting this agent.
"The most effectual method of reducing the
temperature of the body, is by the use of cold
water, which may be taken internally, or applied
externally."
"The only effectual method of cooling the body
in these cases (hot stage of typhus), is by the use of
cold water applied externally; by this means we can
lessen the heat to any degree we please."
"The method which I have adopted, is to turn
down the bed clothes, and to dash from a pint to a
gallon of cold water on the patient's head, face and
body, so as to wet both the bed and body linen
thoroughly. As soon as the linen and bed clothes are
dry, if the heat returns again, the water should
be again and again applied until the heat is subdued."
We are aware that physicians have been deterred
from the free external use of cold water in fevers,
through fear of aggravating existing inflammations,
causing metastases., congestions, &c., by repelling the
blood from the surface to the internal organs, but the
danger from this cause is purely imaginary: for cold
water, externally applied, not only operates by abstracting the superfluous heat, and reducing the animal temperature, but it also acts as a tonic, imparting
tone and vigour to the debilitated and relaxed capil.
laries in which the morbid action is supposed to
reside.
In slight cases, frequent sponging of the surface
will be sufficient to accomplish our object; but in more
severe instances, the method adopted by Prof. Smith
may be resorted to.
By adopting this course of treatment, while at the
same time we administer appropriate remedies, the
disease will run a milder course, and most of those
grave symptoms which are too often witnessed, will
be absent. It has been a question whether typhus
* Treatise on Typhus, by N. Smith.




TYPHUS.                 183
can ever be cut short by remedies; some maintaining that it may be broken up in the first stage, while
others are of opinion, that it must have its course.
Upon this point, Dr. Drysdale observes as follows:
"We do not believe it possible to cure typhus; all
we can do is, to conduct it to a favourable termination by carefully watching, and curing all the intercurrent affections so apt to appear in it, by judicious
management. At the same time we have always
given the remedies usually recommended, especially
rhus, bryonia and arsenicumr; and we believe that the
convalescence will be much hastened by judicious
treatment." Dr. D. advises the use of brandy and
wine in addition to our remedies during the stage of
collapse; " especially when there is great want of animal heat, and the pulse is very quick and small, attended with much trembling of the hands and constant muttering delirium."
The appropriate medicines will be determined by
the form which the malady assumes, and the exact nature of each particular case.
TYPHUS CEREBRALIS.
Belladonna, bryonia, aconite, opium, and rhus, will
cover most of the symptoms which are ordinarily present in this form. The following are the indications
for these medicines.
Belladonna. - External indications. - Countenance
flushed and bloated; eyes red and sparkling, or dull and
turbid; or pale, brownish and glassy; wild expression,
stupid, fixed, or wandering look; visible pulsation of
the carotids; respiration irregular, short and quick,
or slow and deep; pupils contracted or dilated, generally immovable; pulse variable, but generally quick
and resisting; tongue red, moist or dry, or yellowish
white; breath offensive; urine brownish or red;
spasms; distortion of the face and eyes; head very
hot, while the extremities are cool.
Physical sensations. —Fulness and heavy pain in
the head; vertigo; dizziness; violent throbbings in
the head; strong pulsation of the carotids, and arteries of the head; double vision, sparks before the




184                 TYPHUS.
eyes, or weak sight; humming in the ears; inflammation of the throat, chest, and abdomen; pains,
heaviness, or numbness of the limbs; palpitation of
the heart; pressure and cramp-like pains in the stomach; dryness of the mouth; adypsia, or thirst; continued watchfulness or lethargy; constipation, or
diarrhea with tenesmus; constant moaning.
Mental and moral symptoms.-State of mind apathetic; or irritability of temper; illusions of the senses, and frightful visions; or gloomy, suspicious;
constant moaning, or drowsiness; profound coma.
Administration. - A drop of the third dilution in
water once in two hours, until the desired impression
is produced.
Remarks. — Belladonna is indicated in typhus, presenting  a sub-synochal character.  It is contraindicated, in great depression of the cerebral and
nervous energy; but applies in vascular and nervous
erethism.
Bryonia. - External indications. - Face red, burning, and swollen; eyes red and swollen, or dull,
glassy, turbid, or sparkling and suffused; dryness of the
nose; groans; respiration difficult, short, rapid, anxious,
or sighing; thick and tenacious expectoration; petechiae; mouth dry; tongue dry, and coated with a
dirty or yellowish fur; lips brown and dry;' trembling of the limbs, and appearance of great weariness
and debility; pulse variable; urine pale, or brownish
and without sediment.
Physical sensations.-Fulness, heaviness, and pressure in the head, from within outwards, worse on
movement; confusion and dull pains in the head; vertigo; buzzing in the ears; dulness or acuteness of
hearing; sensation of dryness in the throat; profuse
sweat during the heat; bitter, sour, or putrid taste;
thirst; nausea; hiccough, or pressure at the stomach;
constipation; abdomen inflated; weariness and pains
in the back, loins, and limbs, aggravated by motion;
abdominal pains; drowsy during the day; restless in
the night, with delirium.
Mffental and moral symptoms. —Irascibility; passion;
fear of the future; anxiety; fear; stupidity; delirium,




TYPHUS.                 185
with raving respecting business; visions on closing
the eyes.
Administration. -Same as belladonna.
Remarks.-Bryonia is applicable in the cerebral and
abdominal varieties, and in typhoid pneumonia, especially in the first period before the muscular and
nervous strength have become materially depressed.
After the system is reduced to a certain extent, it may
be alternated with one of the other remedies with benefit. Bryonia may often follow belladonna with propriety.
Aconite. —In the first stages of this, as well as in
most other maladies in which there is excessive action
of the circulatory vessels, aconite is an indispensable
remedy. Its properties and uses are so well known,
that we shall add nothing respecting it in this place,
excepting a simple caution to the inexperienced practitioner, that while endeavouring to reduce the force
of the general circulation, he should not neglect important local inflammations. It may be administered
in the same manner as belladonna.
Opium.-External indications.-Face dark red, or
brownish, hot and bloated; pupils dilated and immovable; lower jaw hanging from relaxation; lethargy,
with snoring; mouth and eyes open; irregular and
slow respiration; pulse slow or suppressed; bluish
colour of the skin; convulsive movements of the
limbs; offensive black faces; involuntary evacuations; urine scanty, high coloured, depositing a brickdust sediment.
Physical sensations.-Sensation of great heaviness
in the head, vertigo, dizziness, buzzing in the ears;
general diminution, or entire loss of sensibility; cloudiness of sight; paralysis of the tongue; sensation of
weight and pulsations in the stomach and abdomen;
difficulty in evacuating the bladder; great oppression
at the chest; hoarse, dry cough, with bloody expectoration; troublesome itching of the skin; convulsions.
Mental and moral symptoms.-Stupor; loss of consciousness; delirium; frightful visions.
Administration.-A drop of the third dilution in an
ounce of water-a table spoonful once in two hours,




186                  TYPHUS.
until a medicinal aggravation or an amendment occurs,-afterwards repeat according to the exigencies
of the case.
Rhus tox.-This remedy is particularly adapted to
the nervous forms of typhus, and may often be used
with advantage in cerebral typhus after bryonica or aconite, or in ganglionic typhus, when the following symptoms present themselves:
Externalindications. —Petechiae; face red and swollen; blue circle around the eyes; nose pointed; lips
dry. brownish or black; eyes red, with viscid secretion
at the angles; eyes fixed and dull; nose dry, swollen,
and tender when touched; tongue dry, red, or dark;
mouth filled with viscid mucus, which collects upon
the teeth, forming sordes; constipation or diarrhmea;
teeth white, dry, and shining; colour and consistence
of freces variable;' retention or incontinence of urine;
clear, red, or turbid urine; paralysis of the lower extremities; pulse quick and small; coma, with snoring
or moaning.
Physical sensations -Stupefaction; vertigo; dizziness; bruised sensation within the head; soreness of
the scalp; painful oppression in the stomach; pulsations in the epigastric region; spasms and pinchings
in the abdomen; pains in different parts as if from a
bruise, worse during repose, or at night, and relieved
by movement; great weakness; tendency to faintness; pain and difficulty in swallowing; tenesmus,
with loose, slimy, frothy, sanguineous, white, yellow,
or red evacuations; constant and pressing desire to
urinate; oppression at the chest, with difficult respiration; soreness in the limbs, back, and neck, when
touched or at rest; raw feeling in the throat and
chest; excessive weakness, tremblings, sweats.
]Mlental and moral symptoms.-Muttering delirium,
or coma somnolentum, with snoring; anguish and
dejection in the evening and at night; inclination to
weep; fear of death; frequent sighing.
Administration.-A drop of the first dilution in an
ounce of water; a dessert spoonful every two or four
hours. If no decided effect ensues after a reasonable
time, give a drop of the mother tincture in a tablespoonful of water. repeating as may be necessary.




TYPHUS.                  187
Mercurius vivus has been successfully employed in
cases where there is great weakness, rapid sinking of
strength, profuse perspiration, fainting fits, trembling
and numbness of the limbs, cramps, and convulsive
movements, great agitation and uneasiness of body
and mind.
PNEUMO TYPHUS.
The medicines which have proved most efficient in
this form of typhus, are, aconite, bryonia, phosphorus,
ammonia, carb., acid phosph., and mercurius viv.
When the affection is characterized by accelerated
circulation, great heat of skin, thirst, difficult, anxious,
short and rapid breathing, with painful stitches in the
chest and side when inspiring; cough on motion;
flull, hard, and rapid pulse, aconite should be exhibited.
A dose of the third dilution every hour or two, until
an impression is made upon the symptoms.
After aconite has been administered. and symptoms
remain unsubdued, it will be necessary to resort to
some of the following remedies, the indications for
which we proceed to describe.
Bryonia.-External indications.-Same  as under
cerebral typhus.
Physical sensations.-Confusion, fulness, heaviness,
and swimming in the -head; headache, aggravated by
movement or opening the eyes; respiration difficult,
short, anxious, rapid, or sighing; oppression of the
chest; stinging in the chest when coughing, or
breathing deeply.  Shooting  pains in  the  chest,
side, and abdomen; pains in the limbs on movement;
nose swollen, dry, and painful to the touch; throat
dry, with sharp pains when touched or in motion;
nausea and oppression at the stomach; constipation
and diarrhoea alternating, the one in the night, and
the other during the day; urine scanty and high
coloured; cough, with stingings or stitches in the
chest and side, with yellowish or bloody expectoration, or pains in the head; shooting pains under the
left shoulder-blade when coughing; tongue dry, contracted, dark, or yellow; pulse rapid and full, or
quick, weak, and irregular.




188                 TYPHUS.
Mental and moral symptoms.-Same as under cerebral typhus.
Administration.-Same as under cerebral typhus.
Phosphorus.-External indications.-Yellow, brown,
coppery, or bluish spots upon the skin; viscid secretion about the eyes, particularly at night; quivering
of the eyelids; dryness and obstruction of the nose;
face pale, dingy, or red and bloated; eyes sunken and
surrounded by a dark circle; lips dry and bluish;
ulcers at the corners of the mouth; tongue with a
dry and dark, or whitish fur; respiration irregular,
laborious, noisy, or panting; pulse quick and hard.
Physical sensations.-Stunning headache, vertigo,
and dizziness, worse in the morning; smarting or
burning sensation in the eyes; throbbing in the ears;
deafness; offensive discharge from the nose; dryness
and raw sensation in the throat; nausea and pains
in the stomach; uneasiness and painful contraction
of the abdomen; stitches and roughness in the chest;
expectoration of mucus, slimy, sanguineous, or purulent matter; sharp pains in the shoulder-blades; stiffness of the neck; trembling, coldness, and numbness
of the limbs; great oppression at the chest, with distressed and anxious respiration.
Mental and moral symptoms.-Despondency, anguish, and fear, especially at night; disposition to
weep or laugh.
Administration. —A drop of the third dilution in an
ounce of water; a dessert spoonful once in two to
six hours, until an effect is perceptible.
Ammonium carb.- External indications. - Miliary
eruptions, or redness of the skin; eyes dry; nose obstructed with dry coryza; face pale and bloated;
lips dry and dark-coloured; faeces in small, hard
lumps; respiration short and anxious; breath offensive; tongue covered with slime or vesicles; pulse
weak and rapid.
Physical scnsations. —Great restlessness at night;
drowsy during the day; disturbed sleep at night, with
frightful dreams; pains in the head; nausea; ringing in the ears, worse at night; sensation of excoriation in the mouth and throat; constant thirst; constipation and itching at the anus; frequent desire to




TYPHUS.                 1 89
urinate during the night; hoarse, or short dry cough,
with tickling and roughness in the throat; mucous
and sanguineous expectoration; sharp pains in the
chest and sides, on coughing, breathing, or moving;
drawing pains in the nape of the neck and small of
the back; extremities stiff and numb; cramps, coldness, and swelling of the feet; excessive weakness of
the limbs; right side worse than the left.
Mental and moral symptoms. - Discouragement;
anxiety; apprehension; anguish; sad, weak, timid;
mental distress, worse at night.
Administration.-A grain of the first trituration
every two, four, or six hours, as the nature of the case
requires.
Acid Phosphoric.-External indications. —Eruption
of small pimples on the skin; redness of the skin;
coma; eyes dull, glassy, fixed, with pupils dilated;
coryza, with redness of the nostrils; face pale, or
covered with pimples; teeth yellow; gums swollen
and bleeding; tongue covered with thick and adhesive mucus; faeces hard, knotted, and slimy; urine
clear or white, depositing a white sediment; pulse
quick and weak.
Physical sensations.-Great physical and mental
prostration; pains in the chest, abdomen, and head,
worse during repose, relieved by motion; head confused, bewildered with pains when moving it; eyes
weak and sensitive to candle-light; music painful to
the ears; cheeks hot and burning; nausea and oppression at the stomach; diarrhoea, frequent inclination to urinate; tightness and oppression in the chest;
cough, with purulent expectoration; sharp pains in
the chest; burning sensation in the hands and feet.
Mental and moral symptoms.-Indifferent; taciturn;
peevish; stupid.
Administration. —Suitable in some cases of advanced
pneumo typhus. A dose of the third dilution may be
given once in four to six hours.
The following medicines should be named as appropriate under certain circumstances, in pneumo
typhus, viz., lachesis, tart., emet., senega, merc., lobel.
inflat.




190                   TYPHUS.
TYPHUS ABDOM1NALIS.
From the close analogy of appearances produced
upon the intestinal canal, by fatal doses of arsenicur
and by fatal abdominal typhus, it would be a natural
conclusion that arsenicum is for this disease a valuable homweopathic remedy. There has been, however,
a wide difference of opinion upon this question, between some of our most eminent practitioners. Many,
like Hausmann, Fleishmann, Gumpendorf, Staph,
Jahr, Henderson, Laurie, Currie, and Hartmann, have
eulogized arsenicum for this form of typhus, in the
most enthusiastic manner; at the same time a very
few, as Wurmb, Lorentz, &c., have denied that it
possesses any special curative properties in any stage
of the malady.
But the weight of testimony is so much in favour of
the advocates of arsenicum in abdominal typhus, that
we shall not enter into any discussion of the question,
but simply express the opinion, that in all cases of the
genuine forms of this disease, arsenicum, when exhibited judiciously, will prove a remedy of immense importance. Indeed, we believe in those cases of ulceration of the mucous membrane of the ileum, Peyer's
glands, &c., and in those instances where the blood becomes congested in different parts of the intestinal canal, giving rise eventually to sphacelation if unopposed, that arsenicum is a specific of positive and decided power. In support of this opinion, we refer
with full confidence to the numerous hospital and private reports, which have been presented to the public
in the last few years.
In relation to the cause or causes of the ulcers so
often discovered by the Hippocratics in autopsical examinations of those who have died of typhus abdominalis, an'allopathic* physician of forty years' standing
in Massachusetts, makes the following very pertinent
inquiries in a late number of the Boston Medical and
Surgical Journal: After expressing himself as "fully
persuaded that one of the great secrets of curing patients is not to kill them," he proceeds:-" I should like
to be informed whether there is not danger in giving
* Silas Brown, M. D.




TYPHUS.                  191
inwardly, in any quantity, strychnia, creosote, prussic acid, nitrate of silver, and a host of other virulent
caustic poisons; and whether some of them would not
have a tendency to cauterize or constringe the delicate
absorbents and other vessels of the digestive organs;
and whether such medicines have congeniality or
affinity enough with the membranous and vascular portions with which they come in contact, to become sanative medical agents; or whether they would not have
a tendency to produce obstructions and those ulcers
which we meet with in the post-mortem examinations of
those subjects who die of typhus fever." He requests
an answer, and we venture the suggestion that if he
adopts an affirmative one, he will be in little danger
of error. But to proceed with our description:
Arsenicum.-External indications. —Skin dry or yellowish, or cold and bluish; reddish or dark spots on
the skin; petechiae; eyes dull, glazed, and sunken;
pupils contracted; face shrunken, hollow, pale, and
cadaverous, or yellowish, bluish, or leaden coloured;
expression of countenance distorted and unnatural;
cold sweat on the forehead; lips dark, dry, and
cracked; teeth dry, white, and shining; sordes upon
the teeth; tongue dry, shrivelled, bluish or black, with
trembling and inability to protrude it; fweces variable,
generally loose, darkish, or greenish, and fetid; involuntary discharges of feeces and urine; urine reddish,
brownish, yellow, or turbid; tympanitis; guggling
noise of liquids swallowed; respiration short and
anxious; cramps in the legs; pulse irregular, or
quick, weak, small, and frequent, or feeble and trembling; voice sepulchral and tremulous; coma or low
muttering delirium; trembling of the limbs; subsultus
tendinum; sometimes deafness; hippocratic countenance; colliquative sweats.
Plhysical sensations.-Extreme debility or complete
prostration; burning and heat at the pit of the stomach
and epigastrium; nausea, and vomiting, especially
after eating or drinking; violent pains and burnings
in the abdomen, generally on the left side; sometimes
only pain on pressure; pains in the right hypochondrium; stitches in the side with anxious and difficult
breathing; universal loss of strength, and excessive




192                  TYPHUS.
restlessness; stools dark, greenish, putrid, fetid and
involuntary; head painful, weak, confused, as if
stunned; distention of the abdomen; stiffness of the
limbs.
Mental and moral symptoms. The patient is dissatisfied, restless, anxious, discouraged; or muttering;
delirious; sleep disturbed, with unpleasant visions.
Administration. In extreme cases, a grain of the
second or third trituration may be given every half
hour, gradually lengthening the intervals as circumstances require.
Remarks. Arsenicum is especially serviceable in
the third stage of abdominal typhus, when ulcers have
formed. It will also frequently apply in the second
stage, when the bowels become relaxed.
Carbo vegetabilis, is also a remedy of importance in
the last stages of abdominal, and in all stages of putrid
typhus. In the former, it may sometimes be exhibited
in alternation with arsenicum, with good effect. The
following are the external indications:-hippocratic
countenance; face pale, yellowish, or dingy; eyes
sunken and glazed, with nocturnal agglutination; lips
dry and cracked; tongue dry, dark, and tremulous;
position upon the back; cold, clammy sweat; pulse
rapid, trembling, and almost imperceptible; tremblings and jerkings of the limbs; urine red and highcoloured; faeces putrid and offensive.
Physical sensations.-An entire prostration of the
animal powers; heavy, pressing, or drawing pains in
the head; ulceration and bleeding of the gums; rattling in the throat; cramp-like, pressing, or burning
pains in the stomach and intestines; burning pains
and oppression at the chest; rigidity, or complete paralysis and relaxation of the nape of the neck and
limbs; bowels swollen and tender on pressure; feet,
legs, and hands cold; numbness of the limbs.
Mental and moral symptoms.-Coma, or sleeplessness, with muttering delirium; mind dull, confused,
wandering, or stupid.
Administration.-A dose of the third trituration
may be given in water, every half hour, in extreme
cases, until the necessary impression is made.
Hartmann speaks in high terms of staphysagria in




TYPHUS.                 193
the first stage of the disease, when the following symptoms appear: " Sordes on the teeth, pale and bleeding gums, with painful swelling of the gums, and rapid
decay of the teeth; vanishing of thoughts and ideas,
weakness of memory, dulness of mind, great indifference and ill humour; vertigo, with stupifying headache; dimness of the eyes, itching, stinging, and heat
in the canthi; fulness in the pit of the stomach, with
frequent hiccough and vomiting; tension across the
hypochondria, oppressing the breathing; pressure,
weight, and teusion in the abdomen; cutting pain in
the bowels, with nausea; copious diarrhceic stools."
Muriatic acid is a highly important remedy in many
cases of advanced typhus, when the patient is stupid,
unconscious of surrounding occurrences, and extremely prostrate. Other symptoms are, constant tendency
to settle down towards the foot of the bed, low muttering delirium, groaning in sleep, moaning, picking at
the bed-clothes; inability to protrude the tongue, dry
heat, with transient and partial sweats, general uneasiness, " depression of the lower jaw, digging with the
head into the, pillow, turning up of the whites of the
eyes, slavering, &c." (Hempel.) We may employ the
first to the third dilution-a drop in a drachm of water,
every two hours as long as necessary.
Dr. Kidd foundphosphorus a valuable remedy in the
treatment of the typhus which devastated Ireland during 1847 and 48. Rhus tox., bryonia and arsenicum are
likewise highly commended by the doctor, when,
"' from the very commencement, the heat of skin and
acceleration of pulse are very inconsiderable, and in
the middle and latter stages, are almost invariably below the natural standard. For two or three days the
patient would labour under lassitude and languor, with
loss of appetite and of sleep, the tongue being generally the first index of the probable mischief in store.
About the fourth or fifth day, the disease being generally
well marked, with a very slight heat of skin, which
felt soft and clammy, being covered with moisture,
(not like the ordinary feel of a perspiring skin, but as
if the skin were damped, and by some contrivance all
evaporation prevented,) the pulse very little, if at all
altered, except in strength, which even a.t this period
9l




194                  TYPHUS.
would be somewhat deficient; the tongue presented
a most characteristic appearance: in general dry, hard,
and glazed, like brown leather, or deeply covered with
brown or blackish fur. In some cases it appeared
soft, moist, and tremulous, covered with a perfect and
uniform layer of pure white paste or mucus, (this in
general omened a very severe and dangerous form of
the disease,) the gums and teeth became covered with
brownish incrustations, thirst being incessant and insatiable, with nausea and vomiting; in many cases
abdominal symptoms, as tension and tympanitic resonance of the abdominal walls, with tenderness and
shooting pain over either iliac region, (in general the
right;) bowels seldom costive, in general relaxed,
with or without pain; urine in a few cases suppressed,
in most unchanged; head in general implicated: in
most from the beginning, with aching and heaviness
at the forehead, throbbing at the temples, vertigo,
sense of emptiness and bewilderment; delirium, mostly
at night, with low muttering, or with stupid, heavy
insensibility, and incoherence of speech. The eyes
appeared dull, inanimate, and listless, with the head
instinctively turned from the light. In a few cases,
towards their termination, a peculiar sort of stolid
deafness supervened, which gradually disappeared as
convalescence advanced.
" Almost invariably the lower extremities were complained of as being dead and numbed, rendering the
least motion impossible, (but without any actual pain,)
the feet and legs feeling cold and damp.
" General debility and prostration set in early in the
disease, and proved the most obstinate of the symptoms."*
Dr. K. relied upon the four medicines above named,
in this form of the malady, and the results show a
mortality of less than two per cent. His success in
the numerous cases of continued fever which came
under his care, was no less gratifying. The low dilutions were employed for the most part; but in a few
cases drop doses of the tinctures were deemed necessary.
* Truths and their Reception, &c.. by J. Kidd, M. D., London, 1849.




TYPHUS.                195
The other medicines necessary in the treatment of
certain stages of this, as well as the other forms of
typhus, are: rhus tox., acid. nit., nux vom., secale cor.,
merc., op., camph., china, nux mos., valer., stram., hyos.,
and lach. These remedies will all occasionally be
called into requisition, so that their effects upon the
human system should be well understood and appreciated.
It will be observed that we have divided typhus
into but three varieties. Other authors add a typhus
putridus, typhus contagiosus, typhus lentus, typhus petechialis, &c. In practice, however, we seldom find
any one of these forms distinct and unmixed; but the
brain, nervous system, lungs, and abdominal viscera
partake more or less in the general disturbance, causing each particular case to present peculiar and diverse symptoms. So in regard to the treatment of this
fever, it will often be found, from its commencement
to its termination, to require one or more of the medicines which we have placed under each form of the
malady. The sympathetic connections are so strongly
pronounced, between the important organs in which
the different varieties of typhus are located, that one
cannot be affected without imparting disorder to the
others.
Physiologists note it as a curious fact, that no two
human faces are exactly alike, and it may be asserted
with equal safety, that no two instances of typhus
fever ever presented, from first to last, precisely the
same symptoms. Therefore it is, that in all cases of
this, as well as of other maladies, we must trust to
symptoms alone, and be guided by them in the application of our remedies, rather than by the name of the
disease. Our nomenclatures and classifications unquestionably facilitate the investigations and diagnosis of complicated cases, but they can be of very little
importance in the practical exhibition of medicines.




196
CHAPTER XIX.
HECTIC FEVER.
Diagnosis.-The ordinary symptoms of this fever,
are: daily febrile paroxysms, general debility, emaciation, skin pale, face often tinged with the "hectic
flush," irritable stomach, loss of appetite, moderate
thirst, night sweats, tendency to perspire through the
day, diarrhma, pulse quick, small, and sharp.
Causes. -The combination of symptoms denominated hectic fever, in most cases, proceed from long
continued and profuse suppuration; but they may
arise from protracted local irritation without suppuration. Some writers suppose that hectic can only
proceed from the absorption of pus, but this is erroneous, as the symptoms of hectic often make their
appearance before suppuration occurs. In nearly all
instances, it is a secondary affection consequent upon
either protracted disease in some vital part, some of
the joints, or of some extensive surface. It proceeds
more readily from diseases of the "bones, ligaments,
and tendons, than from those of the muscles, skin,
cellular membrane, &c." *
It may, then, be considered as a constitutional disturbance, originated and kept up by some previous
local disease, and which cannot be permanently cured
until the original cause upon which it is dependent, is
eradicated or removed.
In those cases where it is kept up by incurable diseases of the joints, bones of the extremities, or other
parts which can be safely removed by the surgeon,
amputation or excision shouldibe at once resorted to,
and the hectic symptoms will speedily disappear.
Mr. Hunter remarks, that " a hectic pulse at one hundred and twenty has been known to sink to ninety in
a few hours after the removal of the hectic cause."
Several instances have occurred in my own practice,
in which an almost immediate and entire cessation
* Sir A. (ooper.




HECTIC FEVER.              197
of the hectic symptoms, such as sleepless nights,
febrile paroxysms, night sweats, diarrhnea, rapid pulse,
&c., has resulted from amputation or excision of the
offending parts.
When the original cause is a suppuration of some
important organ like the lungs, liver, stomach, &c.,
our prognosis must generally be unfavourable. In
these instances it is of the utmost importance to the
homceopathic practitioner that he makes a thorough
investigation of all remote causes, in order to arrive
at an accurate knowledge of the latent and original
sources of the malady.  He will thus be able to
direct his remedial applications with judgment,
and afford to his patients the only possible chance of
cure.
Therapeutics.-In the selection of remedies, every
thing must of necessity depend upon the original
cause,-its'seat, nature, and violence; and upon the
secondary consequences to which it gives rise. It
should always be a prime object, to direct our most
potent remedies with perseverance against the local
affection; and if any latent or apparent influences
exist, against these also.
If we are called to a case of hectic fever, proceeding from an inflammation of a scrofulous character,
advantage will be derived from the use of some of
the following medicines: sulphur, aurum mur., calcarea, china, iodine, ol. jecor., asel., acid. nit., acid. mur.,
acid. phos., plhos., arsenicum, silicea, and mercurius.
In cases proceeding from syphilitic or mercurial
diseases of the bones, ligaments, &c., the medicines
adapted to the cure of these disorders should be selected.
If a chronic miasm, whether psoric or otherwise,
has originated the disturbance, then strike deeply at
the original cause with antipsorics, as well as at present symptoms, and good results may accrue in apparently desperate cases.




198
CHAPTER XX.
OF THE FEBRILE CUTANEOUS DISEASES.
EXANTHEMiATA.
These fevers, like some of those heretofore described, can only arise from certain specific morbific contagions which give rise to uniform and readily recognised symptoms. They all commence with general febrile disturbance, followed sooner or later by
eruptions, and other characteristic symptoms, which
serve to distinguish each particular variety.
A peculiarity attending this class of diseases, is,
that a single attack usually renders the subject safe
against any future action of the morbific poison. I
have, however, witnessed two or three well marked
examples of second attacks of scarlatina in the same
individuals.
The maladies which we shall notice under this
head, are, Scarlatina, Rubeola, Variola, Varicella, Miliaryfever, Roseola, Urticaria, Erysipelas, Plague.
SECTION I.
SCARLATINA.- SCARLET FEVER.
This fever has been divided into three varieties,
namely: first, Scarlatina simplex; second, Scarlatina
anginosa; third, Scarlatina maligna.
In its simple form, scarlet fever is not attended
with danger, btt runs its course mildly like a simple
continued fever, and terminates in five or six days in
convalescence.
In the other varieties, however, inflammations and
congestions often supervene soon after the attack,
and if not promptly met by suitable remedies, gangrene, sloughing, and fatal disorganizations occur in
the throat, larynx, and other important parts of the
organism.
Scarlet fever is of much more frequent occurrence




FEBRILE CUTANEOUS DISEASES.      199
in the fall and winter, than during the summer
months. Its attacks are usually confined to children
passed the nursing period, and persons under twenty
years of age; but it may occur at all ages from infancy to old age.
1. SCARLATINA SIMPLEX.
Diagnosis. — Shiverings, succeeded by heat, moderate thirst, frequent pulse, slight soreness of the
throat, nausea, loss of appetite, headache:- After
these symptoms have continued about forty-eight
hours, a scarlet eruption makes its appearance upon
the face, extending gradually downwards to the neck,
trunk, and extremities. This eruption consists of an
immense number of fine pimples (aptly compared by
Dr. Armstrong to a boiled lobster shell), either running together and diffusing themselves uniformly over
the skin, or appearing in patches in different parts of
the body. Upon the appearance of this eruption,
many of the unpleasant symptoms, like nausea, oppression at the stomach, dyspnea, &c., abate, and the
case thus progresses until the fourth or fifth day of
the fever, when desquamation of the cuticle takes
place, and a happy convalescence usually ensues.
2. SCARLATINA ANGINOSA.
Diagnosis. - The anginose variety of scarlet fever
is ushered in with chilliness and shiverings, succeeded
by intense heat and pungency of the skin, frequent
and hard pulse, nausea, vomiting, headache, sore
throat, painful deglutition, intense thirst, pain and tenderness of the epigastrium, abdomen tender, pain and
stiffness in the neck, tongue covered with a whitish
or yellowish fur, through which the papillae are seen
red, inflamed, and prominent; fauces, throat, and tonsils swollen, deep red, inflamed, or ulcerated; eyes
red and injected, voice thick and hoarse, sometirnes
dyspncea and cough, and universal tenderness of the
whole surface.
These symptoms continue an indefinite period, varying from two to five days, when the eruption shows
itself, either uniformly diffused over the body, or in




200        FEBRILE CUTANEOUS DISEASES.
irregular blotches. If the disease progresses favourably, the skin desquamates in from six to eight days
from the commencement of the fever, the febrile symptoms all subside, the ulcers in the throat granulate
kindly, and a speedy convalescence obtains.  On
the contrary, if the eruption prematurely disappears
from the surface, the ulcers assume a foul and unhealthy
appearance, secreting an acrid and highly irritating fluid; while the fever continues to rage with unabated severity. We may have a supervention of abdominal, bronchial, or cerebral inflammation, which
will complicate the malady in a serious and perhaps fatal manner.
"In this fever, the temperature, as indicated by the
thermometer, rises several degrees higher than in any
other."* The pulse is also more rapid and strong than
in almost any other fever, indicating conclusively that
it is an affection of an inflammatory character.
3.-sCARLATINA MALIGNA.
Diagnosis.-Scarlatina maligna was formerly known
under the name of "putrid sore throat," and is at present designated by some writers as scarlatina typhoides.
It is unquestionably one of the most dangerous maladies with which the physician has to contend. It generally commences with the common precursory
symptoms of the anginose form, which, however, very
soon give way for a train of symptoms bearing a close
resemblance to typhus. The eruption is either entirely
wanting, or makes its appearance only partially, in
irregular blotches of a pale colour; the heat of the
skin often subsides below the natural standard; the
pulse becomes very frequent and weak; the countenance assumes a besotted expression; the eyes become
dull and suffused; the throat is filled with ash-coloured ulcers; fauces, larynx, and bronchia inflamed and
swollen; an acrid discharge issues from the nostrils;
the tongue, at first red, soon becomes dry and black;
the surface, in the advanced stages, acquires a dark
red or mahogany colour, and petechias, diarrhaea, and
haemorrhages finally ensue. The ulcers in the throat
* Southwood Smith, on Fever.




FEBRILE CUTANEOUS DISEASES.      201
often slough and extend in all directions, involving in
their ravages the cartilages of the larynx and the soft
parts within the nostrils.
If the disease seizes particularly upon' the brain,
lungs, or abdominal viscera, there will be a predominance of those symptoms which characterize the disorders of these particular parts. From the tendency of
this malady to these different organs, some authors
have subdivided scarlatina maligna into the inflammatory, congestive, and mixed varieties. Examples have
occasionally occurred in my own practice, in which,
in the very onset of the malady, those symptoms have
appeared, indicating congestion of the brain,-as
coma; slow, oppressed, and noisy respiration; sighing;
face pale or livid, skin cold, pulse slow and irregular,
pupils contracted or dilated. In these cases, the eruption seldom comes out well, but is of a pale colour,
and shows itself irregularly in different parts of the
body.
In other instances the inflammation seizes upon the
laryngeal, bronchial, or intestinal mucous membranes,
thus often deciding the case against the patient, when
the local affection of the throat seemed to be progressing favourably.
Causes.-Scarlatina can only proceed from a specific morbific contagion, respecting the nature of which
we are entirely ignorant. Whether this contagion is
generated and diffused solely by those suffering under
the disease, or whether, as some pathologists assert, it
may be generated in the atmosphere independently of
the animal body, is a question which admits of discussion, although we entertain the former opinion. Of
this we are confident, that when the agent is infinitesimally diffused in the air, it is capable of being absorbed into the circulation, and of producing its specific morbific effects upon the organism.
Some have doubted the contagiousness of this affection, because certain individuals of families occasionally
escape, while others are affected; but let it be remembered, that this happens now and then in smallpox,
plague, typhus, and all other maladies which are universally deemed contagious.
We have before observed, that the contagion of ty9*




202        FEBRILE CUTANEOUS DISEASES.
phus cannot make a serious impression upon the organism, so long as every part is in a perfect state of
health and vigour. The same remark will apply with
equal truth' to the disease under consideration. In
these cases, the tissues on which the poison operates,
are stronger than the noxious influence, and are thus
enabled to resist its action until some cause predisposes
the system to receive the impression.
Therapeutics. —The provings of belladonna upon the
healthy subject, as well as the numerous successful
experiments made at the bedside of the sick, have
stamped it as a remedy of distinguished importance in
the treatment of scarlet fever. It has even been extolled by eminent practitioners of the old school, and in
some instances adopted, both as a remedy in this disease, and as a valuable prophylactic against it.
In the scarlatina simplex, an occasional dose of this
medicine at the third attenuation, will suffice to conduct
the patient safely through the malady. Should the febrile symptoms run high, the belladonna may be advantageously preceded by aconite.
In the anginose form, where there is intense inflammatory excitement, swelling and soreness of the
throat, painful deglutition, quick pulse, burning hot
skin, nausea, tenderness at the epigastrium, belladonna
is still the grand remedy. If the fever assumes a violent character, evincing a tendency to excite inflammatory action in any particular structure, aconite may
here also be administered with advantage, either by
itself, or in alternation with belladonna. So long as
the local inflammation in the throat is retained within
due bounds, and the eruption shows itself in a proper
manner, remaining out a sufficient length of time, we
shall receive ample aid from these potent remedies.
We take the liberty of introducing the following special symptoms of belladonna, from Drs. Curre, Hermann, Laurie, &c.:
External indications.-Spots of a scarlet or deep
red colour on the face, or other parts of the body;
swelling of the submaxillary glands, and those of the
neck; eyes red, sparkling, and convulsed, or fixed,
shining, and prominent; pupils dilated or contracted;
tongue red, hot, and dry, or white in the centre, with




FEBRILf CUTANEOUSf DISEASES.     203
red edges; throat, tonsils, uvula, and velum-palati
dry, inflamed and swollen; suppuration of the tonsils;
strong pulsations of the temporal arteries; inflammation of the stomach and abdomen; constipation, or
involuntary evacuations; urine turbid, of a brownish
red or yellow colour, with a red or whitish sediment;
pulse small and quick, or strong and quick, or full and
slow, or small and slow, or hard and tense; pulsations
of the carotids; face hot, red, and bloated; sweat
with the heat, or after it.
Physical sensations.-Vertigo, confusion, fulness,
heaviness, pressure; shooting or expansive pain in the
head, aggravated by motion of the head or eyes, by
contact, and by cold air, mitigated by holding the
head back, and by supporting it; mouth dry and hot;
dryness and burning in the throat, with painful and
difficult deglutition; loss of appetite; nausea and
vomiting; great thirst; sense of fulness and distention
in the stomach and abdomen after eating; drawing
pains in the back and shoulders; difficult respiration;
violent cough; shiverings, alternating with heat, or
followed by heat, worse in the evening or night;
adypsia, or excessive thirst; dry, burning heat.
MIental and moral symptoms.-Great agitation and
tossing about; anguish and inquietude in the afternoon and night; delirium, with muttering, groans, and
cries; vivid and frightful dreams; starting from sleep
with fright, groans, and cries; ill humour and irritability.
The same writers give us the following special indications for the employment of aconite:
External indications.-Face red, hot, and bloated,
or alternately red and pale; skin dry and hot; forehead cold, and tips of the ears hot; deep redness of
the throat; bilious or mucous vomitings; urine scanty,
deep red, with brick-coloured sediment; pulse hard,
frequent, and accelerated; respiration rapid and
difficult.
Physical sensations.-Oppressive or throbbing pains
in the head, aggravated by motion; talking, rising up,
&c.; better in the open air; great sensibility of the
affected parts to the touch, or on movement; pains in
the joints and limbs; fainting and weakness; ex



204        FEBRILE CUTANEOUS DISEASES.
treme'thirst; coldness of the surface, with internal
heat, or burning over the whole body; pain in the
throat, and difficult deglutition; burning and prickling
in the throat in swallowing; bitter or putrid taste;
loss of appetite; sense of swelling, weight, or pressure in-the prawcordial region; hot and burning urine;
bruised pains in the loins, back, and nape of the neck.
Mental and moral symptoms.-Discouragement and
agitation; noise appears insupportable; humour
changeable: at one time sad, depressed, irritable, contradictory, despairing, at other times excited, gay, and
full of hope; inquietude under disease, and even despair respecting a cure.
If there is slight fever through the day, but an increase in the evening, with sleeplessness, sadness, despondency, and tears, ipecacuanha is our remedy. The
following are the particular symptoms which point to
this medicine:
External indications.-Face pale, sallow, yellowish,
and bloated, with livid circles round the eyes; tongue
loaded with a white or yellowish fur; profuse secretion of saliva; vomiting of green, bilious, acid, slimy,
or gelatinous matter; sweat; fetid breath; turbid
urine, with sediment like brickdust.
Physical sensations.-Nausea and vomiting of drinks
or food; no appetite; insipid and clammy taste;
adypsia; violent itching of the skin; empty risings;
great uneasiness in the stomach and epigastrium;
feeling of emptiness and flaccidity in the stomach;
sensation of debility in the bowels, worse on motion;
colic, with agitation; tossing, with cries; diarrhcea,
with nausea; griping and vomiting.
Mental and moral symptoms.-Anxiety and fear of
death; moroseness; cries, and howling; vague desire
for different things.
~When the disease commences with prominent derangement of the stomach and bowels, headache, vertigo, shiverings, weakness, nausea, and nose-bleed,
soon succeeded by hasty, anxious, and oppressed respiration, mucous vomiting, taste of food, longing for
acids, spirits, or beer; flatulence; adypsia, or great
thirst; constant anxiety, moaning, or sighing, and disturbed sleep, pulsatilla is appropriate.




FEBRILE CUTANEOUS DISEASES.       205
Scarlatina occurring in individuals of decidedly
scrofulous dyscrasias, will sometimes require the employment of sulphur, or calcarea carb.
Dr. Elb, of Dresden, advises zinc in those cases
where paralysis of the brain is threatened, or when it
already exists. He has likewise used it with success
in the malignant form, with violent delirium, alternating with sopor; icy coldness of the skin from sunken
vitality; small and frequent pulse. and fixed and stupid expression of the eyes. Dr. E. usually employs
the first trituration in grain doses every two to six
hours.
Occasionally, troublesome ulcers form in the mouth,
throat, and upon the tonsils, covered with ash-coloured
sloughs; deglutition becomes exceedingly difficult,
and is attended with a stinging pain; the fluids which
the patient attempts to swallow, often escaping
through his mouth and nose, with perhaps an acrid
discharge from the nostrils, and profuse secretion of
saliva. Under these circumstances, mercurius is a
proper remedy.
In malignant scarlet fever, where, in addition to the
above symptoms, we have inflamed, swollen, and tender salivary glands, dark-coloured ulcers, with a decided tendency to slough and extend, together with
great debility, lassitude, tremours, obtuseness of intellect, cold extremities, and other signs of a typhoid
condition, muriatic, or nitric acid, from the first to the
third dilution, should be exhibited.
If, at the same time, there should be present a considerable amount of pulmonary or cerebral excitement,
indicated by delirium, restlessness, contracted or dilated pupils, heaviness and dull pain in the head onl
motion, difficult, anxious, and sighing respiration, sensation of weight and pressure upon the chest, troublesome, hacking cough, with soreness and sensitiveness of the whole surface, bryonia, third dilution, may
be called into requisition.
Arsenicum is a remedy of great power in the advanced stages of malignant scarlatina, where there
are extreme prostration, pain in the stomach and abdomen, diarrhoea, eruption of a livid or mahogany
colour, ulcers dark and foul, tongue and lips dry and




206        FEBRILE CUTANEOUS DISEASES.
black, pulse extremely frequent and weak, cold, clammy sweats, hippocratic countenance. This remedy
has often rescued patients from the grave who have
been given over in despair by physicians of the old
school.
Should profound coma supervene during the course
of the malady, with snoring and open mouth, open
and convulsed eyes, red and puffed face, hanging jaw,
difficult, slow, or intermittent respiration, convulsive
movements of different muscles, retention of urine,
&c., opium will be found the best specific. We are
satisfied that this is an agent which will rarely disappoint our expectations in instances of this description.
When the rash suddenly disappears during the
eruptive stage, Drs. Schmidt, Hartmann, and others,
recommend very highly acetat, cuprum as a specific
against this symptom. Sulphur, iodine, bryonia, phosphorus, and belladonna also deserve consideration, and
will, in some cases, promptly restore eruptions which
have been prematurely repelled.
The other remedies which may be consulted in
cases where those above described do not accord with
the symptoms, are, ipecac., nux v., carb. veg., rhus tox.,
stram.,phos., kreosote, hyos.
For the troublesome sequela which sometimes follow scarlet fever, as dropsical affections, purulent
otorrihea, deafness, furunculi, enlargements and suppuration of the glands of the neck, axilla, and groin,
appropriate remedies may be found in apis., mel., ars.,
dig., hellebore, sulph., hep., senega, cham., aur. mur.,
and merc.
Administration.-We most commonly employ the
first, second, and third attenuations; but in young
and impressible children, we often resort to the higher
dilutions with the most satisfactory results. Some
cases are characterized from the commencement by a
high state of vascular and nervous excitement, while
others evince a loss of vascular and nervous power,
and a very low grade of impressibility. The propriety,
therefore, of the employment of both the high and
low attenuations, in different instances, is evident. If
dilutions are used, a drop may be given at a dose, in




FEBRILE CUTANEOUS DISEASES.        207
a drachm of water; but if the triturations are selected, one grain is a suitable dose, given dry or in water.
We advise a frequent repetition of the dose until
decided changes arise from the remedy, or until we
are satisfied that it is not producing the required
effect upon the disordered structures.
SECTION II.
RUBEOLA.-MEASLES.
Formerly, measles and scarlet fever were described
and treated as one and the same disease, the differences which were observed in different cases being
ascribed to modifications originating from peculiarities of constitution, the state of the atmosphere, and
other accidental causes. About fifty years ago, however, Withering, and several other writers, recognised
a distinction between them; and measles, for the first
time, was accurately described and ranked as a distinct malady.
As it generally occurs, it is unattended with danger,
unless interfered with by purgatives, emetics, and infusions. Fortunately, it is confined for the most part
to children, for when adults are the subjects of attack, it is far more severe and dangerous. Like scarlatina, one attack renders the subject secure against
any future operation of the contagion.
Diagnosis. —The precursory symptoms of measles
are similar to those of ordinary catarrhal fever: as
lassitude, chilliness, sneezing, coryza, red and watery
eyes, headache, nausea, slight soreness of the throat,
short, hoarse cough, pain and soreness in the chest;
dyspncea, heat, and thirst. These symptoms continue
with more or less severity for four or five days, when
the eruption makes its appearance, commencing at
the forehead, and proceeding gradually downwards to
the neck, breast, arms, body, and lower extremities.
About the period of the eruptive stage, there is usually an increase of the febrile symptoms, which continue
for four or five days, when a bran-like scurf is cast
off from the surface, and the fever subsides. During
the fever, the cough is often very trublesome, and
sometimes terminates in inflammation of the bronchia




208        FEBRILE CUTANEOUS DISEASES.
or lungs. Schroen thus describes the malady: "' Small,
scattered, red spots, in the centre of which we generally find a small pimple. These spots soon become confluent, and spread over the whole body, after
being preceded by catarrhal fever, for three or four
days, attended with redness of the mucous membrane
of the mouth, with cough, catarrh, dread of light, and
flow of tears. They disappear upon pressure, and
develope themselves again from the centre towards
the periphery, after the pressure is removed. The
pimple becomes a small yellow prominence in the
course of sixteen hours, when a scurfy desquamation
commences."
The attentive observer will have no difficulty in
distinguishing this malady from scarlatina, by the
following marks of difference: the primary symptoms
of measles are red and watery eyes, sneezing, fluent
coryza, short cough and some hoarseness.  These
signs, which are almost uniformly present in this disease, are usually wanting in scarlet fever.  In the
general character and appearance of the eruption also
there is a marked difference. The scarlatina rash is
composed of innumerable fine pimples, resembling in
appearance the shell of a boiled lobster, uniformly
diffused over the surface, and of a bright scarlet colour.
The eruption of measles appears in spots (sometimes
papular) resembling flea-bites, which run together and
form semi-lunar patches. There is a roughness or
elevation where the eruption exists, perceptible to the
touch: and which is not usually observed in scarlatina. But one of the best marks of distinction is the
difference in the colour of' the rash, that of' measles
being a purplish, or darkish scarlet, while that of
scarlet fever is a light scarlet.
Measles is a disease which, under different circumstances, assumes a great variety of forms, both as to
its general character and violence.  During some
seasons it prevails as a mild and simple affection, requiring little or no treatment; while at other periods
it assumes a highly inflammatory, congestive, or
typhous character. Sometimes almost all cases seem
to have a tendency to run on to pneumonia; at other
times cerebral or typhoid symptoms predominate; in




FEBRILE CUTANEOUS DISEASES.       209
still other instances, gastric disorder prevails; but in
the great mass of cases, the malady is mild and tractable.
In contemplating the numerous varieties of this, as
well as of most other diseases, the impartial physician
must acknowledge the utter uncertainty and empyricism of prescriptions guided only by the name of a
disease.
Causes.-In common with the other contagious disorders, measles arises from a specific morbific contagion. This has been amply proved by Home, Dewees,
Speranza, and Majendie, who, in numerous instances,
succeeded in communicating this affection by inoculation. The season of the year, the condition of the
atmosphere, and the peculiar circumstances of the
individuals exposed, exercise a powerful and perhaps
controlling influence, in determining the character of
the epidemic. When measles prevail during seasons
of influenza, typhus, or dysentery, the disease will partake of the peculiar character of the existing epidemic,
and its course be modified accordingly.
Therapeutics. —The most common medicines in the
treatment of measles, are, acon., andpuls.: next in importance stand bry., bell., ipecac., mere., sulph., cup. ac.,
rhus, ac., phos., ars., cham., Vc.
Schroen recognises five different varieties of measles,
founded upon the characteristic symptoms present in
each given case: viz., first, the simple or erethistic, in
which aconite is the appropriate remedy; second, the
inflammatory, requiring the use of aconite, bryonia, and
belladonna; third, the gastric, demanding the employment of pulsatilla, chamomela, ipecacuanha, and veratrum; fourth, the typhus, or irregular, calling for rhus
tox., china, nux vom., and belladonna; fifth, the septic, or
malignant, corresponding with acid. phos., acid. sulph.,
acid. mur., opii, and arsenicum.
At the commencement of an attack, when heat,
thirst, quick pulse, red, inflamed, and watery eyes,
sneezing, fluent coryza, cough, dyspncea, oppression at
the chest, and sore throat are present, aconite at the
third potency is the most suitable remedy. So long
as the disease progresses mildly, running through its
regular stages in due form, no other medicine will be




210           FEBRILE CUTANEOUS DISEASES.
requisite to complete the cure. Even in those complications which call for the use of other medicines,
as pneumonia, croup, cerebral or gastric disturbance,
whether occurring before, during, or subsequent to the
eruption, should the inflammatory excitement run
high, aconite will still be required.  Its repetition
must, of course, be subject to the circumstances of
each particular case.
When there exists a predominance of catarrhal
symptoms, and a tardiness in the appearance of the
eruption, we have an appropriate remedy in pulsatilla.
This medicine may often succeed aconite with peculiar
advantage in the catarrhal forms of more than ordinary
severity. In these cases, some writers claim for this
agent important prophylactic properties. It is also a
valuable in retrocession of measles, attended with one
or more of the following symptoms: hoarseness, swelling of the parotids, puffiness of the face, pain in the
ears, discharges from the ears, hardness of hearing,
dry short cough, great restlessness, pains in the head,
back, and loins, and mucous diarrhoea.
Dr. Croserio believes pulsatilla to be especially
adapted to measles, not only as a remedy, but as a
prophylactic.  He asserts that " it is to this disease,
almost what belladonna is to scarlet fever. The precursory symptoms of measles accord perfectly with
the febrile symptoms of pulsatilla, viz., chills, heat,
lassitude, throbbing pains in the head, anxiety, nausea,
vomiting of bile or glairy mucus, violent coryza, red
eyes, lachrymation, photophobia, &c. Then follow
pricking of the skin, red spots like flea-bites, excoriation and creeping in the throat, difficult deglutition,
dry, fatiguing cough, epistaxis, &c. If given in the
precursory stage, I have often seen the disease terminate in abundant perspiration in twenty-four hours."
Belladonna is indicated when the throat is much
inflamed and swollen, with very painful and difficult
deglutition, short, hacking, throat cough, inflamed
eyes, nervous, uneasy and sometimes delirious, hurried
respiration, headache, intense thirst, dry hot skin, and
signs of cerebral disturbance. It has likewise been
recommended in cases of sudden disappearance of the
eruption after having been out one or two days.




FEBRILE CUTANEOUS DISEASES.       211
"When the eruption suddenly disappears and is
succeeded by fever, violent headache and breathlessness, great benefit will be derived from the administration of aconite and arsenicum alternately; and
afterwards, when the head appears to be the chief
point of attack, indicated by excruciating headache,
screaming or moaning during the night, belladonna and
cuprum aceticum, repeated every hour or two, will
afford marked relief."-(British Jour. of Hornm., No.
xxiv., p. 232.)
Bryonia will apply in cases attended with marked
pectoral symptoms, like stitches or darting pains in the
side and chest, anxious, sighing, difficult and painful
respiration, and very great general uneasiness.
Hartmann says, that bryonia " is also a powerful remedy in retrocessent measles, in reproducing the eruption
on the surface, or in rendering its disappearance
harmless. In these cases I give bryonia in the fifteenth
dilution, and notice that it is chiefly indicated, if after
the retrocession of the eruption, a morbid affection of
the eyes supervenes, which resembles that which I
lately noticed when speaking of ophthalmia."
Ipecacuanha should be administered when there is
gastric disorder, indicated by nausea, vomiting, pain
and oppression in the stomach, and inability to retain
food or drinks.
For the ulcers which sometimes form in the mouth
and throat, also the glandular swellings which occur
in the neck, mercurius is a valuable specific.
As a remedy for the restoration of retrocessent measles, as well as for the inflammatory affections of the
eyes, which now and then remain as sequela of this
malady, sulphur is sometimes a remedy of' the highest
importance. Many cases, after having apparently
ran their courses in a mild and regular manner, leave
the patient with some annoying dreg, like discharges
from the ears, weak eyes, eruptions of various kinds,
or chronic cough, with profuse expectoration, which
are attributable to some miasm which has been roused
during the course of the disease. For the cure of cases
of this description, sulphur is an indispensable agent.
We occasionally meet with nervous or typhoid
symptoms which render the use of ars., rhus tox., strama.,




212         FEBRILE CUTANEOUS DISEASES.
op., and phos. necessary. Whatever symptoms present
themselves, the judicious physician will be able to select from the great number of medicines of which the
pure effects are known, those that are precisely
homeopathic to the malady.
Administration. -In cases of children, we employ
from the third to the sixth attenuations; and in those
of adults, from the first to the third. Our repetitions
must be governed by the nature of the case, and the
effects produced by the medicine.
SECTION III.
VARIOLA.-SMALLPOX.
Two varieties of this disease have generally been
recognised by pathologists; one termed distinct and
the other confluent. The former is more mild and less
dangerous than the latter, being attended with less severe constitutional disturbance, and having detached,
distinct, and fewer pustules, which are surrounded by a
pale red areola. The confluent variety, by the pustules running together and meeting each other, presents the appearance of a uniform and homogeneous
swelling, from which it has derived its name.
Diagnosis. —Smallpox may, with propriety, be divided into the following stages or periods, viz.: 1, the
primary fever; 2, the eruptive stage; 3, the maturing
period; 4, the period of exsiccation.
The primary fever in the distinct variety is ushered
in with lassitude, rigours, pains in the head, back, and
loins, slight sore throat, soon followed by nausea and
vomiting,pain at the epigastrium, often severe, with tenderness on pressure. hot and dry skin, thirst, scanty and
high-coloured urine; these symptoms continue for
about three days, when there is a supervention of the
Eruptive stage. —The eruption first comes out in
small red spots or points, which, in the course of fortyeight hours, become rounded into pimples with vesicles upon their tops and slight depressions in the centre. They show themselves first upon the face, and
then in regular succession upon the scalp, neck, arms,
breast, body, and lower extremities, requiring about
twenty-four hours for the full development of the erup



FEBRILE CUTANEOUS DISEASES.      213.tion. After this period, there is a marked remission
of all the febrile symptoms, which continues for three
or four days, when the
Maturing or suppurative period commences. There
is now a renewal of the febrile disturbance still more
violent than at first, which commonly continues during
the remaining course of the disease. This period continues from three to five days, when the serous fluid
within the pustules acquires a purulent character,
becoming thick and yellow. On the tenth or eleventh
day, the pustules burst, giving vent to the matter
which collects upon the surface of the pock, forming
hard dark scabs or crusts, which in a few days fall off,
leaving the skin scurfy and sometimes pitted.
Now commences the period of exsiccation, which occupies from three to five days; after which, if the malady has pursued a moderate course, the morbid symptoms all subside, and convalescence ensues.  Thus it
will be perceived, that the regular course of the disease occupies about fifteen days; this course, however,
is subject to modifications from a great variety of
causes, such as the supervention of pneumonia, bronchitis, ophthalmia, abdominal inflammations, disease
of the glands, retrocession of the eruption, &c.
In the confluent variety, the primary fever is of a
more violent character, the eruptive period more irregular, usually commencing at the end of two days
from the onset of the malady; there are often spasmodic twitchings of the muscles, at or previous to the
appearance of the pustules, the secondary or suppurative fever frequently assumes a typhoid form, salivation occurs about the period of the eruption, after
which the tongue, mouth and throat become dry and
dark, pocks form in the mouth, throat, larynx, pharynx,
rectum, and urethra, and occasionally symptoms manifest themselves which indicate a high degree of malignancy. The face is often much swollen and disfigured from the pustules running into each other, so
that the eyes become entirely closed, and the nostrils
obstructed. The matter of the pustules is of a dusky
colour, and is sometimes so acrid as to irritate the surrounding skin.
What has been denominated varioloid, is nothing




214        FEBRILE CUTANEOUS DISEASES.
more or less than an exceedingly mild form of small
pox, modified by previous vaccination, or some other
accidental influence. The primary fever is very mild,
the eruption distributed over the body in patches, the
suppurating process slight and imperfect, attended
with little or no secondary fever.
Causes. —All agree that variola proceeds from a
specific morbific poison, sui generis. There are, however, causes constantly in operation, which exert a
powerful influence in modifying or aggravating the
character of the malady, respecting the nature of
which, authors are not so well acquainted. - At some
periods, smallpox is characterized by a high degree of
putridity, the symptoms assuming a low typhoid form,
and a majority of the cases proving speedily fatal in
spite of all remedial measures. At other seasons we
may have a predominance of pulmonary or cerebral
symptoms, attended with a high grade of synochal
fever, and requiring a very different course of treatment from the form above mentioned. Again it may
run its course in a regular and moderate manner,
without serious complication from disturbance of any
capital organ, and demanding but little aid from remedial agents.
Some writers have supposed that these different
modifications were owing to certain occult conditions in the atmosphere, and also that the existence
at the same time of other epidemics, has a material
influence over the character and progress of smallpox.  This is doubtless true; but there are other
causes more under our control, which are of no less
importance, as predisposing agents to the more violent forms of the malady. The most prominent of
these, are, small and ill-ventilated dwellings, a lack
of healthy and nutritious food, want of' cleanliness,
insufficient clothing, immoderate use of ales, and impure liquors, and the pernicious custom of crowding
together in the same apartments, a number of individuals, who thus inhale, a good part of the time, a
vitiated and unhealthy air.
The fatality of the disorder, when it seizes upon
this degraded class, indicates the importance of the
influences just enumerated, in aggravating the char



FEBRILE CUTANEOUS DISEASES.       215
acter of the malady. Does it not, then, behoove the
guardians of the public health, during the prevalence
of contagious affections, to look well to these deleterious agencies, and purge their towns of the filth,
the dissipation, and the other corruptions of these
hot-beds of contagion?
Therapeutics.-The following are the ordinary medicines used in the treatment of smallpox, namely,
aconite, belladonna, rhus tox., vaccinin, variolin, sulphur,
opium, mercurius, bryonia, pulsatilla, nux vom., carbo
veg., (Irsenicum.
Aconite, second or third dilution, is the proper medicine during the primary fever, provided the attack
is regular, and there exists no tendency to inflammation or congestion of any important organ.
In case the eruption is slow in making its appearance, or the process should be attended with great internal oppression, either rhus or sulphur, at the third
attenuation, may be exhibited-a dose every three or
four hours.
Belladonna is the specific, when, during any part
of the malady, inflammation or congestion attacks
the brain. In cases of this description, this remedy
exercises a two-fold effect; first, by its special action
upon the cerebral organs, and second, by its power of
forcing and of retaining the eruption upon the surface. The third dilution may be used in these instances-one drop every two hours until amelioration
of the symptoms is evident.
Dr. Liedbeck of Stockholm considers tart. antim.
our most valuable remedy in smallpox. When taken
in large doses, it produces dryness, heat and redness
in the throat, internal eruptions, large pustules (with
depressions in their centres) in the mouth, throat, larynx, and trachea: therefore, Dr. L. infers, that "it
is as much the specific remedy for the smallpox, according to homaeopathic principles, as mercury. is that
for syphilis." The second trituration may be usedone grain every two to six hours, as circumstances require.
Sulphur at the commencement of the attack, and
about the period of desiccation, will often prove exceedingly serviceable in determining the eruption to




216        FEBRILE CUTANEOUS DISEASES.
the surface, and in disposing it to progress kindly. In
individuals who suffer from a psoric taint, it cannot
well be dispensed with. It may be administered at
the third trituration, in grain doses, and repeated
sufficiently often to ensure the kindly progress of the
eruption.
Vaccinin and variolin have been highly extolled
within the past three or four years, as a remedy in
all stages of this affection. It is said, that, by the
use of these agents, variola is rendered a very mild
and harmless disease. It is claimed by those who
have made considerable use of them, that all of the
stages of the malady are shortened in duration, and
that a majority of the cases thus treated, resemble
varioloid more than real smallpox. These medicines
may be used in the form of trituration, of the third
attenuation.
Bryonia will be called for if pneumonic symptoms
obtain. This remedy will also prove serviceable in
typhoid forms, attended with gastric or biliary derangements.
Bryonia may be administered in mild cases, at the
third dilution, and in severe congestive forms at the
first-a drop every two or three hours in water.
Mercurius viv., third trituration, should be administered, if salivation, ulcerated throat, or diarrhcea
-with bloody stools, and tenesmus, occur. It is also a
remedy of value during the suppurative stage, and in
the ophthalmias which often accompany and succeed
the variolous attack.
Opium, at the third dilution, will always be appropriate whenever coma, and nervous sensibility, stertorous respiration, convulsive movements, and impaired muscular action supervene during the progress
of the malady.
In cases of great malignancy, with a gangrenous
tendency, and other symptoms evincing a low typhus
grade, carbo veg., acid. nit., acid. mur., or arsenicum,
may prove serviceable when all hopes from other
remedies have been abandoned. From the first to
the third attenuations should be employed in these
instances. The age, sex, temperament, and the pe



FEBRILE CUTANEOUS DISEASES.      217
culiar circumstances connected with each particular
case, must determine the proper strength of the medicine and the frequency of its repetition.
SECTION IV.
VARICELLA.-CHICKENPOX.
Diagnosis.-There are a few points of similarity
between the milder cases of smallpox and the more
severe forms of varicella, which require an acute observer to discriminate between them during the early
part of an attack. Both diseases commence with a
similar primary fever, which continues until the eruption makes its appearance; the pustules in both instances resemble each other; both are likewise contagious, and communicable by inoculation.
At the eruptive period, however, an attentive observer will perceive that the resemblance usually
ceases, for the pustules of variola make their appearance in a uniform manner, first on the face, then successively upon the neck, arms, breast, body, and lower
extremities, occupying usually but twenty-four hours
for the completion of the eruption, while the pustules
of varicella come out in repeated series, first upon
the breast, then upon the face, head, arms, body, and
lower extremities, and require three or four days
before the eruption is complete. Therefore, we often
observe during the progress of the latter, some vesicles drying up, some in a state of partial development,
while others are but making their first appearance.
The vesicles of chickenpox contain a whitish or yellowish lymph, which seldom advances far towards
the suppurating stage; and even in those cases where
pus is formed, there is never any secondary or suppurative fever, as in variola.
Causes.-Varicella, like the other contagious disorders, is a distinct affection, and proceeds from a
peculiar specific cause. This is apparent, from the
fact that inoculation with varicellous matter never
gives rise to any other malady than varicella itself.
It is not only a much milder disease than smallpox,
or varioloid, but is of much shorter duration, running
10




218        FEBRILE CUTANEOUS DISEASES.
its course generally in six or seven days, when the
pocks all disappear, leaving smooth surfaces.
Therapeutics.-Vaticella, as it commonly occurs,
requires no medicinal treatment: a due regard to diet,
and avoidance of exposure to cold, dampness, &c.,
being only necessary to ensure its safe progress.
In cases where the malady assumes unusual severity, manifested by a high grade of febrile excitement,
determinations of blood to the brain, lungs, or abdominal organs, then the medicines which are homaeopathic to the existing symptoms may be administered.
The remedies which have been -most frequently
used in these cases, are, acon., coff., bell., merc., rhus
tox., and sulph. The strength of the medicines, as
well as the repetitions of doses, the same as under
modified smallpox.
SECTION V.
MILIARIA.-MILIARY FEVER.
Diagnosis.-This disease is ushered in with lassitude, slight creeping chills, pain in the loins and lower
extremities, oppression at the precordia, cough, general uneasiness, more or less heat and thirst, rapid
pulse, and high-coloured urine.  These precursory
symptoms continue about five days, when a very fine
eruption, resembling millet seeds, makes its appearance on different parts of the body. The little vesicles which compose this eruption are round, hard, and
transparent, becoming after a time opaque. As they
are about coming out, there is an itching, stinging,
and burning sensation in the skin, the oppression at
the chest and stomach is increased in severity, and, in
general, a profuse pers iration of a disagreeable, sour
odour, breaks out over the whole surface. After two
or three days the vesicles become opaque, then soon
dry up and fall off in the form of scurf.
Some writers consider miliary fever as a purely
symptomatic affection, while others, with equal tenacity, maintain that it often occurs idiopathically. According to my own opinion, it is not at all improbable
that it may be dependent upon some latent miasm,
which.only requires an exciting cause, like puerperal




FEBRILE CUTANEOLTS DISEASFS.     219
fever, heating and stimulating ptisans, undue exposure in heated and close rooms, &c., to call it into
action. I am confirmed in this opinion frQm the fact,
that in nearly every case with which I have been
made acquainted, where the eruption has retroceded,
whether by improper use of external lotions, or otherwise, there has been a supervention of some serious
internal disorder.
If this view of the cause of the malady be correct,
the therapeutical indications are evident, and the prudent physician will use every effort which our specific
medicines afford, to aid nature in casting off the poison from the system through the medium of the skin.
Therapeutics.-In conjunction with our internal
remedies, it is essential that the patient be kept in a
dry apartment, of uniform temperature, and be confined to a strict dietetic regimen. By these means,
we shall prevent the retrocession of the rash from
the sudden application of external cold, and avoid
those unpleasant complications which errors in diet
are so apt to induce.
A strict- adherence to the above rules, with an occasional dose of aconite, third dilution, will generally
suffice for the cure of this complaint.
After the eruption has manifested itself, if the patient is troubled with a train of nervous symptoms,
like sleeplessness, general uneasiness, partial loss of
power over the voluntary muscles, spasmodic twitchings, and constant desire to change position, a dose of
the sixth dilution of hyoscyamus may be given, and
repeated as circumstances require.
Should the brain become affected in any stage of'
the disease, belladonna may be exhibited in the same
manner as advised under measles.
Chamomela, at the tenth potency, should always be
administered when infants and children are the subjects of attack. If the malady commences with strong
fiebrile excitement, this medicine may be preceded by
aconite.
Bryonia is also highly recommended in cases of
miliaria in infants and parturient women. It may be
administered in the same manner as bell.
Ipecacuanha will apply when the eruption is ac



220         FEBRILE CUTANEOUS DISEASES.
companied with laborious and noisy respiration, nausea, or vomiting, groaning, aversion to food, chilliness, alternating with flushes of heat, and sweet, insipid taste. The third trituration should be employed
-one grain every four or six hours until the symptoms yield.
SECTION  VI.
ROSEOLA.
Diagnosis.-This is one of the mildest and least
dangerous of all the eruptive fevers. It is characterized by an eruption or efflorescence of a rose colour,
preceded and accompanied by some slight symptoms
of febrile disturbance. The rash shows itself on the
third or fourth day of the fever, and comes out in distinct and irregular spots upon different parts of the
surface, or the spots run together, giving to the skin
an almost uniform redness. The cuticle is neither
elevated, nor is there any appearance of papulae;
but a simple blush of a rose colour, characterizes the
eruption, and serves as a mark of distinction between
it and that of other diseases of this kind. The appearance of the rash is often attended with itching and
tingling, which are present more or less until the eruption vanishes, which is usually in five or six days, without desquamation of the cuticle or any unpleasant
after symptoms.
Causes.-Roseola is for the most part confined to infants and females. It arises from undue exposure to
cold, after having been confined in a warm room, indigestible food, dentition, gastro-intestinal irritation,
and the abuse of stimulating infusions, cathartics, &c.
Therapeutics.-Rigid dietetic regulations, a moderate, dry, and equal temperature, mental and physical
rest and quietness, and an entire exclusion of all " herb
teas," and such other " domestic remedies," so called,
as are commonly suggested by the officious ignorance
of old women. A regard to these rules will suffice to
secure the patient from any ill consequence of this naturally mild and simple affection.




FEURILE CUTANEOUS DISEASES.       221
SECTION V~1.
URTICARIA. —NETTLE RASH.
Diagnosis. —The primary symptoms of urticaria are.
languor, oppression, and sickness at stomach, foul
tongue, bitter taste, giddiness, creeping chills, succeeded
by preternatural heat of skin and thirst. During the
early period of the disease, elevated, circular, and
florid spots or weals, each with a whitish spot or point
in its centre, appear, sometimes in only one part of the
body, at other times generally diffused over the whole
surface. These weals are attended with an exceedingly annoying itching, stinging, and burning sensation, somewhat resembling the stings of nettles. The
itching, as well as the febrile excitement, is always
worse in the evening or during the night; but when
the eruption is upon the surface, the nausea and distress at the stomach abate, and do not return until
another eruptive period, unless there is a sudden retrocession of the weals.
In some instances the eruption appears suddenly
without any febrile or other premonitory symptoms,
and without any apparent exciting cause. At other
times, certain articles of food, like shell-fish, porgies,
esculent vegetables, acid fruits, or stimulants like wine,
spirits, hot ptisans, condiments, or frictions upon the
skin, seem to become its exciting causes. It usually
terminates in a few days, but now and then it persists
many months, sometimes apparent upon the skin, at
others suppressed.
" Its sudden disappearance without leaving a trace
behind, and its equally sudden reappearance, are quite
characteristic. Inclination is also present in all the
varieties of this disease, and vomiting frequently occurs as a crisis." —(Schroen.)
Some nosologists have divided this malady into two,
and some into four varieties; and others, like Bateman, and a few of the older writers, have gone so far
as to recognise and describe seven: but these fine and
arbitrary distinctions are not founded in nature, and
therefore offer no aid in diagnosis; while, on the other
hand, there is danger that they may confuse and em



222         FEBRILE CUTANEOUS DISEASES.
barrass the inexperienced practitioner. We know that
the eruption is very irregular in regard to the periods
of its appearance, and also in the size, form, general
aspect, and diffusion of the weals, yet, we see no tecessity for complicating our classification with so many
varieties, for we might with as much propriety go
on with divisions, ad infinitum, as to stop after having
described six or seven genera, since the most acute
nosologist will scarcely be able to discover any two
cases presenting precisely the same symptoms in all
respects.
If, however, we were to adopt any classification, it
would be that of Schroen, who distinguishes two forms
of the malady, the acute and the chronic. Under the first
form, he includes: first, urticaria maculosa, or spots of
different degrees of redness, attended with sensation of
formication and intense itching; second, urticaria vesicularis, orvesicular prominences,with empty and almost
transparent apices; third, urticaria tuberosa, or hard,
tense, and painful tuberosities, generally appearing in
the night. Amongst the chronic varieties, he ranks urtzcaria evanida, resembling the urticaria tuberosa, appearing on exposure to cold, and disappearing on the
application of warmth. This variety sometimes continues for weeks, and even months.
Causes. —We entertain the opinion that the remote
cause of nettle rash consists of a specific miasm,
either generated within the organism, or introduced
from without, and which is liable to be roused into
action by numerous exciting causes. The proofs of
this are numerous, and we think satisfactory; for if it
were merely an.effect or symptom of one of the various
exciting causes, like indigestible food, certain kinds of
fish, acid fruits, vegetables, wines, liquors, &c., it would
disappear as soon as the exciting cause was withdrawn, and all irritation from this source obviated;
but in very many instances no such result takes place,
and after the noxious article has been entirely removed, and the part previously deranged restored to its
usual normal condition, there is a persistence of the
urticaria for months, and even years; it appearing and
disappearing at frequent intervals, without the slightest apparent reason.




FEBRILE CUTANEOUS DISEASES.     223
Another fact which sustains the position we have
advanced, is, that if the eruption be suddenly repelled.
by the use of lotions, or cathaitics, serious internal
disorders frequently supervene as a consequence of
the retrocession, which terminate, if the weals are not
reproduced either spontaneously or artificially, in dissolution. A painful case, illustrative of this position,
came under niy observation a few years since. The
patient was a lovely and highly interesting young
lady, who from some slight exciting cause was afflicted with urticaria, although previously she had remained for many years in excellent health. The
malady annoyed her by turns for more than three
months, when, from the application of a lead-water
lotion, the external symptoms suddenly vanished,
leaving irn their place wandering pains in the chest
and side, some cough, fits of oppression at the chest,
and difficulty of breathing. These symptoms of pulmonary disturbance continued to increase until she
was pronounced by two eminent physicians of a,
neighbouring city to be past cure, with tubercular
consumption. About this period the case came under
my charge, in what seemed to be the last stages of
consumption,  Notwithstanding, however, the unpromising condition of affairs, my patient slowly but
gradually recruited, so that in six or seven months the
abscess which had existed in one lobe of her lungs
was healed, and the lungs, with her whole system,
were restored to a comparatively sound and healthy
state. In this condition she continued for nearly two
years, when a second attack of urticaria supervened,
affording still farther relief for a few days, from all
remaining difficulties, when the rash permanently
disappeared. From this time her symptoms were all
aggravated, her old complaints returned, the lungs
became again ulcerated, so that in a few months the
malady advanced to a fatal termination. Is this an
isolated instance? Without doubt, the experience of
almost every physician could furnish one or more
cases of the same description.
This example offers conclusive proof to my own
mind, that an intimate connection existed between the
two diseases, and that whenever the rash was upon




224        FEBRILE CUTANEOUS DISEASES.
the surface, nothing disturbed the lungs; while the
moment retrocession ensued, pulmonary symptoms
manifested themselves. If urticaria is a purely local
disease, depending upon a distention or spasm of the
extreme cutaneous vessels, how can the suppression of
such local inflammation affect so seriously internal
organs?
It must be confessed, that our knowledge respecting
the causes and intimate nature of cutaneous affections, is at present quite limited; but when we take
into consideration the fact that so many internal constitutional maladies take their exit through the surface in the form of eruption, we are constrained to
believe that this is almost uniformly only a symptom
of some internal constitutional disorder.
Therapeutics.-As it is of the first importance in all
cutaneous diseases, that the eruption should be urged
and retained upon the surface, in order that the miasm
may not fall upon any vital organ, we should select
our remedies chiefly from those which exercise a specific action upon the skin.
Another point of no less importance in the management of eruptive fevers, consists in securing for the
patient a dry, moderate, and equable temperature.
This precaution, combined with cleanliness, and a
placid and composed frame of mind, will always aid
us materially in our therapeutical measures.
The medicines which are the most appropriate for
the treatment of this complaint are, acon., sulph., dulc.,
rhus., calc., carb., lycop., nat. mur., acid. nit., puls.,
ignat., ipecac.
Aconite will only be required in those cases which
are attended with undue febrile action. It may be
administered as advised, under measles.
Sulphur. —This medicine should always be prescribed in cases occurring in individuals of a marked scrofulous dyscrasia, when the following symptoms obtain.
External Indications. — General appearance of debility; pale, sallow, and sickly expression of face; redness of the margins of the eyelids; swellings of the
glands of the neck.
Physical Sensations. —Eruption and violent itchings
occurring in the night, from the heat of the bed, and




FEBRILE- CUTANEOUS DISEASES.-        5
occasionally from  exposure to cold air; great sensitiveness to cold; dizziness and pains in the head;
spasmodic twitchings of the eyelids; bad taste in the
mouth; nausea; pyrosis; weakness and oppression
at the chest..Mental and moral symptoms.-Melancholy; sadness;
irritability.
Administration.-One grain of the third trituration
in two ounces of distilled water,-a dessert spoonful
once in twelve hours.
Dulcamara is useful in urticaria, which proceeds
from taking cold, and is attended with nausea, vomiting, oppression at the stomach, heat of skin, thirst,
bitter taste, diarrhmea, and great general uneasiness.
The symptoms are aggravated at night, during repose,
and by the heat of a room; but they disappear in the
open air.
Administration. —A drop of' the third dilutioin, in a
small quantity of water, may be given once in six to
twelve hours.
Rhus tox.-Eruption, attended with itching and
burning during inaction, or on entering a room from
the open air; disappearance of the weals, on exercise, followed by shifting rheumatic pains, pains and
pressure in the stomach, difficult respiration, short
breath in the evening, agitation and anguish. This
medicine is particularly applicable in urticaria vesicularis.
Administration.-Same as dulcamara.
Calcarea carbonica is indicated in cases where the
rash vanishes on going into the fresh air, and excited
by the application of cold water: face yellow, upper
lip swollen, skin rough and covered with goose pimples, stunning lateral pains in the head, with nausea
and vertigo at night, or in the morning, on waking,
with faintness; anxiety, anguish, apprehension.
Remarks. —Calcarea carbonica is suitable in obstinate chronic urticaria, especially when occurring in
scrofulous or cachectic constitutions.  It is sometimes
necessary to persist in the use of this remedy for
several weeks.
Administration. —A drop of the third dilution in an
ounce of water,-a dessert spoonful once or twice in.
the twenty-four hours.
10*




226         FMBIE1 CVTANXUS DIMSEASES.
Lycopodium.-Rash and itching during repose, headache in the afternoon or at night, smarting of the eyes
by candle-light, nausea when in a hot room, relieved
in the air, silent and peevish.
Administration.-Same as calcarea carbonica.
Natrum  mur., at the sixth potency, may be prescribed, when there are languor, uneasiness, nausea,
headache, weakness when lying down at night, relieved on rising in the morning, eruption coming out
after violent exercise.
Nitric acid, third dilution, will be proper for patients
of a consumptive or scrofulous habit, afflicted with
debilitating night sweats, weak, enfeebled, subject to
hemorrhages from the bowels, lungs, nose, &c., and
rash caused by exposure to cold air. A drop should
be prescribed two or three times daily.
Pulsatilla, sixth dilution, when the elevations are
redder than the skin, when the itching is of a burning
or pricking character, worse at night in bed, in a hot
room, or by scratching; better in the open air; worse
every other evening; heaviness and disposition to
numbness in the limbs; great sensibility tb the open air.
Ignatia, sixth dilution, is particularly adapted to
attacks occurring in nervous and hysterical females:
the eruption is brought out by exercise, and is often
preceded by nervous symptoms; there is also fulness
and pressure of the head, with sparks before the eyes;
also sighing, and irregular respirations.
Ipecacuanha, third trituration, is useful in cases attended with excessive vomiting, oppression at the
chest, and dyspncea; it is also a valuable remedy in
asthma from suppressed urticarias.
Other remedies worthy of consideration are, arsenicum, balsam copaib&a, iodine and bryonia in the chronic
forms; and in the acute varieties, clematis, staphysagria,
and belladonna, for urticaria vesicularis; urtica and
hepar sulphur, for urticaria tuberosa; mercurius, iodine,
aurum mur. and sepia, for urticaria maculosa.
Administration.-The above remedies may be given
dissolved in pure.water. They may be repeated in
six, eight, or twelve hours, according to the urgency of
the symptoms. In all cases of this description, where
a latent miasm is suspected to exist, a persevering and
judicious course of anti-psoric treatment, should be




FEBRIL OCUTANEOUSF DISEASM          -2 7
adopted, after the: eruption has disappeared and the
acute symptoms have subsided.
SECTION VIII.
ERYSIPELAS.-ST. ANTHONY S FIRE.
Erysipelas presents itself under so many different
aspects, and so often makes its appearance in connection with other morbid conditions of the system, that
any description which shall cover all its various phases, is scarcely possible. The structures upon which
it seizes are the skin, the cellular-tissue, and the internal organs, especially the brain and the lungs. It may
exist in a chronic form, unattended by febrile, or other
constitutional disturbance, and persist for a long
period-displaying itself at intervals, upon the surface,
in the form of slight superficial inflammations; or
sometimes passing to an internal organ, and producing
temporary derangement of function; while at other
times it will remain latent and inactive. But it very
frequently appears in an acute form, either as an
idiopathic or a symptomatic affection. It is in this active
condition that erysipelas has proved so formidable to
the old-school physician and surgeon. It was in this
fobrm of the malady, that the late celebrated Liston,
conscious of the inefficiency of allopathic remedies,
was induced to adopt homoeopathic treatment in the
numerous symptomatic cases, from surgical operations,
wounds, &c., which came under his care; the results
of which were so highly satisfactory to Mr. Liston and
the friends of homceopathy.*
Erysipelas prevails most commonly in the spring
and autumn, and not unfrequently it assumes an epi.
demic character. Females are likewise more subject
to its attacks than males.
The circumstances which operate to modify the
character and course of the malady are very numerous.
In some instances a peculiar state of the atmosphere
exists, which serves to develop the affection in a highly malignant form, in those who are predisposed to its
influence. At other times, the effluvia arising from
A See Reports of North London Hospital, 18386, 7 and 8.




228        FEBRILE CUTANEOUS DISEASES.
those who are suffering from the disease, appears to
possess contagious qualities, and to be capable of communicating the morbid influence to those who come
within its reach. Cases of this kind, are usually severe and malignant-attacking the cellular-tissue
with a low grade of inflammation, which is exceedingly prone to terminate in gangrene, and not unfrequently to extend its ravages to the brain and lungs.
The habits and constitution of the individual likewise
exercise an important influence in determining the
character of the disease. Excessive indulgence in
malt liquors, and impure spirits, and the exclusive use
of fresh meat, reduce the system to a condition peculiarly favourable to the generation of malignant erysipelas, whenever slight exciting causes operate. So
also, general debility, a dropsical tendency, a scrofulous or scorbutic habit, or any other dyscrasy, will be
likely to determine a dangerous form of the complaint.
Diagnosis.-Erysipelas is sometimes preceded by
general lassitude, depression of spirits, and protracted
rigours, followed by accelerated circulation, hot skin,
thirst, headache, wandering pains in the back and
limbs, and general restlessness; or it may make its
appearance without any premonitory symptoms, except, perhaps, slight chills, succeeded in a few days
by fever; or it may occur during an attack of
pneumonia, typhus, bilious, or gastric fever; or after
wounds, or other injuries, in different parts of the body,
especially of the scalp; or it may arise suddenly from
violent mental emotions, as terror, joy, anger, &c.
When the inflammation is confined to the skin, the,
malady runs its course in a mild and simple manner,
and the accompanying symptoms will be merely stiff,
heavy, burning, or pungent sensation in the part affected, impaired appetite, slight febrile disturbance,
and nocturnal restlessness. The inflammation generally comes out in blotches, which sometimes run
together, and after a few days, are covered with vesicles filled with a limpid or yellowish fluid. These
blotches vary from a light red, to a dark red, or purplish colour, becoming white under pressure, but again
resuming their original appearance as soon as the
pressure is removed. As the disease is about subsid



FEBRILE CUTANEOUS DISEASES.     229
ing, the colour of these spots changes to a pale or dirty
yellow, after which desquamation of the cuticle takes
place.
When the malady is complicated by gastric or
biliary derangement, we may have a high grade of
febrile excitement, and the other phenomena which
usually attend affections of this kind. In these instances, the erysipelatous inflammation is apt to be
more violent, and to extend deeper, than when no
complications exist. The tumefaction is more extensive, and deep-seated, the inflammation is more intense, the hardness greater, and the pain more profound, in this variety, than in that first described.
Some authors have designated this variety the erysipelas phlegmonodes. The most common seat of this
phlegmon is in the face and head, although it occasionally attacks other parts of the body.
Another and highly malignant variety of erysipelas
prevails at certain seasons, and attacking more particularly females after confinement, and individuals who
have already been enfeebled by other diseases. The
tumefaction in these instances is more soft and spongy
than in the preceding varieties-often pitting on pressure; the skin assumes a pale, waxen, or sallow colour; the temperature of the parts is sometimes
above and at other times below the natural standard;
the skin of the affected parts presents a smooth and
glossy appearance; vesicles, containing a limpid or
yellowish serum, are diffused over the swelling; sensations of stiffness, weight, and deep-seated burning
pains are experienced; followed, if the disease advances, by nausea, vomiting, obtusion of the senses,
rapid and feeble, or slow and full pulse; constant inclination to sleep, and finally profound coma; stertorous respiration; contracted or dilated pupils, either
partially or wholly insensible to light; protrusion of the
lips at each expiration; frothing at the mouth; diminished temperature of the skin; livid and inactive
appearance of the diseased part, and general and rapid abasement of the energies of the system. This
form of erysipelas has been recognised under the term
erysipelas cedematodes, from the resemblance of the
affected parts to dropsical swellings.




230        FEBRILE CUTANEOUS DISEASES.
There is another form of the disease which evinces
a strong disposition, from the commencement, to gangrenous degeneration. The inflammation is confined
principally to the sub-cutaneous cellular -tissue; the
swelling is hard and inelastic; the colour of the skin
is dark-red or purple; large vesicles filled with an
acrid fluid, form on the surface, presenting a sluggish
and gangrenous tendency; the accompanying fever is
of a low typhoid character; the muscular and nervous
energies are below the natural standard; delirium or
coma are for the most part present, and suppuration,
gangrene, and sloughing soon supervene. This form
of the malady has been termed erysipelas gangrenrosum.
Another form attacks newly born children. The
inflammation is generally confined to the lower part
of the body in the first instance, but sometimes extends
over the whole surface. The character of the attack
depends much upon the constitution and predisposition
of the child; although, commonly, the inflammation is
of a high grade, the swollen parts very painful and
tender, and disposed to suppurate and slough. The
course of the complaint varies from two to four weeks.
This variety is called erysipelas neanatorum.
Another, and very common kind, may be observed
in old people and in cachectic and intemperate persons. It is unattended with febrile disturbance, or
much pain: but as it is apt to make its appearance
from very slight exciting causes, it becomes a constant
annoyance. When the inflammation is upon the surface, the subject feels well; but on its disappearance,
there often occur internal pains, congestions, and numerous unpleasant symptoms, which lead to the inference that the disorder is dependent on some internal
miasm. Frank terms this form, habitual erysipelas.
A number of other varieties have been described,
founded upon the disease as it has prevailed in different localities and climates, and as modified by various
forms of disease which may have accompanied it; but as
we only aim to give a general outline of the complaint,
with its characteristic phenomena, we shall refrain
from entering here into a more minute enumeration
of symptoms.




1F. RIES  ~A fItIM   DbltA~.   fJMl
Causes.-There is much difference of opinion respecting the causes of erysipelas. Some attribute it
to a local cutaneous vice; some to a degeneration of
the blood in consequence of improper food, abuse of
stimulants, &c.; some to a derangement of the biliary
organs; some to atmospheric influences; while others
entertain the opinion that it is dependent upon a peculiar dyscrasia which is constantly present as a predisposing cause. This opinion appears to us reasonable; but whether this dyscrasia is in all instances
hereditary, or whether it may be acquired by intemperance, unwholesome food, or from contaminated air,
we are as yet unable to determine.
The more common exciting causes of erysipelas
are, debility and loss of resisting power, from disease,
abuse of stimulants, violent emotions of the mind, undue exposure to cold, certain states of the atmosphere,
accouchement, disordered stomach and bowels, confinement in close and crowded apartments, and wounds.
Eberle asserts that " the inflammation which is produced by the recent leaves of the rhus toxicodendron,
is strictly of an erysipelatous character." This, however, is an error, for although a close similarity exists
between the two inflammations, the careful observer
will be able to distinguish decided marks of difference.
Therapeutics.-The important- medicines in the
treatment of erysipelas, are, rhus toxicodendron, belladonna, aconite, sulphur, opium, graph., arsenicum, carbo
vegetabilis, merc., phosphorus, pulsatilla, acid phosphorus, acid nitric, sil., china, hep. sulph., lach., bryonia,
chamomela, clem., and euphorb.
Rhus toxicodendron. - External indications.-Inflammation confined to the skin; numerous vesicular
blotches, attended with itching and burning sensation;
swelling and redness of the face, worse in the eyelids,
around the eyes, and in the lobules of the ears, attended with burning and itching; swelling in the
scalp; erysipelatous inflammation of the scrotum in
new-born children; distinct or confluent vesicles, containing an acrid, limpid, or yellowish fluid, with redness of the skin over the whole surface of the body;
partial or entire closure of the eyelids; swelling and




2M      DT~fELEfl  OTAm1COBB DISROMEW
hardness of the alce nasi; gangrenous ulcers; hot
and dry skin; rapid and full pulse; urine small in
quantity, dark and turbid.
Physical sensations.-Burning, itching, and stinging
of the affected parts, aggravated by scratching; irritation and sometimes excoriation of the skin from contact of the vesicular discharge; the itching and burning sensations worse in the evening; stiffness and
sense of immobility in the swollen parts; bruised feeling in the limbs and back; general sensation of heat,
both externally and internally, occasionally interrupted
by slight rigours; mouth filled with saliva, or dry,
with or without thirst; dryness and obstruction of the
nose, relieved by drafts of cold air, or by being fanned; painful pulsations in the internal ears, when
resting on the affected side; scalp swollen and painful
to the touch; eyes painful on motion; dull heavy pain
in the head, aggravated by motion or stooping.
Mental and moral symptoms.-Obtuseness of intellect, stupefaction, and weakness of memory; sadness,
anxiety, and despondeircy towards evening, and during
the night; nightly delirium.
Administration.-A drop of the second or third dilution in water, once in two to four hours.
Remarks.-Ruoff and Schroen consider rhus particularly applicable in vesicular erysipelas which is confined to the skin; but if symptoms indicative of serious cerebral disorder are present, they prefer belladonna. It has been used with success in infantile
erysipelas.
Belladonna.-External indications.-Skin swollen,
red, hot, and painfill; cheeks, eyelids, nose, lips, and
forehead, swollen, tense, shining, and painful to the
touch; eyes red, prominent, and glistening, or dull and
cloudy; pupils dilated or contracted; whole head
swollen and painful; obstruction of the nostrils; inflammation and enlargement of the parotid glands;
hardness of hearing; redness and swelling of the
tonsils and throat; urine scanty, dark, yellow, or
reddish, clear or turbid; vesicular inflammation, with
intense febrile excitement; tongue and lips dry; sordes upon the teeth; occasionally spasms, tremblings,
and rigidity of the limbs; pulse generally full and
quick.




FEBRILE CUTANEOUS DISEASES.      233
Physical sensations. - Tension and pressure, or
sharp, throbbing pains in the head; scalp very painful, especially on pressure; violent heat and burning
of the inflamed parts; dryness, smarting, or burning
of the eyes; disordered vision; stitching and throbbing pains in the ears, both externally and internally;
roaring and humming in the ears; mouth and throat
dry, hot, and painful; sticking and burning sensation
in the throat when swallowing; aversion to food and
drinks, or violent thirst for cold drinks; bad taste in
the mouth, bitter eructations, and other signs showing
biliary and gastric derangement; short, anxious, and
difficult inspirations; great weariness and uneasiness;
pains worse in the afternoon and at night, and aggravated by contact or movement.
Mental and moral symptoms.-Vertigo, conftusion of
ideas, or loss of consciousness, or delirium, violent at
night, but moderate during the day; or melancholy,
despondent, and apathetic.
Administration.-A drop of the third dilution in
water every two or three hours, according to the
severity of the symptoms.
Remarks.-It was chiefly from the employment of
belladonna and aconite, that Liston produced. the successful results in the North London Hospital, and in
private practice, to which we have already alluded.
We believe it to be our most valuable remedy in those
cases which have been excited by intemperance and
violent emotions of the mind. It is applicable also in
nearly all cases of erysipelas where there exists prominent cerebral disorder. In these cases, should it
not cover all of the important symptoms, we may give
some other appropriate medicine in alternation.
Whenever febrile symptoms are strongly pronounced, and there exists a decidedly augmented action of the circulatory vessels, aconite will be required,
either alone or in alternation with some other remedy.
It should be used in the first, second, or third dilutions
-a drop in water as often as the exigencies of the
case may demand.
Opium is indicated in those cases which supervene
during pneumonia, typhoid, and other fevers, and present the following signs: profound coma; stertorous




234         FEBRILE CUTANEOUS DISEASES.
respiration; eyes dull and watery; pupils dilated and
immovable; general appearance stupid and besotted;
spasmodic motions in different parts of the body;
pulse.slow and feeble, or slow, intermittent, and full;
inability to rouse the patient. The second or third
dilution may be employed-a drop every half hour
until an impression is produced.
When ulcers have formed, and there is a disposition
to gangrenous degeneration, we must refer to ars.,
carb., veg., sulph., lach., euphorb., sil., clam., acid., nit.
and acid phos.
In erysipelas phlegmonodes, when the inflammation
is extending into the cellular tissue, our best remedies
are bell., graph., hep-sulph., merc., phos., sil., and
sulph.
If the inflammation exhibits a tendency to shift from
place to place, and is attended with gastric or intestinal derangement, and constantly shifting pains, pulsatilla will prove specific.
Bryonia has been strongly recommended when the
inflammation takes place about the joints, and is accompanied by rheumatic pains.
China will often prove serviceable during convalescence from severe and protracted attacks, when the
energies of the system have been exhausted, and
there is great irritability of the nervous system. Some
of the signs which point to this medicine, are emaciation, cedema of the limbs, deficiency of animal heat,
pale countenance, great debility, ringing in the ears,
disturbed sleep.
External applications to the affected surfaces, in the
form of blisters, and of nit. of silver, have sometimes
been employed with success by gentlemen of the old
school, and as they are in accordance with our principle of cure, it becomes us to give them all due attention.
Respecting the administration of the remedies above
enumerated, we suggest, as a general rule, the employment of the first, second, and third attenuations;
but in cases of infants and young children, we may go
up to the tenth or twelfth dilution. In acute cases,
the dose should be repeated once in two to four hours;
but in the chronic varieties, two or three times daily
will suffice.




FEBRILE CUTANEOUS DISEASES.       235
SECTION  IX.
THE PLAGUE.
The plague is said to resemble in many respects
malignant typhus; the only phenomena which serve
to distinguish it from this fever, being the numerous
buboes and carbuncles which appear on the body.
By many it is supposed to be really nothing more or
less than a genuine typhus fever, rendered peculiarly
putrid and malignant by the atmospheric and other
influences which prevail in Egypt and the other oriental nations in which it has prevailed. As in the worst
grades of typhus, maculw,a petechise, diarrhcea, hamorrhages from the bowels, &c., generally supervene in
the advanced stages of the disorder, in addition to the
buboes and carbuncles.
Our knowledge in relation to this disease is so
limited, it being derived solely from the imperfect descriptions we have seen, by other writers, that no attempt will here be made to detail its symptoms. But
if we may be allowed to judge of its nature from those
phenomena which seem to be characteristic, we suppose the following remedies will correspond with its
manifestations, and prove to it homeopathic, namely:
arsen., acid nit., rhus tox., veratrum, merc., bell., chin.,
ipecac., carb. veg.




236
CHAPTER XXI.
OF THE CHRONIC CUTANEOUS DISEASES.
VESICULAR VARIETIES.
SECTION X.
HERPES. -— TETTER.
Diagnosis.-The eruption consists of groups of small
vesicles, situated upon red and inflamed bases, and
separated from each other by sound portions of skin.
As the vesicles increase in size, the colourless fluid
which they contained in the first instance, becomes
gradually opaque, and in two or three weeks dries up
into thin crusts which scale off. When the eruption
makes its appearance, there is an unpleasant burning
and crawling sensation, which soon settles into a deepseated, and in some cases, severe pain. It may be
confined to a single point, or extend, in clusters of different sizes, over a large surface.
Another variety of tetter, is often observed to commence in the form of broad and irregular clusters of
small vesicles, sometimes seated on swollen and inflamed bases, and shortly becoming confluent; or the
eruption may appear in distinct groups and unattended with any inflammation or swelling of the surrounding skin. In the first form, when the inflammation is
somewhat active, the vesicles often burst and discharge their contents, leaving troublesome ulcers at
their bases. This variety is sometimes described under
the term eczema, or humid tetter.
According to Bateman, most kinds of herpes pass
through a "regular course of increase, maturation,
and decline, and terminate in about ten, twelve, or
fourteen days. The eruption is preceded, when it is extensive, by considerable constitutional disorder, and is
accompanied by a sensation of heat and tingling, and
sometimes by severe pains in the parts affected."
Herpes has been subdivided into many different species, on account of presenting some points of distinction when attacking different parts of the body.




THE CHRONIC CUTANEOUS DISEASES, ETC.    237
Thus, when the vesicles appear upon the lips during
colds, fevers, and inflammations of the mucous membranes of the pulmonary or digestive apparatus, the
disease is termed herpes labialis. The eruption in this
instance, is usually of a more inactive and unhealthy
character, than when it occurs in other parts of the
body. The matter which escapes from the vesicles
is purulent or sanious, and concretes into black
crusts.
When the eruption consists of a narrow belt of vesicles, extending partly around the body, or over the
shoulder, it receives the appellation of herpes zoster,
or shingles.
Another, and very common form, is thus described
by Schroen: " An inflamed red ring, commonly perfectly circular, and upon which numerous small globular vesicles appear, which, though at first perfectly
transparent, soon become turbid; these burst, and discharge a thin fluid, which forms a slight lamellated crust
that soon becomes detached, leaving a bright red
mark. Sometimes the fluid is absorbed, and the vesicles fade and fall off in thin, scurfy exfoliations. The
duration of the disease is about seven or eight days for
each ring; but as successive rings appear and go
through a similar course, it may last between two or
three weeks." Schoenlein supposes that a repulsion of
this eruption predisposes the patient tofungus haematodes. This variety is called herpes circinnatus, or ringworm.
Other subdivisions have been made into herpes preeputialis, herpes iris, herpes phlyctaenodes, &c.; but since
the nature of the malady is the same in all these varieties, and as the modifications which occur are dependent in a great measure upon the peculiar structure of the affected parts, we do not deem it necessary
to enter into a more minute exposition of the details
pertaining to each species.
Causes.-Errors in diet; immoderate use of fat, rich,
and indigestible food; a morbid condition of the cutaneous excretion; local irritations from external injuries, and the application of acrid substances. It
has been observed that those who have suffered from
attacks of syphilis, scrofula, scurvy, or who have taken




238     THE CHRONIC CUTANEOUS DISEASES, ETC.
much mercury, are most prone to the disease. In these
cases, a predisposition is established in the skin, so
that, from slight causes, herpetic eruptions are excited.
Therapeutics.-When the eruption attacks the face,
head, body, or extremities, our best remedies are, sulphur, calcarea carb., silicea, carbo veg., sepia, rhus tox.,
belladonna, lycopodium, iodine, graphites, aurum mur.
Herpes of the lips should be treated with arsenicum,
acid phos., graphites, phosphorus, hepar sulphur.
If the eruption appears upon the scrotum or prepuce,
the appropriate medicines are mercurius, arsenicum,
sulphur, calcarea carb., conium, rhus tox.
Nearly all cases which occur may be cured by sulphur, ca carea carb., sepia, and mercurius; but should
these remedies disappoint us, there will be no difficulty in making an appropriate selection from the
medicines first enumerated.
Administration.-For the most part, we rely upon
the first, second, and third attenuations; and prescribe
drop doses of the dilutions, or grain doses of the triturations, twice daily until a satisfactory amendment is
evident.
SECTION  XI.
PEMPHIGUS.
Diagnosis —This is also a vesicular affection, characterized by the appearance of single vesicles of
large size upon the legs, and occasionally upon other
parts of the body. The vesicles are filled with; a yellow or straw-coloured fluid, and are seated upon an
inflamed, hard, and red base. This disease occurs
during the course of fevers, or in old and enfeebled
persons, after undue exposure to cold, or improper indulgence in stimulants or indigestible food. "I have
frequently seen," writes Mackintosh, "large bullwe
take place in the course of slight, as well as severe
fevers; but instead of considering them thereby entitled to any specific character, I have always looked
upon their occurrence as an accidental circumstance,
and have made no difference in the treatment of the
original disease. The appearance of the vesicles is




THE CHRONIC CUTANEOUS DISEASES, ETC.    239
sometimes preceded by slight chills, followed by transient flushes of heat, and other signs indicative of mild
constitutional disturbance. In these instances the integuments at the base of the vesicles are hard,
swollen, and painful. The ordinary duration of the
eruption is from one to two weeks; but in some instances the vesicles continue to appear for months.
Therapeutics.-Sulphur, rhus, arsenicum, dulcamara,
iodine, acid nit., and mercurius.
Administration.-The medicines may be employed
in the same manner as advised in herpes.
SECTION XII.
POPULAR VARIETIES.-LICHEN.
Diagnosis.-Many kinds of this malady are described by writers, although the general character of
the eruption is in all instances the same.  Willan
gives us seven different forms; and other authors describe even a greater number. But the propriety of
these minute subdivisions is very questionable, since
some slight distinctions might be made in almst all
cases which occur, and thus lead to a very extensive
and inconvenient classification.
The eruption consists of numerous small papillae
upon the breast, arms, and limbs, in the first instance,
which afterwards spread over the whole surface of
the body, attended with tingling and itching, especially when exposed to heat, or when covered up warmly in bed. The eruption is generally preceded by slight
febrile excitement, and symptoms of gastric or intestinal disorder. The bases of the papillae are red, inflamed, and painful, but they do not often suppurate,
or become filled with serum, but continue about eight
or nine days, when they dry up, and fall off in the
form of scurf.
The eruption which is so often seen in infants
during the period of dentition, and known as " the red
gum," is a form of lichen. In these cases the colour of
the papillae may be red or white.
Sometimes the eruption appears in the palms of the
hands, the arms and legs, when it receives the vulgar
appellation of salt rheum.




240    THE CHRONIC CUTANEOUS DISEASES, ETC.
The eruption now and then comes out in a mild
form upon the trunk or extremities, attended with
heat, and troublesome itching on becoming heated, or
from rubbing or scratching, but entirely unattended by
febrile excitement. This variety is familiarly known
under the designation of prickly heat.
Causes.-Irritation of the stomach and intestines
from errors in diet, worms, and teething. Also protracted exposure to a hot fire; going into the cool air,
after long exertion while in a profuse perspiration;
or, sometimes from entering a hot apartment, after
having been exposed for a long time to intense cold.
Therapeutics.-The following medicines will suffice
for the cure of all forms of this complaint: sulphur,
graphites, calcarea carb., sepia, iodine, antimonium tart.,
copaibae bals., acid phos., chamomela, dulcamara, rhus
tox., hepar sulphur.
Administration.-Same as for herpes.
PRURIGO.
Diagnosis.-Prurigo is believed by some authors to
be asevere form of lichen. The papillae are, however, larger, "more isolated and distinct, and scattered
over larger surfaces" than those of that affection. The
eruption is sometimes of a red or pinkish colour, at
other times white, like the surrounding skin, and attended with the most intense itching and stinging.
The papillae are most commonly distributed about the
labia pudendi, but the disease is not unfrequently observed in other parts of the body.
The causes and treatment are the same as those
described under lichen.
SECTION XIII.
PUSTULAR VARIETIES:-SCABIES. —PSORA.-ITCH.
Diagnosis.-The great diversity of appearances
which this disease is constantly presenting, renders a
complete  description  almost impossible.  It has
been regarded by some writers of note, as papular,
by others as pustular, but by the majority as vesicular. It consists of a pustular, papular, or vesicular
eruption, generally situated between the fingers, on




THE CHRONIC CUTANLOUr.S:tS su'.~, —, TEr'C.    241
the wrists, near the joints, but sometimes extending
over the whole body. The eruption is attended with
almost constant itching, which is aggravated by
scratching, or by the heat of a fire, or of the bed. The
disorder is decidedly contagious in its character, and
according to Schroen, 4' never gets wvell of itself; but
will last for years, and may exist upon the skin a whole
life-time, if its cure is neglected2' This author recognises four distinct forms:
1. Scabies sicca, or pimply, or dcry itch, most common in adults. This form, when repelled, often gives
rise to " nervous apoplexy, ascites, or chronic hydrocephalus, and it is best treated by sdlphur, mercury,
causticumrn, carbo veg.,psoricum, sepia, lachesis, and veratrum."
2. Scabies vesicularis, or common itch, occurring most
commonly in highlands, —very rarely in low and
swampy districts. When this form is abruptly repelled,
it gives rise to serious affections of the cerebral and
pulmonary organs, and to the nervous system. Sulphur is undoubtedly the appropriate  specific, and
should be given at the first trituration. In obstinate
cases we may employ one or more of the following
medicines: psoricum, sepia, hepar supll/i., arsenicum,
rhus. mercurius, iodine, copaibe, calcarec carb.
3. Scabies purulenta, appearing in the form of yellow
and prominent pustules between the fingers and toes.
In this form, Schroen advises sulphur, antimonium tart.,
sepia, cicuta, lycopodium, and mercuriu-.
4. Crusta serpiginosa, —" This form resembles crustea
lactea, but is marked by the appearance of small vesicles behind the ears, which burst, forming a thin
dark-coloured scab, from which an acrid fluid is secreted." The face, neck, arms, and trunk eventually
become involved. For the cure of this form Schroen
advises sulphur, clematis erec., calcarta carb., lycopodi4m, and arsenicum.
Causes. —By many the disease is supposed to be
owing to the presence in the skin of minute animalcula, of the species acarus scabei. It has likewise
been attributed to want of cleanliness, and the use of
unwholesome food.
Administration. —The remedies should be given at
11




242      THE CHRONIC CUTANEOUS DISEASES, -ETC.
the first or second attenuation, and repeated two or
three times a day until the eruption disappears. In
recent cases, Hartmann, Schroen, and Schmid, employ
the tinctures and the first dilutions; but in obstinate
cases they -employ from the third to the sixth attenuations.
SECTION XIV.
ECTHYMA.
Diagnosis.-This disease originates from a morbid
condition of the skin, which supervenes during the
course of eruptive, and other fevers, venereal diseases,
scrofula, scurvy, &c. The pustules are of considerable size, seated upon swollen, bright red, and painful
bases, and never running together, but always preserving a distinct character. After a few days the
pustules become covered with hard, and dark or
greenish scabs, which, in one or two weeks, dry up
and disappear. Ecthyma has been subdivided into
several distinct varieties, on account of some trifling,
and as we believe, unimportant modifications which
the eruptions occasionally present, from peculiarities
of age, constitution, disease, and habits of life. The
most common of these varieties are:
1. Ecthyma vulgare, " consisting of a partial eruption of small, hard pustules; on the neck, shoulders, or
extremities, which is completed in about three days.
They enlarge and inflame, form pus, and thenscabs.
These eventually dry, fall off, and leave no mark behind. They are chiefly seen in young persons whose
health has been impaired."
2. Ecthyma luridum, with pustules, " larger, more
(liffused, more repeated, and fixed upon a hard, elevated base of a peculiar dark red colour."*
_3 Wirthyma infantile, occurring generally in int&nts of delicate, or scrofulous constitutions, or in those
whose systems have been enfeebled by abuse of drugs.
4. Ecthyma cachecticum, peculiar to individuals
who are suffering under a venereal, scrofulous, or
psoric taint.
* Hall.




THE CHRONIC CUTANEOUS DISEASES, ETC.    243
RUPIA,
Is another pustular affection, often resembling very
closely ecthyma.  Bateman describes it thus: "an
eruption of flat, distinct vesicles, with bases slightly
inflamed, containing a sanious fluid, the scabs accumulating, sometimes in a conical form, easily rubbed
off, and soon reproduced." Although this author describes the eruption as vesicular, it is now generally
conceded that the disease is for the most part pustular.
The eruption may be distinguished from that of ecthyma, by the appearance of the scabs, and the ulcerations which frequently occur. Several varieties have
been described, but we do not deem it necessary or
useful to enter into a particular enumeration of all the
minute points of difference in the various cases which
present themselves, since the general character of the
eruption is sufficiently marked to enable the careful
observer to detect its true nature without difficulty.
Therapeutics.-The medicines usually employed in
the above complaints are, sulphur, sepia, mercurius,
rhus, antimonium  tart., silicea, hepar sulph., aurum
mur., arsenicum, iodine, calcarea carb., dulcamara.
Administration.-Attenuations and repetitions of
doses, the same as in scabies.
SECTION XV.
IMPETIGO.
Diagnosis.-The eruption consists of clusters of
small pustules, vesicular in the first instance, but soon
becoming purulent. After a few days the pustules
burst, and thick and dark yellow scabs remain. The
skin around the pustules is somewhat swollen, inflamed, and painful, and when the secretion from the
ruptured pimples is acrid, the patient is often annoyed
with an exceedingly disagreeable burning and itching
sensation. Willan, Bateman, Rayer, Schroen, and
several other eminent writers on cutaneous affections,
recognise five different varieties:
1. Impetigo figurata, occurring generally in children
during dentition, and in "young men and women of
lymphatic or sanguine-lymphatic temperaments."
Rayer advises lycopodium, sepia, sulphur, rhus tox.,




244      THE CHRONIC CUTANEOUS DISEASES, ETC.
graphite, calcarea carb., dulcamara and petroleum in this
form of the disease.
2. Impetigo sparsa.-In this variety the pustules are
isolated, and dispersed over the shoulders, buttocks,
face, and scalp, or legs. It generally " appears in the
fall and winter, and disappears in spring and summer." —(Bateman.)  Mercurius, sulphur, cicuta, and
lachesis will be found specific in this form.
3. Impetigo erysipelatodes.-The eruption is usually
a disease of the face, and bears some resemblance to
erysipelas in the first instance, but soon changes to a
pustular character. The scabs which form on the
pustules are of a dirty yellow or greenish colour, and
are kept soft by the secretion which is under them.
Schroen considers belladonna, rhus tox., mercurius, and
arsenicum, the proper remedies for this form.
4. Impetigo scabida. —This is a severe form, attended
with more inflammation and pain in the affected parts,
and more extensive ulceration and discharge, than
either of the other varieties. We may employ, hepar
sulph., mercurius, arsenicum, and iodine.
5. Impetigo larvalis, or crusta lactea.  "Common
amongst young sucklings; characterized by an eruption upon the cheek, of superficial, more or less confluent pustules, united in groups, attended with slight
itching, and followed by yellowish and green —generally thin and lamellated, at times, however, with
thick and soft crusts, that when loosened, leave a red
and inflamed surface, which is quickly covered with
new crusts. The best remedies are, sulphur and rhus
tox.," (Schroen,) or dulcamara, lycopodium, and sepia,
(Knorre,) or graphites and mezereum, (Lobethal.)
Administration. —In the same manner as in herpes.
SECTION  XVI.
PORRIGO.
This is a contagious disorder, and presents itself in
the form of "straw-coloured pustules, sometimes circumscribed, sometimes diffused; generally, but not always confined to the head; the pustules break and
give issue to a fluid which concretes into yellowish or
brownish, thin or thick, crusts or scabs." —(Hall.)-It




THE CHRONIC CUTANEOUS DISEASES, ETC.    245
commonly makes its appearance upon the scalp and face,
but may occur in any other part of the body. The disease has been subdivided into several different varieties,
but the divisions are of no practical utility, and tend
directly to create confusion and embarrassment.
In some constitutions, the eruption becomes so extensive and severe, as to give rise to troublesome ulcerations, and considerable constitutional disturbance.
In cases of this kind, as well indeed as in all others,
the utmost care should be taken to ensure cleanliness,
so that the secreted fluid shall not accumulate, and
thus serve to perpetuate the disorder. The principal
remedies are sulphur, rhus toxicodendron, calcarea, carbo vegetabilis, sepia, graphite, and arsenicum.
ACNE,
Is another pustular affection, making its appearance
generally upon the nose, face, forehead, and shoulders,
first in the form of a thickening redness, and induration of the integuments, from which eventually proceed suppurating points or tubercles. The parts affected often acquire a depth of redness and a conspicuousness which much annoy the patient. Plumbe
supposes that the malady consists in a diseased condition of the sebaceous follicles, induced by excessive
indulgence in the pleasures of the table, sedentary habits, &c. Sometimes it is violent, and extensive inflammation and suppuration occur. The remedies
enumerated under porrigo will apply in it.
Administration.-The doses and repetitions of the
medicines, the same as in scabies.
SECTION XVII.
SQUAMOUS DISEASES - LEPRA.
Diagnosis.-This disease is characterized by the
appearance of spots of various sizes, with red and inflamed borders, slightly raised above the surrounding
skin, and covered with scurfy, bran-like flakes or
scales, which are constantly falling off, to be reproduced. In some instances, a raw and tender surface
remains after the scales have fallen, attended with
severe itching and smarting, on rubbing or scratching,




246    THE CHRONIC CUTANEOUS DISEASES, ETC.
or on exposure to a high he it. The eruption is unattended by any febrile disturbance, but is not unfrequently associated with scrofulous or venereal taints,
and an impaired condition of the digestive apparatus.
The causes which tend to render the eruption severe,
extensive, and permanent, are want of cleanliness,
constant exposure to a hot sun, and unwholesome food.
PSORIASIS.
Mackintosh regards psoriasis as an aggravated form
of lepra. According to Hall, it "differs from lepra
chiefly in the irregular form, in the diffusion of the
scaly patches, and in the absence of its inflamed borders, depressed centres, and regular oval or circular
forms. The subjacent surface is also more tender,
more easily denuded, and more prone to become affected by fissures." The disease attacks the scalp, face,
the arms, the legs, the palms of the hands, the lips, the
prepuce and the scrotum. Occasionally the inflammatory action runs so high that the parts becolne much
swollen and highly painful. In these cases there is
usually a considerable secretion from the eruption.
PITYRIASIS.
Simple pityriasis is most commonly confined to the
hairy scalp, and displays itself in the form of a superficial bran-like scurf, which may easily be removed
by a comb or a brush, but which is speedily reproduced. In mild cases, and with ordinary care. the
disease may continue with but slight annoyance for
many years, or it may be roused into a more active
and troublesome form by general debility, attacks of
eruptive fever, and by the relaxing effects of a hot climate.
Therapeutics.-We consider sulphur, iodine, conium,
calcarea, carbo veggtabilis and sepia, the best remedies
for the above diseases. Arsenicum, graphites, acid
nit., phosphorus, lycopodium, natrum mur., copaibae,
argenti nit., aurum mur., and hepar sulph., have likewise been employed with success.
Administration. —The first, second, and third attenuations should be employed-a dose each day until
the morbid action is subdued.




247
CHAPTER XXII.
DISEASES OF THE ORGANS AND TISSUES CONNECTED
WITH THE DIGESTIVE SYSTEM.
SECTION I.
GLOSSITIS.-INFLAMMATION OF THE TONGUE.
Inflammation of the tongue is by no means a common affection, but cases now and then occur in which
this organ is so enormously inflamed and swollen, as
to place the sufferer in imminent danger of suffocation.
It may arise spontaneously, with but few and slight
premonitory symptoms of its approach, or it may proceed from derangements of the stomach, sudden
changes of temperature, and the application of irritating or poisonous substances. Generally it runs its
course rapidly, and if not met by prompt and efficient
measures, will so fill the mouth and throat as to suspend respiration.
Diagnosis.-Previous to the pain and swelling of the
tongue, the patient is affected with slight chills, loss
of appetite, lassitude, indications of disordered stomach,
dull pains in the head and back, succeeded with throbbing and aching pains in the tongue, heat of skin, and
rapid pulse. The tongue now commences swelling,
and often progresses, if the inflammation is not arrested, to an alarming extent. It. is usually red and
dry, but in some instances continues moist through all
the disease.
Causes.-Derangements of the stomach, exposure to
strong currents of air, mercurial salivation, smallpox,
the application of irritating substances, stings of in.
sects, and certain poisons.
T7terapeutics.-The physician is sometimes summoned to cases of this description, where the danger
of suffocation is so threatening, as hardly to render it
prudent to await the operation of remedies. In these
instances free and deep incisions should be made into
the substance of wthe tongue in a parallel direction,




248    DISEASES OF TIE ORGANS AND r3iSUES
which will afford prompt temporary relief, and thus
allow us time for the action of our specific remedies.
The medicines which will apply specifically in these
cases are, merc., bell,. plumb., aur., and Iep.
Mercurius sol.-External indications.-Expression
of countenance, anxious and terrified; tongue inflamed,
swollen, red, dry or moist; respiration exceedingly
difficult; pulse rapid and full; constant inclination
to keep an upright position; skin hot and dry.
Physicalsensations.-Febrile symptoms; heat, thirst,
pains in the head, back and limbs; throbbing, stinging, or aching pains in the tongue; mouth and throat
filled with the swollen organ, giving rise to a dreadful sense of suffocation; symptoms somewhat aggravated during the night; rapid sinking of strength; respiration rather better in the air, and on gentle motion;
deglutition partially or entirely suspended.
Mental and moral symptoms.-Excessive anguish,
apprehension, and constant and insurmountable dread
of immediate suffocation.
Administration.-Divide two grains of the third trituration into six equal parts-one powder dry upon
the tongue every half hour in urgent cases, until there
is relief or a medicinal aggravation. In less severe
cases the medicine may be given once in two, four, or
six hours, according to the symptoms.
Belladonna.-External indications,-Face red; eyes
bloodshot, or suffused; tongue inflamed, red, dry, and
swollen; violent pulsations of the carotid and temporal arteries; pulse rapid and bounding.
Physical sensations.-Congestion of blood to -the
head; throbbing pain in the head; eyes sensitive to
light; skin hot and dry, thirst; throbbing, darting, or
drawing pains in the tongue; difficult and anxious
respiration; deglutition extremely difficult or entirely
suspended; sense of suffocation.
Mental and moral symptoms. —Great agitation; fear
of death; anxious and depressed.
Administration.-A drop of the third dilution on
two grains of sugar of milk: divide into four equal
parts, and exhibit one dry upon the tongue once in
one, two, or three hours, as the urgency of the case
demra.nd s.




uuNNECTED WITH THE DIGESTIVE SYSTEM.   249
Plumbum is appropriate in cases of chronic swelling
of the tongue, with numbness and partial paralysis.
Convulsive tremors and general muscular debility are
other indications for the employment of this remedy.
In cases of glossitis proceeding from the abuse of
mercury, recourse may be had to aurum muriatic. and
hepar sulph. If the inflammation be owing to a wound
or injury, arnica is the proper remedy.
SECTION II.
TONSILITIS.-QUINSY.
Diagnosis. —Febrile symptoms, succeeded in a few
hours by soreness of the throat, painful deglutition,
swelling and redness of the tonsils, uvula, and soft
palate. As the tonsils continue to enlarge, deglutition
and respiration become more difficult, the voice is
changed, the pains increase in severity, extending
often through the eustachian tubes into the ears, the
tongue becomes covered with a thick yellow fur, there
is an abundance of viscid saliva on the tongue and
tonsils, the breath acquires an exceedingly offensive
odour, which, according to Mackintosh, proceeds from
sebaceous matter escaping from the mucous follicles.
The disease may terminate in resolution, suppuration, or in permanent induration. When the appropriate remedies are administered at the commencement, the inflammation usually resolves itself without
suppuration. If no medicines are given, or those only
which are inappropriate, the disorder usually progresses until suppuration ensues, when an artificial
opening is made, or the tonsil bursts spontaneously,
and the swelling and inflammation gradually subside.
Not unfrequently the tonsils become affected with
chronic enlargements and indurations, from frequent
and partially subdued acute attacks, which prove exceedingly troublesome by their proneness to take on
acute inflammation from the slightest exciting causes.
There is reason to suppose that chronic enlargements of the tonsils often lead to coughs and expectoration of muco-purulent matter, which are confounded
with and erroneously attributed to chronic bronchitis, &.
1 1 S




250    DISEASES OF THE ORGANS AND TISSUES
Causes.-The predisposing causes are: scrofulous
dyscrasia, irritability, and chronic enlargement of the
tonsils from mercurial salivations, and derangements
of the stomach and bowels. The common exciting
causes are, cold, atmospheric vicissitudes, wet-feet.
Therapeutics.-The best remedies for acute tonsilitis
are, belladonna, mercurius, aconite, baryta carb., nux,
pulsatilla, and hepar sulph.
Belladonna.-External indications.-Cheeks flushed;
violent pulsations of the carotids; enlargement of
tonsils perceptible on the outside of the throat; tonsils, uvula, and soft palate, inflamed, dark, red, and
swollen; tongue dry, or covered with a thick transparent and tenacious mucus; skin hot; pulse full,
hard, and frequent; voice hoarse, stifled, or suppressed.
Physical sensations.-Headache; burning and shooting pains in the throat when swallowing; constant
inclination to swallow; choking sensation; tonsils
painful to the touch; putrid or bitter taste; thirst;
eyes sensitive to the light; stitches extending into the
ears; deafness from obstruction of the orifice of the
eustachian tube; burning fever.
Mental and moral syniptoms.-Uneasiness and dejection, worse at night, and occasionally delirium.
Administration. —Two drops of the third dilution to
two grains of sugar of milk. Divide into six parts
and exhibit one dry once in two to four hours as long
as necessary.
Mlercurius.- External indications.-Offensive, putrid odour from the mouth; tongue covered with a thickl
yellow fur; mouth dry or filled with viscid saliva;
uvula elongated and red; tonsils and soft palate dark
red, inflamed and enlarged; roots of the tongue red
and swollen; ulcers in the mouth and throat; enlargement of the parotid or submaxillary glands; pulse
firequent and moderately full.
Physical sensations.-Heat, alternating with chills;
frequent profuse sweats; stinging and shooting pain
in the throat, particularly when swallowing; very
great difficulty in swallowing, although frequent
inclination; glands of the neck painful on motion of
the jaws, at sight of savoury food, or on swallowing;




CONNECTED WITH THE DIGESTIVE SYSTEM.   ~51
the pains and difficulty of deglutition worse at night;
pains darting.through the eustachian tube to the eals
and parotid glands; loss of appetite and disgust for
food; putrid or coppery taste; thirst for cold drinks;
symptoms mitigated during repose in bed.
Mental and moral symptoms.-Morose; dejected;
uneasy; out of hurnour.
Administration. —Divide four grains of the third
trituration into six powders-give one dry, upon the
tongue, once in four to six hours until an impression
is apparent.
Aconite is a suitable remedy in cases of tonsilitis
attended with a high grade of arterial reaction, painful
deglutition, bright redness of the fauces, uvula and
tonsils, with pricking or burning pains when swallowing.
Administration.-A drop of the third dilution to two
grains of sugar of milk. Divide into four parts and
exhibit one dry, once in two hours until the symptoms
abate.
Baryta carb. may be given in cases of catarrhal tonsilitis, where there is suppuration of the tonsils, swollen and elongated uvula, raw scraping or shooting
pain on swallowing, obstruction, as if by a plug in the
throat, bad taste, offensive breath, especially in the
morning, and discharge of sebaceous matter from the
follicles of the throat.
Administration.-Same as aconite.
When derangement of the stomach appears to be
the prime predisposing cause of the complaint, and
when the symptoms of the acute attack are, scraping
pains during deglutition, or when inhaling cold air;
obstruction from the enlarged tonsils, choking and
spasmodic contractions of the throat when swallowing,
nuax vomica is the specific remedy. It may be administered at the third dilution, by means of sugar, like
aconite.
Pulsatilla will apply in cases arising from a chill
by being wet, wet feet, &c. The signs for this remedy
are, burning, scraping, smarting or shooting pains in
the throat when swallowing, deglutition obstructed
by viscid mucus which adheres to the tonsils and
fauces, pains worse in the afternoon and evening, bit



252     DISEASES OF THE ORGANS AND TISSUES
ter or saltish taste in the mouth, loss of appetite, unnatural taste of food, tongue furred with a thick yellow: coat, and breath offensive.
Administration.-A drop of the third dilution on sugar. Divide into four parts, and let one be given dry,
once in four hours until the desired effect is produced.
Hep. sulphur has been much employed by our English brethren, in those habitual cases of inflammation
and suppuration of the tonsils, which appear to owe
their origin to a scrofulous dyscrasia. This medicine
occasionally arrests the disease and prevents suppuration, after belladonna, mercurius, and aconite have
entirely failed to produce an impression. It may be
given in grain doses, at the third trituration, once in
two hours.
SECTION III.
PAR OTITIS. —— UiUMI's.
This affection is classed by writers as an epidemic.
It is more prone to attack children than adults, and
generally makes its appearance during cold and damp
seasons. Its cause is a specific morbific contagion,
which may be generated during certain peculiar conditions of the atmosphere, or it may be communicated
from the bodies of those having the disorder.
Diagnosis.-Slight febrile disturbance, followed by
swelling and pain in one or both parotid glands. Un-:der'favourable circumstances the local affection continues to progress until the end of the fourth day, at
which time the inflammation and swelling have
reached their height: when the tumefaction and pain
gradually subside, until at the end of about seven or
eight days from the commencement, all traces of the
complaint have departed. As soon as the inflammation
has fairly declared itself in the glands, the patient experiences much difficulty and pain in moving his jaws,
masticating, or even at the sight of savoury food.
It is highly important during its progress, that there
be no exposure on the part of the patient, either to
cold or dampness, nor from any undue mental or physical excitement. In this manner we may guard against
th1ose troublesome metastases to the brain, mamma,




CONNECTED WITH THE DIGESTIVE SYSTEM.   253
and testes, which sometimes supervene from improper
exposure, external applications, &c.
Therapeutics. —But little medicinal treatment is required in this malady, provided the precautions just
alluded to are heeded; a few doses of the sixth dilution
of mercurius sol. being all that is necessary to conduct
the patient happily through the attack.
Sometimes, however, coma and other alarming symptoms of cerebral disorder, suddenly appear from metastasis of the disease to the brain, which require the
prompt administration of belladonna, opium, or other
cerebral specifics. More commonly, however, the
metastasis occurs to the mamma or testes, causing inflammation, swelling, induration, and occasionally
suppuration in these glands. The remedies in these
cases are merc., sol., bell., nux, puls., and acon. See
the particular indications for these medicines under
" Inflammation of the mamma and testes."
SECTION IV.
GASTRITIS.-INFLAMMATION OF THE STOMACII.
Diagnosis.-Burning, pricking, or lancinating pains
in the stomach, nausea and vomiting, great soreness,
tenderness, and pain on motion or pressure, intense
thirst for cold drinks, which are ejected almost as soon
as swallowed, affording some temporary relief, pricking and soreness. in the throat and esophagus, tongue
red at the tip and on the edges, and covered through
the centre with a white or yellowish fur, position
mostly upon the back or side, with the limbs drawn
up and the abdominal muscles relaxed, great depression, anxiety, and fear of death; pulse rapid, sharp,
contracted, sometimes almost threadlike; bowels constipated; disgust for food and warm drink, either of
which are expelled as soon as received into the stomach; and in severe cases, delirium, and fever'of a synochal grade.  There is an unusual fulness in the epigastric region, and often of the abdomen. As the disease progresses, the extremities become cold, the features contracted and sunken, the eyes glazed or suffused, and finally diarrhoea, cold sweats, coma, and
convulsions supervene.




254     DISEASES OF TIME ORGANS AND TISSUES
When death occurs, it is usually caused by ulceration or sphacelation of some portion of the mucous and
sub-mucous coats of the stomach.
Causes. —Excessive use of highly seasoned food,
stimulating drinks, the introduction of irritating substances into the stomach, poisons, injuries, and the
use of emetics, drastics, stimulants, and other medicinal poisons with which the allopathic practice, governed by no scientific method, frequently induces this
and other diseases, and destroys the existence it is intended to preserve.
Therapeutics.-The ordinary remedies used in the
treatment of gastritis, are, arsenicum, veratrunt, nux,
pulsatilla, aconite, iodium, ipecacuanha.
Arsenicum. - External indications. - Countenance
contracted, sunken, and expressive of anguish and
anxiety; stomach swollen and hot to the touch; position upon the back: respiration short, rapid, and
suppressed; tongue red and clean, or red on the
edges with a dirty fur in the centre; pulse contracted, tense, and frequent; voice hoarse, stifled, and suppressed; skin dry and hot, wvith perhaps cold and
clammy extremities.
Physical sensations.-Burning, sharp, or shooting
pains in the stomach; aggravation of the sufferings
from motion, pressure, coughing, and inspiration;
scraping and burning pain in the throat and mesophagus; great prostration; weakness and trembling of
the limbs; urgent thirst fbr cold drinks; persistent
nausea and vomiting; all food and drinks speedily and
violently rejected; exceeding tenderness in the epigastric region on pressure; respiration suppressed and
painful.
MIental and moral symptoms.-Intense anxiety, anguish, depression, and despair; expectation of speedy
death; sometimes delirium.
Administration. —Two drops of the sixth dilution in
an ounce of water; a dessert spoonful once in two to
four hours, until the proper impression is made upon
the inflammation.
Veratrum. - External indications. - Hippocratic
countenance; nose pointed; eyes sunken and glazed;
lips bluish and dry; tongue red at the tip and on the




CONNECTED WITH THE DIGESTIVE SYSTEM.   295
edges. with a dark, dry fur running through the centre; pulse quick, weak, and almost imperceptible;
stomach and abdomen distended; extremities cold,
and covered with a clammy sweat; position on the
back, with the knees drawn up; hiccough; and whole
appearance indicative of extreme prostration.
Physical sensations.-Feeling of great exhaustion;
burning pain in the stomach; rough, dry, and scraping sensation in the throat, rendering deglutition difficult and painful; great soreness in the epigastric region; short, troublesome cough; severe and continued nausea and vomiting; great dread of warm food
and drinks; intense thirst for cold drinks; inability
to retain anything upon the stomach; spasmodic contractions of the throat, (sophagus, and abdominal
muscles; hiccough; painful respiration.
Mental and moral symptoms.-Excessive dejection,
discouragement, and sadness; fear of death, complete
despair; delirium.
Administration.-In urgent cases we may give a
dose of the sixth dilution, in water, once in one hour,
until an amendment declares itself; or there occurs a
well pronounced medicinal aggravation. We may
then await the result, and hold ourselves in readiness
to repeat this, or whatever other medicine mlay be appropriate, as the circumstances of the case may require.
Nux vomnica.-External indications.-Face bloated;
eyelids red, weak, and watery; stomach distended;
tongue tremulous, red, and clean, or furred with a
whitish coat in the centre; offensive breath; frequent
hiccough; pulse frequent, small, and feeble.
Physical sensations.-Burning pain in the stomach,
with pulsations and spasmodic contractions in the
epigastric region; nausea and vomiting, aggravated
after eating or drinking; tenderness and pain in the
pit of the stomach when pressed, or during movement;
contraction and obstruction in the (esophagus when
attempting to swallow; painful sensation of distention
of the stomach; dizziness and confusion of the head,
on rising from the recumbent position, or in attempting
to walk; sour or bitter eructations.
tMental and moral symptonzs.-Great uneasiness and




256     DISEASES OF THE ORGANS AND TISSUES
anxiety; morose, peevish, sad, and often disposition
to commit suicide.
Administration.-This medicine is peculiarly appropriate in those cases which are induced by abuse of
coffee, wine, spirits, condiments, and stimulating food.
One drop of the sixth dilution to an ounce of water;
a tablespoonful once in two to four hours, so long as
the symptoms remain stationary. Occasionally we
shall have conjoined with the above symptoms, cerebral disorder, indicated by delirium, optical illusions,
and great derangement of the nervous system. In
such instances an occasional dose of belladonna will
prove specific.
Pulsatilla is a valuable remedy when the inflammation is brought on by the use of crude, indigestible,
and irritating food. It covers the following symptoms: pressing or shooting pains in the stomach;
pulsations in the pit of the stomach; epigastrium
sensitive, and painful to the touch, or on pressure;
nausea and vomiting after eating or dri nking;
nausea and disagreeable feeling, extending even to
the esophagus and throat; regurgitation of food;
eructations; hiccough; painful distention of the
stomach; pulse quick and small; and bitter taste in
the mouth.
Aconite, at the third to the sixth dilution, will do
good service when the febrile symptoms run high; to
be repeated often until amendment ensues, either
alone or in alternation with the gastric specifics, as
the nature of the case demands.
Iodine, at the third potency, has afforded relief in
inflammations of the stomach caused by abuse of mercury and other irritating drugs. The indications for
its use are, frequent nausea; vomitings, especially
after eating; burning pains and pulsations in the
stomach, pyrosis, sour eructations, contraction and
burning of the esophagus; pulse frequent, small and
hard. Colchicum is an important remedy in cases of
metastases of rheumatism to the stomach.  It acts
specifically as an irritant to the stomach, even when
injected into the veins.
A single dose of ipecacuanha, at the sixth potency,
will sometimes afford prompt relief in cases where




CONNECTED WITH THE DIGESTIVE SYSTEM.   257
vomiting is violent and incessant. It is applicable
in inflammation caused by excessive doses of tartarized
antimony, corrosive sublimate, arsenic, &c., for the purpose of allaying the excessive irritation and vomiting
which follow poisonous doses of these articles.
SECTION Y.
CHRONIC  GASTRITIS. - CHRONIC  INFLAMMATION OF THE
STOMACH.
Diagnosis.-Many of the symptoms of this malady
are similar in character to those which occur in
the acute form, but there is a material difference in
regard to their grade of violence in the two diseases.
Sometimes chronic gastritis is the result.of a partially
subdued acute attack, which from various causes is
kept up for a long period in this state of sub-acute inflammation. At other times it comes on slowly and
insidiously, from a combination of causes operating at
the same time. Amongst the symptoms which usually
attend this complaint, may be enumerated these:pain and tenderness in some particular part of the
stomach, excited by pressure, or by certain kinds of'
food and drinks; frequent vomiting of food and drink
soon after they are swallowed; loss of appetite, putrid taste in the mouth; thirst; fetid breath; acid or
bitter eructations; acidity; distention of the stomach
with wind, which causes distressing vertigo, and pains
in the epigastric and hypochondriac region; tongue
red and clean, or furred in the middle with a dirty fur;
melancholy; peevishness; irritability; discouragement; and, finally, hectic fever, emaciation, sudden
prostration, and death.
Causes.-The most powerful predisposing causes of
this malady are, protracted sufferings under the depressing mental'emotions and the habitual use of irritating drugs.  It often succeeds to acute gastritis
which has been but partially subdued; it may also
arise from high living, the abuse of wine, liquors,
coffee,. &c., repelled eruptions, nietastases of rheumatism and gout, injuries, and occasionally as a consequence of other diseases which have been badly
managed.
Therapeutics.-The medicines to which we have




258     DISEASES OF THE ORGANS AND TISSUES
alluded under acute gastritis, will be the most applicable in the ordinary forms of the chronic variety.
The following medicines will likewise cover many
symptoms of sub-acute gastritis, namely, bismuthum,
baryta muriatis, bryonia, cuprum met., digitalis purpurea, hyoscymrnus, ignatia, mercurius, phosphorus,
urnsca.
SECTION VI.
DYSPEPSIA.-INDIGESTION.
Diagnosis.-This very troublesome malady, regarded for some reason as one of the banes of good society,
manifests itself under so many different aspects, and
is so entirely.irregular in its causes, modes of attack,
progress, violence, and duration, that there is a wide
difference of opinion amongst physicians in regard to
its true nature. While some have referred it to a
sub-acute inflammation of the mucous coat of the stomach, others have considered it as in the liver, the
cardiac nerves, or the secretory apparatus of the stomach. The nature and precise location of dyspepsia
have been, and still are, to a considerable extent, involved in obscurity, and it is a consequence of this that
its victims have re-ceived so little sympathy or charity
either from medical men or from non-professional observers. It is a disease, nevertheless, which in its different phases displays symptoms and sufferings almost
innumerable, as is proved from the circumstance of its
having been confounded. with chronic gastritis, cardialgia, bilious affections, liver complaint, &c. At one
time the patient will attribute his sufferings to his
head. and entertain the most alarming apprehensions
of apoplexy; at another, to his respiratory organs, and
imagine he has consumption; again, he describes his
malady as in the liver, or the stomach, or the bowels,
or the spleen; and thus he continues on from month
to month, or from year to year, a martyr to the most
distressing chronic affection to which humanity is subject.
Dyspepsia may make its appearance in a gradual
and almost imperceptible manner, or it may supervene
suddenly in a severe form without previous warning.
It may so affect the system as to remind one constantly




CONNECTED WITH THE DIGESTIVE SYSTEM.    259
of its existence, or its symptoms may only manifest
themselves after the use of certain indigestible articles
of food, or protracted depression of spirits.
Amongst the more common symptoms of this complaint may be mentioned, tenderness and distention
of the epigastrium, acidity, flatulency, eructations,
sense of weight and fulness in the stomach after eating; also quick breathing, sensitiveness at the pit of the
stomach from pressure, tight clothing, &c., pyrosis,
vertigo, giddiness, sensation when walking as if the
pavement were rising up immediately in front; constipation, pressure in the stomach and epigastrium,
hemorrhoids, sallow or yellow complexion, distention
of the abdomen with flatus, loss of ambition and
energy, sad, desponding, dread and apprehension respecting the future, frequent inclination to commit
suicide, nights restless and disturbed by unpleasant
dreams. In the advanced stages of indigestion, there
often supervenes a troublesome cough, attended with
occasional pains in the chest, and mucous or -mucopurulent expectoration, which some writers have
termed dyspeptic, phthisis. It is probable, in these
cases, that the disease is confined to the mucous membranes of the respiratory organs, being a continuation
or extension of the gastric disturbance, to the pulmonary'mucous tissues.
~ The character of the gastric sensations is so diverse
in different cases, that scarcely a pain or a sensation
can be described, which has not been experienced by
the dyspeptic. It is often conjoined with cardialgia,
chronic gastritis, or chronic hepatitis, and therefbre
some symptoms of either of these diseases may be
present in any given case.
Our own opinion is, that indigestion is not attributable solely to sub-acute gastric irritation, or disease of
the cardiac nerves, or of the intestinal canal. or derangement of the gastric secretion, but to a combination of all these maladies. This is satisfactorily
evinced from the fact, that in the worst forms of indigestion, many of the principal symptoms of each of
these disorders are uniformly present.
Causes.-Protracted depression of spirits, whether
occasioned by want of occupation, deprivation of the




260     DISEASES OF THE ORGANS, AND TISSUES
accustomed mental and physical exercise, pecuniary
misfortune, loss of friends, disappointment, or mortification, is a prominent cause of dyspepsia. This cause
is very general and extended in its operation, affecting
not only the mucous structure of the stomach, but the
liver, the bowels, the cardiac nerves, and in some instances the whole nervous system. It is to this variety
of indigestion that should be attributed many of those
hypochondriacal affections, which are often referred
exclusively to disorder of the liver.
Next in importance to the above, may' be named,
the abuse of rich and highly seasoned food, stimulating drinks, coffee, tea, tobacco, irregular eating hours,
and inattention to the daily frecal evacuations.
When chronic gastritis becomes complicated with
cardialgia, chronic hepatitis, &c., the resulting malady
will be dyspepsia. Another common cause of this
complaint, and one to which we desire to direct particular attention, is the habitual use of cathartics.
The belief has so long and so generally obtained, that
all of the ills of the organism can be expelled forcibly
by inflaming and raking the sensitive and delicate
coats of the stomach and bowels with cathartics, that
it will be no light task to change opinions which have
become (if I may be allowed the expression), constitutional. If, however, the intelligent reader will retnember that dyspepsia consists in an irritated and weakened state of the nerves, and the mucous coat of the
stomach, together with disorder of the liver, he cannot
fail to perceive that the effect of purgatives must be
injurious rather than beneficial. We are quite aware
that some temporary relief is occasionally afforded by
cathartics, but innumerable facts warrant the assertion that. this slight alleviation is always at the expense
of renewed and vastly increased future suffering, and
that each new dose communicates an additional impetus to' the advancement of the disease towards
fatal disorganization.
Another not unfrequent cause of indigestion, is repelled cutaneous diseases, like erysipelas, &c. I have
met with a number of well-marked cases of this description, in which alleviation of all the symptoms uni.
formly occurred when the eruption was upon the sur.
face.




CONNECTED WITH THE DIGESTIVE SYSTEM.   261
Therapeutics.- An essential. condition in the treatment of dyspepsia is the maintenance on the part of
the patient, of a healthy, active, and cheerful state of
mind. Unless this be accomplished, our remedies will
either be of only temporary service, or entirely unavailing. Next in importance, is a course of rigid
dietetic regulations. In proposing a bill of fare for the
dyspeptic, much must depend upon the circumstances
of each particular case. If the patient is of a highly
bilious temperament, a much more simple diet will be
requisite, than for one who is nervous or sanguine.
As a general rule, an intelligent person will be able
to select a suitable diet for himself, by observing attentively the effects which different articles exert upon
his constitution.
Another equally important condition in the treatment of this complaint, is perfect regularity in all the
habits of life, as eating, sleeping, alvine evacuations,
exercise, &c. First, sufficient sleep should be allowed,
to enable the system to recover entirely from the fatigues of the preceding day; second, moderate and agreeable exercise should be taken for an hour or so, previous to breakfast, bearing in mind that exercise, in
)rder to be beneficial, must not be undertaken and perrormed as a task, but as a pleasant recreation; third,
in partaking of our food, we should never forget, while
we are thus repairing the waste of the body, from the:xercise of the functions, &c., that this also was in-;ended by our Creator to be a source of pleasure to
is. Let the rational man, therefore, and especially
he dyspeptic, never eat with disordered rapidity, but
lowly, so that, masticated properly, his food may be
aken into the stomach in a fit condition for the pro-,esses of digestion. This is the true philosophy of eatng. Finally, at a certain hour every day, perhaps after
)reakfast, an evacuation from the bowels should be
olicited. It matters not whether the inclination be
Lniformly present, let the patient never fail in his
eadiness, and the bowels will soon form the habit of
esponding. So much are we the creatures of habit,
hat we can train our bodies, our organs, our appeites, tastes, &c., to almost anything we desire, by a
teady persistence in our object,




262     DISEASES OF THE ORGANS AND TISSUES
The most approved remedies for the different grades
of indigestion, are, nux, sulph.,puls., bry., lycopod., calc.
carb., sepia, graph., ignat.
Nux vomica is well adapted to the cases which occur in sanguine or bilious temperaments, and which
have been induced by " high living," sedentary habits,
undue mental exertion, irregularity in eating, sleeping,
&c. The external indications for nux, are, florid or
pale, sallow or yellow complexion; general expression
of countenance, anxious and sad, care-worn; tongue
dry, or covered with a whitish coat; occasional fulness in the region of the stomach and bowels.
Physical sensations.-Distress at the stomach after
eating; nausea and vomiting of food; eructations;
pyrosis; distressing sense of debility; irritability of
the nervous system, with constant inclination to roam
about; symptoms worse after meals, and in the evening; constipation; heemorrhoids; tenderness at the
pit of the stomach on pressure; vertigo, dizziness, or
swimming in the head, particularly when rising in the
morning, or on walking about; cramp-like pains at
the pit of the stomach, sometimes extending upwards
to the diaphragm and oesophagus.
-Mental and moral symptoms.-Confirmed hypochondria; constant dread of approaching misfortune; inclination to look upon the dark side of everything;
trifles exaggerated into matters of importance; urgent
inclination, at times, to commit suicide; excessive nervous irritability.
When dyspepsia consists simply of impaired activity
of the nerves of the stomach, from the causes just
named, nux is without doubt the appropriate specific;
but it is an almost invariable occurrence, that this condition of the stomach is attended with more or less derangement of the nervous system, manifested by loss
of animation and energy; depression of spirits; an invincible tendency to look on the dark side of affairs,
and an indefinable sense of dissatisfaction, dread, and
uneasiness, which impairs the appetite, disturbs the
sleep, and almost unfits the individual for the ordinary
duties of life. When this condition of the nervous system has existed for a considerable time, it receives the
name of hypochondria. For this complications, nux




CONNECTED.WITH THE DIGESTIVE SYSTEM.   263
alone is insufficient, but one or more of the medicines
hereafter ennumerated, will be required.
Administration.-In cases of: this description, we usually prescribe nux vomica from the third to the sixth
potency; a dose to be given each night, as long as
may be necessary.
Sulphur is peculiarly adapted to the treatment of
cases occurring in persons of a scrofulous dyscrasia,
and to cases which appear to be connected with erysipelatous and other eruptive affections. Dyspeptic
symptoms occasionally supervene upon the disappearance of erysipelatous and other eruptions from the surface, also from the sudden suppression of long continued heemorrhoidal discharges. In many cases of this
kind, sulphlur will be found a valuable remedy,
The external marks wich indicate this medicine, are,
pale or sallow countenance; light hair; blue eyes;
thin skin; white teeth; glandular swellings; eruptions; weak eyes, and the other signs of scrofulous diathesis.
Physical sensations.-Distention and distress of the
stomach after eating; nausea; vomiting; pyrosis;
frequent eructations, acid or bitter; the symptoms occurring, for the most part, on the disappearance of a ome
eruption or accustomed discharge, and going off on the
reappearance of' these eruptions or discharges.
_Mental and moral symptoms.-Sadness; irritability;
moroseness.
Administration.-This medicine may be administered at the third attenuation, in the morning and middle of the afternoon.
Pulsatilla, at the third potency, is a valuable remedy
in dyspepsia occurring in females, especially when the
malady is complicated with deranged menstruation.
If the disorder has arisen from excessive use of greasy
and indigestible food, wine, &c., it will also prove a
suitable remedy.
Bryonia, at the third attenuation, is well adapted to
persons of a bilious temperament, with black hair,
dark complexions, and black eyes. The particular indications for its employment, are, yellowness of the
skin and eyes; tongue covered with a yellowish fur;
bitter taste; vomiting or regurgitation of food soon




264     DISEASES,F THE ORGANS AND TISSUES
after eating; sensation of fulness and burning in the
stomach after meals; fulness and pains in the region
of the liver; urine high-coloured; head confused and
giddy; pressure in the head; loss of memory; inability to transact business; great despondency; frequent
inclination to commit suicide; constant sighing; sleepless nights, or sleep disturbed by unpleasant dreams.
Lycopodium, calcarea carb., and sepia, may be given
in mild cases of indigestion, occurring in weakly females and children, and persons of a lymphatic or
scrofulous constitution. It may be exhibited at the
third attenuation-a dose each day as long as may be
necessary. In cases where the above remedies are indicated, a highly nutritious regimen may be enjoined
with great advantage, also the constant employment
of all those means which tend to invigorate the system, like active exercise, sea air, and bathing; frequent amusement for mind and body, &c.
Graphite is valuable in dyspeptic symptoms which
appear to be connected with scrofulous or arthritic affections. It will be found particularly serviceable
when they supervene upon the sudden disappearance
of eruptions from the skin, or the sudden suppression
of old discharges, or the drying up of old sores.
Administration.-Same as lycopodium.
Ignatia.-We have witnessed much benefit from the
use of this medicine in indigestion afflicting persons of
a nervous temperament.  It covers the following
symptoms, viz: countenance pale or sallow; eyes constantly in motion; general expression indicative of
anguish and despair; frequent sighing; constant inclination to move about; confusion of ideas; loss of
memory; pressure and other bad feelings in the head;
distress at the stomach after eating; appetite variable;
tongue covered with a thin white fur; entire despair
of recovery; feels as if getting worse every day; dread
of misfortune, coming want, &c.; frequent inclination
to commit suicide; disinclination to see or converse
with friends or acquaintances; seeks solitude, and
broods over imaginary troubles.
This medicine may be given at the third attenuation, a drop once in twelve hours, until an impression is
made upon the malady.




CoNNEOTED WITH THE DIGESTIVE SYSTEM.   265
In cases where the nervous system is so much involved that the patient desires to die, and continually
contemplates suicide, rather than suffer longer from
his morbid and unfounded imaginings, and the wretchedness and anguish which tortures him day and night.
aurum muriate at the first or second trituration, will be
found a remedy of the utmost importance. One grain
may be given twice daily until an amendment occurs.
The occasional use of mild aperients in certain
cases of dyspepsia, as well as in convulsions, diarrhcea, &c., caused by the presence of indigestible food
in the stomach and bowels, may be advisable for the
same reason that paracentesis is recommended in urgent cases of abdominal or thoracic dropsy. By
evacuating the unnatural accumulations, we not
only place the disordered parts in a more favourable
condition to recover their lost energy, but we also
secure a much better state of things for the operation
of our remedies. In obstinate constipation, for example, the indurated and impacted fecal matter sometimes induces so great an inactivity of the muscular
and nervous structure of the intestinal canal, as to
amount almost to paralysis. In these cases, both high
and low attenuations now and then prove inefficient;
and it is here that mild aperients and injections will
sometimes prove serviceable, not, however as curative
agents, but by speedily removing a cause of disease,
and thus placing the affected parts in the best possible
condition to ensure the proper action of a homaeopathic
medicine.
The observations of Dr. Madden, of Brighton, are so
just respecting this subject, and so much to the point,
that we take pleasure in quoting them in this connection. "But it not unfrequently happens, that the benefit gained by an immediate unloading of the bowels
more than compensates for the subsequent increased
tendency to constipation. This is acknowledged by
all in the case of poisoning. No homceopathist hesitates to give emetics and purges when a person has
swallowed a substance which, if not speedily removed, will cause death; but does not the same hold
good with an indigestible meal? It is no doubt true
that our remedies are often sufficient of themselves to
12




266     DISEASES OF' THE ORGANS ANIY TISSVEgF
overcome the evil influence of an occasional excess- at
table; yet I am convinced that- it not unfrequently'
happens, especially in childhood, that a judicious
aperient would- at once remove a state of things
which, if treated otherwise, would entail an illness
requiring several days to overcome. There is much
unreasonable prejudice among homceopathic practitioners on this point; they will unhesitatingly condemn the use of the mildest medicinal aperient, and
yet will order their patients to eat prunes, figs, roasted
apples, green vegetables, brownr bread, &c., in the
hopes of producing the same result. But where is
the difference?  A dose of castor oil, for example+
produces an increased action of the bowels, in virtue
of its being an indigestible oil, which passes through
the whole intestinal tube unchanged, and perhaps
exerting some slight irritating effect on the mucous,
membrane; whereas the aliments above named produce the samne results, in virtue of their having either
a large indigestible residuum  which irritates by its
presence, or by their containing vegetable acids, which
directly and specifically irritate the mucous memr
brane. The result, therefore, is similar in both eases.'7
-British Jour. qf lHom. No. xxix, p. 311.
In conclusion, we deem  it proper to ohserve, that
aperients should never ble employed except hi very
urgent cases, or in those where our attenuations have
failed of producing the required effect.  In all instances it is to be looked upon as a mere tempora'ry
expedient.
SECTION VM.
H:M-A-TEMESS.V —VOMITING OF BLOOM.
Di'agnosis.-Previous to the vomiting there i's experienced a sense of weight, fulness, pressure, and
distuirbance in the stomach, nausea, fainltness, debility,
gerrera} uneasiness, giddin'ess and' confusion in the'
head,. roaring in the ears, anxiety, bitter or saltish}
taste in the mouth, loss of appetite, occasionial chills,
and sometimrres pains in the! staomach, side, or chest.
The pulse is for the most part small and conitracted,
though now and then full and bounding.




CONNECTED WITH THE DIGESTIVE SYSTEM.   267
"The haemorrhage no doubt generally occurs from
the mucous membrane of the stomach, but it is
thought also to proceed in some cases from the liver
or spleen. When the blood comes from the former
organ, it passes along the common bile duct into
the duodenum, and thence regurgitates into the stomach. When the spleen is the source of the haemorrhage, if this be ever the case, the blood, it is supposed, gains admission into the stomach through the
vassa brevia."-(Dewees).
The appearance of the blood which is thrown up
varies, being in some instances liquid and bright red,
at other times black, or coagulated. If the haemorrhage proceeds directly from the rupture of a bloodvessel in the stomach, it will be red and liquid; but
if it has been conveyed from the liver or spleen into
this organ, it will be black and perhaps coagulated.
The quantity of blood which is sometimes vomited
from the stomach is very great. I have in several instances witnessed the loss of two, three, and even four
quarts from this organ without any very serious inconvenience, and that too in persons whose constitutions had been impaired from long-continued intemperance.  A not uncommon result of these profuse
evacuations is, however, the supervention of dropsy,
and I am able to call to mind two instances of this
description.
Causes. -Intemperance, suppression of accustomed
discharges, as hemorrhoids, catamenia, &c.: congestions and engorgements of the liver, spleen and pancreas, schirrous and other ulcerations of the gastromucous membrane, violent inflammations, whether
caused by active drugs or mechanical injuries.
Therapeutics. - The principal medicines for the
treatment of this malady are, aconite, nux vomica,
pulsatilla, ipecacuanha. arlnica, veratrum, arsenicum.
SECTION VIII.
CARDALGIA.-GASTRALGIA.
Cardalgia, as we have seen, is usually a symptom
of dyspepsia, although writers have classed it as a
distinct malady, having no necessary connection with




268     DISEASES OF THE ORGANS AND TISSUES
this disorder. The intimate relation between the
nerves and membranes of the stomach and the liver,
and those which their functions sustain towards each
other, incline us to the opinion that derangements of
either of these parts of the organism must involve, to
a greater or lesser extent, each of the others. The
seat of cardalgia is in the nerves of the stomach,
and as the healthy tone of the mucous membrane,
&c., is dependent upon the normal integrity of the
nerves which supply this organ, their mutual dependence will be readily perceived.
Diagnosis. - Pinching, gnawing, and cramp-like
pains in the stomach, often extending into the back
and loins, relieved on pressure at the epigastrium, or
when the abdominal muscles are relaxed, faintness,
anxiety, appetite natural, or but slightly impaired,
pulse natural; food may be taken into the stomach
with impunity; pains of a more severe character than
those which occur in chronic gastritis, although there
is no feeling of heat or thirst.
Causes.-Highly seasoned or crude and indigestible
food, abuse of stimulants, coffee and tobacco, irregularity in'eating, and the use of narcotic and other
drugs.
Therapeutics. —The following medicines will cover
all symptoms which may be present in any case of
cardalgia, viz., nux vomica, pulsatilla, acid hydrocyanic, carbo veg., chamomela, cocculus. argentum, sulphur, causticum, and bryonia. For the treatment of
other symptoms with which the disease may be complicated, the reader is referred to the chapter on dyspepsia.
Administration.-The remedies may be exhibited
from the third to the sixth potency, and at intervals of
six to twelve hours, until the desired effect is produced.
SECTION IX.
ENTERITIS.
Under this head we shall proceed to describe two
varieties of intestinal inflammation, the peritoneal and
muscular, and that of the mucous membrane. The




CONNECTED WITH THE DIGESTIVE- SYSTEM.   269
older writers have confounded peritoneal enteritis
with ordinary acute peritonitis, but the researches of
modern pathologists have pointed out the true location
and nature of these different maladies.
PERITONEAL ENTERITIS.
Diagnosis.-Lassitude, rigours, chills, acute pain in
some part of the abdomen, swelling and exceeding tenderness in the affected part, nausea, vomiting, obstinate and persistent constipation, urgent thirst, bitter
taste, loss of appetite, parched mouth, hot skin, inspirations short and painful, position on the back with
knees drawn up, and inclination to preserve the recumbent posture, pulse frequent, tense, contracted,
and irregular, urine scanty and high coloured.
The above symptoms will be modified according to
the particular location of the inflammation. If the
small intestines are the principal seat of the disorder,
symptoms will obtain which simulate gastritis: if the
colon be the part affected, we may expect symptoms
resembling hepatitis to be present. This form of enteritis is violent and rapid in its course, and according
to most writers is " peculiarly prone to terminate in
gangrene. When this termination is about taking
place, the pain suddenly subsides, the pulse sinks rapidly, the countenance becomes pale and cadaverous,
the extremities cold, the surface covered with a cold
clammy sweat, and hiccough, slight delirium, and occasionally convulsions, close the scene. This affection is seldom protracted beyond the seventh or eighth
day, without terminating either in resolution or in
death."-Eberle.
Causes.-The employment of irritating cathartics,
like calomel, jalap, croton oil, aloes, scammony, colocynth, colchicum, gamboge, &c., poisons, alcoholic
liquors, sudden suppression of accustomed discharges,
repelled eruptions, worms, external injuries, persistent
constipation, atmospheric changes.
Therapeutics.-Arsenicum, veratrum, aloes, aconite,
nux vom., lycopodium, opium, ipecacuanha, sulphur,
plumbum, rhus tox., ac. cuprum.
Administration.-The principal remedies in the
treatment of this malady, are arsenicum and veratrum.




270    DISEASES OF THE ORGANS AND TISSUES.
They may be exhibited at the third potency, at intervals of one to four hours, according to the severity of
the symptoms. Should vomiting be very violent and
persistent, after the proper administration of arsenicum
or veratrum, recourse should be had to ipecac., third
attenuation. When the inflammation attacks the
large intestines, aloes and plumbum may be given in
some cases, at the third dilution, after veratrum and
arsenicum. If the disorder has arisen from repelled
eruptions, or metastasis of rheumatism, gout, erysipelas, &c., we may resort to sulphur, rhus, or ac. cuprum,
as circumstances require. During the course of the
disease, aconite will occasionally be found useful in
controlling the action of the heart and arteries. It
may be given at the second potency, either alone or
in alternation with arsenicum or veratrum, according
to the symptoms.
Auxiliary to the above remedies, the employment
of fomentations, either of warm or cold water, as the
case may demand, will prove of eminent service.
Cloths should be wrung out, and applied over the affected part, (care being taken to protect the body linen
and bed-clothes,) renewing them once in fifteen or
twenty minutes, when the inflammation and pain are
severe.
SECTION X.
ACUTE MUCOUS ENTERITIS.-DYSENTERY.
Diagnosis. —This disease sometimes commences with
griping pains in the bowels, with frequent discharges of
mucus or mucus mixed with blood, attended during the
evacuations with more or less straining and burning
pain. After the first two or three evacuations, nothing
but mucus, or mucus and blood, are passed. Occasionally the griping and diarrhcea are preceded by
lassitude, chills, weakness and pains in the limbs,
thirst, bad taste in the mouth, furred tongue, hot and
dry skin, frequent and hard pulse, anxiety, and general
restlessness.  The disease is peculiarly apt to be
ushered in with these last-named symptoms, when it
has been caused by sudden suppression of perspiration,
atmospheric vicissitudes, or miasmatic influences.




'ONNECTED WITH THE DIGESTIVE SYSTEM.   271
The appearance of the fluids discharged, will depend
much upon the climate, temperament, the exciting
cause, aad the particular portion of the intestinal
canal affected. If the small intestines are chiefly disordered, the evacuations will consist of dark watery
-matter, mixed with mucus and blood, while inflammation of the colon and rectum will give rise to discharges of pure mucus and blood, preceded and attended with distressing tormina, and inclination to remain
a good part of the time at stool. These discharges,
which are highly offensive, afford some temporary relief to the patient, only to be renewed with increased
severity. There are tendernessof the bowels on pressure, pain and burning in making water, inclination
to lie upon the back, with the knees drawn up, great
depression of spirits, short and painful inspirations,
universal heat and dryness of the skin, more or less
derangement in the function of the liver, indicated by
an icterode hue of the skin, and the absence of bile in
the evacuations, rapid emaciation, loss of strength,
and increasing disinclination to physical effort. As
the disease advances towards a fatal termination, the
countenance assumes a contracted and cadaverous expression, the pulse sinks, the evacuations become more
fetid, and are discharged involuntarily, the pains
abate or cease entirely, a cold sweat occurs, hiccough,
delirium, cramps, and extreme prostration obtain,
an~d then death.
Causes.-Atmospheric vicissitudes, deranged function of the liver, abrupt checks to perspiration,
"koino miasmata  have- frequently an unequivocal
agency in the production of this disease,"(Eberle),-the
irritation of teething, worms, and drastic drugs, crude
vegetables and unripe or decayed fruits.
Prognosis. —The prognosis of dysentery will vary
according to the climate, the location, the season of
year, the constitution of the patient, and its complications with typhus, cholera, or other contagious maladies.
Hot and damp regions, abounding in luxuriant vegetation which is constantly undergoing decomposition,
and filling the air with miasimatic particles, predispose
the system to dysenteric affections, and serve to ren



272      DISEASES OF THE ORGANS AND TISSUES
der them violent and dangerous. Low, marshy, and
damp situations favour the formation of the disease,
more than elevated and dry locations. It is far more
common, severe, and fatal in the months of July and
August, in this country, than at any other period of the
year; and it is rare that individuals who are strongly
predisposed to it, entirely escape during these months.
When it is succeeded or accompanied with typhoid
symptoms, or when it occurs as a symptom of typhus
fever, it may be looked on as a malady of the most dangerous character, and one which will require the most
judiciously directed resources of our art. In these instances we have to combat, not only the local intestinal disorder, but also constitutional symptoms of the
greatest severity. During the prevalence of Asiatic
cholera, dysentery has been observed to assume a more
malignant form than in those years when this destructive epidemic has not prevailed. While the cholera
was destroying its thousands weekly~ in our- large
cities, during the last summer, a malignant dysentery
prevailed in most of the smaller cities and towns,
sweeping off numbers entirely -unprecedented.  In
these last examples, the epidemic influence was not
sufficiently active to generate the actual cholera
asphyxia, but it conduced to aggravate very materially, the type of dysentery.
Therapeutics. —Mercurius, arsenicum, chamomela,pulsatilla, colocynth, aconite, ipecacuanha, nux vomica,
carbo veg., sulphur, dulcamara, aloes, acid nit., acid mur.
Mercurius corrosive.-External indications.-Anxious expression of countenance; features distorted by
pain; knees drawn up; head and shoulders elevated,
or bent forward; fulness of the abdomen; skin hot and
dry; tongue dry and dirty; pulse frequent and tense;
inspirations short and imperfect, and effected principally with the muscles of the chest; evacuations of
pure blood, or mucus mixed with blood, or dark and
bilious and fcetid.
Physical sensations. —Sharp, cutting pains in the
bowels, accompanied with very frequent and urgent
desire to go to stool, and tenesmus; desire to remain
long at stool; abdomen excessively painful on pressure,
writh constant sensation of distention; dryness of the




CONNECTED WITH THE DIGESTIVB SYSTEM.   273
mouth and throat, with intense thirst; involuntary
twitchings of the muscles ongoing to sleep; pain at
the neck of the bladder in urinating; cheeks and
abdomen hot and flushed, while the extremities are.
cold; drawings, pinchings, or cramps in the limbs,
often deep seated; pains increased at each inspiration; shivering on the least exposure; aggravation
of the symptoms at night; sense of pain and fatigue
in the joints.
Mental and moral symptoms.-Out of humour; irritable; petulant; desponding; reckless.
Administration.-One grain of the third trituration
may be given every hour until the violence of the disease is subdued, when the intervals may be lengthened,
or the medicine suspended, according to the exigencies
of the -case. Some writers advise, an alternation of
this remedy with colocynth, where the indications
point to the latter as well as the former medicine.
We have occasionally prescribed these articles in
alternation with unequivocal benefit.
M7ercurius sol.-This form of mercury is more particularly adapted to the treatment of those cases
which are principally located in the upper portion of
the intestinal canal, the external indications for which
are, yellowish colour of the skin; offensive breath;
tongue covered with a white, thick, tenacious mucus;
distention in the superior part of the abdomen; evacuations of fetid mucus and bilious matter, of a green
or darkish colour, or of bloody mucus; prolapsus of
the rectum, which is red and inflamed; urine of a
deep red or brown colour and offensive; position,
respiration, pulse, temperature, thirst, &c., same as
under mere. cor.
Physical sensations. —Violent cutting pains in the
abdomen, accompanied by shivering, during and after
the evacuations; great tenderness on pressure, in the
region of the small intestines; frequent desire to
evacuate the bowels, accompanied by violent tenesmus; discharges small in quantity; aggravation of
pains at night; frequent and urgent desire to urinate;
nausea and vomiting, with pain in the stomach; thirst
for cold drinks; cramps and contractions in the
umbilical region; weakness and rapid sinking of
12*




274      DISEASES OF THE ORGANS AND TISSUES
strength; painful sense of distention in the abdomen;
sense of fatigue and great weakness in the limbs.
Mlental and moral'symptoms.-Morose; irritable;
great anguish and discouragement; peevish; quarrelsome.
Administration. —Same as merc. cor.
Remarks.-In malignant dysentery, mercurius sol.
and nitric acid are unquestionably remedies of the
highest importance. In all cases where the symptoms
are not covered by one of them, but are entirely so
by both, or when either administered singly, does not
promptly arrest the disorder, we may use them in
alternation with every prospect of success.
The following are the external indications of nitric
acid: countenance pale or flushed, and indicative of
anguish and anxiety; evacuations bloody, slimy, and
fetid; abdomen distended; urine red, or dark and turbid; body hot, while the extremities are perhaps cold;
pulse hard and frequent.
Physical sensations.-Frequent evacuations with
severe tenesmus. and urging to urinate; headache;
fever; thirst; sweat during the night and occasionally
in the day time; sense of fulness and pain in the
abdomen; general character of the disease typhoid.
Mlental and moral symnptons.-Sometimes delirium;
or anxiety, fear, apprehension, depression, and sleeplesness.
Administration.-We may give a drop of the second
or third dilution in water, after each evacuation: or
when used in alternation with mercurius, after every
other discharge from the bowels.
Mercurius viv.-This medicine covers the same
range of symptoms as the mere. sol., and may be substituted for it, if desired, in the treatment of dysentery.
Its mode of administration is also the same.
Arsenicum alb. —Where dysentery has arisen from
the abuse of drastic and other debilitating medicines,
after excessive loss of blood, or after the organism has
been enfeebled from previous disease, arsenicum will
often prove an efficient remedy. It is also peculiarly
useful in dysenteric affections, occurring in individuals
of a nervous, dropsical, or lymphatic constitution, and
when the disease is attended with typhoid complications.




CONNECTED WITH THE DIGESTIVE SYSTEM.    275
External indications.-General appearance of debility and prostration; trembling or stiffness of ther
limbs; face pale or yellowish, hollow and cadaverous;
position on the back, with tendency to sink to the foot
of the bed; eyes dull and sunken; lips dry and darkcoloured; tongue dry and brownish; abdomen swollen
and hard, or tympanitie; faeces offensive, putrid, and
variable in colour, but generally slimy and streaked
with blood, or greenish or darkish; skin cold and
bluish, or dry and shrivelled; breathing short and oppressed; pulse frequent, small, thready, sometimes
irregular.
Physical sensations.-Violent, sharp and cramp-like
pains in the abdomen, accompanied with nausea and
vomiting; sensation of fulness and burning in the
bowels; frequent eructations; flatulency; frequent
evacuations with some tenesmus, burning pain at the
anus, and nausea; retention of urine, or burning pain
in making water; pain increased by the slightest motion; faintness upon the least exertion; great tenderness of the abdomen; colliquative sweats; entire
inability to sit up, or make any effort; puffiness of the
eyes or cheeks; disturbed sleep, with constant jerking
of the limbs, and tossing.
Mental and moral symptoms.-Sad; desponding;
anxious; discouraged; irritability, impatience; delirium; loss of consciousness.
Adrministration.-One grain of the first trituration to
two ounces of distilled water-a teaspoonful once in
two or three hours until the required effect is produced.
Chamomela.-A  useful remedy in dysenteric affections arising from a sudden chill, from difficult and
protracted dentition, from violent grief or passion. It
applies especially to affections of this nature which
occur in women and children, and when judiciously
prescribed, will often act promptly and efficiently.
Laurie has found it of service after aconite in cases
attended with inflammatory symptoms, which have
been partially subdued by this medicine. It may be
given at the third potency, as circumstances require.
Pulsatilla. —This remedy has been highly recommended infall dysenteries, and in some cases of chronic




276      DISEASES OF THE ORGANS. AND TISSUES
dysentery... The indications for its:use are, nausea,
vomiting, bad feeling in the head; bruised sensation
in the integuments of the abdomen; cutting pains in
the bowels, with discharges of sanguineous mucus;
pain in the small of the back; chilliness, especially
towards night; bad taste in the mouth; eructations,
acid or bitter; prickling or numbnesss of the skin; constant inclination to sleep during the day; yellow tinge
of the skin.
Administration.-Four drops of the third dilution
to an ounce of distilled water-a dessert spoonful
every two, four or six hours in acute cases. One dose
every afternoon in chronic dysentery.
Colocynth should be exhibited in cramp-like, colicky
pains in the bowels, with inflammation of the whole
abdomen; slimy or bilious evacuations, with pains
and contractions at the rectum; bitter taste, with urgent desire for cold drinks; nausea and vomiting of
bilious fluids; shooting and cramp-like pains on one
side of the body; pains in the head, and throbbing of
the temporal arteries.
Administration.-Same as chamomela.
Nux yonr. sometimes effects speedy cures in protracted dysenteric discharges, which appear to be kept up
from relaxation and loss of tone in the abdominal mucous membrane rather than from actual inflammation.
By imparting tone and vigour to the enfeebled nerves
of the stomach and intestines, it cures the disease, and
enables these organs to resume their healthy functions.
The indications for its employment are, fulness and
distention of the abdomen; contractive or cramp-like
pains in the umbilical, epigastric, or hypochondriac
region; frequent small evacuations of mucous and
bloody matters; contractive pain in the rectum during
the discharges; bowels and cheeks hot; thirst; feeces
putrid and offensive.
Administration.-A drop of the third potency may
be given every two to six hours, as the urgency of the
symptoms demand, until an impression upon the disease is apparent.
Another medicine which has proved highly serviceable in my hands, is aloes soc. The indications for its
use are similar to those -of colorynth; and in some




CONNECTED WITH THE DIGESTIVE SYSTEM.   277
cases where colocynth has failed to afford the desired
relief, this medicine has succeeded promptly.
Rau has also used aloes with distinguished success
in purely inflammatory dysentery. The external indications are: abdomen distended and tender to the
touch; stools slimy and mixed with blood, or thin and
watery; urine scanty and high-coloured; tongue red
and dry; pulse full and rapid; skin hot and dry, &c.
Physical sensations. —Severe pressing, cutting and
burning pains in the lower part of the abdomen; violent tenesmus and smarting in the rectum, during the
evacuations, with sharp pains extending to the sacrum
and abdomen; high fever; pain in urinating, &c.
Mental and moral symptoms. —Anxiety and general
indications of nervous excitement.
Administration.-Same as chamomela.
Dulcamara may be used in dysentery arising from
cold, and attended with cutting pains in the intestines,
bloody discharges, burning and itching at the rectum,
heat of skin and thirst. It may be prescribed at the
third potency —a dose once in two to six hours, according to circumstances.
Carbo veg. may succeed or alternate with arsenicum
in certain low forms of dysentery, when the former
does not act with sufficient efficiency. It may be given
for the same train of symptoms, and at the same potency as arsenicum.
Sulphur is a remedy which deserves consideration
in instances where the more ordinary remedies fail in
affording prompt relief, and especially, if any latent
miasm is suspected to have conduced to the disease,
or prevented the usual action of the medicines administered. It is also often serviceable in the dysenteries
of hamorrhoidal patients.
Sulphuric acid has been highly commended inputrid
dysentery. The external indications are: thin, bloody,
and very faetid stools; red, or darkish urine, turbid,
or depositing a dirty sediment; burning hot skin;
apthe; petechime; blood-blisters; vomiting of water
and food.
Physical sensations.-Frequent inclination to go to
stool, with severe tenesmus,.nausea, and vomiting;
desire for acids, fresh fruit. &e.




278     DISEASES OF THE ORGANS AND TISSUES
Mental and moral symptoms. —Indifferent, or irritable; irascible and peevish. It may be given in the
same manner as nitric acid.
Belladonna is indicated in inflammatory dysentery,
with determination of blood to the head, and delirium.
There is constant tenesmus, but nothing is evacuated,
with violent fever, vomiting, tympanitic distention of
the abdomen, &c.
In bilious, catarrhal, erethistic, and rheumatic forms of
dysentery, examine colocy., puls., nux vom., cup., cham.,
chin., rhus,, sulph., ip., dulc., euph., canth., ant. crud.,
rheum.
When the malady degenerates into a chronic form,
our best remedies are, phos., acid nit., sulph., china,
lach., acidphos., calc. carb., verat., merc.,ferr., and colocynth.
We have often observed the most decided benefit
follow the employment of enemata of cold water, in
dysenteric inflammations. They may be administered
after each evacuation, in suitable cases, and when
they afford evident relief.
SECTION XI.
ACUTE PERITONITIS.
Diagnosis.-Three varieties of this disease have
been recognised, viz.: first, natural peritonitis; second,
puerperal peritonitis; third, chronic peritonitis. We
shall, however, include under the present head, each
variety, detailing, as we proceed, the characteristic
symptoms pertaining to all of the different forms of the
malady.
Acute peritonitis is usually ushered in with more or
less of the ordinary symptoms of fever, as lassitude,
irregular chills, succeeded by flushes of heat, headache,
frequent pulse, uneasiness, or pressure in the region of
the stomach, nausea, and loss of appetite. These
symptoms are speedily succeeded, and occasionally
accompanied, by a pain and tenderness in the abdomen, either confined to circumscribed points, or universally diffused over its whole extent.  Generally
the abdomen is excessively tender and painful upon
pressure, often rendering the weight of the bedclothes




CONNECTED WITH THE DIGESTIVE SYSTEM.   279
intolerable; but in some instances, the pain is slight
from the commencement to the fatal termination of
the malady. The tongue is moist and covered with a
white fur, in the first instance, which soon becomes
dark and dry in the centre, with red edges. The
bowels are constipated, but may be readily acted upon
by appropriate remedies. The pulse is commonly
frequent, tense, corded, and wiry, though in some instances it varies but little from the natural standard.
This, like most other inflammations of the abdominal
viscera, imparts to the countenance a contracted,
sharp, and anxious expression, indicative of both acute
physical and mental suffering. The patient inclines
to relax those muscles which operate upon the abdominal parietes, and on this account we find him with his
legs drawn up, his head and shoulders elevated, and
his respiration short, imperfect, and exercised almost
entirely by the muscles of the chest.
Puerperal peritonitis is that form of the disease
which occurs in females after confinement, and is
known as puerperal fever. It differs from ordinary
peritonitis, in being more sudden and violent in its
attack, and in having a tendency to run its course with
greater rapidity. Among the first symptoms are pain
and tenderness in the hypogastric region, occurring
soon after delivery, and succeeded by chills, &c.
Some authors assert that the lochia are almost invariably suppressed, while others of equal eminence,
assure us that this discharge is often but little affected,
and never entirely suspended. The secretion of milk
is also either partially or entirely suppressed; and
if the secretion has not yet taken place, it does not'
occur at all. In many cases of both forms of this disease, the brain is affected at an early period, and demands special attention.
In regard to the precise character which this malady
may be likely to assume, much will depend upon the
peculiar constitution and circumstances of the individual, the season of year, the prevalence of epidemic
or contagious influences, &c. " There is also an entire extinction of the maternal feeling," (Dewces,)* and
* Dr. Dewees considers this one of the most remarkable circumstances
attending this disease.




280     DISEASES OF THE ORGANS AND TISSUES
frequent inclination to pass water, which is often attended with pain. The duration of this malady is
from twenty-four hours to two or three weeks.
Chronic peritonitis, although often consequent upon
a partially subdued acute attack, may also arise independently from sudden changes oftemperature, insufficient clothing, irritating food, external injuries, surgical operations, and chronic bowel complaints. Many
of the symptoms of this disease are like those of dyspepsia, as sensation of fulness, distention, weight, and
occasional pains in the region of the stomach and
bowels, constipation, loss of appetite, depression of
spirits, restlessness at night, distress and pains, aggravated after eating, emaciation, thirst, frequent pulse,
foul tongue, &c. This form of peritonitis may terminate in a few weeks, or it may run on for a year or
more, and then result in ulcerations opening into the
intestines.
Causes.-Certain occult conditions of the atmosphere, undue exposure to cold, excessive physical exertion, injuries, labour, miscarriage, over-exertion when
the organism is weakened by previous disease, atmospheric vicissitudes, metastases of rheumatism, and
gout, suppressed discharges, &c.
T7erapeutics.-The most approved remedies in the
treatment of peritonitis are, aconite, belladonna, bryonia,
arnica, bismuth., chamomela, coffea, colocynth, ipecacuanha, mercurius, nux vom., pulsatilla, rhus tox., sulphuris,
veratrum.
Administration.-We advise the employment of the
three first attenuations-and a repetition of the dose
every one, two, or three hours, according to the urgency of the case.
SECTION  XII.
COLIC.
Under this head, we shall describe three varieties:
first, bilious colic; second, flatulent colic; third, painter's colic.
I.-BILIOUS COLIC.
Diagnosiv.-'The first symptoms of this disease, are




CONNECTED WITH THE DIGESTIVE SYSTEM.   281
headache; nausea; bitter taste; bilious vomiting; foul
tongue; loss of appetite; thirst, and uneasiness in the
bowels. These symptoms are speedily followed by
severe griping, twisting, or shooting pains in the umbilical region; hot skin; painful distention of the
stomach and abdomen; obstinate constipation,- and
finally, tenderness of the abdomen; yellow cast of the
skin and eyes; coldness and torpor of the extremities;,cold sweats; feeble or extinct pulse, and other signs
indicative of a fatal termination of the disorder. During the first stage of the malady, the patient involuntarily makes firm pressure over the navel, which affords temporary relief, and it is by this symptom that
we may distinguish the disease from inflammation of
the bowels, in which pressure is attended with an aggravation of the pain.
Causes.-Deranged function of the liver, is supposed
to be the chief cause of this complaint, but what the
precise nature of this derangement consists in, we
know not. Dewees supposes that the liver is in a state
of morbid activity, and secretes bile of an acrid quality,
-which serves to irritate the stomach and intestines,
and thus induce the disease. Gregory, Eberle, Johnson, &c., assert that this organ is in a torpid condition,
and consequently secreting only a small amount of
bile, thus leaving the ingesta to be only partially
acted upon by one of its natural solvents, and
thereby rendering the half digested food an irritant
to the digestive organs. From the fact of its occurring only at particular periods of the year, it is reasonable to conclude that atmospheric causes exert
some influence in its production.
It is quite evident, however, that derangement of
the liver is intimately connected with genuine bilious
colic, and it therefore behooves those who have been
afflicted, to take every precaution to ensure a healthy
condition of this organ.
2.-FLATULENT COLIC.
Diagnosis.-Flatulent colic may be distinguished
from the variety last described, by the greater distention of the stomach and bowels with flatus; frequent
eructations; borborygmus; the pain, although as severe




282    DISEASES OF TtlE ORGANS AND TISSUES
as in bilious. colic, yet coming on more in paroxysms,
absence of nausea and bilious vomiting, and from the
fact that it usually occurs an hour or two after eating
ssomething indigestible.
Causes.-Indigestible food, unripe or decayed fruits;
beer; mental emotions, or any other cause capable of
morbidly altering or suspending tbr a time, the healthy
action of the stomach and bowels, in such a manner
as to cause them to generate an unusual quantity of
gas.
3.-COLICA PICTONUM.-PAINTER S COLIC.
Diagnosis. —Lead colic commences with feelings of
lassitude; dull pains in the head; loss of' appetite; bad
taste in the mouth; wandering pains in the bowels
and limbs; transient chills, and depression of spirits.
After these symptoms have existed for some time, the
pain in the region of the umbilicus becomes exceedingly severe, obliging the patient to make firm pressure against the abdomen, with the body in a bent position; indeed, so intolerable is the pain, that the patient
is unable to remain quiet in any position. He is now
in h state of great agitation and excitement. and feels
confident that he must die unless speedily relieved. It
is important to observe, that in all the varieties of colic,
the skin is cool or not above the natural standard, and
sometimes covered with a cold sweat. The pulse, also, exhibits but little arterial excitement. These last
symptoms, together with the relief which firm pressure
upon the abdomen affords, in the early stages of the
malady, indicates its spasmodic character, and will
serve to distinguish it from enteritis and other inflammatory conditions of the abdominal viscera.
Therapeutics.-The specifics for the different kinds
of colic, are, colocynth, plumbum, nux vomica, arsenicum,
chamomela, hyoscyamus, stramonium, veratrum, cocculus,
senna, colchicum, phosphorus. pulsatilla.
Auxiliary to the above remedies, we beg leave to
impress upon the practitioner the importance of fonzentations and enernata of warm water. These measures, conjoined in certain cases with the tepid bath,
are worthy of high consideration, and should never be
lost sight of in the treatment of this, as well as other




CONNECTED WITH THE DIGESTIVE SYSTEM.   283
maladies of a spasmodic character. The fomentations
should not only be applied to the abdomen, but to the
extremities, more especially if these parts are cold and
inclined to cramp. In moderate cases, fomentations,
together with an ordinary enema, and the proper specific, will suffice to effect a speedy cure; but if'the
case has been very violent and obstinate from neglect
or mismanagement, by calomel and opium, a general
bath, with very copious injections of warm water while
immersed in the water, cannot be too highly recommended. Indeed, we have in several instances, observed the abdominal spasms to relax, the pains to
cease, and free evacuations of feecal matter and of
wind to occur, while the patient was yet in the bath.
By adopting this course, we secure the advantage of
internal, as well as external fomentations, and thus
bring a safe, yet efficient remedy, to bear directly upon
the parts affected. All who have practically tested
the soothing influence of warm water applications
upon the nervous system, when in a state of unnatural
erethism, will appreciate the truth of our remarks.
The medicine which is most generally applicable in
the treatment of colic, is colocynth. It is particularly
appropriate when the complaint has been caused by a
chill, by mental emotions, as grief, indigestion, mortification, &c., also when biliary derangement has been
the exciting cause.
The external indications are, inflation of the abdomen;
position of the body bent forward, so as to relax the
abdominal muscles; cramps in the calves of the legs;
general agitation; temperature of the skin, about the
natural standard, or cold and covered with sweat;
pulse natural, or but slightly increased in frequency;
tongue covered with a yellowish fur, or natural; face
pale and indicative of intense suffering; rigidity and
contraction of the abdominal muscles, as well as of the
tendons in other parts of the body.
Physical sensations.-Violent cramp-like contraction
or cutting pains in the abdomen, generally in the region of the umbilicus; painful cramps in the calves
of the legs; sensation of faintness, with coldness and
shuddering; bitter or insipid taste in the mouth; nausea; loss of appetite; disgust for drinks; constant in



284     DISEASES OF THE ORGANS AND TISSUES
clination to move about, to grasp objects violently,
and to make pressure against the abdomen; empty
eructations; pains in the back and loins, especially
semilateral; obstinate constipation, or small and loose
evacuations.
Mental and moral symptoms.-Most intense anguish
and agitation; dejection; extreme restlessness and desire to move about; fear of speedy death.
Administration.-From the first to the sixth dilution
may be employed according to the age, sex, constitution, temperament, and severity of the disease. A
dose may be given every half hour in urgent cases,
until amendment or medicinal aggravation occurs, to
be resumed and repeated as the exigencies of the case
may require.
Plumbum.-On account of the very marked and
decided specific action of lead upon the colon and
ileum, whether introduced into the blood through the
stomach, rectum, lungs, or skin, this drug is peculiarly
appropriate for the treatment of some of the varieties
of colic. The practitioner will, of course, avoid exhibiting it in that variety of colic which has been
caused by the absorption of lead. The following are its
External indications.-Rigidity and contraction of
the abdominal muscles; hard ridges, or elevations in
the abdomen; borborygmus; frequent expulsion of
offensive flatus; eructations; tremblings, jerkings, or
cramps of the limbs; face and skin pale, bluish, or
yellow; surface cold, and covered with clammy
sweat; mouth dry or moist, and clammy; pulse weak,
and somewhat frequent; body bent double.
Physical sensations.-Violent constrictive, shooting,
or pinching pains in the umbilical region; constant
and urgent desire to eructate and expel flatus; chilliness or shuddering during the paroxysms; sensation
of faintness; torpor, numbness, stiffness, and weakness in the limbs; desire to press the abdomen against
something hard; extremities cold; dizziness; sweetish or bitter taste; thirst; vomiting of bilious or faecal
matters; pressure and cramps in the stomach; obstinate constipation; evacuations, scybalous and difficult
to expel; shooting pains in the loins, and back, and
limbs; cramps in the feet, excessive agitation and
restlessness.




CONNECTED WITH THE DIGESTIVE SYSTEMI.   285
Mental and moral symptoms.-Very great anguish
and uneasiness; melancholy; discouragement; impatience.
Administration.-Same as Colocynth.
Nux vomica is very useful in colic, arising from torpor of the liver, indicated by deficient secretion of
bile, indigestion, flatulence, &c. It is also useful in
fJatulent colic, occurring in dyspeptic subjects after
the use of improper articles of food. In cases where
nux is indicated, the face is pale or yellowish, the
stools, previous to the attack, light and clay-coloured,
the abdomen distended, there are frequent eructations,
hiccough, sharp and cramp-like pains in the stomach
and bowels, rumbling in the bowels, giddiness, sensitiveness of the stomach and abdomen when pressed
upon.
Administration. —This medicine may be used at the
second or third attenuation; a dose once in half an
hour to two hours until relief is obtained.
Arsenicum is specific in colic pains coming on in
regular paroxysms, and attended with decided remissions. In extreme cases, it may also be resorted to
with advantage, where the powers of the system have
been exhausted, and other remedies seem to be incapable of arresting the disease. The first to the third
potency may be used, and repeated as circumstances
appear to require.
Chamomela is advised by Hahnemann in the colics
of pregnant and parturient women, of new-born infants, and of children during dentition. It is also recommended for the colics of nervous and hysterical
females. If this medicine does not afford the desired
relief, resort may be had to hyoscyamus, stramonium,
or senna.
Administration.-A dose of the third to the sixth
dilution every hour or two as long as necessary.
Veratrum, cocculus, and colchicum, will often prove
valuable in spasmodic and flatulent colic occurring in
nervous and hysterical females, and in persons of a
mild and phlegmatic temperament.  In instances
where the above described remedies do not correspond, let the indications of these articles be considered.
Pulsatilla is principally useful in colics arising from




286     DISEASES OF THE ORGANS AND TISSUES
the abuse of crude, esculent vegetables, unripe fruits,
and abuse of fat and greasy articles of food. The
pains are very severe, and usually occur a few hours
after eating, attended with borborygmus, and the
expulsion of large quantities of flatus. We have often
seen the most prompt relief follow a single drop of
the tincture, and we have rarely been obliged to repeat the dose more than two or three times.
Phosphorus will apply to cases occurring in persons
of a feeble organization, who have been weakened
by long-continued gastric affections, and especially for
those who are afflicted with disease of the mesenteric
glands. A dose of the third trituration may be administered every two hours until relief ensues.
SECTION XIII.
ASIATIC CHOLERA.
When the Asiatic cholera first pursued its destructive course amongst the millions of Europe and America, the disciples of the ancient school of medicine
stood aghast and almost powerless before the awful
scourge, their best resources often hastening rather
than retarding the work of the destroying angel.
Destitute of an accurate or reasonable system of
practice, without any definite rules of action, or any
true knowledge of the operation of medicines, the allopath brought to the treatment of the malady his
vague, indefinite, and uncertain remedial theories;
and in contemplating the numerous and contradictory
modes of treatment advised and adopted by different
eminent persons of this description,-the ridiculous,
and often fatal experiments, by means of which they
hoped to guess out and blunder on to some actual remedy-we are forcibly reminded of the entire worthlessness and unsoundness of their system. Here was a violent and relentless enemy, seizing its victim with unwonted energy, and pursuing its deathly course with
rapid strides-one requiring active, prompt, and decided processes to stay its fatal ravages,-and what
course did the allopath adopt in the fearful crisis? Did
he attack symptom after symptom with medicines
which possessed specific, uniform, and decided effects,




COWNECTED'WITH THE DIGESTIVE SYSTEUM.   287
and thus repel the invader step by step?  Did he administer his stimulants, opiates, mercurials, and counter-irritants with  that confidence which an exact
and correct system of medicine must naturally inspire?
Let their results and confessions everywhere answer.
It is universally conceded, at the present time, that
homceopathy is far more efficient in the treatment of
Cholera than any other mode of practice. During
its prevalence in Europe, from 1831 until its disappearance, the average mortality of cases under this
treatment was about one in twelve, while under allopathic treatment, the average was one in three. In
Germany, Russia, France, and other European kingdoms where our system had become known, even distinguished gentlemen of the old school were forced to
admit its vast superiority over their own system; and
it was undoubtedly this superior efficacy and success
which caused so many distinguished men of Europe to
investigate the claims of the doctrine of "similia similibus," renounce the fallacies of Hippocrates and
Galen, and throw their influence on the side of truth.
Being a disease of extreme violence, and having a
tendency to run its course with great rapidity, there
was no time to apply remedies according to the principle contraria contrariis, nor would its severity permit the additional waste of strength and nervous
energy which ever follow opiates, stimulants, and
counter-irritants. A positive specific, a real antidote,
could alone reach the seat of the disease, and arrest
its progress; and to the disciples of Hahnemann is
due the credit of bringing forward these specifics, and
demonstrating to the world their tremendous power
and efficiency over this world-wide scourge.
Diagnosis.-Asiatic cholera varies much in its mode
of attack, violence, and duration. It may seize its
victim in such a manner as to produce an immediate
prostration of strength, together with most of those
symptoms which indicate an almost total loss of vitality. as a sunken and cadaverous expression of countenance, small and almost imperceptible pulse, surface
of a bluish tinge, and cold, cramps in the calves of
the legs and fingers, burning in the stomach and
throat, extreme anguish or stupidity, vomiting, diar



288     DISEASES OF THE ORGANS AND TISSUES
rhaea, and an almost entire loss of power over the
voluntary muscles. Other cases set in with vertigo,
humming in the ears, oppression and burning pain at
the pit of the stomach, nausea, vomiting, griping, and
purging of a liquid resembling "rice water," which
are soon succeeded by oppression of the chest, difficulty of breathing, cramp-like pains in the extremities
and abdominal muscles, intense thirst, great loss of
strength, bluish colour of the lips, nails, and skin,
pulse almost imperceptible, hippocratic countenance,
delirium, cold, icy skin, profuse sweats, weak, hoarse
voice, and sometimes sopor, with eyes half open and
fixed, with partial or total loss of consciousness. A
few or the whole of these symptoms may be present
in any given case, according to the constitutional, predisposing, and exciting causes which may exist.
Causes.-A. peculiar subtle poison, capable of being
conveyed by currents of wind from place to place,
either dissolved in aqueous vapour, or in some other
manner, and possibly, by attaching itself to articles of
clothing, &c., capable of communication in this
way. Whether this infinitesimal, imponderable morbific agent is generated during the prevalence of some
peculiar conditions of the atmosphere, from vegetable
or animal matters in a state of partial or total decomposition, or from some other source, is as yet a matter
of speculation. Like most, other of the more potent
agents in nature, the particles of' the poison are in so
minute a state of subdivision, and so subtilely diffused
in the air, that in the present imperfect condition of the
sciences, we are entirely unable to investigate or appreciate their nature. That the cause or agent is material,
however, no one can for a moment doubt; for it must
be something or nothing; if it is the former, it must be
composed of minute particles or atoms of matter,
which, by being absorbed, produce those specific effects which constitute cholera. If it is contended that
the cause is not material, but simply a property of
matter; something spiritual, unreal, intangible, and
yet capable of producing powerful impressions; we
say proofs of this view are wanting, and we reason
upon fallacious, if not absurd data. We hear much
said respecting the "properties of matter," when ab



CONNECTED- WITI THE. DIGESTLVE SYSTEM.   289
struse subjects are the topics under consideration, and
this unmeaning phrase serves the purpose of explaining everything which is obscure, and cannot be explained by the existing knowledge concerning the
nature of certain imponderable substances. Properties of matter are merely efects produced upon the
organism by actual contact of material atoms, and
must never be substituted or confounded with the
agent-the morbific cause itself. Let medical men,
therefore, confess their ignorance respecting the
causes and physical character of those imponderable
atoms, which so often contaminate the atmosphere,
and by being absorbed into the blood, induce those
baneful specific diseases which so sorely afflict mankind.
Therapeutics.-Dr. Lobethal, of Germany, who had
charge of a large cholera hospital (allopathic) during
the prevalence of the epidemic in 1831, and who
treated an immense number of cholera patients homceopathically in the summer of 1847, and again in 1849,
observes: "It has been reserved to the'specific'
healing art, generally known under the name of homeopathy, to stand the test of practical observation,
and to demonstrate its superiority in combatting this
fearful disease, (cholera,) the appearance of which,
followed by an immense number of well substantiated
cures, has tended in the highest degree to the spread
of the new healing art. In 1831, 1 learned from experience that the various methods of treatment pursued
in the old school, in spite of all the science on which
it was based, led, on the average, to very unfavourable
results; whereas in 1848 and 1849, by adopting the
homeopathic treatment, I lost but few out of a very
great number of patients."
When the cholera is preceded by nausea; loss of
appetite; constant borborygmus; violent thirst;
slight febrile symptoms; frequent thin watery discharges; absence of pain in the bowels, and other
symptoms, generally known under the term "cholerine," Dr. Lobethal has derived marked benefit from
the use of phosphoric acid, repeated every two or three
hours until the symptoms are better. If the above
symptoms are attended with coated tongue, vomiting,
13




290     DISEASES OF THE ORGANS AND TISSUES
debility, and indigestion, ipecac., of the third dilution,
is required.
When cholera has actually made its appearance, a
remedy which covers the exact symptoms of the case,
ought to be immediately exhibited. Our best remedies are verat., ars., cup., camph., canth., carb. v.
In the forming stage of cholera, and in cholerine,
with cramps in the calves of the legs, give tincture of
camphor; "and for aching or burning in the epigastrium, ac. phos., ars., cup., phos., ver.; for rumbling in
the belly, ac. phos., ver., phos.; for diarrhrea, ac. phos.,
ars., ip., phos., sec., sulph., ver."-(Nusser).
In the third stage, or collapse, ars., phos., verat.,
carh. v., laurocer., &c., are to be used.
During the prevalence of the epidemic in England
and France in 1848-9, and in America in 1849, almost
every individual experienced unusual intestinal irritation and disposition to diarrhea. In the large cities,
especially, very few exceptions to this rule could be
found.  Even the most strict regard to diet, and
avoidance of all exposure, was no security against
this weakness and rumbling of the bowels, and a certain lassitude and uneasiness which constantly attended it. Most of these cases subsided without any
serious disturbance; others passed into cholerine, which
could generally be controlled when promptly taken in
hand; while those cases which were neglected, or improperly managed, usually terminated in cholera. In
rare instances, individuals would be attacked suddenly and violently, without any apparent premonitory
symptoms, but cases of this description have almost
invariably occurred in those whose constitutions were
impaired from intemperance, disease, or who had
been deprived of proper repose, by mental application,
excitement, fear, &c.
Dr. Hencke found camphor a positive specific in the
spasmodic form of cholera, " when the patients were
suddenly taken with rigor. and even cold in the back,
which was soon followed by faintness and weakness,
sinking sensation in the  stomach, vertigo, nausea,
aching, contracting pain in the epigastrium, gagging,
vomiting, spasms in the calves, general tonic spasms,
disappearance of the natural warmth, therefore cold



CONNECTED WITH THE DIGESTIVE SYSTEM.   291
ness of the hands and the whole body, depression of the
pulse, which could hardly be felt, lividity of the lips,
anxious expression of the countenance, &c., sometimes
diarrhaea." Dr. H. advises that the patient be well
covered, and dry heat applied to his body and limbs,
and that strong spirits of camphor be given in drop
doses every five minutes, until reaction occurs, warmth
returns, and perspiration sets in. Dry frictions may at
the same time be employed. As soon as we observe
signs of reaction, we must either omit the remedy, or
if the urgency of the case demands further remedial
means, give the camphor at the first or second dilution
until reaction is fully established. It was a very common occurrence for patients to be taken in the night,
generally dfter midnight, with cramps in the stomach,
nausea, vomiting and purging of a watery fluid, without pain or effort on the part of the patient; sense of
exhaustion and debility, and great anxiety. If these
symptoms were not speedily arrested, there soon succeeded extreme prostration, almost constant vomiting
and purlging of rice-coloured fluid; contractive or
burning pains in the stomach; coldness of the surface; spasms or cramps in the calves and other parts
of the body; countenance sunken, altered in expression, and indicative of extreme anxiety; voice feeble
or hoarse; marbled appearance of the skin; skin
shrunken and shrivelled; cold breath; cold and pasty
sweat; burning thirst; marked loss of power in the
circulatory and respiratory organs.
Camphor, veratrum, arsenicum, cuprum, acid hydrocianic, secale, laurocerasus, and carbo veg., have been
most successful in the epidemic of 1848 and 1849,
both in Europe and America.
Dr. Griesselich, of St. Petersburgh, considers veratrum by far the most important remedy in cholera. In
Russia, this remedy was so notoriously efficacious,
" that the homceopathic drug shops were overrun by allopathic physicians and druggists to procure it."
Dr. G. found acid phos. exceedingly efficacious in
ch olerine.
In fully developed cholera asphyxia, as it occurred
at Breslau in 1848 and 1849, Dr. Schweikert, of Breslau, found ver. first, and seecale first, a drop every five




292     DISEASES OF THE ORGANS AND TISSUES
minutes, in alternation, more commonly indicated than
any other remedies. When asphyxia took place, Dr.
S. relied upon ac. phos., either alone or in alternation
with secale; but in a few cases he used tinct. phos.,
first or second dilution, with success.
Probably in no part of America did the cholera
rage with more violence in 1849, than at Cincinnati,
Ohio. Two physicians, Drs. Pulte and Ehrmann, treated 1,116 genuine cholera patients, in all stages of the
disease, and with a loss of only thirty-five-two Americans and thirty-three Germans. These gentlemen
also treated 1,350 cases of cholerine, and many cases
of Inalignant dysentery, after the subsidence of the
cholera, without the loss of a single patient. Of the
cases of genuine cholera asphyxia, 538 had vomiting,
diarrhcaa, and cramps-70 of these being in a state
of collapse, and the balance, 578, presented with vomiting and rice-water discharges. These last being
subjected to prompt treatment, were speedily restored without the supervention of more serious symptoms.
The treatment adopted by Drs. P. and E. was as
follows: in the first stage of the malady, tinct. camphor,
one or two drops every five minutes for one to two
hours, or until profuse perspiration ensued, which
should be kept up for several hours, care being taken
to keep the patient well covered. This remedy was
perfectly effectual in almost every case during the
early part of the disease. In the second stage, when
cramps, general prostration, and rapid sinking of the
physical energies appeared, veratrum when the cramps
were in the lower extremities; cuprum, if in the
bowels and breast, and secale cornutum, were relied
on. The latter medicine was found of eminent service in elderly people.  In cases of decided collapse,
arsenicum  and carbo veg. were the remedies employed. Mild frictions of the extremities with the
hands alone, were the only external means made use
of.
In St. Louis, New Orleans, and other cities of the
west and south, a similar plan of treatment.was
adopted by homoeopathic physicians, and with results




CONNECTED WITH THE DIGESTIVE SYSTEM.   293
which, for the most part, compare favourably with
those detailed by Drs. Pulte and Ehrmann.
During the prevalence of cholera, much may be
done towards warding off its attacks, and thus disarming it of a portion of its terrors. The most important
rule which we would inculcate, is the cultivation of
presence of mind under all circumstances, cheerfulness, contempt of danger, and strict temperance and
regularity in all the habits of life. Other precautions
are, frequent ablutions, so as to ensure perfect cleanliness, and a healthy action of skin, careful ventilation,
frequent changes of body linen, moderate and agreeable exercise, good company, and a clear conscience.
As a prophylactic, many European authors have
highly recommended camphor in tincture, in doses of
a drop or two once or twice in twenty-four hours.
From its extensive application as a medicinal antidote, we are disposed to believe that it may possess
virtues of a high order, as an antidote against the
poison of cholera.
The medicines which have been found, upon the
whole, most serviceable in the treatment of this malady, as it occurs in different localities, and in -its
various forms, are, veratrum, cuprum, arsenicum, and
camphor. Symptoms often supervene, also, which call
for the exhibition of secale cornutum, nux vomica,
phosphorus, phosphoric acid, ipecacuanha, and carbo
veg.
Veratrum.-External indications.-General coldness
of the surface of the body; cold perspiration on the
face, and sometimes over the whole surface; skin
white, or of a bluish tinge; bluish colour around the
nails, and of the lips; contraction of the muscles of
the extremities; nausea, vomiting, and purging; face
pale, sunken, and hippocratic; nose cold and pointed;
breath cold; pulse almost imperceptible; general
appearance of prostration.
Physical sensations. —Painful cramps in the limbs;
sensation of extreme debility and faintness; nausea;
vomiting and purging; vertigo and confusion in the
head; constrictive pain in the throat; oppressive and
burning pain at the pit of the stomach; painful contraction of the abdomen; oppression in the chest;




294     DISEASES OF THE ORGANS AND TISSUES
fulness and pressure in the region of the heart; obstructed respiration; rumbling and griping in the
bowels; thirst; great restlessness.
Mental and moral symptoms.-Excessive dejection,
anguish and despair; constant disposition to turn from
side to side, or otherwise to change position; sometimes loss of memory and stupidity.
Administration.-The first to the sixth dilution should
be employed, a dose every ten, fifteen, or twenty
minutes in urgent cases, and extending the intervals
as the symptoms demand.
Arsenicum  alb.-External indications.-Skin of a
pale or bluish colour, and cold; face wan and cadaverous; eyes sunken; nose pointed; general expression of countenance unnatural and indicative of pain;
lips bluish, or black and dry; trembling or stiffness
in the limbs; skin cold and covered with a clammy
sweat, or dry and shrivelled; pulse very weak, irregular, and trembling; watery discharges by vomiting
and purging.
Physical sensations.-Burning pain in the stomach,
worse after vomiting; cramps in the calves of the
legs, toes and fingers; dizziness; nausea; frequent
inclination to vomit and purge; rumbling in the
bowels; ringing in the ears; feeling of extreme debility; very great restlessness and agitation; intense
-thirst, which affords but slight relief; spasmodic contraction and burning in the throat and (esophagus;
cramp-like pains in the stomach and abdomen; frequent desire to pass water, or retention of urine; difficulty of respiration, with hoarseness; general sensation
of coldness and loss of vitality.
Mental and moral symptoms. —Intense anguish, anxiety and discouragement; dread of death; constant
uneasiness; confusion of ideas; delirium.
Administration. —The lower potencies of this medicine should be used, and in urgent cases, the doses
may be repeated once in fifteen or twenty minutes until the symptoms yield. Some writers extol it highly
in alternation with veratrum, and where either of these
remedies does not afford prompt relief by itself, by all
means let them be given in alternation.
Camphor.-It is not alone as a prophylactic that this




CONNECTED WITH THE DIGESTIVE SYSTEM.   295
medicine has been advised. Hahnemann made use of
it in all stages of cholera, but he found it particularly
successful in thefirst stages of the malady, when vertigo, extreme weakness, cramps in the calves of the
legs and muscles of the abdomen, burning and heat
in the stomach, convulsive distortion of the features,
eyes sunken, face and hands bluish and cold, anguish,
dulness, loss of consciousness, and hoarseness,were present. It has been found most useful i0 those cases
which have been almost entirely unattended with nausea,vomiting, and diarrhaea. It has in some instances restored patients who were apparently in articulo mortis.
Secale corn,. and cuprum are appropriate remedies
when there are distortion of the limbs; jerking and convulsive movements in the limbs; great desire to sleep;
great coldness in the back, abdomen, and limbs; cold
clammy perspiration; suppression of urine, and pains
in the extremities.
Nux vomica may be used when the principal suffer.
ings seem to be in the stomach, as anguish and oppression at the pit of the stomach, and severe spasms
in the stomach, also tenesmus with an increase of the
spasms at each discharge.
In some severe cases where the previous remedies
have failed to afford relief, the practitioner should take
into consideration, plhos., phtos. acid, ipecac., carb. veg.
cauth., sulph. ether, chdoric ether, 4c.
SECTION XIV.
SPORADIC CHOLERA.-CHOLERA MORBUS.
Diagnosis.-Distressing nausea and vomiting, with
great fulness and oppression at the stomach; severe
griping or colic pains in the umbilical region; frequent
watery discharges; twisting and cramps in the abdominal muscles and calves of the legs; tongue slightly furred; pulse quick and weak; countenance expressive of suffering and anxiety.
Causes.-Torpor of the liver; obstruction of the biliary ducts; unripe or decayed fruits; crude esculent
vegetables; constant exposure to a cold and damp atmosphere.
Therapeutics. —The most efficacious medicines in the




296     DISEASES OF THE ORGANS AND TISSUES'
treatment of this complaint, are, veratrum, arsenicum,
colocynth, chamomela, pulsatilla, ipecacuanha.
Veratrum alb.-External indications.-Countenance
pale or bluish, cold and disfigured; eyes sunken; nose
pointed; mouth parched, lips dry or cracked, and of a
dark colour; surface cold, or hot and dry; contraction
of the muscles of the abdomen and extremities; pulse
frequent and very weak; cold sweats; evacuations
watery, light, greenish, or brownish.
Physical sensations.-Severe cutting pain in the umbilical region; violent nausea and vomiting, with
diarrhea; burning sensation in the stomach; speedy
rejection of food or drinks; stomach and abdomen
tender on pressure; cramps in the abdomen and in
the extremities; extreme prostration; great oppression and distress at the stomach; intense thirst; general uneasiness.
M~ental and moral symptoms. —Excessive anguish;
fear of death; despair of recovery; delirium.
Administration.-This medicine may be used at from
the first to the third dilution —-a dose every half hour,
in urgent cases, until the requisite impression is produced. In slight cases, two or three doses of the third
dilution, at intervals of two to four hours, will suffice
for the cure.
Arsenicum alb. —The indications for this remedy are
somewhat similar to those of veratrum, but it is espe —
cially useful when the disease is violent from the'commencement, attended with an almost immediate prostration of strength; trembling of the limbs; severe
burning pain in the stomach; constant nausea and
vomiting; diarrhcea; ringing in the ears; vertigo;
giddiness; great anguish and restlessness; skin dry
or cold, and bluish; hippocratic countenance; eyes
sunken, dim, and suffused; thirst; distress from swallowing the blandest liquids; tongue and lips dry, dark,
and cracked; breath cold; excessive anguish, anxiety
and despair.
Administration.-Same as veratrum.
Colocynth will occasionally serve us in cases attended with moderate nausea, vomiting and purging; violent cramp-like pains in the region of the navel;
cramps in the extremities; tongue loaded with a yel



CONNECTED WITH THE DIGESTIVE SYSTEM.   297
low fur; bitter taste in the mouth; great dejection
and anxiety, and general restlessness. It may be
given at the third potency every two hours, gradually
lengthening the intervals as the pains subside.
Chamomela has been highly recommended when the
disease has been "excited by a fit of passion." The
symptoms which point to this remedy, are, frequent
vomiting of food, or of mucous, sour, or bitter substances; great anguish and pressure at the pit of the stomach; cramps in the calves of the legs when lying down;
tearing and cutting pains in the abdomen.
Administration.-Same as colocynth.
Pulsatilla is chiefly useful in cholera which has been
induced by the abuse of fat, crude, and indigestible
food. In cases of this description, it is often promptly
serviceable, administered at the first or second dilution, as circumstances require.
Ipecacuanha is the remedy when vomiting is the
most prominent and troublesome symptom. It may
be given at the third potency every half hour, until
the symptoms abate-afterwards, as the exigences of
the case demand.
SECTION XV.
DIARRHCEA.
Diagnosis.-Looseness of the bowels, with or without griping pains; discharges feculent, or thin and
watery; respiration, circulation, skin, and the organs
generally in a natural condition.
Causes. —Dentition, worms, irritating articles of
food, cold, mental emotions, hectic fever, repelled
eruptions, epidemic influences, &c.
Therapeutics.-For the diarrheas which supervene
during dentition, suitable remedies will be found in
chamomela, ipecacuanha, dulcamara, mercurius, mulphur,
calcarea carb., rheum, coffea, and aconite.
When the disease has been caused by the use ofifat
and indigestible food, and the discharges are pultaceous, mucous, liquid, or foetid, attended with burning
or excoriation of the anus, nausea, regurgitation, colic,
and aggravation of the symptoms in the night, pulsasatilla is appropriate.
Dulcamara is a remedy of the very highest value,
13*




298     DISEASES OF THE ORGANS AND TISSUES
in diarrhceas, and it covers a much wider range of
symptoms than has generally been attributed to it.
It has been employed principally in watery diarrheas,
which have arisen from cold; but we have used it
with distinguished success in bowel complaints which
have been caused by teething, worms, repelled eruptions, errors in diet, &c., and in which there were mucous, slimy, bilious, greenish and sanguineous evacua.
tions. Dr. Rummel expresses the opinion that ninetenths of all cases of diarrhcea may be cured with dulcamara, and we are satisfied that he is not very wide of
the mark. It may be employed in the first or second
dilution, and given in drop doses, with water, after each
evacuation.
If the complaint appears to be characterized by
prominent biliary derangement, specific medicines
will be found in mercurius, chamomela, pulsatilla, fnux
vom., arsenicum, and bryonia.
If the discharges are mucous, slimy, or sanguineous,
and preceded and accompanied by griping and tenesmus, our best remedies are, acid nit., and mercurius sol.,
in alternation. We may use the third attenuations,a dose after each evacuation. Other remedies are,
arsenicum, ipecacuanha, sulphur, acid phos., acid sulph.,
petroleum, colocynth, veratrum, phosphorus, and dulcanara,.
For the diarrheas which supervene during dentition,
suitable remedies will be found in chamomela, calcarea
carb., ipecacuanha, rheum, magnesia carb., coffea, dul.
camara, mercurius, sulphur.
When bowel complaints arise in consequence of
violent mental emotions, we employ chamomela, ignatia,
colocynth, veratrum, antimonium crud., coffea, nux vorn.,
phosphorus, arsenicum,pulsatilla, and Jerrum.
If the discharges can be traced to the presence of
worms, we give sulphur, cina, spigelia, aloes, mercurius,
nux vom., carbo veg., Jfrrum.
For the diarrhweas which occur during hectic fevers,
especially if connected with a scrofulous dyscrasia, the
appropriate medicines are, sulphur, calcarea carb., acid
nit., acid phos., iodine,ferrum, mercurius, sepia, kalmia.
For painless chronic diarrhiea, we suggest phosphorus,ferrunm, veratrum, china, natrum mur., acid nit., sulphur, lachesis, lycopodium, graphite, arsenicum.




CONNECTED WITH THE DIGESTIVE SYSTEM.   299
When the diarrhaea occurs during dentition and is
connected with some chronic cutaneous affection, it
will be necessary to exhibit sulphur, either alone, or
in alternation with dulcamara, chamomela, or mercurius.
It has not unfrequently occurred to us, that after mercurius, chamomela, and other apparently appropriate
medicines have failed in arresting the relax, a few
doses of sulphur has either put a stop to the malady,
or placed the system in such a condition that it will
respond readily to the remedies first employed.
Administration. —Our attenuations may range from
the first to the sixth —one drop, if a dilution, or a grain,
if a trituration, after each evacuation.
SECTION XVI.
HAEMORRHOIDS. —PILES.
Diagnosis.-This very common and troublesome
complaint will probably demand the attention of the
physician more frequently than any other single malady; nor, when we consider the causes which originate
it, and their almost constant and universal prevalence,
shall we be surprised at this. Any cause which
operates upon the rectum in such a manner as to impair the integrity of its vascular and muscular strue.
tures, may induce the disease. The effects in these
cases are, a permanent dilatation of the veins, and a relaxation of the mucous membrane of the part, causing
tumours of various sizes, at the verge of the anus, and
within the rectum, and in some instances, a protrusion
of a portion of the rectum itself. When this last result
obtains, we are presented with the disease known as
prolapsus ani.
Hamorrhoidal tumours may be external or internalhard or soft-sensible or insensible. Their general
appearance, in regard to colour, size, &c., will depend
much upon the amount of inflammation present, the
causes which have been in operation, and the length
of time which has elapsed since the commencement
of the malady. During a " fit of the piles," the tumours
are usually red, or purple, inflamed, and painful, the
pain is of a severe kind, aggravated to an almost intolerable degree when at stool, and accompanied by




300     DISEASES OF THE ORGANS AND TISSUES
tenesmus and frequent discharges of blood. The location and character of the pains vary much in different cases, being sometimes confined to the tumours
themselves, and at others extending upwards into the
intestines, or into the perineum, down the thighs, &c.
The pains may be itching, burning, aching, throbbing,
darting, or shooting-constant, or only when at stool,
or on sitting down.
When the mucous membrane of the rectum is much
relaxed, we almost always have as a complication,
prolapsus ani.  Although this complaint sometimes
originates independently of any hamorrhoidal enlargements, in the majority of cases the two diseases
are conjoined; and this is explicable from the circumstance that the causes of both are generally the same.
The most common of these causes is habitual constipation, induced for the most part, by the reprehensible
practice of inattention to daily alvine evacuations.
We have before observed that the ptrotracted presence
of indurated fincal matters in the rectum gives rise to
a semi-paralytic condition, which impairs the tone of
the parts, and thus induces constipation, piles, and prolapsus ani. The evils, then, to which this condition of
the lower bowels give rise, may be summed up as follows: first, constipation, and the numerous and grave
consequences which often result from it, in the form of
determinations of blood to the brain, lungs, and intestinal canal; also mania, hypochondria, neuralgia.
dyspepsia, blowel affections, colic, fistula in ano, &ec.;
second, piles, and its train olf unpleasant symptoms;
third, prolapsus ani.
Causes.-Other causes of these affections, in addition to the one already mentioned, are abuse of cathartics which operate specifically upon the lower
portion of the intestinal tube, excessive exercise on
horseback, long continuance in the standing posture,
or in certain other constrained positions, protracted
bowel complaints, general debility, dyscrasias, sedentary habits, indulgence in highly seasoned food, wines
and liquors.
Therapeutics.-The first object with the physician in
the treatment of hoemorrhoids, should be to ascertain
the cause or ca.uses upon which the malady depends,




CONNECTED WITH THE DIGESTIVE SYSTEM.    301
so that immediate and efficient measures may be
taken to remove them. In a majority of instances the
disease is unquestionably connected with constipation;
which should therefore receive a due share of attention. Nothing can remove the torpid condition of the
bowel, upon which the constipation depends, unless all
indurated feecal matters be removed daily, in order
that sufficient time may elapse to enable the debilitated parts to recover their impaired tone. The first
step necessary to secure this result, is to adopt suitable
dietetic regulations. In many instances this alone
will suffice to regulate the bowels, and thus to remove
all traces of the haemorrhoidal affection. Amongst
the articles of food which we particularly commend
in these cases, is bread made from unbolted wheat. A
liberal and daily use of this highly nutritious substance,
and of other articles of a similar character, with an
occasional indulgence in ripe and wholesome fruits,
will often surpass our most sanguine expectations in
abolishing diseases of the rectum. Should these simple means alone prove ineffectual after a thorough trial,
we may then call in the aid of enemeta of cold water.
This last resource will rarely disappoint us, provided
the'case is recent, and the cause has not been very long
in operation.  When the hemorrhoidal tumours are
much inflamed and very painful, great service will frequently be derived from external applications of cold
water, and in some instances, of ice enclosed in a linen
cloth, and applied to the parts as long as may be
deemed expedient. In troublesome cases of prolapsus
ani, also, these applications and injections will sometimes afford prompt relief.
The medicines which are entitled to the highest consideration in the complaints under consideration are,
nux vomica, sulphur, trhu s toxicod., srpia, bryonia, lycopodizlm,  opium, pulsarilla, aloes, carbo veagetabilis, and
calcarea carb.
Nux vonmica is appropriate when the disease has
been caused by inactive and sedentary habits, high
living, or the depressing mental emotions, and is attended by constipation, prolapsus, and general loss of
power over the muscular structure  of the rectum.




302     DISEASES OF THE ORGANS AND TISSUES
The second or third trituration may be employed —one
grain every night as long as is deemed expedient.
Sulphur is well adapted to cases occurring in individuals tainted with syphilis, scrofula, psora, or mercury. If the piles bleed frequently and profusely, and
there exists considerable inflammation of the surrounding mucous membrane, with darting pains up the
bowel, tenesmus, discharges of mucus or of fecal matters mixed with blood and mucus, this medicine will
generally prove effective. It should be given at the
third attenuation —one grain morning and evening
until the desired effect is produced.
Rhus tox., in alternation with sulphur or nux, has
been eminently useful in piles and prolapsus conjoined,
which appeared to be connected with some latent impurity of the blood. We are accustomed to use the first or
second attenuations in these cases-giving a dose daily,
and changing the medicine every other week.
When the hamorrhoidal tumours protrude, and are
inflamed, red and painful, with profuse heemorrhage
during each evacuation, we, may consider acid nit.,
acid mur., aloes, calcarea carb., and sepia.
If the disease arises during pregnancy, and constipation is unusually obstinate, we advisepulsatilla, opium,
bryonia and platina.
Administration. —This malady responds most satisfactorily to the first, second, and third attenuations —
given in grain or drop doses once or twice in twentyfour hours.
SECTION XVII,
ACUTE HEPATITIS.-INFLAMMATION OF THE LIVER.
Diagnosis.-When the disease occupies the convex
surface of the liver, we shall have fulness and severe
pain in the region of the liver, increased on pressure,
either of a sharp, aching, or burning character; pains
extending into the chest, under the clavicle, between
the shoulder blades, into the top of the right shoulder,
and sometimes down the arm; short, dry cough;
dyspncea; difficulty in lying upon the. left side; hot
and dry skin; thirst; scanty and high. coloured urine;
constipation; clay-coloured evacuations; full, hard,




CONNECTED WITH THE DIGESTIVE SYSTEM.   - 303
and frequent pulse; headache, and more or less mental disorder. If the inflammation is in the concave
portion of the liver, we shall have, in addition to the
symptoms already enumerated, distressing nausea and
vomiting; tongue covered with a white or yellow fur;
bitter taste; urgent thirst; an aggravation of the pain
in the hypochondrium on pressure; urine scanty, and
of a dark yellow or saffron colour; eyes and skin
tinged with yellow; bowels constipated or relaxed;
pains in the back and limbs; ideas confused; mind
clouded or delirious.
In most instances of acute hepatitis, it is highly
probable that the peritoneal covering of the liver is
implicated to a greater or less extent, and this may
serve to render the pains more severe, and the accompanying symptoms more violent.
CHRONIC HEPATITIS.
Diagnosis.-The symptoms of chronic liver complaint are somewhat similar to those of the acute
form, but much more mild in their character. For
example, the pain in the right hypochondrium is dull,
heavy, and dragging, that in the shoulder and arm of
a vague and heavy kind; the skin is somewhat hot
and dry; the tongue furred; the countenance and
albuginea yellow; the urine and perspiration of a
dark or yellowish colour; the bowels costive, sometimes alternating with relax; evacuations light; occasional cramp-like pains in the stomach; great
weakness and loss of energy throughout the entire
system; inclination to sleep a good part of the time;
trembling of the knees on the slightest exercise; dejection and indifference to life; enlargement and induration of the liver.
Causes.-This is a disease of hot rather than of
temperate latitudes, and may arise from a too free use
of animal food, stimulating drinks, and other articles
abounding in carbon. As the blood passes through
the liver, its office is to separate the carbon, &c.,
which is not wanted in the system. We can, therefore, readily perceive how prone this important organ
must be to be overtasked, in so rarefied a temperature, unless the utmost care is taken to retain the or



304     DISEASES OF THE RESPIRATORY ORGANS.
gans in a healthy state, as well as to avoid highly
seasoned animal food, stimulants, &c.
The chronic form of hepatitis often follows, and is
a consequence of dyspepsia. Indeed, there are but
few, if any, cases of the latter disorder, which are
entirely unattended with derangement of the liver.
Want of exercise, depression of spirits, misfortune,
sudden suppression of perspiration, accustomed discharges, &c., may often exercise a powerful influence
in inducing this disease.
Therapeutics.-Aconite, mercurius, china, eupatorium,
pejfoliatum, nux vomica, bryonia, sulphur, conium, taraxacum, pulsatilla, lachesis.
Administration.-The medicines may be used from
the first to the sixth attenuations, and repeated, in
acute cases, every two, four, or six hours according to
circumstances. In chronic hepatitis, a dose of the
appropriate specific should be given once or twice in
the twenty-four hours, at the same time inculcating
the importance of rigid dietetic regulations.
In chronic hepatitis, there is a peculiarly dry and
harsh state of the skin, and on this accountwe strongly advise the daily use of cold sponging, or bathing, to
be followed by vigorous exercise, in order that the
pores may be opened, and -the cutaneous functions
thus restored.
CHAPTER XXIlI.
DISEASES OF THE RESPIRATORY ORGANS.
GENERAL OBSERVATIONS,
In all of our investigations touching affections of
the lungs and tet*  appendages, whether acute or
chronic, a few preliminary inquiries are essential, in
order that we may be able to arrive at accurate opinions respecting the seat, nature, treatment, and probabia termination of each particular case. Although




.DISEASES OF TIlE RESPIRATORY ORGANS.    305
we are to be governed, as a general rule, by symptoms,
yet certain constitutional or accidental peculiarities,
connected with a given train of symptoms, might induce us to select one specific in preference to another,
which was equally homeopathic to the disease. Thus,
cough, copious expectoration, pains in the chest, and
tickling in the throat, &c., which had followed immediately upon the suppression of some chronic eruption,
might be completely covered by bryonia, ipecacuanha,
phosphorus, phosphoric acid, staphysagria, silicea, &e.,
so far as the mere symptoms are concerned; but who
would not prefer, in cases of this description, sulphur,
or some other specific which would have a tendency
to reproduce the eruption, while, at the same time, it
would be perfectly homeopathic to these indications?
So in regard to temperament, habits of life, occupation, medicinal symptoms, age, sex, climate, &c., our
remedies should always be selected in such a manner
as to bear upon any occult miasm, or other latent
cause which may be operating upon the organism,
and thus either directly or indirectly aggravating and
complicating the apparent symptoms.
When called to treat lung diseases, therefore, let
the physician inquire, first, Is there any hereditary predisposition on the part of the patient to scrofula, consumption, dropsy, erysipelas, nettle-rash, syphilis, &c.?
Second, Is the chest well developed and symmetrical, so
that the lungs can have ample room to perform their
functions? Third, Is the subject, during health, put
out of breath by slight exertion? Fourth, Has the malady supervened on, or shortly after the disappearance of an eruption? Fifth, Do all parts of the chest
dilate equally and properly during inspiration, and is
the respiration natural during health?
Respecting this last question, it is proper to observe
that a difference of opinion exists amongst authors,
Laennec considering respiration natural "when the
anterior and lateral parts of the chest dilate equally,
distinctly, yet moderately, during inspiration, and
when the number of inspirations, in a state of repose,
is from twelve to fifteen in the minute;" while Andral, Broussais, Miller, Forbes, and others, suppose
that Laennec has placed the mean number of inspi



306    DISEASES OF THE RESPIRATORY ORGANS.
rations too low. These gentlemen assure us that the
"' mean average of respirations is more than sixteen
or eighteen in the minute, in the healthy adult, and
that most persons in health breathe from eighteen to
twenty-four times in a minute." From much observation in reference to this subject, we are disposed to
adopt the opinion of Laennec, rather than that of
Andral, &c., and therefore estimate the mean number
of respirations in a healthy adult at fifteen or sixteen
in a minute.
We beg leave in this place to recommend, in strong
terms, the use of auscultation and percussion in the
investigation of chest diseases, if for no other reason
than to form an accurate diagnosis and prognosis. In
order to acquire skill in the use of the stethoscope,
percussion, &c., a patient and careful course of study
and practice upon both healthy and diseased subjects,
is indispensable. By this means, the physician will be
able to pronounce with certainty the seat and nature
of the malady, and its probable termination. As we
advance in our descriptions of the different affections
of the respiratory organs, we shall point out the peculiar sounds elicited by percussion and auscultation,
in the several varieties of disease.
SECTION I.
CATARRH, CORYZA, OR COLD.
Diagnosis. —This disease consists of an inflammation of the mucous membrane lining the frontal
sinuses and the nostrils. It usually commences with
lassitude, a sense of coldness, slight shiverings, sneezing; dull and heavy feeling in the head, succeeded in
a short time by lachrymation; more or less obstruction in the nose; sense of fulness, or pain in the
region of the frontal cavities; swelling or inflammation of the nostrils; nose dry and tender, or constant
discharge of mucus, of a mild, burning, or corrosive
character; eyes inflamed, watery, and sensitive to
light, buzzing, or roaring in the ears; drowsiness,
heaviness, and dull pains in the head; chills, alternating with flushes of heat; pains and soreness in the
limbs and bones; thirst, worse in the night; cold




.DISEASES OF THE RESPIRATORY ORGANS.    307
sores upon the lips; stupid, languid, and indifferent,
or irritable and ill-humoured.
When the inflammation extends to the mucous
membrane of the throat, larynx, and trachea, it has
received the name of
INFLUENZA, (INFLUENZE DELL ARIA,) OR, INFLUENCE OF
THE COLD.
In addition to the symptoms just enumerated, we
have, febrile symptoms; hoarseness; severe cough,
either dry and racking, or hollow and loose; wheezing,
or difficult respiration; impaired appetite; soreness,
oppression, or stitches in the throat and chest on
coughing; incapacity for mental or physical exertion;
bowels constipated or relaxed.
Sometimes the inflammation appears to extend to
the membrane of the thorax and of' the bronchial
tubes, giving rise to sharp, stitching pains, or a sensation of rawness in these parts, severe and painful
chest cough, thick, tenacious, and semi-purulent expectoration, oppression of the chest, and difficult respiration. In these instances, the inflammation is of a
lower grade than obtains in acute bronchitis, pleuritis,
or laryngitis, and, consequently, the symptoms are
more slight and less dangerous. In some cases, the
disease commences with soreness and burning in the
scorbiculus cordis, which gradually extends to the
chest and throat, nose and head, when coryza, obstruction of the nose, and other signs of influenza,
manifest themselves.
Therapeutics.-The chief remedies are, nux, arsenicum, mercurius, dulcanmara, ammonium, carbon, ipecacuanha, causticum, belladonna, bryonia, pulsatilla, chlamomela. When the complaint is attended with marked
febrile excitement from the first, our treatment should
always commence with aconite; but when the local
symptoms manifest themselves without much constitutional disturbance, we may commence with the appropriate local specific immediately.
For common cold, with evening chills, sneezing,
free discharge of thick, yellow, green, or offensive
matter, loss of smell, taste, and appetite, pain and
fulness in the region of the frontal sinuses, pulsatilla
is specific.




308    DISEASES OF THE RESPIRATORY ORGANS.
Drs. Shue and Taft have found tartar emetic, at the
first or second attenuation, the most efficient remedy
in the early part of the influenzas which usually prevail in this region.
Nux vomica, ipecacuanha, and arsenicum, will also
be found appropriate in many instances of the complaint, as it occurs in this latitude.
My friend, Dr. Shue, has employed sabina with
excellent success in several cases of chronic catarrh
occurring in females. The cases which have responded
the most promptly to this remedy, have been those in
which the catarrhal discharge appeared to alternate
with leucorrhoa, disappearing when the fluor albus
was profuse, and returning again at every suppression or material diminution of the discharge.
If hoarseness be an attendant symptom, and proceeds from an inflammation of the. mucous membrane
of the larynx, causticum, bryonia, capsicum, carbo veg.,
mercurius, rhus tox. and belladonna are our best remedies.
When the hoarseness has arisen from loss of tone
of the nerves of the throat, an alternation of carbo
veg. with nux vom., will usually prove curative. Belladonna, causticum, and mercurius will also occasionally demand our attention.
" Hoarseness, with bruised and pricking sensation
in the larynx, coryza, moist cough, pain in the chest,
and complete loss of voice, responds to pulsatilla."Croserio.
Administration.-We usually prescribe from the first
to the third attenuations; the doses to be repeated, in
severe cases, once in two to four hours, according to
circumstances, and in chronic cases, once or twice
daily.
SECTION II.
CYNANCHE TRACHEALIS.-CROUP.
Until the present century this disease was confounded with hooping cough, asthma, and bronchitis, and
the fatal cases were supposed to be violent forms of
-one of these maladies.
In the hands of the allopath, croup has ever proved




DISEASES OF THE RESPIRATORY ORGANS.    309
a most formidable and fatal disease. Acting, in the
application of their remedial measures, only indirectly
upon the part affected, by venesection, leeches, blisters,
emetics, mercurial cathartics, expectorants, &c.,it is
not a matter of surprise that they are so often baffled
in subduing a malady of so violent a character as the
one under consideration.
It is especially in diseases of this nature, that the
truth and value of a system of practice may be satisfactorily tested; for it is here that a prompt, efficient,
and specific remedy is imperatively demanded, in order
that the progressing inflammation may be at once arrested, and the patient saved. These are the cases
which try the truth and soundness of a theory: which
convince the public, —who appreciate facts, if they do
not comprehend abstruse theories-which school possess the knowledge and skill that should command
approbation and support. On the result of these tests
we are willing to rest the claims of homceopathy.
Indeed, the records of the homceopathic practice show
conclusively a large balance in its favour, over the
other systems, in all maladies of an acute as well as
chronic character.
Croup rarely' occurs after the age of seven years,
and may therefore be accounted a disease almost peculiar to childhood. Its seat is the mucous membrane
of the larynx, trachea and bronchia, and sometimes
of the fauces and palate.
Diagnosis.-Croup may with propriety be divided
into two principal varieties, viz.: first, the false,
pseudo, or non-membranous; comprising, however, under this head, the spasmodic, catarrhlal, and slightly
inflammatory kinds; and second, the true, or menzbranous croup.
Some recent writers have distinguished four distinct
varieties, each one forming a distinct and independent
disease, and not liable to run into either of the other
forms.
It is doubtless true that these several varieties do
often exist as distinct and clearly defined maladies,
and that the remedies homceopathic to these varieties
are also entirely distinct, but we are by no means certain that the different forms do not run into each other.




310     DISEASES OF THE RESPIRATORY ORGANS.
Be this as it may, it is of importance that an accurate knowledge should be acquired respecting the
seat, nature and symptoms of the malady in all its
forms, so that we can exhibit without delay a remedy
which shall be truly specific and homnopathic. First,
False or non-membranous croup.
Spasmodic croup usually makes its appearance suddenly, with considerable difficulty of breathing, noisy
and wheezing inspirations, a short, dry, hoarse cough,
occurring but rarely, and an entire absence of febrile
symptoms.
Catarrhal croup also commences suddenly, with a
"croupy cough, hoarse voice, shrill, wheezing, and
sonorous inspirations, oppression and tightness at the
chest, and sudden attacks of dyspncea; but in a few
days the croupy character will wear off of itself, leaving
simple catarrhal symptoms only."-( Watson.)
In the simple inflammatory croup, in addition to the
loud, harsh, and wheezing respiration, and hoarse,
croupy cough, we have usually sore throat, some thirst,
and nightly febrile exacerbations. This, like the preceding variety, will often wear off spontaneously,
leaving only some slight symptoms behind.
An important peculiarity of all the varieties of false
croup, consists in the suddenness of their attacks.
Children may retire to their beds in the most perfect
health, and yet in an hour or two be disturbed from a
sound sleep with an apparently alarming attack of
croup. It is important, however, that all should be
aware that these seemingly dangerous cases are much
less to be dreaded than those which make their appearance in a more slow and insidious manner, as will
be seen by the following description of the true croup.
In all of the varieties above described, although there
may be very difficult, laboured, anxious, and wheezing
respiration, hoarse, harsh, and croupy cough, hoarse
voice, and the patient may seem to be in imminent
danger of suffocation, yet the fact that the attack has
occurred suddenly, and that the cough bears no resemblance to the dreadful metallic cough of real croup,
will afford us sure indications of its nature, and enable
us to assure those interested that the attack will
speedily be subdued.




DISEASES OF THE RESPIRATORY ORGANS.    311
Second, True or membranous croup is usually ushered
in with the ordinary symptoms of catarrh, as chilliness,
sneezing, some soreness of the throat, hot skin, thirst,
slightly accelerated pulse, hoarse voice, and some little
impediment in respiration. At this period a whistling
or " buzzing sound may be heard at the rima glottidis,
by placing the ear upon the back of the neck, or over
the larynx."-( Ware.) Even at this early period the
commencement of the false membrane may be observed upon the tonsils, and sometimes upon the uvula
and pharynx, which gradually increases in thickness
and strength unless the peculiar inflammation be arrested.
As the disease advances, the febrile symptoms increase, the respiration gradually becomes more laboured and difficult, the inspirations, particularly after
coughing, being slow, sawing, sonorous or ringing,
while the expirations are quick, the cough is dry and
gives forth a metallic sound, the voice becomes more
shrill, the pulse is frequent and small, the expression
of countenance swollen and anxious, the head is thrown
back, the extremities are cold, while the rest of the
body retains its exalted temperature, there is often a
profuse perspiration, until finally the respiration is so
much impeded that the blood is but slightly oxygenated, the cheeks and lips become livid, the eyes red and
sunken, the pulse extremely small and frequent, the
whole organism prostrated, and the child expires in a:
state of asphyxia or suffocation.
In membranous croup the inflammation is of a peculiar character; for from the very commencement
of the attack, the mucous membrane continues to pour
out coagulable lymph, which becomes adherent to the
parts affected, forming the tough artificial tube known
as the false membrane. We believe that the progress
of this fictitious formation is never entirely arrested
until a healthy medicinal inflammation is made to
supersede the peculiar morbid action..
"' The false membrane which so frequently forms on
blisters, is, of itself, sufficient to prove that it is much
less to the degree than to the nature of the inflammation, that we are to attribute this concretion or coagulation of pus in certain cases." —(Laennec.)




31-2    DISEASES OF THE RESPIRATORY ORGANS.
Causes.-A  cold and damp atmosphere, wet feet,
and exposure to the air which blows from seas and
lakes. It appears to be necessary also that there
should be a certain predisposition on the part of the
patient, in order to contract the disease, since all of
the children of some families are constantly liable to
its attacks, while those of other families, constantly
exposed to precisely the same influences, are exempted.
This predisposition may frequently be traced back
through several generations, while in other families
the reverse is true, no instances of the malady having
ever been known to exist in them. Croup sometimes
follows as a sequence of scarlatina, measles, &c., and
has by some writers been confounded with the former
disease, and from this circumstance has originated the
idea of its contagious nature.
Therapeutics:
Spasmodic croup.-Aconite, spongia, hyoscyamus,
belladonna, nux, musk, cuprum, ipecacuanha, camphor
and lobelia inflat.
Catarrhal croup. —Aconite, tartar emetic, spongia,
hepar sulph, drosera, lachesis, sambucus, chamomile, and
nux.
Simple inflammatory croup.-Aconite, spongia, hepar,
tartar emetic, phosphorus, iodine, and belladonna.
True or membraneous croup.-Ka li, bichrom, bromine,
ammonia caustic, kepar sulph., argentum nit., sambucus,
spongia and iodine, senega, tartar emetic.
We introduce the following excellent indications for
the employment of spongia, hep. sulph., bromine, caustic
ammon., bichrom, and potash, arranged by several homceopathic physicians in Pressburgh, and translated
by Ch. J. Hempel, M. D., for the Homoceopathic Examiner.
SPONGIA —CROUP.
"Hollow cough; with expectoration; with pain in
the chest and -trachea; roughness in the throat;
(night-cough with weeping expression); breathing aggravated, as from a plug in the throat, slow or quick;
panting; larynx painful, as if from pressure-worse
when touched; scratching, burning, and constrictive
sensation in the larynx; painful feeling of swelling in




DISEASES OF THe RESPIRATORY ORGANS.    313
the cervical glands near the larynx and trachea;
stinging in the throat and sensation in the outer
parts of the neck, as if something were pressing out,
morning and evening; painful tension, on the left side
of and near the apple of Adam, when turning the
head to the right side; the eyes are sunken; the urine
deposits a thick, grayish-white sediment; general
morning sweat; pulse quick and hard; drowsiness;
lassitude of the whole body; out of humour; everything puts him out of humour, even talking and answering questions."
HEPAR CROUP.
"Violent fits of cough, as if one would slffocate or
vomit; deep; occasioned by tightness of breathing;
husky, accompanied with painful soreness of the
chest at every turn of cough; violent; the air rushing
violently against the larynx, which causes a pain in
that part; scraping; scratching; with mucous expectoration; the cough being occasioned by titillation
in the throat, or by a scraping in the trachea;
increased unto vomiting by a deep inspiration;
weakness of the organs of speech and chest, preventing her from talking aloud; short breathing;
pressure in the throat, occasioning a constrictive feeling, as if he should be suffocated; urine pale, clear
while being emitted, afterwards becoming turbid and
thick, depositing a white sediment: or flocculent, turbid while being emitted: dark-yellow: burning during emission; great, unconquerable drowsiness; profuse sweat day and night; viscid, profuse night sweat;
sweat before midnight; sad; apprehensive; inclined
to weep."
BROMINE CROUP.
"Formation of pseudo membrane in the larynx and
trachea; spasm in the larynx occasioning suffocation;
cough with croup-sound, hoarse, wheezing, fatiguing,
not permitting one to utter a word; accompanied with
sneezing; with violent suffocative fits; respiration
characterized by mucous rattling; wheezing; alternately slow and suffocative, and hurried and superficial; laboured; painful; oppressed; gasping for air;
14




314    DISEASES OF THE RESPIRATORY ORGANS.
heat in the face; increased secretion of urine; pulse
rather hard; slow at first, afterwards accelerated."
CAUSTIC AMMONIA CROUP.
" Deep, weak voice; fatiguing, interrupted speech;
increased secretion of mucus in the bronchi; violent
cough, with copious expectoration of mucus, especially
after drinking; difficult, rattling, laboured breathing;
stertorous breathing; suffocative fits; spasm  of the
chest."
DICHIROMATE Or POTASH CROUP.
"Symptoms approach gradually-and insidiously; at
first, slight difficulty of breathing when the mouth isclosed; slight elevation of temperature; pulse irregular and intermittent, or frequent and small; as the
disease progresses, the difficulty of breathing increases; the sound of the air as it passes through the
trachea is shrill, whistling, as if it passed through a
metallic tube; voice hoarse; cough not frequent, but
hoarse, dry, barking, and metallic; deglutition painful;
tonsils and larynx red, swollen, and covered with an
appearance of false membrane; after a time, breathing affected in part by the action of the abdominal
muscles, and those of the neck and shoulder-blades;
head inclined backwards; breath offensive; finally,
diminished temperature  of the skin; prostration;
stupor."
The medicines, of which the pathogenetic symptoms
we have here detailed, are those which are most
completely specific against croup. It is true that the
other articles alluded to, as aconite, iodine, belladonna,
nux, hyoscyamus, sambucus, tartar emetic, lachesis, phosphorus, drosera, arsenicum, &c., cover many of the
symptoms- usually present, especially in non-membraneous croup, bhut they cannot be considered positive and reliable specifics against the disease fatily developed. So far, however, as certain special indications are concerned, these medicines may oiten be employed with very great advantage.
The following is Dr. Bosh's method of` trea a;iiicroup:' If the disease begins, as it frequently does,
w.ith an inflammatory fever, then I give first, accord



DISEASES OF THE RESPIRATORY ORGANS.    315
ing to circumstances, every quarter to half hour, one
to two drops of aconite (the dilution second or third,
depending upon the age), and then I let the child rest
from one to two hours, when I give the remedy, which
I found in my practice to be the main remedy, spongia,
first, second, or third dilutions, according to the severity of the disease; eight drops in four ounces of
water, of this every quarter to half hour, or, in less intense cases only every hour, half a table spoonful. If
the disease has proceeded further, and paralytic signs
are perceptible (by continued obstruction of the respiration, congestions to the brain, &c.), then I give
spongia alternately with phosphorus.  If, notwithstanding these means, the disease increases, I give
spongia in alternation with tartar stibiatus."
Tartar emetic is not only useful in the early stage of
croup, but it is also indicated when there are signs indicative of partial paralysis of the pneumo-gastric
nerve, viz., face livid and cold; cold sweat on the
forehead or body; respiration exceedingly difficult,
short, hoarse, shrill, or whistling; head thrown back;
pulse small and rapid, or feeble and slow; great
weakness, anxiety, and uneasiness; difficulty in swallowing; short, hoarse, and barking cough; disposition to sleep. The remedy should be given in the first
attenuation, and the dose repeated every twenty or
thirty minutes, until relief is obtained.
In spasmodic croup, Dr. Dunsford relies upon aconite,
hyoscyamus and belladonna.
When, in addition to high febrile excitement, the
local croupy symptoms are urgent, we must alternate the proper local specific with aconite. In this
way we may often give spongia, or hepar sulph. and
aconite advantageously in the first instance, or tartar
emetic and aconite. When the disease obstinately resists aconite, spongia, hepar sulph., tartar emetic, both
alone and in alternation, we may consult phosphorus,
lachesis, sambucus, senega pol., &c.
As we progress in the knowledge of medicinal substances, a still greater number of pure specifics will
undoubtedly be added to our Materia Medica.
Before taking leave of this subject, we ask attention
particularly to the employment of one remedy pre



_16    DISEASES OF THE RESPIRATORY ORGANS.
viously named, for the cure of membraneous croup.
We refer to the nitrate of silver as a direct application
to the affected membrane. For some years, we have
been in the habit of employing a strong solution of
this salt, by means of a sponge moistened with it
and introduced into the larynx; and in several instances the most satisfactory results have followed.
This remedy has been used to a considerable extent
by French allopathists, and within the last few years
by a number of American physicians, and in many
cases they have saved life when every other means
had failed. The principle on which it cures, however, is strictly homeopathic, for it is due solely to
the medicinal, of artificial action of the remedy, that
the morbid croupy inflammation is superseded, and the
false membrane gradually destroyed and expelled.
It may be used in any stage of true croup, and will
sometimes succeed in effecting a cure when every internal remedy has failed.
A little tact will enable the physician to apply the
solution to the larynx, or trachea, in an efficient manner, and with perfect safety. For minute directions
upon the subject, the reader may consult " Trousseau
and Belloc," and Dr. Green's work upon Bronchitis,
&c., published in New York.
Administration. - In the treatment of croup, we
generally employ the lower potencies. In regard to
the repetition of doses, no definite rules can be given,
but the practitioner must be guided by the variety of
the disease, the severity of the symptoms, and the
effects of his remedies.
SECTION 1II.
ACUTE BRONCHITIS.
This complaint is of most frequent occurrence in old
age and in childhood. Its seat is in the mucous membrane of the bronchia, but authors assure us that the
bronchial inflammation is always accompanied with
considerable "sanguineous congestion of the lungs."
Effusion into the substance of the lungs, is peculiarly
apt to occur in this disease, and it is to this circumstance that its danger is to be attributed.




DISEASES OF THE RESPIRATORY ORGAN,.    317
Diagnosis.-Constriction and aching sensation, extending over the whole chest; breathing very much
oppressed, quick, anxious, irregular, laboured; the
voluntary muscles of respiration often called into
play; expectoration at first dry, soon becomes viscid
and frothy, and sometimes streaked with blood; more
or less cough, hoarse and painful in children;
throbbing pain in the forehead and aching pain in the
eyes, aggravated on coughing; face red or pallid;
tongue moist, and covered with a white fur; bowels
costive; temperature of the skin nearly natural, but
sometimes hot and dry; pulse at first but little increased in frequency, becoming, as, the disease advances, very rapid; urine scanty and high coloured;
vertigo; rattling in the throat and chest; wheezing
respiration. As the malady approaches towards a fatal
termination, the skin becomes suffused with a cold per-spiration; the cheeks and lips pale and livid; the extremities cold; rattling and sense of suffocation in the
throat; extreme prostration and complete insensibility.
The peculiar respiration (the mucous rale or rattle
of Laennec) which is so apparent in bronchitis, is owing to the " passage of air through the diseased secretion of the air-passages, and may be heard by placing
the ear to the chest, long before it becomes so severe
as to be distinguished by any other means."-McIntosh.
The inflammation in bronchitis is of a much more
intense character than that which is present in catarrih
or influenza, and there is always more or less sanguineous congestion of the lungs. Many of the more urgent symptoms of the complaint are due to this last
circumstance, like the great difficulty of breathing;
the painful sense of tightness; stricture and oppression in the chest; wheezing respiration; severe cough;
pallid countenance; vertigo; pain in the head, &c.
During the progress of this disease, the substance of
the lungs often becomes hepatized.
CHRONIC BRONCHITIS.
Chronic bronchitis is at the present time an exceedingly common and fashionable disease. From the
fact of its occurring for the most part in clergymen,




318     DISEASES OF THE RESPIRATORY ORGANS.
lawyers, and other public speakers, it has acquired
" caste," and therefore, it may be that every slight affection of the respiratory apparatus is now denominated bronchitis. It occurs at all periods of life, and in
general, is insidious in its approach, though it occasionally succeeds to acute bronchitis.
When the disease follows an acute attack, the patient will be left with some cough; expectoration of
viscid or puriform sputa; dyspnoea on the slightest exertion; nocturnal exacerbations of fever; emaciation,
and in some instances hectic symptoms.
The stethoscope usually gives us the sound of the
crepitous ronchus at certain points, and now and then
over the whole chest, while at the same time the respiratory murmur may often be heard.
Those cases which come on more insidiously, will
be often found complicated with chronic laryngitis, indicated by hoarseness of the voice; raw or scraping
sensation in the larynx, and extending over the chest;
copious expectoration of' opaque or purulent sputa,
which affords relief to the patient; hoarse, hollow, and
painful cough; increased susceptibility to changes of
temperature; night sweats, and general debility.
When the expectoration is copious, we shall have
the crepitous ronchus, either at isolated points or over
the whole chest; but if there is no expectoration, then
the sound which will be elicited by auscultation, resembles snoring, and has been termed " dry sonorous
rattle;" or in some instances, the " sibilous rattle," like
the chirping of birds. Laennec also mentions a " clicking" sound, which he compares to the action of a valve.
Percussion affords us nq aid in our investigations of
bronchitis, but pressure with the hand upon the chest,
will often enable us to detect the mucous rattle without difficulty.
Causes.-Protracted exposure to cold; alternations
from heat to cold; inhalations of dust and other irritative substances; insufficient clothing, and improper
exposure of the throat and neck, after much talking,
public speaking, or singing.
We believe that one great cause of the very frequent occurrence of chronic bronchitis, may be
found in the reprehensible fashion of shaving the
beard. That this ornament was given by the Creator




DISEASES OF THE RESPIRATORY ORGANS.    319
for some useful purpose, there can be no doubt, for in
fashioning the human body, he gave nothing unbecoming a perfect man, nothing useless, nothing superfluous.
Hair being an imperfect conductor of caloric, is admirably calculated to retain the animal warmth of
that part of the body which is so constantly and necessarily exposed to the weather, and thus to protect
this important portion of the respiratory passage from
the injurious effects of sudden checks of perspiration.
When one exercises for hours his vocal organs, with
the unremitted activity of a public declamation, the
pores of the skin, in the vicinity of the throat and
chest, become relaxed, so that when he enters the
open air, the whole force of the atmosphere bears upon
these parts, and he sooner or later contracts a bronchitis; while, had he the flowing beard with which
his Maker has endowed him, uncut, to protect these
important parts, he would escape any degree of exposure unharmed.'The fact that Jews and other people who wear the
beard long, are but rarely afflicted with bronchitis and
analogous disorders, suggests a powerful argument in
suppo't of these views.
Therapeutics.-The medicines most worthy of consideration in the treatment of acute and chronic bronchitis, are, aconite, tartar emetic, belladonna, bryonia,
hepar sulphur, carbo vegetabilis, spongia, ammonium
carb., rhus tox., mercurius, sulphur, sambucus, arsenicum, digitalis, hyoscyamus, pulsatilla.
As in other inflammatory diseases, aconite is also indicated in acute bronchitis, whenever there is a rapid
and full pulse, hot skin, and other symptoms indicative
of a high state of febrile excitement. It may be given
at the second or third potency, and repeated every
hour until a decided amendment ensues.
Tartar emetic is indicated when there are severe
paroxysms of coughing, with suffocating obstruction
of respiration; wheezing respiration; mucous ronchus; very great shortness of breath, with anxious
oppression at the chest; great anxiety and agitation;
palpitation of the heart; pain in the back and loins;
pressure on the eyes; pains in the head; thirst.
Administration.-A grain of the first trituration of




320    DISEASES OF THE RESPIRATORY ORGANS.
tartar emetic, to four ounces of water-a teaspoonful
every one, two, three, or four hours, as the urgency of
the symptoms may demand.
In cases of acute bronchitis in which the predominant symptoms are, oppression and weight at the chest;
short, anxious and rapid respiration; shaking, spasmodic cough, and decided cerebral disturbance from
the commencement, belladonna is our most valuable
remedy.
Administration.-Like that of aconite.
The indications which point to bryonia, are, headache aggravated by movement; pressure in the eyes;
dryness in the throat; respiration difficult, short, and
anxious; pressure on the chest as if from a weight;
stingings in the chest; cough with stingings in the
chest, or with severe aching pains in the head. In the
acute attacks of children, with suffocative cough, very
great oppression at the chest, exceedingly difficult,
rapid, and anxious or sighing respiration, loud mucous ronchus, rapid pulse, hot skin, thirst, great
agitation and anxiety, this remedy is also especially
called for.
It may be exhibited at the first to the sixth potency,
and frequently repeated until the disease subsides.
The practitioner may sometimes alternate it with
aconite, with benefit. Pulsatilla is indicated in bronchitis when the cough is dry in the first part of the
complaint, but soon becomes moist, "with easy expectoration of abundant yellow and bitter, or saline
and disgusting matter; sometimes with nausea or
retching, or a sensation of reversion in the stomach, as
if about to vomit. The cough occurs principally at
night, on lying down; proceeds from a tickling or
itching in the larynx, or by scraping and dryness in
the trachea, accompanied with fatiguing pains in the
abdomen, and stitches in the back, shoulders, sides, or
chest, and relieved on rising up in bed."-(Croserio).
It may be given in the same manner as bryonia.
In chronic bronchitis, characterized by anxious,
hoarse, and wheezing respiration, much aggravated
on lying down; attacks of suffocation, which force the
patient to throw the head back, in order to take
breath; dyspncea; dry, rough, and hollow cough;




DISEASES OF TIE RESPIRATORY ORGANS.    321
cough, with expectoration of mucus; hoarseness of
voice; exacerbations of' fever in the after part of the
day, succeeded by night sweats, hepar sulph. is an
important specific. In cases which seem to have been
connected with suppression of salt rheum, or other
eruptive disease, or metastases of arthritic inflammations, this remedy should always be borne in mind.
It is also useful in those cases which threaten to
terminate in tubercular consumption.
The third trituration may be used: a dose from
two to four times in twenty-four hours.
When bronchitis is complicated with angina trachealis, we may resort to spongia tosta with confidence,
either alone or in alternation with hepar sulph. If
febrile symptoms run high, these remedies should be
preceded by aconite.
When suffocation is threatened from loss of tone
and power of the respiratory organs, rendering them
incapable of expelling the morbid secretions which
obstruct the free entrance of' air into the pulmonary
structure, ammonium carb., rhus tox., sambucus, arsenicum, digitalis, hyoscyamus, and stannum, are worthy of
careful examination. In making our selection from
these medicines, regard should not only be had to the
actual symptoms present, but to the temperament,
hereditary predisposition, and the remote cause of the
malady. For example, if in any given case the indications actually present, point equally to hepar
sulph. and rhus tox., but the attack was found to be
connected with a repelled eruption, our choice would
evidently rest upon the former medicine; while if
the disease was found to be dependent upon an
arthritic habit, rhus would be the appropriate remedy.
In the last stages of acute bronchitis, when there is
danger that the malady will run into the chronic
form, sulphur has been highly lauded by many eminent practitioners. If the disease occurs in persons of
lymphatic constitutions, and  subject to eruptions,
swelling of the glands, &c., this remedy can scarcely
be dispensed with during the progress of the attack.
For the profuse and debilitating sweats which now
and then occur during the continuance of the symp14*




322    DISEASES OF THE RESPIRATORY ORGANS.
toms, valuable specifics will be found in mercurius,
acid nit., and acid phos. Many physicians have commended carbo veg. in the strongest terms, in chronic
bronchitis, and it has doubtless effected many excellent cures. It may be used at the third attenuation,
one grain once or twice daily.
SECTION IV.
PNEUMONIA.-LUNG FEVER.
Diagnosis. —The symptoms of lung fever vary so
much in different cases, that an exact portrait, which
shall be recognisable in all instances, can hardly be
given. The signs, however, which are more particularly characteristic, may be enumerated as follows:
dull or deep-seated pain, or a tightness in the chest;
frequent short cough, with expectoration of a viscid,
tenacious matter, of a yellow, green, or pale colour,
sometimes tinged with blood; rapid and difficult
respiration; inclination for the most part to lie upon
the affected side, or the back; great heat of the skin;
headache; thirst; rapid and full pulse (though this
last symptom is by no means uniformly present, as
the disease sometimes runs on to a fatal termination
without any material change in the pulse); general
restlessness; urine scanty, very red, and sometimes
scalding. The character of the expectoration during
thie first stage of the malady is supposed by mmany to
afford a characteristic mark of the malady; and it is
from this circumstance that Lacennec has denominated
the sputa expectorated, pneumonic, or glutinous.
During the stage of hepatization, the sputa diminish
in quantity, become lighter in colour, and less transparent, until finally, when the third stage supervenes,
expectoration of almost a mucous character occurs.
Sometimes pneumonia is complicated by more or
less derangement of the biliary organs, when we shall
have superadded to the lung affection the symptoms
indicative of such derangement. This variety of the
complaint is termed bilious pneumonia.
M. Saucerotte recognises a kind of latent pneumonia, depending upon a certain peculiarity of constitution, entirely unlike ordinary pneumonia, and which




DISEASES OF THE RESPIRATORY ORGANS.    323
seems to commence by the second stage, or that of
hepatization.  His description of the disease is as
follows: First, "Premonitory symptoms, either entirely
absent, or of slight importance, consisting of lassitude,
with shivering, loss of appetite, and but little fever."
Second, " Symptoms. The temperature of the skin is
not sensibly augmented; the pungent heat of ordinary pneumonia seldom present; pulse usually but
little affected; respiration natural, and no pain in the
chest. Percussion always elicits a dull sound over a
considerable extent, and bronchial respiration is
audible over the same locality. In some cases, slight
crepitation may be heard around the hepatized spot."
Third. " Progress and duration variable. In some
cases we have seen the disease linger for six or seven
weeks. When the case terminates favourably, the
dulness gradually disappears, and the bronchial
souffle is replaced by crepitation; respiration  becomes more free, and the general aspect of the patient
improves.
Fourth. " Diagnosis.-Pleurisy is the affection with
which latent pneumonia is apt to be confounded. In
chronic pleurisy, however, there is more constantly a
pain in the side, and the region of the dulness varies
with the position of the patient. Apoplexy, and the
bulging of the intercostal spaces, shortly clear up the
diagnosis. The history of the case distinguishes it
from phthisis.
Fifth. " Causes;-For the most part, exposure to
cold."
Although Dr. Saucerotte is a practitioner of the old
school, his sole internal remedy in this affection is
tartar emetic, our own specific in similar cases.
Viewed anatomically, inflammation of the substance
of the lungs presents, according to Laennec, three different degrees, or stages, which he designates, first,
engorgement, or congestion; second, hepatization;
third,purulent infiltration.
In the first degree, the lung loses in a measure its
crepitous feel, is of a livid colour, and more solid than
natural.
In the second degree, the lung presents the appearance of liver; it is not crepitous, is heavier than in




324     DISEASES OF THE RESPIRATORY ORGANS.,
the first degree, and shows a granular appearance when
cut into, or torn asunder. Laennec, Andral, and Louis,
suppose this hepatization to be owing to the conversion of the air-cells into solid grains, by the hardening of a concrete fluid, which is poured out (luring
the inflammation; while Dr. Williams supposes that
" these granulations contain no viscid mucus, but consist of little bunches of vesicles, which have been obliterated by the swelling of their membranous tunics,
and the enlargement of their blood vessels."
In the third degree, the external appearance of the
lung is similar to that of the second degree, but of a
lighter colour. The same heavy, hard, and granular
character obtains, but when the lung is cut into, a
yellowish and purulent matter makes its appearance.
As the disease advances, the granular condition disappears, and purulent abscesses take its place.
The phenomena elicited by auscultation and percussion, during the stage of engorgement, are the crepitous rhonchus, the respiratory sound being yet audible,
and the ordinary healthy sound on percussion.
As soon as hepatization has occurred, percussion
over the affected part yields a dull sound, and neither
the respiratory murmur nor the crepitous rhonchus
can longer be heard. There are certain other sounds,
like bronchophony, a kind of blowing, &c., which
may exist in certain cases of hepatization, but these
signs are so vague and uncertain. tbat immense practice is requisite to enable the physician to form an
accurate' judgment reseecting btem.
After the third stage has existed a little time, andl
the pus begins to soften, the mucous rhonchus may
be heard in the bronchi. In some instances the pus is
not expectorated or absorbed. b)ut iforms an abscess in
some part of the pulmonary'rissle,. We shall then
have a mucous rhonchus over i;he seat of the abscess,
also pectoriloquy, and what is termed a   b ronlchial
or cavernous cough."
WVhen the disease terminates favourablv, and resolution takes place. it will be found that the lungs
gradually and by successive degrees, return to their
original state, as is indicated by the diminution of the
erepitous rhonchus, and thue return of the natural re.




DISEASES OF THE RESPIRATORY ORGANS.    325
spiratory sound, when the inflammation had ceased at
the first stage; also by the reappearance of the crepitous rhonchus, &c., when the malady had progressed
to the second and third stages.
Causes. —Lung fever is a disease peculiar to temperate and cold latitudes, and usually occurs during
the winter months. The usual causes are, undue exposure to intense cold, sudden suppression of perspiration, epidemic influences, and the inhalation of noxious
vapours or gases. Laennec and Forbes assert that
pneumonia is sometimes induced by the bite of the rattle snake, (crotalus horridus,) and of other venomous
serpents; and that it may also arise from the " injection of various medicinal substances into the veins."
These assertions go far to prove a specific operation of
these substances upon the respiratory organs, and may
afford a valuable hint respecting their homaeopathic
application in pneumonia.
Therapeutics.-The prominent medicines for the
treatment of pneumonia, are. aconite, bryonia, belladonna, tartar emetic, phosphorus, ipecacuanha, sambucus,
sulphur, lachesis, rhus tox., arsenicum, mercurius, acid
phosphoric, arnica.
In the first stage of the disease, when symptoms indicative oan high grade of febrile excitement are present, as hot and dry skin, great thirst, rapid and hard
pulse, scanty and high coloured urine, &c., aconite and
belladonna may be given in alternation, until the inflammatory symptoms subside. These remedies are
often alone sufficient to break up the disease in this
stage; and even when they fail of effectimg a complete
cure, they generally moderate most essentially the
fever, and mitigate all the other symptoms.
If, after the subsidence of these symptoms, stitches
in the side, difficult and anxious respiration, and troublesome cough continue to harlass the patient, recourse must be had to bryonia.
When, however, the second stage, or hepatization
has occurred, indicated by dull sound on percussion,
bronchial respiration, &c., we should at once have recourse to tartar emetic or phosphorus.
The external indications which point to the use of
emetic tartar, are, dull sound on percussion; absence of




326    DiSEASES OF THE RESPIRATORY ORGANS.
the respiratory murmur, or bronchophony; skin cold,
and covered with a clammy sweat; considerable expectoration of a yellowish or brownish colour, and
mixed with blood; pulse small, soft and frequent;
tongue covered with a dry and dark fur, and perhaps
red at the edges.
Physical sensations.-" Great oppression and difficulty of breathing; cough loose, and accompanied
with rattling of mucus;"-(Miiller) —burning under
the sternum, and sometimes as high up as the throat;
sensation as if the chest were lined with velvet; want
of air and want of breath previous to the paroxysms
of coughing; also pneumonia biliosa, with gastric and
bilious symptoms, as yellow tinge of skin; yellow or
brownish fur upon the tongue; bitter taste; nausea
and bilious vomiting; yellow or dark urine; headache;
general sensation of lassitude and debility.
Mental and moral symptoms.-Anxiety; restlessness;
confusion of ideas; sometimes furious delirium.
Administration.-A grain of tartar emetic to six
ounces of pure water-a teaspoonful every one, two,
three or four hours as required.
Phosphorus has been highly extolled also in the
second stage of pneumonia, and in certain cases of
pleuro-pneumonia, where aconite and bryonia have
failed in effecting a cure. Dr. Fleischmann has used it
successfully in all stages of lung fever.
Buchner, Griesselich, Horner, Bosch, and Shellhammer, have employed it with advantage when the third
stage had set in with great prostration, livid or hippocratic countenance, sunken eyes, cold, viscid sweats,
tremulous and feeble pulse, dry and dark lips and
tongue, difficult expectoration of a brown or rust
colour, extreme anguish, subsultus tendinum, muttering
or furious delirium, with grasping at flocks, sense of'
suffocation, and involuntary stools.
Mfiller describes the special pathogenetic symptoms of phosphorus, having reference to pneumonia,
as follows:' Sticking and violent stitches in various
parts of the chest, left and right side, sometimes accompanied with burning, in rest and during motion,
especially when sitting and taking an inspiration;
pain in the chest, especially during an inspiration;




DISEASES OF THE RESPIRATORY ORGANS.    327
itching in the interior of the chest, with dry cough;
feeling of heaviness in the chest; anxiety in the
chest, with arrest of breathing, and beating in the
right side of the chest; great oppression of breathing;
great shortness of' breath; oppressive tightness, and
tensive sensation in the chest, as if a band were encircling it; tension and dryness in the chest; constrictive clawing and pressing in the upper part of
the chest; loud, rattling breathing; dry, hollow cough,
without expectoration; a sort of hacking cough, with
huskiness of the chest, and expectoration of some
mucus; cough, with expectoration of transparent
mucus, accompanied with tensive pain, and afterwards with sticking pain in the chest; fatiguing
cough, with white, tenacious expectoration; the expectorated mucus is streaked with blood; bloody expectoration, with mucus, accompanied with short,
slight cough; coughing up small clots of pus, with
smarting burning behind the sternum; sticking pain
in the pit of the stomach when coughing, compelling
one to lay the hand upon the pit; short breath after
every turn of cough."
From the above it will be seen that phosphorus includes a greater range of symptoms than tartar emetic.
In typhoid pneumonia, especially, it is often of distinguished service where hepatization has occurred, and
the symptoms point to the third stage.
Administration.-It may be employed at the first,
second, or third attenuation, and the dose repeated
according to circumstances.
In typhoid pneumonia, as well as in cases attended
from the first with great debility and prostration of
the energies of the system, rhus tox. will be found a
remedy of much efficiency, either alone, or in alternation with some other specific. Should the case be
complicated with pains in the chest or side, of a rheumatic character, rhus rad. may occasionally be employed with advantage. This medicine is usually
given after aconite and bryonia.
Sulphur is an important remedy in certain protracted cases of pneumonia occurring in psoric or
scrofulous subjects, and which threaten to terminate
in phthisis. Indeed, in most of those cases of chronic




328    DISEASES OF THE RESPIRATORY ORGANS.
pneumonia which seem to have arrived at a fixed
point, the patient neither improving nor apparently retrograding, we should always bear in mind this powerful antipsoric.
When the disease has reduced the patient, notwithstanding our remedies, to a state of extreme prostration, with very short breath on the slightest exertion,
dry and dark tongue and lips, extreme anguish, stitches
in the side, great thirst, diarrhmea, ringing and buzzing
in the ears, arsenicum is the proper remedy. In examples of this description, the remedy should be frequently repeated until a decided impression is produced.
If the pulmonary inflammation threatens to run
into gangrene, as will be indicated by fetid and greenish, or dark expectoration, arsenicum is appropriate,
as are also sometimes carbo veg. and china.
Pneumonia occurring in old and feeble persons, and
attended with symptoms showing a low grade of inflammatory action, will require the use of phosphorus,
ipecacuanha, sambucus, veratrum, nux vom., china, belladonna, lachesis, lycopodium, and cantharis.
Arnica is applicable in pulmonary inflammations
proceeding from mechanical injuries.
The symptoms of pneumonia and bronchitis combined, will be covered by tartar emetic, aconite, mercurius, phosphorus, capsicum, bryonia, carbo veg.,pulsatilla,
senega, and nux vom.
We usually select one of the low attenuations, and
repeat the dose once in two, three, or four hours, until
a marked impression is produced upon the symptoms.
SECTION V.
PLEURITIS.-PLEURISY.
Diagnosis. —This malady commences with lassitude,
chills, and other febrile symptoms, succeeded in a
short time by the following local phenomena: " The
stitch, dvspnwea, cough, and recumbency on the aft
iecte(l side."-Laennec. Dr. Wurm, of Vienna, maintains, however, that "the posture of the patient is
usually upon the back." The inspirations are short,
r:,pid, andi attended with severe sharp stitches, unless




DISEASES OF THE RESPIRATORY ORGANS.    329
the inflammation be very slight, in which case, but
little alteration will be observed in the breathing;
there is often experienced a sense of tightness and
oppression at the chest; there is generally little or no
cough unless the lungs or the bronchia are involved,
when there occurs a short and dry cough, with but a
small quantity of glairy expectoration, and very painful; the pulse is rapid and full; skin hot and dry;
urine scanty, and of a deep red or dark colour; the
pain is almost invariably confined to one side of the
chest, and increased by inspiration, coughing, and
movement; urgent thirst; great dyspncea; constant
inclination to lie upon the affected side or back; abdominal respiration, and pain in the intercostal spaces
on pressure. These symptoms are speedily succeeded
by others, which indicate that effusion has taken place.
Laennec, Johnson, and Mackintosh believe that effusion commences as soon as the inflammation is established; while others, equally eminent, contend that a
considerable period elapses before it occurs. But the
weight of testimony seems to be in favour of the opinion of the former gentlemen. Amongst the signs
which are characteristic of pleurisy with effusion,are,
increased size of the affected part of the chest, apparent to the eye, or by mensuration; also wgophony,
perceptible by the stethoscope from the commencement of the inflammation, or after a moderate quantity of fluid has been effused, disappearing when the
effusion becomes very large in quantity, and re-appearing as absorption takes place, and the liquid diminishes; dull sound on percussion, and failure of the,
respiratory murmur in the affected side.
Should the lungs happen to be involved, the sputa
will be tinged or streaked with blood, and more copious than in simple pleuritis. Other symptoms will
also obtain which characterize pleuro-pneumonia.
The effusion in pleurisy may be either of a plastic,
serous, or hemorrhagic character. The severity of
the febrile, and other symptoms, will depend upon the
rapidity of the effusion, and its quality and quantity.
Causes. —Atmospheric vicissitudes, sudden checking
of the perspiration, metastases of rheumatism, erysipelas, gout, &c., mechanical injuries, surgical opera



330     DISEASES OF THE RESPIRATORY ORGANS.
tions upon cancerous and scrofulous parts. We have
witnessed two cases of pleurisy which supervened as
a consequence of surgical operations. One of these
cases occurred after amputation of the thigh for a
malignant disease of the leg, and proved speedily
fatal. The other case came on about two weeks
after excising a large fungous tumour from the breast
of a female, which also proved fatal. Both of these
cases were unusually violent, and ran their course
with very great rapidity. It is worthy of remark, that
in both, the wounds by the operation were progressing
as favourably as usual. Whether pleurisy, in these
instances, is attributable, as some writers suppose, to
the absorption of pus into the system, or to some other
cause, we are at a loss to determine; but that the
disease is peculiarly violent and fatal, has been observed by all who have witnessed its occurrence.
Therapeutics.-The most valuable remedies in the
treatment of pleurisy, are, aconite, bryonia, tartar
emetic, phosphorus, arsenicum, rhus tox., and arnica.
During the progress of the disorder, we should also
bear in mind sulphur, scillae, rhus rad., lachesis, silicea,
and china.
Aconite is eminently appropriate, either alone or in
alternation with other specifics, whenever the inflammatory action runs high, accompanied with hot skin,
quick and full pulse, urgent thirst, and general suspension of the secretory functions. Wurm and Trinks
commend it in the highest terms in that variety of
pleuritis which is characterized by the plastic nature
of the effusion, and the severity of its inflammatory
fever. It should be exhibited at the very commencement of the disease, and in the lowest potencies, and
repeated, in urgent cases, every hour until the fever
subsides.
Bryopia is a specific of great value in the malady
under consideration. and the power which it possesses
of promptly controlling and subduing the most violent
cases of pleurisy, is a matter of astonishment to us,
who formerly believed copious and repeated venesections to be the only safe means of effecting a cure.
We have treated a great number of cases, in which
bryonia has been our chief remedy, and we have not




DISEASES OF THE RESPIRATORY ORGANS.    331
failed in a single case, but our cures have been far
more prompt, pleasant, and satisfactory, than we ever
effected under the old treatment. The effusion has
invariably been more speedily absorbed, and the pleura
and lungs, as well as the system at large, have more
perfectly recovered their original tone and vigour,
than in cases which have been treated by the old
method. Nor will this appear at all strange, when it
is remembered, that by one method, the structure actually diseased is alone acted upon, while by the other,
the whole organism is subjected to the'influence of the
most powerful medicines, impairing the integrity and
vigour of almost every part, without producing any
certain or decided effect upon the pleura, or any other
pulmonary tissue.
Let the sceptical allopath prove upon his own person in health, the pure effects of bryonia, tartar emetic,
phosphorus, lachesis, scillce, &c., upon the respiratory
organs, and then test them judiciously in cases of disease after the homeopathic principle, similia similibus,
and he will forever abandon the'uncertainties and
dangers of the lancet, mercurials, counter-irritations,
&c.
Bryonia may follow  or alternate with  aconite,
advantageously. The external indications are, cheeks
flushed and hot, dry or moist; respirations short and
rapid, and performed principally with the abdominal
muscles; position upon the affected side; pulse quick
and full; tongue dry; breath hot; urine scanty, and
red or dark; dull sound on percussion of the affected
side; respiratory murmur indistinct or entirely wanting.
Physical sensations.-Stinging, shooting, or burning
pains in the side, aggravated on inspiration, coughing,
on movement; respiration difficult, short, anxious, and
rapid; sense of tightness; a weight or oppression at
the chest; painful cough, dry or with expectoration of
a glairy sputa, sometimes tinged with blood; great
heat of skin, alternating with frequent coldness and
shivering; urgent thirst; pain in the intercostal spaces
on pressure; weariness and inclination to retain the
recumbent position.




332    DISEASES OF THE RESPIRATORY ORGANS.
Mental and moral symptoms.-Anxious, apprehensive,
desponding; fear; irritability; peevishness; restlessness.
Administration.-A dose of the first dilution every
hour, alone or in alternation with aconite, until the
pain, difficulty of breathing, &c., are relieved.
Tartar emetic.-According to Majendie, this medicine possesses the specific power of causing engorgement and inflammation of the lungs when given in
large doses. There can be no doubt that it is an absolute and decided specific over the respiratory organs
as well as the gastro-intestinal membrane. This has
been demonstrated by Cloquit, Muiller, Majendie,
Gross, and others, by autopsical examinations, and by
numerous provings upon persons in health.
It is a common remedy with the old school, in affections of the respiratory organs; yet they are entirely
ignorant of its curative action. It is only necessary
to refer to the unsatisfactory and contradictory opinions
of Laennec, Rasori, Broussais, Eberle, Payne, Blake,
and Barbier, upon this subject, to be convinced of the
utter want of accurate knowledge and uncertainty of
principle amongst allopathists in the administration of
medicines.
The homoeopathist, on the contrary, demonstrates by
numerous provings in health, that it exerts a specific
force upon the lungs and their appendages, and he
therefore gives it in inflammations of these organs
with confidence and success. With him there is no
random and crude speculation-no breaking down of
the organism by violence, hoping in the general ruin
to crush the malady, but having a definite object, and
seeing his goal, he quietly, safely, and surely attains it.
The external indications for tartar emetic, are: face
flushed, hot and dry, or pale, wan and anxious, and
covered with sweat; respirations short and obstructed;
surface burning hot and dry, or cold and bathed with
cold perspiration; pulse quick, weak, or full; tongue
moist and clean, or loaded with a white or brown fur;
urine scalding hot, red or brown; mucous or bloody
expectoration; general appearance indicative of great
anxiety and physical prostration.
Physical sensltions.-Respiration short, difficult, ob



DISEASES OF THE RESPIRATORY ORGANS.    333
structed, and attended with stinging or shooting pains;
cough with expectoration of mucus, sometimes tinged with blood; violent throbbing of the heart; coldness and shivering whenever the bed clothes are raised,
or on motion; fever with adypsia, or moderate
thirst; lassitude, debility, and disposition to syncope;
trembling of the limbs, from the slightest exertion;
sense of suffocation.
Mental and moral symptoms.-Agitation; apprehension; discouragement; despair.
Administration.-From half a grain to- a grain of
the tartar emetic, may be dissolved in a tumblerful of
pure water, and given in teaspoonful doses, every
one, two, three, or four hours, as the urgency of the
case demands.
Phosphorus.-External indications.-Countenance
pale, alternating with redness; eyes hollow and surrounded by a blue circle; respiration short, difficult,
and noisy; tongue dry; pulse quick and hard; expectoration slimy or bloody.
Physical sensations.-Respiration rapid, short, and
difficult; lancinating pains in the chest, mostly on the
left side; sharp pains on pressing the intercostal
spaces; anguish, fulness and tension of the chest;
palpitation of the heart; dry, shaking cough, or cough
with expectoration of bloody mucus; weakness, pain
and trembling of the limbs; mouth and throat dry;
thirst.
Mental and moral symptoms.-Uneasiness; melancholy; anguish; dread of the future; indifference to
everything; passionate and irritable.
Administration.-Same as bryonia.
After the more violent febrile symptoms have subsided, and those of effusion into the cavity of the pleura
remain, —as enlargement of the affected side, dull
sound on percussion. absence of the respiratory murmur, oppression and constriction of the chest, difficult
and short breathing, with occasional attacks of suffocation, dry cough, coldness of the body, clammy sweats,
anxiety and general sense of prostration, arsenicum is
our remedy. It may be given in these cases, at the
third potency, a dose once in two to four hours, lengthening the intervals as improvement occurs.




334    DISEASES OF THE RESPIRATORY ORGANS.
Rhus tox. is sometimes useful after the febrile
symptoms have subsided, and there yet remain wandering pains in the chest, shortness of breath, and general debility. In cases also which have arisen from
metastases of rheumatism or gout, this remedy is peculiarly appropriate. It may be administered in the
same manner as bryonia.
When inflammation of the pleura has' arisen from a
contusion, bruise, or other injury, arnica, both internally and externally, is our best specific. For internal exhibition, we may use one of the lower dilu.
tions; externally, a lotion made of a drachm of the tincture to twelve ounces of water.
The other medicines to which we desire to call
attention, and which will often be found highly serviceable in some of the sequela of pleuritis, are, sulphur. scillae, mar., rhus rad., lachesis, silicea, and china.
Sulphur especially, is recommended by Wurm, in
plastic pleurisy, and in cases complicated with pneumonia and hepatization, after aconite has moderated
the more active symptoms. He uses the tincture.
SECTION VI.
PERTUSSIS. —WHOOPIN G COUGH.
Diagnosis.-Most writers recognise three distinct
stages in whooping cough, viz.: first, the forming
stage, presenting symptoms like ordinary catarrh, as
sneezing, watery eyes, dry cough, headache, constriction and oppression at the chest, feverish nights, &c.,
which.continue for two or three weeks, when the second or convulsive stage sets in. At this period of the
malady, there are violent paroxyms of cough of a convulsive and suffocative character. This cough is distinguished from others by a peculiar stridulous or
whooping sound, which occurs during inspiration,
while the expirations are interrupted by frequent fits
of coughing. This whooping sound is owing to a. spasmodic contraction of the glottis, which renders respiration very difficult, and gives rise to a sense of
obstruction and impending suffocation. This spasm
and contraction, together with a tickling in the throat,
come on previous to the paroxysms, and subside some



DISEASES OF THE RESPIRATORY OBRANS.    335
what after the coughing has ceased. The duration of
the paroxysms varies from one to five minutes, at
the termination of which there is often vomiting or
expectoration of mucus. This stage usually acquires
its greatest degree of violence in from one to two
weeks, and its continuance is from five to six weeks,
when the third, or stage of declension, commences. At
this period all of the symptoms gradually become milder; the paroxyms are less frequent,-the cough less
urgent; the contraction and obstruction less strongly
marked, until at the end of two to four weeks, under
favourable circumstances, all of the symptoms have
disappeared.
Causes.-Pertussis is unquestionably attributable to
the absorption into the organism of a miasm of a specific nature. We know nothing of its chemical or
physical character, but in this, like other maladies,
the system must be rendered susceptible by previous
preparation, or predisposition, to enable the miasm to
exercise its specific effects and induce the phenomena
of whooping cough.
Whether this specific miasm operates primarily upon
the mucous membrane of the air passages, the stomach, the diaphragm, the lungs, or the eighth pair of
nerves, we are unable to decide in a satisfactory manner. It would seem that the advocates of each particular opinion in regard to its primary location, have
found in their autopsical examinations, appearances
which indicated that there had been inflammation in
each of the structures alluded to. That the pneumo
gastric and other nerves, as well as the membrane of
the glottis, larynx, &c., are involved, either as a primary or secondary effect of the contagion, there can be
no question.
The causes which act upon the organism in such a
manner as to render it susceptible to the action of the
miasm. are, atmospheric vicissitudes, colds, debility
and chronic diseases of the respiratory organs, inhalation of irritating substances, fatigue and exhaustion of
the physical or nervous system.
Therapeutics.-In the first stage of the malady the
ordinary remedies for catarrh are appropriate, as nux




336    DISEASES OF THE RESPIRATrORY ORGANS.
vom., chamomela, belladonna, ipecacuanha, mercurius,
aconite, dulcamara, pulsatilla, arnica, bryonia, J4c.
In the second, or convulsive stage, the best remedies
are, tartar emetic, veratrum alb., carbo veg., chamomela,
cuprum acetat., sambucus nig., conium mac., drosera,
hyoscyamus, ipecacuanha, nux vom.
In the third stage,-we may consult, in addition to
the medicines already enumerated, pulsatilla, hepar
sulph., sulphur, lachesis, arsenicum, sepia. acid phos.,
and china.
Dr. Bosh speaks very strongly in favour of cuprum
metallicum in firmly developed whooping cough.
"In simple whooping cough of children under one
year of age, I give in the morning and evening, cuprum
third, one grain; in older children, cuprum second, one
grain twice a day, and in this way the disease was
generally removed under gradually decreasing coughing turns."  When the cough is complicated with
symptoms arising from dentition, or other affections
disconnected with the cough, these symptoms should
be met by appropriate remedies, either alone, or in
alternation with cuprum.
Administration.-Our attenuations may range from
the first to the sixth, in this disease, according to the
age, temperament, and impressibility of the patient.
The doses should be repeated at intervals of six or
eight hours.
S ECTION  VII.
ASTHMA.
Diagnosis.-For a week, or two previous to an attack of asthma, the patient will often be troubled with
sneezing every morning, itching at the inner canthi of
the eyes, irritation of the throat, with constant disposition to hem or hack, lassitude, dull pains in the head,
back, and limbs, loss of appetite, dry hacking cough,
and great depression of spirits.
The attack most commonly commences during the
night, with tightness and constriction about the chest;
urgent and distressing dyspncea, aggravated by the
slightest movement; inspirations short and strong,
while the expirations are long, laboured, and wheez



DISEASES OF THE RESPIRATORY ORGANS.    337
ing; great and rapid movement of the nostrils; countenance bloated and livid, and indicative of intense
distress and anxiety; inclination to retain the erect
position; even during the forming symptoms, inability
to lie upon the right side or back; more or less prickling or burning heat after the attack commences, aggravated by scratching; symptoms aggravated by eating even bread; respiration very difficult, as if from
want of air, yet the wind from a fan or the draft from
a door or window, stops the breath, and cannot be
borne; face and forehead livid, or pale; sharp pain
through the temples; inability to lie upon a feather
bed from the first; during the paroxysm must constantly retain the erect posture; the dyspnoa, &c.,
worse in the night, and remitting during the day; dry
cough in the first instance, sometimes but not always;
followed in a few hours by expectoration of' a viscid
mucus; perfume of flowers, hay, &c., increases the
symptoms, and almost puts a stop to the breath during
the paroxysm; extremities cold; respiration through
the mouth; attacks brought on from excitement, particularly grief and fear; also certain odours or irritating
substances inhaled; palpitation during the attack;
the asthma occurs for the most part during the season
of flowers; tongue foul; breath offensive; eructations; flatulency; urgent desire for cool, fresh air;
pulse variable.
Causes.-It has been often observed that asthma almost always occurs in individuals who are suffering
from  some chronic miasm. In numerous instances
we have been able to trace a direct connection between an attack of urticaria. but partially developed,
and then suddenly suppressed, and asthma. Indeed,
it may be safely asserted, that a majority of the cases
of true asthma, are attributable to this or some other
miasm, which has been thrown, from some exciting
cause, upon some portion of the respiratory apparatus.
We are confirmed in this opinion, from the fact that
in several instances where an attack of asthma has
been seriously threatened, and even commenced, we
have been able to cut it short by administering a remedy like puls., bry., and cup. acet., which had the ef15




338     DISEASES OF THE RESPIRATORY ORGAN.,
fect to develop the nettle rash, and thus relieve the
air passages.
Other causes, which are, properly speaking, excit-.
ing causes, may be enumerated, as humid easterly
winds, atmospheric vicissitudes, inhalation of certain
medicinal and other irritating substances, like pecac.,
the odours of certain plants, and electricity in the air,
the inhalation of the imponderable particles of which
often causes severe paroxysms of the malady; also indigestible food, anger, fear, the irritation of pregnancy,
spinal disease, sedentary habits, &c.
Therapeutics.-Pulsatilha, ipecacwtanha, arsenicun,
bryonia, nux vomiea, belladonna, china, sulphur, lobelia
inflata, coftea, digitalis, and acid hydrocyanic, are the
principal remedies in this complaint,
Pulsatilla.-This remedy is indicated in cases occurring in persons of a mild temper, light complexion,
hair and eyes, from suppressed or confined rash, cessation or other derangement of the mernse-s, and inhalation of the vapour of sutphur. The external indications are: short, suffocating, and extremely difficult
respiration, as if from want of sufficient air,or choked
by some irritating substance.; the patient is obliged
to retain the erect posture; his movements are rapid,
and his whole appearance indicates great distress and
anxiety; tongue loaded with a thick coating, breath
offensive; frequent eructations; hiccough  countenance pale, sometimes alternating with redness; attacks usually coming- on in the night during sleep.
Physical sensations.-Cramp-like and constrictive
tension of the chest or, larynx; respiration irmpeded,
and distressing, increased by- motion, walking in the
open air, or by eating; short spasmodic cough; nausea; palpitation of the heart; sensation offulness and
distention in the stomach:; throbbing pain in the forehead; bad taste in the- mouth; cramp-like pains in
the abdomen; itching, burning, or priekling- sensation
in the skin, in the evening or during the night; pains
in the-limbs; nausea and- vomiting; smarting or-burniing pain in the canthi, arnd pressure in the- eyeballs.
Mentalt ar moral sympt-omrr.-Very great dipressior
of spirits, and melncholy from the onset of'the symp



DISEASES OF THE RESPIRATORY ORGANS.    339
toms; intense anxiety, agitation and dread -of suffocation during the paroxysms.
Administration.-From the third to the sixth dilution may be used-a dose every half hour in urgent
cases-until aggravation or amendment occurs.
Ipecacuanha. —In asthma caused by the suppression
of miliaria, urticaria, and by the inhalation of irritating vapours, ipecacuanha at the first to the third attenuation, may be exhibited. The signs which particularly indicate this medicine, are, spasmodic contraction of the larynx and chest; anxious, sighing, or
panting respiration; palpitation of the heart; air
seems full of dust; face pale; extremities cold; nausea; vomiting; coated tongue; insipid or bitter taste;
dry, spasmodic cough; irritability, impatience and
fear of death.
Arsenicum alb., is a valuable remedy in bad cases
occurring from suppressed eruptions or catarrh, also
in persons of feeble or impaired constitutions, whether
from excesses, previous sickness, or old age. The following symptoms point especially to this medicine, viz.:
feeling of extreme lassitude and debility; difficult,
stifling dyspncea, with attacks of suffocation; spasmodic constriction of the larynx and chest; respiration
short, anxious, and wheezing; irregular throbbings of
the heart; sufferings aggravated at night by lying
down, movement. eating, mental excitements, or exposure to the cool fresh air; distention and cramp-like
pains in the abdomen; frequent eructations; nausea;
vomiting; burning sensation at the stomach; f~etid
breath; smarting or burning sensation in the throat;
pressive burning pains in the eyes; face pale or bluish;
anxious and desponding. The first to the third trituratign may be employed, regulating the repetition according to the urgency of the symptoms.
Bryonia is applicable in cases arising from suppressed eruptions, or rashes but partially developed.
It is also appropriate in cases complicated with catarrhal and pulmonary disorder.
The paroxysm usually occurs in the night; the respiration is difficult, short, sighing, impeded by stingings in the chest, and aggravated by exercise; there
are oppressive, tensive or contractive pain in the chest;




340    DISEASES OF THE RESPIRATORY ORGANS.
cramp-like pains, cuttings or shootings in the abdomen; bitter or acid eructations; throbbing or pres.
sive pains in the head, increased by movement; pressure and burning pain in the eyes on motion. It may
be exhibited in the same manner as pulsatilla.
Asthma which has been caused by derangement of
the digestive functions, excessive study and watching,
sedentary habits, and abuse of drugs, liquors, coffee,
&c., may often be cured by the use of nux.
The nux symptoms are, weight and constriction at
the chest; great difficulty of breathing, aggravation
of the symptoms in the night, on walking, eating, or
lying down in the evening; heat and burning in the
chest; bitter and acid eructations; pressure and contractive pains in the stomach and epigastrium; palpitation of the heart; short, dry, spasmodic cough,
sometimes attended with a scraping in the throat;
foetid breath; loaded tongue; heartburn; distention
of the abdomen after eating; heaviness, or tearing,
throbbing, drawing or jerking pains in the head; frequent sneezing, with coryza; hypochondria, anxiety
and irritability. It may be employed like pulsatilla.
Belladonna has been especially recommended in
cases occurring in females of an irritable constitution,
also in cases where there exists a tendency to spasms,
or any organic lesion. Hartmann asserts that "it often
proves radically curative after the exhibition of some
intercurrent remedy, particularly in cases which have
not become too chronic by repeated relapses, under
which circumstances we must have recourse to sulphur, calcarea, or some other proper antipsoric."
It is particularly called for when the paroxysms
come on in fits of short, difficult, irregular, and suffocating respiration, accompanied by dry cough; pressure on the chest; violent beatings of the heart; vertigo, swimming or darting pains in the head; pains
in the small of the back and limbs; cramps in different
parts of the body; anxiety, irritability, and fretfulness.
A dose of the second or third dilution every hour or
two until an impression is produced.
Chamomela is an important remedy in the flatulent
asthma of children, also that following a suppressed




DISEASES OF THE RESPIRATORY ORGANS.    341
catarrh. It is likewise specific in those attacks which
are caused by anger, grief, fear, &c., in adults. Among
the symptoms which point to it, may be mentioned,
distention and sense of fulness of the stomach and
bowels; pressure, anxiety, and fulness in the. region
of the heart; short, wheezing respiration; great restlessness; dry irritating cough; bad taste; tainted
breath.
Administration.-Same as of belladonna.
Lobelia inflata is a remedy of great value in cases of
spasmodic asthma induced by humidity, and certain
other conditions of the atmosphere. It is indicated
when the attack is preceded or accompanied by a kind
of " prickly sensation through the whole system, even
to the extremities of the fingers and toes;" constriction across the chest; short, anxious and wheezing
respiration; nausea; vomiting; sense of prostration;
trembling of the limbs; giddiness and headache; spasmodic cough; burning sensation in passing urine; intermittent pulse; cramp-like pains in the abdomen;
cold sweats.
Administration. —Potencies from the third to the
sixth, —a dose every two to four hours, as the symptoms require.
In cases of asthma of long standing, and which
appear to be connected with some chronic miasm
lurking in the organism, sulphur, digitalis, acid hydrocyanic, calcarea, &c., are worthy of consideration, and
will sometimes effect cures when the other medicines
enumerated have disappointed our expectations.
There are other remedies, like coffea, ignatia, stramonium, china, arsenic, arnica, &c., which should always
be borne in mind by the practitioner, for instances may
occur in certain complicated cases, where one or more
of them will be required.
SECTION VIII.
PIITHISIS PULMONALIS.-CONS UMPTION.
We come now to the consideration of that disease
which has proved the most destructive of human life
of all that claim the attention of the profession. Slow,
insidious, and gentle in its progress, from causes




342    DISEASES OF THE RESPIRATORY ORGANS.
which have been in operation for years, it steadily
draws its victims to the brink of the grave, before they
have an apprehension of danger, or are conscious of
even serious indisposition. We are accustomed to
regard.with terror the yellow fever, because its subjects are seized suddenly, and destroyed by a single
blow. But if this fearful agent of death possesses, in
the torrid climates to which it is almost always confined, a nearly indiscriminate and unlimited dominion,
during two or three of the sultriest months of summer,
consumption, with its deliberate and almost invisible
step, traverses all the world, destroying in its treacherous and fatal embrace innumerable numbers, of
every age, and sex, and condition. The yellow fever
indeed strikes suddenly and violently, and leaves the
patient no hope or consolation; but consumption
quietly and gently fastens its chains upon its victims,
while brightening the intellect, charming the spirit,
and tinting the cheeks with the colours of the lily and
the rose, distracting their attention with songs of hope
and -security; and the poison pervades its subject
organs, and the deluded patient sooner or later awakes,
from his fancied safety, scarcely in time to realize his
peril ere he yields his life.
How few physicians are there, of extensive practice,
whose diaries might not furnish histories of the most
touching pathos, in connection with the treatment of
this disease, which (it may be by a perversity of the
judgment) seems to fulfil its mission in disappointing
the fondest expectations, and in blighting the fairest
creations of human loveliness! A maiden, perhaps,
becomes the belle of the season, in which she makes
her entrance into the gay world. To an assured position of the highest elevation in society, she brings
the most exquisite physical beauty, and grace and
elegance of manner, and the finest and rarest moral
and mental endowments, subtlest intelligence and
quickest wit, and a sweetness of disposition which
crowns a sudden admiration with the dearest and
most permanent affection. When Hope comes to her
with the most enchanting promises, the Angel of Ill
approaches also, in the guise of consumption, and the
two contend until the last is victor, and his triumph is




DISEASES OF THE RESPIRATORY ORGANS.    343
celebrated with all the displays of unaffected wo. Or
it is a young man, who has scaled the difficult heights
that obstructed an ambitious vision, and is about to
grasp the prize upon which his eagle eye has been
steadily fixed through years of varying toils and
storms. The moment he dares to dream of rest, the
enemy that has dogged his steps, unseen, through half
his career, is disclosed, and leads him from the presence of Hope into that of Despair. With what a
profound interest must the physician contemplate a
disease of which the path is constantly thus marked!
True tubercular phthisis, when once fully developed,
is beyond question incurable by medical means. The
physician may palliate symptoms, and often protract
for a considerable period the fatal termination of the
malady, but he cannot remove those foreign accumulations which constitute tubercles, either by a gradual
absorption or in any other manner, so as to prevent the
formation of ulcerous excavations, nor can he heal
-these ulcerous cavities when once formed, since they
are constantly being disturbed and irritated by the incessant motions of the lungs. The few instances of
spontaneous cures of ulcerated lungs, reported by
Laennec and others, are only exceptions to the general principle which we have advanced. Much, however, may' be done in the early stages of phthisis, while
the tubercles are yet small, and but slightly irritated,
to retain them in a latent condition for an indefinite
number of years. We are aware that in some instances there will be great difficulty, even on the part
of the physician, in detecting the insidious advances
of the disease at this early period, but by watching
with great care every slight indication of disturbance
connected with the respiratory organs, by ascertaining
whether any hereditary predisposition exists in the
family, by examining the physical conformation of the
chest, the respirations, as relates to their strength,
freedom, number per minute, and whether unduly increased by exercise; and finally, by investigating
minutely the previous history of the individual, in
order to be able to judge whether any cause may have
been in operation which might originate the disorder,
we may be able to advise such measures as shall re



344    DISEASES OF THE RESPIRATORY ORGANS.
tain the tubercles in a latent and undeveloped condition, and thus for years prolong life.
The most common period for the occurrence of
phthisis is between the ages of eighteen and thirty;
and it is probable that more deaths occur in persons
under the age of eighteen, than after thirty. It is
calculated by Drs. Forbes and Clark, " that above one
quarter part of the individuals who die before the age
of puberty, die with tubercles!" It is also estimated
by the latter gentleman, " that the maximum of mortality in this disease is at thirty, and that from this
point it gradually diminishes." No age, however, is
exempt from it; for infancy, childhood, youth, manhood, and extreme old age, are all more or less subject to its withering attacks.
Females also suffer more from the malady than
males, as is shown by the statistical facts which have
been published by Louis, Forbes, Skoda, Laennec,
Andral, Clark, Young, and others. Nor is this at all
surprising, when we reflect upon the education, and
the habits of life of the women of civilized countries.
Born and reared during infancy in hot-houses, where
the invigorating breath of heaven rarely penetrates;
their childish intellects crammed with ideas which
they are unable to understand, while their physical
frames are permitted to wither in crowded schoolrooms, without that free and abundant exercise and
indulgence in childish sports, which are so absolutely
essential to their growth and well being; submitted at
the period of puberty to those instruments of torture
and distortion, stays, in order that the symmetrical
figures which God in his wisdom has given them, may
be contracted sufficiently to meet the ideas of an
abominable fashion; rejecting constant and vigorous
exercise in the open air, early hours, regular habits,
and all of those means which tend to promote physical
strength and vigour: is it strange, in view of these
things, that the seeds of phthisis are so often and so
early planted?
There are habits also prevalent among the youth of
the male sex, which conduce in an alarming degree to
generate and develope phthisical affections. The vice
to which we allude, from false delicacy, from its soli



DISEASES OF; THE RESPIRATORY ORGANS.   345
tary nature, and from the very gradual manner in
which it impairs the nervous system and undermines
the constitution, has either been entirely overlooked,
or but slightly touched upon by writers. But unless
we are much deceived, a very large number of consumptive cases, especially in young men, are attributable to onanism, as their remote cause; and we are
sure that those who have minutely investigated theprevious histories of consumptive patients, will fully
coincide with us.
It is quite true that there are many other habits and
customs which pertain to refined society, that also
have their effect in engendering phthisis, but we believe that the cause just touched upon has been productive of more evil amongst the youth of the male
sex, than any two other causes combined. This cause
applies, to some slight extent, to females, but, compared with the male sex, it is trivial and unimportant,
for the reason that women are, Cfy nature, purer, less
sensual, and less addicted to gross, carnal, and beastly
thoughts, than a vast majority of the other sex.
Let parents, then, banish all mawkish delicacy upon
this subject, and caution their children against this
dreadful evil. Let them talk plainly, and display before their minds the inevitable consequences, in the
form of consumption, idiocy, lumbar abscess, &c., to
which an indulgence in this degrading and pernicious
vice so surely leads.
There are many other causes of phthisis which we
might here dilate upon, but we shall allude to them
under the head of " causes of phthisis,"
The appearance of the tuberculous formations vary
in different subjects, some being small as millet
seeds, and irregular in shape, either distinct or running
into each other, of the consistence of cheese, and of
a light yellowish colour. This variety, which is by far
the most common, has been termed the miliary tubercle.
Another variety is called the granular tubercle,
which, according to Laennec, is only the ordinary tubercle in its first stage. Bayle and McIntosh entertain different opinions, the former believing the miliary granulations to be distinct from tubercles, while. Es




346    DISEASES OF THE RESPIRATORY ORGANS.
the latter supposes them to be genuine tubercles, but
sui generis.
Bayle, Laennec, and others, also assert that they
have met with a few cases which they term encysted
tubercle. Other writers speak of the occasional occurrence of this variety of tubercle, it being semitransparent, whitish, and in consistence like hard
cheese.
Laennec describes, likewise, three kinds of tuberculous infiltration, viz., the irregular, the gray, and the
yellow. This Infiltration is generally formed around
tuberculous excavations, but it may exist where there
are no tubercles. It is sometimes found in large
masses, "occupying the whole lobe of the lung, and
having no connection with the miliary tubercle."-Mc
Intosh.
Respecting the nature and cause of these tuberculous formations, there is a wide difference of opinion.
Broussais supposeid that irritation, or inflammation,
were only " degrees of the same affection, and that
they may produce, indifferently, tubercles, encephaloid
cancer, melanosis, fibrous, bony, cartilaginous growths,
Laennec and Andral maintain that they are "accidental productions, foreign to the natural organization of the lungs," and caused by an aberration in the
nutrition of the organ.
Others are of opinion that tubercles are primitively
hydatids.
In the first stage of development, tuberculous matter is " a gray, semi-transparent substance, which
gradually becomes yellow, opaque, and very dense.
Afterwards it softens, and gradually acquires a fluidity nearly equal to that of pus i it being then expelled
through the bronchi, cavities are left, vulgarly known
by the name of ulcers of the lungs, but which I shall
designate tuberculous excavations."-Laennec.
Whether these accidental formations are inorganic
substances deposited in the pulmonary structure, like
pus or calculous concretions, by a kind of exudation,
or whether they are organized, and possess life and
vitality, cannot easily be determined. We incline,
however, to the latter opinion.




DISEASES OF THE RESPIRATORY ORGANS.    347
For a more particular description of the morbid
appearances found on dissection, the reader is referred
to the writings of Louis, Laennec, Skoda, Bayle,
Forbes, and Clarke.
Diagnosis.-One of the first symptoms which announces the approach of phthisis, is an undue shortness of breath after exercise. If, in addition to this,
there are haemoptysis, wandering pains, constriction
and tightness at the chest, great' sensitiveness of the
lungs to cold air, a dry morning cough, a dull sound
in the clavicular region on percussion, and a partial
or total absence of the respiratory murmur, the most
serious apprehensions may be entertained.
Let all remember, also, that it is only at this early
stage of the malady, that our preventive and remedial
measures can be brought to bear with any assurance
of success, and on this account, we shall dwell particularly upon these primary indications, trusting that
we may in this way impress upon the minds of all
their vital importance.
In all of our investigations of diseases of the chest,
it is a matter of importance, in the first instance, to
ascertain whether any hereditary predisposition exists on the part of the patient to tuberculous affections. Secondly, whether from occupation, previous
habits, excesses, protracted mental anxiety and depression, and frequent exposure, without a sufficient
supply of wholesome, nutritious food, the patient has
not acquired those peculiarities of constitution which
render him susceptible to attacks of phthisis; and,
thirdly, whether the physical development of the chest
is such that the lungs can have ample room to exercise their functions.
In making up our diagnosis in the early stage of
any given case, much will depend upon the presence
or absence of these remote causes, for most of the
symptoms enumerated may exist in a man with a
large and well formed chest, and with no hereditary
or acquired predisposition to the malady, and yet excite no serious apprehensions, while the same symptoms in au individual with a narrow, flat, and illshaped thorax, with a predisposition to the disease,
would induce us to form a diagnosis of an entirely




348     DISEASES OF THE RESPIRATORY ORGANS.
different character.  Commencing, then, with the
primitive symptoms of consumption, we shall notice
firstThe respiration. "Healthy respiration," according
to Marshall Hall, " is performed with ease and freedom, and without the aid of the auxiliary muscles, in
any of the usual positions of the body. It is effected
by a nearly equal elevation of the ribs, and depression
of the diaphragm, except in females, in whom the
thorax is observed to move more than in men; each
side of the thorax moves also in an equal degree,
and inspiration and expiration occupy nearly equal
spaces of' time."
Laennec considers the respiration natural "when
the anterior and lateral parts of the chest dilate
equally, distinctly, yet moderately, during inspiration,
and when the number of inspirations in a state of
repose is from twelve tofifteen in the minute."
Andral puts the mean average of respirations in a
healthy adult, at more than sixteen or eighteen in the
minute, Majendie at twenty, and some writers even
as high as twenty-six.
Taking, then, the mean number of respirations of a
healthy adult to be eighteen per minute, and bearing
in mind the natural movements of the healthy thorax
during inspiration and expiration, we shall be enabled
to form a pretty satisfactory opinion respecting the
condition of the respiratory organs, by judicious comparisons of different stages of disease with the supposed natural standard.
We are convinced, from much observation, that
Laennec, Andral, and Louis, have laid quite too little
stress upon this important indication; for, although
individuals may now and then be short breathed who
have no tendency towards diseases of the lungs, yet,
when taken in conjunction with an hereditary predisposition, unusual susceptibility of the lungs to cold,
slight, dry, hacking cough, narrow or flat chest, or occasional wandering pains in the chest, we may be
certain that mischief is threatened.
A very fleshy person, or one afflicted with disease
of the heart, and certain other maladies, may be short
breathed after slight exercise, but these cases can




DISEASES OF THE RESPIRATORY ORGANS.    349
never be mistaken by the observing physician as
phthisical, since the history of the case, as well as the
general aspect of the patient, sufficiently mark the
distinction in all instances.
Whenever, therefore, an individual has more than
the usual number of respirations during repose, the
expirations and inspirations being unequal in point of
time, and is put out of breath after the slightest exercise, it is the duty of the physician to ascertain the
cause of this unusual action, and whether consumption is not insidiously approaching. Is his chest large,
full, and. well developed,-are its movements natural
during inspiration and expiration,-is scrofula hereditary in his family, —is he troubled with tightness or
pains in the thorax,-is he subject to cough upon the
slightest exposure, —is he inclined to stoop when sitting or walking,-is his respiration sighing,-has he a
slight morning cough, —finally, is the sound in the
clavicular region, or in any other part of the chest,
dull on percussion, and is the natural respiratory murmur absent at this, or any other point? Upon the
presence or absence of these symptoms will depend
our diagnosis.  Taken as a whole, they indicate
clearly the existence of phthisis pulmonalis; and
where there is a family tendency to phthisis, even dull
sound on percussion, and absence of the respiratory
murmur, with dyspncea after ascending a stairs, or
other moderate exercise, will warrant the opinion that
tubercles exist in the lungs. If, furthermore, one or
more of the other signs enumerated obtain, our opinion must be still more decided and unfavourable.
Physical conformation of the thorax. —One of the
causes which especially favours the formation and development of tubercles, is a small, flat, and contracted
chest. This want of symmetry and proportion may
be owing to natural organization, or it may be acquired from indulgence in sedentary habits, stooping,
a neglect to keep the body in the erect posture, and
to breathe in that full, free, and vigorous manner
which is so essential to the development and wellbeing of the lungs.
If the thorax is naturally contracted and ill-shaped,
a suitable course of physical culture should be promptly




350    DISEASES OF THE RESPIRATORY ORGANS.
adopted and persisted in until it has acquired sufficient
size and symmetry. This result is practicable in all
cases by steady perseverance and energy on the part
of the patient.
The means of accomplishing this desirable end, are
gymnastic and other exercises which particularly bring
into action the muscles of the chest, constant exercise
with the body erect, in the open air, the habit of taking long, free and full inspirations in order that all
portions of the lungs may constantly receive a due
proportion of air, and thus execute their functions
properly, and lastly, the use of tubes for the purpose of
exercising more efficiently the pulmonary organs. By
a regular and systematic employment of these means,
the size of the chest may be increased to a surprising
extent, and the lungs made to acquire a degree of
strength and vigour which could have been attained
by no other method.
There are other instances where well-formed chests
are contracted, distorted, and weakened, by the wearing of tight clothing, stays, 4c., and by sedentary occupations and habits, with the body constantly inclined
forward and bent over. These pernicious habits are
so commonly indulged in, and have become so much
a part of our social system, that their important influences,-their baneful consequences upon the most
vital part of the organism, are almost entirely overlooked. Yet no one who reasons at all, can be
unaware of the dangerous and undermining effects of
these things; and to those whose pride, or indolence,
or imbecility, still prompts them to persist in such
habits, we would say, and without much sympathy for
their sufferings, "you have sown the wind, and you
shall reap the whirlwind."
Hereditary and acquired predisposition to phthisis.An alarming circumstance connected with the history of any individual, even when no symptoms point
to an approaching consumption, is an hereditary pre.
disposition to tuberculous disease of the lungs. To
know that the seeds of a dreadful malady are implant.
ed in the system, liable at any moment to be roused
into activity by the numerous exciting causes which
prevail, is enough, one would naturally suppose, to




DISEASES OF TIE RESPIRATORY ORGANS.   -351
call forth all of the energies 6f the individual in order
that he may escape the threatened evil;-yet how few
under such circumstances use proper means of prevention, and exercise that care and attention towards
themselves which these cases require!
But the root of the evil must be traced farther back
to those injudicious marriage connections, where one
or both of the parties are labouring under a scrofulous
taint. It appears singular that intelligent persons of
this description should be willing to enter the matrimonial state, when they are so certain of entailing upon
their offspsring, disease, misery, and an early death;
yet how often do we see the desire for temporary selfgratification, for riches, display, or pride, outweigh the
potent reason named, and induce the unfortunate victim of the malady, to plunge herself and her children
into almost certain future suffering!
A predisposition to phthisical affections is often acquired by constant exposure in small, damp, and illventilated habitations, insufficient clothing, scanty and
unwholesome food, free use of pork, incessant occupation in close rooms and constrained positions, onanism,
protracted depression of spirits, and certain occupations, like the stone-cutter, scythe-grinder, &e.
All of these causes exert a powerful influence in
bringing the system into that condition which renders
it peculiarly susceptible to tuberculous formations in
the lungs, and for this reason,' should be avoided as
much as possible by individuals, and should receive
the attention of all benevolent men,
Amongst the first signs which should lead us to suspect latent phthisis, are, an ill-formed thorax, respirations above the natural standard, and greatly accelerated on slight exercise, and the existence of an hereditary taint. Whenever these signs obtain, the chest
should be at once explored by auscultation, and percussion, so that if tubercles are discovered, immediate
measures may be taken to keep back or prevent their
development. Sometimes a slight dry cough, with
tightness and pains in the lungs, are the first symptoms
which announce the affection: at other times the disease supervenes suddenly, after a pleurisy, or an influenza, or some other acute malady. In the majority




352     DISEASES OF TEE RESPIRATORY ORGANS.
of instances, however, the symptoms occur in the order
enumerated, viz., habitual shortness of breath, especially after exertion, short and dry cough, burning in
the pallns of the hands and soles of the feet, constriction and pains in the chest on inspiration, sensitiveness
of the lungs to cold. These symptoms may remain
stationary for months or years, when from some exciting cause the pulse becomes unnaturally frequent,
there are febrile exacerbations in the evening, and generally about noon, the respiration becomes more rapid
and laborious, being often executed by the diaphragm,
the anterior and lateral parts of the chest dilate
unequally during inspiration and expiration, particularly in the recumbent posture, the catemenia in female subjects cease, a mucous expectoration occurs,
profuse night sweats and diarrhmea set in, the body
wastes away, the expectoration becomes gradually
more purulent and abundant, the body is bent forward;
as the tubercles soften, the guggling or rattle of the
matter may be heard either with the naked ear or the
stethoscope, the cough is cavernous, the respiration and
rattle also become cavernous, and pectoriloquism is
heard as soon as the softened tuberculous matter is
thrown off, and the cavity becomes empty; the sound
on percussion still continues dull, but now and then a
peculiar metallic sound is evident. As the disease
progresses towards the last stage, and the cavities acquire a large size, the respiration, voice and cough
give forth the peculiar hollow, metallic sound or buzzing, termed amphoric resonance. The whole body
now presents the appearance of extreme emaciation,
the face is pale, cadaverous, and frequently tinged
with a waxen or lemon hue, the lips and roots of the
nails are bluish, the nose pointed, the voice becomes
hoarse, the mouth and throat apthous, the feet cedematous, occasional delirium at night, and a continual
failing of the physical powers, until death ensues.
Hamoptysis, though not a necessary attendant upon
phthisis, is of general occurrence during some part of
its course: it may occur at any period of the disease,
but most commonly it is one of the first symptoms.
Causes of Phthisis.-The causes of consumption




DISEASES OF THE RESPIRATORY ORGANS.    353
may be divided into, first, the constitutional; second,
the accidental; and third, the exciting.
Under the first head may be included, first, hereditary scrofulous taint; second, hereditary impurities of
the blood of a syphilitic, erysipelatous, or psoric character; third, imperfect organization of the thorax,
feeble constitution; and fourth, a melancholy nervous
temperament.
The most prominent accidental causes, are, confinement in close, crowded, and ill ventilated apartments,
protracted mental depression, insufficient nourishment,
unwholesome food, intemperance, damp and unprotected habitations, onanism, the habit of stooping, and
thus contracting the capacity of the chest, tight clothing, late hours, over-excitement, abuse of drugs, especially mercury and opium, excesses in venery, want
of exercise, and abuse of tobacco.
The exciting causes, are, atmospheric vicissitudes,
suppression of the perspiration by cold, imperfectly
subdued acute diseases of the pulmonary organs, repelled cutaneous eruptions, inhalation of irritating
vapours, etc., external injuries. Of these proximate
causes, Eberle, Laennec, and others, consider cold by
far the most common and dangerous. It is probable,
however, that cold of itself is by no means so injurious
as these gentlemen have supposed, but that the sudden alternations from heat to cold which obtain in
temperate latitudes, exert far more influence in engendering phthisis, than the severe but steady cold of more
northern regions. Indeed, some recent writers have
strongly recommended a change from temperate to
cold latitudes, as more advantageous to consumptive
subjects than a warm climate. In this opinion we do
not coincide, since the highly condensed air of the
former must act as a constant and powerful stimulus
to the already irritable tubercles. We much prefer a
warm, mild, and equable climate in these cases.
Therapeutics.-In all cases when it is well ascertained that tubercles exist in the lungs, either in a
latent or partially developed state, the following course
should be adopted, as far as circumstances will admit, viz.:
First, an immediate removal to an equable, mild,




354    DISEASES OF THE RESPIRATORY ORGANS.
dry, and healthy climate. In making this selection,
we should choose the interior of the country, rather
than the coast, in order, as far as possible, to be away
from the influence of the breezes which blow from the
ocean.
Second, constant exercise in the open air. By this
we do not mean that snail-like moping around, with
the body coiled up, and a countenance the picture of
melancholy and despair; but that vigorous, free and
cheerful exercise which invigorates and expands the
physical powers, and cheers the mind. Exercise, to
be beneficial, should be employed in such a manner as
to bring all of' the muscles into moderate and agreeable action, and as a pleasant recreation, rather than a
necessary task. By this means the organism is
strengthened, the circulation equalized, the "bluedevils" exorcised, and the pulmonary organs placed in
the best possible condition to recover themselves.
In pursuing this course of physical exercise, regard
should also be had to those gymnastic and other sports
which tend to expand and strengthen the thorax. Too
much cannot be said with reference to the importance
of this subject, also the erect position of the body, and
the habitual custom of taking deep and free inspirations; for the muscles of the chest, as well as of other
parts of the body, waste away and become enervated,
without constant exercise in a natural manner.
In connection with this course, we must strongly
advise the frequent use of breathing tubes. Having
experienced decided benefit in our own person from
the employment of this kind of exercise of the lungs,
and having often seen it adopted by others with prompt
and marked advantage, we speak confidently of its
efficacy in debility of the pulmonary organs.
Third, persons of a consumptive habit should make
use of highly nutritious food. The articles which
are particularly to be avoided, are pork, in all its
diversified forms, as ham, sausages, lard, &c., all fish
not having scales, like eels, catfish, clams, crabs, lobsters, &c., and oily and greasy food generally.
How far a free use of pork may exert an influence
in generating tubercles, we know not, but the following fact is not without significance, viz.: The Jews




DISEASES OF THE RESPIRATORY ORGANS.    355
and all other tribes and nations that are prohibited
by their religion from using the swine as an article of
food, are almost uniformly exempt from scrofula and
consumption. The very common occurrence of tuberculous formations in this filthy animal, would seem to
be presumptive evidence that it is peculiarly subject
to scrofula. We commend therefore to the consumptive a strict adherence to the dietetic regulations
which were advised by Moses of old to his brethren,
the Hebrews, as being most conducive to health and
longevity.
Fourth, as an important means for promoting a
healthy action of the skin, and equalizing the circulation, too much cannot be written in praise of external applications of cold water. These applications
should be employed daily, either in the form of baths,
sponging, or the wet sheets; in many instances the
greatest service will be derived from using cold water
applications to the chest in such a manner as to bring
out an eruption.
The effect of this remedy is to impart tone and
vigour to the cutaneous structures, and to allay in a
decided manner nervous irritation.
Fifth, another valuable preventive, as well as remedial agent in lung affections, consists in the cultivation of a cheerful and happy disposition. The invalid
must never brood over his ailments, for by gloomy
ponderings upon his case, he is quite prone to exaggerate symptoms, imagine complaints which have no
existence, and thus detract from his prospect of recovery.
Laennec ranks the depressing emotions as one of
the most prominent accidental causes of phthisis, and
we are quite satisfied that he has not over-estimated
their importance.
Sixth, (and finally), we commend a strict avoidance
of all excesses, whether in the pleasures of the table,
wine, and liquors, or in the indulgence of any thing
which over-stimulates and fatigues mind or body.
In conjunction with the above measures, some one
of the following medicines may be occasionally exhibited with benefit; making the selection, of course,
according to the peculiar character of the indications




356     DISEASES OF TEE RESPIRATORY ORGANS.
which may be present, viz.: ol. jecoris aselli, sulphur,
hepar sulph., calcarea carb., mercurius, stannum,ferrum,
silicea, sepia, phosphorus, acid phos., acid nit., lycopodium, lachesis, iodine, iod. potassca, arnica, belladonna,
sambucus and china. Of these medicines the oleum
jecoris aselli is probably the most valuable, and should
receive more attention from the advocates of homceopathy than it has hitherto done. Holding its active
principle, iodine, in a most excellent state of attenuation, the infinitesimal atoms of the drug with its oily
vehicle are absorbed and conveyed to the lungs, where
the most happy curative effects are often produced.
We think the point clear, that iodine is the only real
curative agent in these cases; although it is by no
means improbable that its medium, the animal oil,
which is composed principally of carbon and hydrogen,
may serve the purpose of neutralizing a portion of the
inspired oxygen, which would otherwise act upon the
weakened lungs themselves. In administering this
medicine, therefore, let it be borne in mind, that the oil
is not the medicinal agent, but the mere vehicle by
means of which the real remedy, iodine, is introduced
into the system. Two drachms of the oil may be prescribed three or four times daily.
Sulphur and hepar sulphur. should always be selected
when the pulmonary affection can be clearly traced to
-abruptly suppressed psora, whatever may be the general character of the symptoms. If, however, symptoms are present which point strongly to some other
medicine, an alternation may be resorted to.
Consumption occasionally arises in those whose
lungs are naturally weak and irritable, in consequence
of violent and protracted syphilitic attacks. In these
instances, the most suitable remedies are mercurius,
acid nit., potassae iodide, and hepar sulphur.
When phthisis is threatened during the progress of
chlorosis, or in consequence of masturbation, or excessive venery, the appropriate medicines are,phosphorus,
acid phosph., calcarea carb., china, silicea, and ferrum.
For uncomplicated scrofulous consumption, our most
reliable remedies are, unquestionably, oleum jecoris
aselli, calcarea carb., iodine, sulphur, hepar sulphur.,
sepia, lachesis, phosphorus, and silicea.




DISEASES OF THE RESPIRATORY ORGANS.    357
Administration.-The first, second, and third attenuations are most efficient in all stages of phthisisthe doses to be repeated from two to four times in
twenty-four hours, until the required specific impression is produced.
It is to be regretted that as yet so few positive specifics have been discovered for the cure of tubercular
phthisis, but we are sanguine in the belief that many
such remedies will, sooner or later, be found. In the
meantime let us be on the alert to attain these -much
coveted desiderata.
SECTION IX.
COUGH.
In most instances, cough is one of the symptoms of
inflammatory action, either of the parenchyma of the
lungs, or of some membrane connected with the respiratory organs; but coughs occasionally arise and
reduce the patient to a very low state of hectic fever,
without the presence of any inflammatory action, except that which is produced by the act of coughing,
from an elongation and relaxation of the uvula, from
the pressure of tumours and swellings in the throat,
trachea, or thorax, from hypertrophy and other organic
affections of the heart, and from accumulations of serum or pus within the thorax.
We have in several instances speedily succeeded in
removing troublesome coughs, and of restoring patients
to health, who were apparently in the last stages of pulmonary consumption, by clipping off a portion of an
elongated uvula. It is not uncommon that protracted
and troublesome coughs are promptly cured by the
removal of tumours in the neck, by the puncturing of
abscesses in the throat or chest, or by evacuating from
the thorax an effused fluid. It behooves us, therefore,
in all cases of cough, where the cause is not perfectly
apparent, to make our investigations with reference
to the above enumerated complications, in order that
surgical measures may be resorted to on all suitable
occasions.
It is to be feared that errors are sometimes committed by gentlemen of our school, in underrating the




358    DISEASES OF THE RESPIRATORY ORGANS.'value and importance of surgery, as a means of curing disease. When the cause is of such a nature that
our remedies are at best slow and uncertain, while a
speedy and safe removal may be effected by a surgical operation, we should never hesitate in our choice.
Even in cases like paracentesis abdominalis. or paracentesis thorasis, where only a troublesome symptom
is removed, we often accomplish much good by placing the patient in the best possible condition for the
favourable operation of remedial agents. But in the
examples of obstinate tumours and abscesses, pressing
unduly upon some part of the respiratory apparatus,
the aid of the surgeon is often indispensable.
Many individuals are troubled with coughs in
temperate latitudes from an inherent debility of the
lungs, and a want of vigour to resist the stimulating
influence of cold air. Such persons often succumb
eventually from phthisis, without having experienced
any actual inflammation of the pulmonary structure.
Others, from excesses of various kinds, acquire a predisposition to coughs, from the most trivial exciting
causes.
Tlterapeutics.-Appropriate medicines for all ordinary kinds of cough, may be selected from those already
referred to, when treating of the different affections of
the respiratory organs.




CHAPTER XXIV.
DISEASES OF THE HEART AMD ITS APPEXIDAG1E9
ThE heart and its appendages are subject to several
kinds of morbid action, which authors have described
under the terms angina pectoris, hypertrophy, and dilatation of the heart, diseases of the valves, carditis, and
pericarditis, and palpitation. Many of the symptoms
of these affections are similarf but we shall endeavour,
in the following brief description, to point out a sufficient number of signs to enable the physician to form
a ready and accurate diagnosis in all cases.
SECTION 1.
ANGINA PECTORIS.
Diagnosis.-At the commencement of the disease,
the patient experiences occasional sharp pains in the
region of the heart, especially after active exercise,
or when putting the muscles of the chest upon the
stretch. After a time, the pains recur more frequently,
continue for a longer period, and are accompanied by
palpitation, attacks of syncope, sense of suffocation,
and tightness in the chest, and great difficulty of
breathing. The attacks are usually excited by violent
physical exertions, mental emotions, and deranged
stomach, from abase of stimulants and of indigestible
food. In very severe cases, there are almost constant
dyspncea, pains extending down the arms and into the
back, very frequent and alarming attacks of syncope
and suffocation, pale and haggard, or livid and exceedingly anxious expression of countenance. If the disease is not arrested, the patient generally expires suddenly in one of these distressing paroxysms.
When angina pectoris proceeds from hypertrophy of
the heart, we shall observe, in addition to the symptoms just named, powerful pulsations of the heart,
which are visible at a distance, full and vibrating
pulse, and dull sound on percussion.
If the disorder has arisen from dilatation of the ven



360 DISEASES OF THTS HEART AND ITS APPENDAGES.
tricles, there will be swelling and visible pulsation of
the jugular veins, a loud and distinct sound on applying the ear over the fifth and sixth ribs, vertigo, frequent turns of syncope, palpitation and dyspncea, pulse
weak and tremulous.
When angina pectoris is connected with disease of
the valves of the heart, the following signs will be present: great dyspncea on the slightest exertion, frequent
and violent palpitations, pulse feeble and irregular,
livid and unnatural appearance of the countenance,
edematous swelling of the feet and ancles, and "a
permanent sawing or rasping, or filing sound over the
valves of the heart, especially after depletion and
rest."-(Swett.)
Causes.-Angina pectoris may proceed from some
organic disease connected with the heart, like ossification of the coronary arteries, or of the valves of the
heart, dilatation or hypertrophy of the heart, obstructed circulation from  an accumulation of fat about the
organ, from the pressure of the tumours, or from asthma. Very often, however, it is a purely sympathetic
affection, and entirely disconnected with any structural disorder of the heart or its appendages. In these
instances, the nerves which supply the heart are affected in such a manner that slight exciting causes,
as errors in diet, mental emotions, or ascending a flight
of stairs, induce the paroxysms.
Therapeutics.-In the selection of remedies, strict
regard should be had to the remote and exciting
causes of each case. If the symptoms are the result
of some organic affection of the heart, like those to
which we have alluded, our prognosis must be, for
the most part, unfavourable, and we can only reasonably expect to palliate the sufferings of the patient.
But if the remote cause consists simply of a diseased
condition of the par vagum, or of the cardiac nerves,
which renders them liable to become morbidly excited
from trivial causes, we may prescribe medicines with
every prospect of ultimate success. The most reliable
specifics in this malady, are aconite, digitalis, hepar
sulphuris, lachesis, nux vom., veratrum, sepia, sambucus,
ipecacuanha, pulsatilla, arsenicum, aurum.
The attenuations should be selected with reference




DISEASES OF THE HEART AND ITS APPENDAGES. 361
to the impressibility of the patient, and the medicine
persisted in, at suitable intervals, during the continuance of the complaint.
SECTION II.
CARDITIS AND PERICARDITIS.
Diagnosis.-Inflammation of the fleshy substance of
the heart, uncomplicated by disease of the pericardium,
of the pleura, or of the aorta, is an occurrence so rarely
met with, that some authors have described under one
general head, the symptoms resulting from inflammations of the heart and its appendages. The signs
usually present in carditis, often render our diagnosis
very obscure, on account of their resemblance to affections of the lungs, and of the pleura, and of their frequent complication with the latter. Frank believes
that much of the uncertainty which prevails respecting
cardiac affections, is attributable to the general neglect of the profession in investigating the movements
of the heart during disease, and in examining its morbid appearances in those who have died in consequence
of diseases of the chest. " II n'est pas douteux que, si
les hommes de l'art observaient avec la meme attention
les mouvements et les vibrations du cesur que les battements des artlres, s'ils multipliaient leurs recherchles sur
les cadavres. ils viendraient d bout de dissiper les
epaisses tenebres qui environnent les maladies de l'organe
central de la circulation."-(Frank.)
The ordinary symptoms of inflammation of the heart
and its envelop, the pericardium, are acute pains in the
region of the heart, increased by motion, or on assuming
the horizontal posture, sense of fulness and oppression
in the chest, palpitation, from the slightest exertion, or
from mental excitement; rapid. difficult, and irregular
respiration; short, dry, spasmodic cough; rapid, small,
irregular, and intermittent pulsations of the heart and
arteries; great anxiety, dread of suffocation, " absence
of the respiratory murmur, and dull sound on percussion."-(Hall.)  General febrile disturbance almost
always accompanies the inflammation, although the
heat is unequally distributed, some parts being intensely hot, while other parts are cold.  The counter
16




362 DISEASES OF THE HEART AND ITr APPENDAGES.
nance is always expressive of anxiety and distress, the
patient is desponding, irritable, and restless, and experiences alarming palpitations, faintness on rising up
in bed, or on talking.
Causes.-Protracted grief, anxiety, or mortification,
violent muscular efforts, external injuries, asthmatic,
and other pulmonary affections, metastases of rheumatism, or gout.
Therapeutics.-Digitalis, aconite, bryonia, arnica,
cannabis, pulsatilla, lachesis, spigelia, iodine, and arsenicum, are the medicines commonly employed in this
malady.
Digitalis, on account of its specific power over the
sympathetic nerve, and the cardiac plexus, is especially
adapted to those cases of pericarditis which have
been caused by violent emotions, and protracted grief,
care, and anxiety. The special indications are, sharp
stitches, or contractive pains in the region of the
heart; uneasy sensations in the left side of the chest,
often extending to the shoulder and arm; palpitations
excited, by talking, movement, or on laying down,
particularly on the left side; pulse rapid, weak, and
irregular, or slow, soft, and intermittent; sense of oppression and anguish in the thorax; general weakness;
frequent attacks of faintness; respiration slow, difficult, and unsatisfactory, or short, painful and sighing;
frequent flushes of heat in the chest, face, and head,
while the extremities remain cold; general feeling of
anxiety and despondency. A drop of the second or
third dilution should be prescribed, in water, every two
hours.
Aconite is a suitable remedy, when the movements
of the heart and arteries are more rapid and vigorous
than in health, and when the congestion to the heart
is accompanied by an unusual degree of erethism.
The pains in the cardiac region are of a constrictive,
oppressive or lancinating character; the breathing is
short. anxious, and laboured; the pulse is rapid, strong,
and intermittent; the action of the heart is exalted,
and often irregular; febrile symptoms are strongly
pronounced; the patient inclines to sit with his body
bent forward, in order to relax the muscles of the
thorax, and thus to obviate the liability of pain from




DISEASES OF THE HEART AND ITS APPENDAGES. 363
this cause. The first or second dilution of aconite may
be selected, and a single drop administered in water,
every two, three, or four hours, as the nature of the
case demands.
Bryonia will occasionally be required, in inflammations of the heart and its appendages, which are complicated by disorder of the pulmonary structures. It
will likewise prove serviceable in cases which are connected with rheumatism or gout. The following are
its indications: drawing and stitching pains in the
chest, aggravated by breathing, or by movement; rapid, anxious, and painful respiration; dry, spasmodic,
and painful cough; lancinating pains extending into
the shoulders and back, between the shoulder-blades;
oppression in the chest, which causes frequent sighing;
determinations of blood to the chest, and head; rapid,
weak, and intermittent pulse; anxious, depressed, and
irritable. Its administration is the same as aconite.
- Arnica is chiefly useful when the inflammation has
been caused by external injuries, like contusions,
wounds, &c. The special indications are, lancinating
pains in the region of the heart; oppression at the
chest; great difficulty of breathing; short, dry. and
irritating cough; sharp pains through the heart, which
cause faintness; irregular action of the heart; pains,
and dyspncea, increased by mental or physical exertion.
It may be given the same as aconite.
Cannabis, pulsatilla, lachesis, iodine, and arsenicum,
have been employed with success, in cardiac inflammations which have arisen from suppression of eruptions, or the drying up ofi' old ulcers. They may be used
at the second or third attenuations-the repetitions of
doses to be governed by the urgency of the symptoms,
and the medicinal or other effects produced.
Should the disease terminate in dropsy of the pericardium, our best remedies are, arsenicumn, apis mel.
and iodine. We prefer the first or second attenuations
-a dose once in six hours until an impression is
evident.




364
CHAPTER XXV.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
SECTION I.
GENERAL OBSERVATIONS.
IF the soul of man manifests itself through the
healthy organism in a certain definite manner, and
if these manifestations are modified precisely in accordance with the abnormal conditions which the organs and tissues may acquire, the importance of a correct understanding of the exact healthy functions of
all the structures, and of their alterations during disease, will be duly appreciated. Unfortunately for
science, the profusion of hypotheses, the arbitrary assumption of ancient ideas for facts, as well as the inherent difficulties attending the pathology of diseases
of the cerebro-spinal system, have until recently retarded the onward progress relative to their nature
and treatment. Until Sir Charles Bell demonstrated
that the nerves which arise from the posterior column
of the spinal marrow were devoted to sensation; those
from its anterior column, to muscular contraction;
while the middle column gives origin to the respiratory
nerves, the most erroneous and contradictory notions
were entertained respecting the functions and diseases
of the nervous system.
Majendie, Flourens. Abercrombie, Hall, Solly, Serres, Bennett and Andral have also thrown much light
upon the functions of particular portions of the brain;
but much yet remains to be done in this important
field of discovery, and it is only by banishing from
our medical vocabulary all vague and obscure expressions, and contemplating the body as a complicated machine, actuated and kept in operation by an intelligence which pervades every part, and in conjunction with its material stimuli, giving rise to sight in
the organ of sight,-hearing, taste, smell, digestion,
assimilation, calorification, motion, &c., in their several
organs;-and perceptions, memory, comparisons and




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 365
ratiocination, by their operation upon a combination
of organs, that we can arrive at accurate conclusions.
The cerebral organs may be affected throughout
their whole extent, or in isolated parts alone; but
whatever condition obtains, diseases of certain sections
of the cranium usually give rise to peculiar and well
defined symptoms. Thus, compression of the brain,
whether from effused blood, serum or pus, depression of
a portion of the cranium, or a congested and relaxed
condition of the cerebral vessels, give rise to coma,
with slow pulse and stertorous respiration: organic
lesions of the brain, toparalysis of one or more parts
of the body, depending upon the extent of the lesion
and the part affected: irritation of the brain, to convulsions: disease of the cortical substance or hemispherical ganglia, to delirium and mania: of the medullary or tubular structure, to convulsions: effusion within the ventricles, to dementia: effusion upon the surface of the brain, to lethargy: inflammation of either
lateral lobe of the cerebellum, to paralysis of the lower
extremity of the opposite side: inflammation of the
middle lobe, to erection of the penis, (Hall:) of the
arachnoid and pia-mater, to delirium: ramollissement, to
torpor of the intellectualfacullies and loss of muscular
power.
So strongly marked are these signs, that pathologists
have made somewhat minute classifications of the diseases of the brain, as of the arachnoid, of thepia-mater,
of the cortical, or the medullary part, the base, the tuberannulare, the hemispheres and the cerebellum. But it
is to be observed in most cerebral affections, that inflammations of particular structures rarely exist uncomplicated with more or less disease of the surrounding parts, and on this account we meet with a great
diversity of symptoms during their progress. For this
reason, if no other, it is more consistent to prescribe
for the totality of the symptoms than for the mere name
of the disease. By the former-course we pursue a definite object, and apply our remedies with an assurance
of success, even if we are in error respecting the pathology of the case; while by the latter method, we
are liable to mistake the location and nature of the
malady, and thus adopt a pernicious mode of practice.




366  DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
For example, by mistaking the cerebral symptoms of
a typhus fever for encephalitis, or the ancemic condition of the brain which obtains in true delirium tremens, in some cases of apoplexy, in epilepsy, and in
ramollissement, for acute inflammation, and resorting to
the usual remedies for the cure of the latter, viz.:
copious venesections, the most disastrous results
might be apprehended. It is now a well-ascertained
fact, that delirium, coma, hydrocephalus, and one form
of ramollissement, may result from an ancemic, as well
as an inflammatory condition of the brain. Drs. Abercrombie and Marshall Hall recognise still another
comatose condition independent of disease of the brain,
and arising from exhaustion of the general system occurring during the last stages of certain diseases; but
from the fact that this coma generally occurs after
protracted bowel'complaints where opium has been
used as the principal remedy, we are of opinion that a
real cerebral disease has been superinduced by the
remedy.
For the cure of the symptoms above named, arising
from an anaemic condition of the brain, tonics, stimulants and a nutritious regimen are deemed essential by
the practitioners of the old school. Blood-letting and
antiphlogistics in these cases, are fatal. But when
the same symptoms arise from an inflammatory condition of the encephalon, a treatment directly the reverse, is supposed to be necessary to save life, like
venesection, leeching, purging, blisters, &c. Now
when we contemplate the great uncertainty attending
the diagnosis in these two forms of disease, and the
danger which must attend mistakes in treatment originating from errors respecting the peculiar condition
of the brain, is it strange that people have no more
confidence in allopathy?
We have before remarked, that morbific substances,
in order to develop diseased action in the organism,
must be taken into the blood and conveyed to those
tissues upon which they exert a specific morbific influence, there producing those alterations (probably
upon the sentient extremities of the nerves) which constitute disease. It is only necessary to refer to the
examples to which we have alluded in another part




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 367.
of this work, to render this supposition entirely probable.
It is also equally evident, from the multitude of experiments by Muller, Majendie, Orfila, Pereira, Hahnemann, Trinks, Philips, Flourens, and Bichat, that
poisonous drugs and all medicinal substances operate
in the same manner in producing their specific poisonous or medicinal effects.
There are other causes constantly operating upon
the system, of a character entirely different from those
to which allusion has just been made, and which may
with propriety be termed spiritual or dynamic. Thus,
violent mental disturbance may cause epilepsy or apoplexy-chagrin and grief, biliary derangements, jaundice, and dyspepsia-sudden news, whether good or
bad, diarrhmea-anger, fear, disappointment, and ill
news, sometimes instantly destroy the appetite; fear
and apprehension, predispose to contagious disorders;
the sight of blood induces syncope; and of human suffering, pain and disorder in the stomach. In these
cases, the unusual mental excitement determines an
unnatural amount of blood to certain parts, the bloodvessels and nerves of such parts are oppressed, and
disease results.
But it is of vast importance that these spiritual or
dynamic causes be not confounded with those which
are material and imponderable. Let us not deceive
ourselves and the world, by classing them where they
do not belong, simply because our limited knowledge
of the sciences renders us as yet incapable of appreciating the nature and the precise mode of operation of
the latter!
Although. cerebral affections may arise under favourable circumstances, from the absorption of morbific and medicinal substances, and from spiritual or
dynamic influences, yet the latter rank first in importance, especially in what are termed chronic cerebral
maladies. In the treatment of brain diseases, therefore,
too much importance cannot be attached to an accurate knowledge of these causes; for it is only by their
prompt removal, together with a judicious application
of remedial agents, that we can expect complete success.




368 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
The curious reader will find much to amuse, if not
instruct, by tracing the medical history of cerebral maladies from Hippocrates to the present time. Throughout all of this period, notwithstanding the numerous
changes of opinion respecting their nature, causes, &c.,
one striking fact will always be observed, viz.: that
the treatment for all of these complaints has remained
almost the same as first instituted by that very respectable heathen philosopher, Hippocrates, until the period of Hahnemann.
In proof of the singular tenacity with which the medical world has clung to the opinions of the ancients,
we may cite the doctrines of eminent physicians as
late as the time of Sydenham, who supposed the cause
of many brain diseases, as lethargy, coma, paralysis,
&c., to consist in a " viscid condition of the blood and
lymph, which obstructed the pores of the brain, and dulled
the animal spirits.  While the viscid bloodforces its way
into the brain, through the two carotids, it leaves in its
passage a slimy matter, through which the animal spirits
passing, stick by the way, and so the pores of the brain
are obstructed."-(Sydenham  and Salmon, Prac. Phys.,
p. 203.)
Their indications of cure, were: first, " to evacuate
the redundancy of phlegm and choler, or to carry of that
vicious acid which has created the viscosity of the blood.
Second, to alter thepresent dyscrasia of the blood. Third,
to open the pores of the brain now obstructed, and give a
free passage to the spirits. Fourth, to strengthen the
weakened parts, quicken the dull spirits, and increase
their store or stock."-(Ibid.)
To fulfil these indications of cure, the fathers of allopathy adopted almost precisely the same treatment
as that which prevails with their brethren of the present day, viz.: blood-letting, emetics, cathartics, "to
purge of the phlegm and choler," antimonials and alteratives, " to cut up the gross phlegm, dissolve the coagulums of the blood and humours, and excite the animal
spirits to a brisker and more lively air." Paracelsus
and Van Helmont particularly commended opiates and
narcotics in chronic affections of the brain. If we refer to the most recent writers on insanity and other
cerebral affections, we shall find not only the same




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 369
remedies retained, but the same diversity of opinions
respecting the application of these remedies; some
trusting to venesection and purges, some to tonics,
while others depend upon opiates and narcotics.
In a book which is now before me, published in the
year of our Lord, 1587, by " Andrew Boord, Doctor of
Physic-an Englishman," our sapient author supposes
that maniacs are possessed of devils, and advises for
their cure, in addition to blood-letting, cathartics, &c.,
that they should be sent to Rome to be made whole.
" For within the precincts of St. Peter's Church, without
St. Peter's Chapel, standeth a pillar of white marble,
grated round about with iron, to the which our Lord
Jesus Christ did lie in himself at his delivery unto Pilate, as the Romans doth say, to the which pillar, all
those that be possessed of the devil, out of divers countries and nations, be brought thither, and as they say
at Rome, such persons be made there whole." It was
a matter of doubt, however, whether the pillar or the
priest (who accompanies the patient within the enclosure) effected the cure, though we believe the weight
of argument was in favour of the priest.
The same writer supposes the cause of phrenitis to
consist of "water or wind enclosed in the head," and
the remedies were "to purge the head with sternutatories, and the bowels with physic."
Modern pathologists have discovered that maniacs
are not possessed of devils,-that phrenitis is not owing to " wind being enclosed in the head,"-that coma,
lethargy, and paralysis, are not caused by "viscid
blood rushing into the brain through the two carotids,
and leaving in its passage a slimy matter, through
which the animal spirits passing, stick by the way,"
but they have demonstrated that inflammation, irritation, organic lesion, and compression, give rise to the
phenomena which characterize the different diseases
of the brain. But notwithstanding this change of
opinion in a pathological point of view, the therapeutical doctrines remain the same as formerly, with the
single exception of advising maniacs to be sent to the
marble pillar at Rome.
Blood-letting, probably to let out the " slimy " part
of the blood; emetics and purgatives, to " purge off
16A*




370 DISEASES OF, THE BRAIN AND NERVOUS SYSTEM.
the phlegm and choler," irritating and inflaming the
intestinal canal in order to cure a disease located in
the brain, and now and then an opiate to cover up
symptoms when too troublesome, are still resorted to
by gentlemen of the old school.
It is to be hoped that the time is not far distant
when all such indirect and unreasonable practices for
the cure of diseases, will be entirely superseded by
the more direct and philosophical method of treatment
which has been instituted by the father of homceopathia and his disciples.
Probably in no class of maladies has allopathy been
so much at fault as in her classification of cerebral
affections. Each author who has written upon the
subject, has taken upon himself to promulgate.pathological views different from those of his predecessors,
and from these views to form new classifications and
new modes of treatment.  While some nosologists
recognise inflammations of the arachnoid, of the pia
mater, of the cineritious, or cortical substance, of the
medullary, or tubular structure, of the different lobes
of the cerebellum, of the tuber-annulare, &c., as distinct diseases, requiring different modes of treatment;
others, as Frank,* describe inflammation of the hemispheres of the brain, the cerebellum, and their
common envelopes, as a single disease, under the
general term encephalitis, and demanding for its cure a
definite course of treatment. Thus, " L'inflammation
du cerveau, die cervelet, de leur enveloppes communes, ne
prisente pas, selon la difference de son siege, des sympt6mes distinctifs szurs et constants." So also Solly, in his
work on the human brain, at page 322, remarks, "I
have long felt convinced that there is no such thing as
inflammation of the pia mater; independent of the
brain, and that much mischief has accrued from our
systematic writers treating of inflammation of the
membranes of the brain as distinct from inflammation
of the brain itself." The same writer lays down the
following broad principles, viz., " that inflammation of
the brain is a depressing disease, and that, as a general rule, general blood-letting is not often admissible.
* Trait6 de M6dicine-practique, page 116.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 371
That, although blood-letting may sometimes be attended with benefit at the time, the good derived from
it is seldom permanent."  Again, "II n'existe pas de
signes certains qui annoncent le siege de l'encdphalite,
qui caracterisent la phlogose superficielle et l'inflammation phlegmoneuse avec tendance a la suppuration. Ces
varietes n'ofrent pas des caracteres diferentiels assez
constants pour distinguer la frenesie de la cephalite.
L'invasion subite de la douleur, la violence de la fitevre,
la stupeur des organes des sens et de l'entendement,
bientot suivie de l'extinction de leurs facultes, ne prouvent pas l'inflammation de la pulpe cerebrale.-(Frank)."
In view of these radical differences of opinion, and
from the generally acknowledged fact, that no single
structure within the cranium can become inflamed,
without involving to a greater or less extent other
portions of the cerebral region, we shall adopt the
fbllowing classification: First, encephalitis, embracing.
acute inflammation of the hemispheres, the cerebellum, and their membranes; under which head we
shall point out, as clearly as possible, the peculiar
symptoms which are supposed to characterize affections of these different parts. Second, the diseases
which occasionally result from encephalitis, as ramollissement, hydrocephalus, and epilepsy. Third, apoplexy and paralysis. Fourth, delirium tremens. Fifth,
insanzty.
SECTION II.
ENCEPHALITIS.
Diagnosis.-There are certain symptoms which are
common to the first stages of all acute inflammations
of the cerebral organs; and which, taken by themselves, afford no indication of the actual seat of the
disorder. These symptoms are, a vague sensation of
coldness in the first instance, perhaps succeeded by
occasional flushes of heat, lassitude, anxiety, sadness,
irritability, often alternating with great exaltation of
the intellectual faculties; hilarity, sudden bursts of
laughter, petulance, unwonted impudence and vulgarity; redness of the skin, heat, pain, pressure or tension in the head; strong pulsations of the carotid




372  DISEASES OF THE BRAIN A-ND NERVOUS SYSTEM.
and temporal arteries; singing noises in the head,
vertigo, weakness of memory, frightful dreams, fantastic visions when awake; trembling of the limbs,
nausea, vomiting; eyes bloodshot, great sensibility to
light; constant wakefulness; acuteness, or dulness of
hearing; mouth and tongue dry; urine, copious, yellow, and thin as water.
The symptoms which usually obtain in the second
stages of these affections are, stupidity, coma, paralysis, eyes suffused and dull, besotted expression of
countenance, strabismus, position upon the back, pupils dilated, suppression of urine, and general loss of
muscular power.
The signs which are supposed to be peculiar to the
first stage of inflammation of the cortical substance,
or hemispherical ganglion, and the membranes of the
brain, are, early derangement of the intellectual faculties, fixed pain in the upper part of the head; hot and
dry skin, conjunctiva injected and red; eyes brilliant,
ferocious, fixed, and intolerant to light;tone rough,
violent, and defiant; face red and swollen; inclination
to do himself or others injury; great exaltation of
muscular strength; strong pulsations of the carotid
and temporal arteries; constant wakefulness; continued and rapid motions of the head; impatience, irritability:. and constant agitation.
The first stage of inflammation of the medullary
substance of the brain, is recognised by the following
symptoms: vague chills; deep-seated headache, or
vertigo; vomiting, lassitude, trembling of the limbs;
convulsions before any signs of mental disorder, anxiety, sadness, great agitation, arms continually raised
towards the head, position mostly upon the back,
noises in the head. This disease is so insidious in its
approach, that convulsions may occur as the very first
symptom. In instances like this, it is probable that
inflammation exists in the medullary substance alone,
without involving in the slightest degree the gray
matter of the convolutions surrounding this part, or
the envelopes of the brain. We are forced to this
conclusion if we adopt the opinions of Bouilland, Solly,
Duchatelet, Hall, and Bennett, who suppose the cineritious, or cortical substance of the brain, to be " im



DISEASES OF THE BRAIN -AND NERVOUS SYSTEM. 373
mediately connected with the intellectual powers,"
while the medullary portion presides over the muscular powers of the organism. Therefore, after an injury to the head, if the intellect is only impaired, we
may be certain that the hemispherical ganglion is
the seat of the injury, while if, in addition, there are
involuntary convulsive motions of the muscles soon
after the accident, we may be equally sure that the
medullary substance has also received detriment.
Inflammation of the medullary structure is more
prone than either of the other cerebral inflammations,
to terminate rapidly in softening, and for this reason it
is incumbent upon physicians to exercise the greatest
care in their investigations of this class of maladies,
and to apply their remedial measures with due
promptness.
The most prominent secondary symptoms of disease
of this portion of the brain are, muscular paralysis,
and loss of sensation in the parts affected.
According to MarshalHall, " disease of a lateral lobe
of the cerebellum  induces paralysis of the opposite
side, and chiefly of the lower extremity. Disease of
the middle lobe of the cerebellum is denoted by erection of the penis. Disease of the medulla oblongata
induces paralysis of the respiratory muscles, and consequently, when complete, instant death."
We have now enumerated those symptoms which
are supposed to characterize the inflammations of the
different cerebral structures, and in this connection,
we call the attention of homeopathic practitioners
especially to this subject, with reference to the therapeutical application of medicines. Flourens has demonstrated, by experiments upon birds, that belladonna,
opium, and alcohol, uniformly exercise a specific action upon certain portions of the brain.  Hahnemann
and his disciples have also proved that large doses of'
these articles taken in health, uniformly give rise to
those physical and mental manifestations which pathologists have shown to proceed from disease of these.same. parts.  When, therefore, in our provings of
drugs, it is observed that the prominent symptoms are,
derangement of the intellectual faculties, exaltation of
the mental and muscular powers, eyes bloodshot, and




374 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
expression furious and defiant, manner violent and
overbearing, voice loud and rough, throbbing pain in
the head, face red and swollen, we may be certain
that a specific effect has been produced upon the cortical substance of the brain. If, instead of these
symptoms, we are presented with convulsions, paralysis, and general depression of the powers of the
system, we may infer that the drug has acted specifically upon the medullary portion of the brain. The
same law obtains in relation to those symptoms which
characterize diseases of the different lobes of the
cerebellum of the medulla oblongata, of the different
portions of the spinal marrow, of the nerves, and
indeed of all other parts of the organism.
In our selection of remedies, therefore, we should
always endeavour to choose those of which the action
has been shown, by pathological facts, as well as by
provings, to be positively specific upon the structure
affected.
Causes.-Solly hag very justly observed, in his treatise on the human brain, that " there is no single cause
which so frequently produces inflammation of the hemispherical ganglion, or meningitis, as sudden emotion,
whether of joy or fear. The latter is, however, much
more common."  Other causes are, fractures and contusions of the cranium; insufficient sleep; intense and
protracted thought upon a particular subject, disappointed love or ambition; repelled eruptions, whether
by natural causes or by the abuse of ointments; exposure to cold, or to a burning sun; abuse of opium,
and spiritous liquors; metastases of rheumatism, gout,
or erysipelas, and suppression of the lochial and other
habitual discharges. It often arises during the progress
of pneumonia, scarlatina, erysipelas, otitis, and bowel
affections. The most common predisposing causes
are, plethora, a passionate and excitable disposition,
want of exercise, high living, and abuse of stimulants.
Therapeutics.-In the treatment of this class of diseases, it is of especial importance that due regard be
paid to the causes which may have conduced to the
attack. An encephalitis which has followed immediately upon the suppression of a lochial discharge,
an habitual nasal heemorrhage, or the retrocession of




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 375
an eruption by improper external applications, not
only requires a remedy which shall cover all of the
manifest symptoms, but one which, at the same time,
shall operate in such a manner as to bring back the
original discharge, or eruption. If disappointment,
pecuniary embarrassments, fright, or political or religious excitement, has been the exciting cause, the
mind of the patient should be soothed and attracted
into new and agreeable trains of thought. By these
means we shall prepare the organism to receive our
remedies in the most favourable manner.
The principal remedies employed in encephalitis,
are, belladonna, aconite, opium, hyoscyamus, stramonium,
moschus, chamomela, laurocerasus, and ignatia, for inflammation of the medullary substance alone: moschus, plumbum, acid oxalic, nux vomica, opium, and
oleander,:for paralysis: rhus rad., rhus tox., bryonia,
and belladonna, for metastasis, or extension of rheumatism to the brain: spigelia, cuprum acetat., tartar
emetic, bryonia, sulphur, tabac., and belladonna, when
the disease has arisen in consequence of repelled
eruptions.
Belladonna will be required when the disease presents itself as follows: febrile symptoms, accompanied with dryness of the mouth, tongue, and throat;
difficult deglutition, nausea, vomiting; confusion of
the head; giddiness; dilatation of the pupils; injection of the conjunctiva; eyes suffused, brilliant, furious, and protruded; imperfect vision; gay delirium;
increased secretion of urine, and frequent desire to
evacuate the bladder; heaviness, pressure, or throbbing pain in the head; roaring in the ears; vertigo,
with nausea.
When children are the subjects of attack, Dr. Bigel
gives the following excellent indications for the use
of belladonna: "The children constantly press their
heads into their pillows, they are startled by the least
noise or light, there are, snoring sleep, great heat of
the head, face red and puffed, with visible beating of
the arteries of the head and neck, swollen veins, and
occasionally hydrophobic phenomena."
During the period of dentition, and directly after
being weaned, children are particularly prone to at



376 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
tacks of inflammation of the brain. At this age, the
child is exceedingly sensitive, and there is an unusual
tendency of blood towards the brain; but if the signs
of cerebral disturbance be closely watched, we shall
find nio difficulty in combating them successfully at
the onset with belladonna. We have often employed
this remedy with satisfactory results when the following phenomena were present:
External indications.-Face hot, red, and swollen;
eyes red, sparkling, and fixed, or half open and distorted; pupils contracted; visible throbbing of the
carotid and temporal arteries; veins of the head distended; constant boring with the head into the pillows; paralysis of one or more parts; convulsive
movements; rapid, small, or intermittent pulse; subsultus tendinum; distortion of the features; grinding
of the teeth; tongue bright red, and cracked;, urine
scanty or suppressed.
Physical sensations.-Sharp, throbbing, or confused
pain in the head; great restlessness and agitation;
intolerance to soundoand light; thirst; head and face
very hot; limbs cold, with internal burning heat;
roaring or humming in the ears; deafness; inability
to speak or to swallow; nausea and vomiting during
the course of the disease; sparks, flashes, or visions
before the eyes.
Mental and moral symptoms.-Great sensitiveness
of the nervous system; violent delirium at night;
profound sleep; mania; hydrophobic symptoms.
Belladonna is likewise especially necessary in inflammations of the brain, proceeding from metastases
of scarlatina, measles, erysipelas, and smallpox.
Its specific action is upon the cortical substance,
the tubercula quadrigemina, and the membranes of
the brain. When febrile symptoms are strongly pronounced, it should be preceded by aconite, or given in
alternation with it.
Administration.-We advise from the first to the
third attenuation for adults, and from the third to the
sixth for children. As a general rule, the dose may
be repeated every two hours until the required impression is produced upon the inflamed structure.
There is no proof that aconite affects specifically




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 377
either the brain or its envelopes. In autopsical examinations of those who have died from having accidentally taken poisonous doses, no traces of inflammation have been found in the cortical substance, or
the membranes of the brain, and but slight marks of
action in the medullary structure. The prominent
symptoms to which large doses give rise, are, "numbness and tingling of the parts about the mouth and
throat, and of the extremities, vomiting, contracted
pupil, and failure of the circulation." —Pereira, Materia Medica, vol. ii., p. 153. The intellectual powers
remain unaffected, and neither convulsions nor stupor
usually occur.
Dr. Lombard, of Geneva, in his clinical practice,
and in his experiments on animals, found that the internal exhibition of aconite, generally had the effect
of." rendering the pulsations less frequent, without
irregularity, and, consequently, that it exerted a decidedly sedative effect upon the heart; whence he
infers that it is a proper remedy in inflammatory affections in general."
Others have observed, that its primary effect was to
stimulate the action of the heart and arteries, and
cause a universal glow over the surface; while the
secondary effect was decidedly sedative upon the circulatory vessels.
Its effects are so manifest upon the action of the
heart and arteries, that its use will be of eminent
service in all those cases of encephalitis, or congestion, dependent upon a plethoric state of the system,
or organic disease of the heart. It should also be
given during the existence of active febrile symptoms,
in all cerebral affections, and generally in alternation
with some positive specific, in order that the malady
may be met at all points. Attenuation and repetition
of doses the same as belladonna.
Opium. It is conceded by both schools, that opium,
when exhibited in moderate doses, exercises upon the
human constitution two different effects-a primary,
and a secondary —hich are of directly opposite characters. The first of these effects is invariably stimulant, as is evinced by such phenomena as increased
force and frequency of the pulse, dryness of the mouth




378 DISEASES OF THE BR&INS AND NERVOUS SYSTEM.
and throat, a pleasant glow upon the skin, exaltation
of the mental faculties and of the muscular system,
a sense of intoxication, and temporary retention of
the stools.
The secondary manifestations are, general diminution of sensibility throughout the body, a feeling of
relaxation and calmness, tremulousness in the limbs,
disinclination to exercise, pulse full and slow, drowsiness, dryness of the mouth and throat, thirst, nausea,
and, finally, if a large dose has been taken, slow and
laborious respiration, spasmodic contractions of the
muscles, eyes half closed, pupils dilated or contracted,
and insensible to the light, bloated, suffused, and besotted expression of countenance, cold and clammy
extremities, respiration gasping, rattling, stertorous,
face pale, sunken, and deathlike, rigidity of the jaws,
entire insensibility to external impressions, puJse
thready, and almost entirely imperceptible.
Wood and Bache suppose " that the active principle
of opium is conveyed into the circulation, and operates
upon the brain, and probably upon the nervous system
at large, by immediate contact with their interior structure."-Wood 4 Bache's U. S. Dis., p. 476.
Opium is generally supposed to cause death by suspending the " cerebral influence necessary to sustain
the respiratory function; and it is supposed, also, that
the heart ceases to act in consequence of the cessation of respiration."-Brodie.
From these facts, we infer that the specific action
of opium is principally upon the medulla oblongata,
although the other symptoms indicate that there has
been some action upon other parts of the brain, and
also upon the skin, and lungs.
In autopsical examinations of those who have died
from the effects of this substance, extravasated blood
has been found in the brain, distention of the sinuses,
and of all the cerebral vessels, but it is probable that
many of these appearances are results of the impeded
respiration, the imperfect decarbonization of the blood,
and the impaired circulation which have arisen from a
paralysis of that portion of the cerebral mass which
presides over the respiratory functions, rather than
from any specific operation of the opium upon these
different structures.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 379
Opium, in small doses, has always been observed to
excite the venereal propensities, and has been used
for this purpose for a long period by the Turks, Chinese, and Egyptians. This fact, viewed phrenologically, affords another proof of its specific action upon
the cerebellum.
In proof that the active principle of opium is absorbed, and operates by actual contact in producing its
specific effects, we quote the following from Pereira
and Barbier: "' The odour of opium is frequently recognisable in the secretions, exhalations, and breaths
of persons poisoned by it, and the secretions, in some
cases, appear to possess narcotic properties."
My own opinion, derived from post-mortem examinations of those who have been poisoned by opium, and
from the effects to which it usually gives rise, is, that
it exercises, first, a specific action upon the cerebellum
and medulla oblongata. If the drug be taken in moderate doses, this action is in the first instance, excitant,
producing venereal desires, erections, accelerated respirations, circulation, and augmented muscular force;
and secondarily, sedative, as is shown by the languid,
relaxed and calm state of the whole system, the diminution in the number of respirations, and in the action
of the circulatory vessels.  If taken in very large
doses. the parts appear to be paralyzed at once, and
all of those organs the functions of which are dependent upon the integrity of this part of the brain, cease
to act.
Another specific effect of opium is upon the skin,
as is evinced by the perspiration and its odour, and
the eruption to which it occasionally gives rise.
Nor is it at all improbable that it may operate
somewhat upon the par vagum, or the lungs themselves.
The most prominent indications, therefore, for the
use of opium, are, exaltation of the physical and mental powers, succeeded by depression and calmness, dry
throat and mouth, agreeable reveries, dreams, pulse
at first rapid and full, afterwards slow and feeble,
drowsiness, disinclination to muscular exertion, slow,
irregular and stertorous respiration, profound coma,
pallid, sunken and ghastlyface, immoveable, contracted,
or dilated pupils, rigidity of the jaws, cold and clammy




380 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
extremities, complete insensibility to external impressions, and sometimes convulsive twitchings, extinction
of the pulse, interrupted and gasping respiration, and
finally death. It may be administered in the same
manner as belladonna.
Hyoscyamus, stramonium, and musk, are applicable
in cases attended with complete loss of sense, convulsive or spasmodic movements; closed eyes, low muttering delirium, constant movements with the hands,
dilatation of the pupils, rapid and anxious respiration,
frequent sighing.
If inflammation of the brain has arisen in consequence of a suppressed otorrhoea, sulphur should be
employed. In those cases which occur in children
from teething, chamomela, belladonna, and aconite, are
our most reliable remedies.
In cases of metastases or extensions of rheumatic
inflammations to the brain, rhus rad. and rhus tox.
are our best remedies.
- Cuprum acetat, should be given, in cases which have
arisen from repelled eruptions.
When encephalitis threatens to run into dropsy of
the brain, mercurius sol. is the best remedy to counteract the tendency to effusion.
If the disease has arisen from exposure to the sun,
repeated doses of camphor are highly-recommended.
Administration.-Our attenuations may range from
the first to the sixth, and the doses repeated every two,
three, or four hours, according to the severity of the
symptoms.
SECTION III.
RAMOLLISSEMENT DU CERVEAU. —SOFTENING OF THE BRAIN.
It is not yet decided whether ramollissement, or softening of the brain, proceeds from inflammation, or is a
disease, suigeneris. Many of the French pathologists
suppose it to be the result of inflammation; while
others, as Rostan, believe it to be a disease, suigeneris.
Abercrombie believes it may arise from either inflammation, or from a condition of the cerebral structure
analogous to those parts which have become gan-.grenous in other parts of the body, while Solly sup



DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 381]
poses that it may arise from inflammation, from a
total failure of the circulation, and from " local and
general anaemia." Dr. Burnett recognises two kinds of
cerebral and spinal softening, an inflammatory and
a non-inflammatory, and "which may always be distinguished from each other by means of the microscope."
Inflammation of the tubular structure is more prone
to terminate in softening than any other portion of the
brain, and it is usually very insidious in its approach.
Diagnosis.-Softening of the brain may supervene
suddenly upon an attack of acute inflammation, like
hydrocephalus, or it may make its appearance in a
gradual and imperceptible manner.  Some of the
characteristic symptoms of ramollissement are, insensibility, dilated pupils, slight muttering delirium,
paralysis, contraction of the flexor muscles, constipation, and a urinous smell.
Those cases which have arisen from an anaemic
condition of the brain, or from an obliteration of the
arteries which supply this organ, are usually slow in
their progress, and manifest themselves by a gradual
failure of the memory, drowsiness, an cedematous
state of the body, occasional wandering of the mind,
especially during the night, general languor, slow,
dragging, and imperfect articulation, constipation, loss
of energy and ambition, and an almost entire absence
of pain or febrile symptoms.
Ramollissement, from whatever cause it may proceed, is seldom cured. As remedies, however, we suggest opium, hyoscyamus, china, secale cornutum, carbo
vegetabilis, belladonna, nux vomica.
SECTION IV.
ACUTE HYDROCEPHALUS.
Diagnosis.-This is a malady almost peculiar to infancy and childhood. The symptoms which indicate
its approach, are neither very uniform nor regular.
Indeed, so -various and; uncertain are these symptoms,
that some writers suppose the effusion to be dependent
upon a debilitated condition of the membranes, analo+




382 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
gous to dropsy, while others attribute it to inflammation in all cases.
It may appear suddenly, with most of the phenomena which we have designated as characteristic of
encephalitis, viz., febrile symptoms, quick pulse, fits
of screaming, expression bold and furious, eyes bloodshot and brilliant, great heat of the head, nausea, vomiting, noise and light painful, convulsions, ending in
coma and death, in a few days. In cases of this description, there exists unquestionably acute inflammation of the meninges of the brain, and the effusion
commences almost simultaneously with the inflammation.
In other instances, the disease approaches insidiously, presenting no marked symptoms for some days.
The child will perhaps be observed to be petulant, to
complain of some pain in the head, to become easily
fatigued, to have occasional flushes of heat, to be restless at night, occasionally to grind the teeth, to have
lost the appetite, and to prefer the recumbent position.
After these symptoms have continued for an indefinite
period, the more serious signs of effusion present
themselves, as general diminution of sensibility, less
frequent and more irregular pulse, greater debility,
constant inclination to keep the bed, or to be held in
the arms, dilatation or contraction of the pupils, frequent sighs, strabismus, or an unnatural expression of
the eyes, turning inwards of the feet and hands, slight
convulsive twitchings of the face, upper lip, and arms,
automatic movements of the hands towards the head,
rolling of the head from side to side, constant motion
of the lips, convulsions, paralysis, and coma.
Chronic hydrocephalus, is usually the result of a very
slight inflammatory action, which has progressed very
slowly and insidiously. The indications which mark
this affection are, gradual emaciation, feebleness,
unnatural enlargement of the head, occasional giddiness, and now and then strabismus.
Therapeutics. —The medicines which we would suggest in this affection are, belladonna, digitalis, nux
vomica,phosphorus, stramonium, tartar emetic, veratrum
and aconite.
During the first stage of the acute variety, our most




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 383
reliable remedies are, aconite and belladonna. They
should be given as often as once in two hours, until a
manifest effect has been produced, after which we may
repeat as circumstances require.
If the inflammation has not been promptly subdued
by the use of aconite and belladonna, but signs of
effusion manifest themselves in the form of " deep red,
or almost brown face; eyes rolling in their orbits,
sometimes closed, and at others wide open; lips dry;
tongue covered with a brownish yellow fur; tension
and swelling of the belly; constipation; generally, retention of urine, or difficulty in passing it; respiration
quick, anxious, and sighing; deglutition difficult; skin
of the whole body dry and burning, bryonia acts surprisingly."-(Bigel.)
Helleborus nig., has been successfully employed in
many apparently hopeless cases, which were attended
with coldness, and insensibility of the surface; rapid
and feeble pulse; convulsions and spasmodic rigidity
of the limbs; face pale and swollen; constant rolling
of the head from side to side; moaning; general prostration.
After decided marks of effusion obtain, digitalis,
mercurius sol., belladonna, veratrum and arnica deserve
our consideration.
Nux vomica and stramonium will be required when
great agitation, flushed face, convulsions, strabismus,
haggard and staring look, involuntary twitchings of
the muscles, dilated or contracted pupils, groaning
and crying, and opisthotonos, are present.
Phosphorus and tartar emetic will be found useful in
hydrocephalus, depending upon metastasis of some
disease to the brain, and in cases occurring in worn
out constitutions.
Administration.-The first, second. and third attenuations should be used, and the doses repeated
once in from four to six hours.
SECTION V.
EPILEPSY.
Diagnosis.-The symptoms of epilepsy are exceedingly variable. Sometimes premonitory symptoms are
present, like headache, giddiness, ringing in the ears,




384 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
aura epileptica, or prickling sensation extending from
the extremities to the head, drawing inwards of the
thumbs towards the palms of the hands, and sensation
of fulness of the head; but more frequently the subject is struck down without any warning. When the
attack comes on, the patient falls suddenly; there are
violent convulsive movements, with loss of consciousness; the face and eyes become distorted; the tongue
is often bitten, and in consequence we see blood and
froth issue from the mouth; stertorous and difficult
respiration; the muscles of one side are often more
agitated than those of the other, and pulse weak, frequent and irregular; after the paroxysms have subsided, the patient usually sleeps profoundly for eight
or ten hours, and sometimes remains for a considerable
period in a feeble and languid state, with headache
and occasional delirium, but more commonly he very
speedily recovers his usual state of health and vigour.
The seat of epilepsy is supposed by some to be in
the tubular structure of the brain, while others suppose that it may arise from irritation of the spinal
marrow, but nothing is known with certainty upon the
subject. The pathology of epilepsy is still involved in
obscurity.
Causes of Epilepsy.-Organic affections of the brain,
abnormal osseous deposites within the cranium, ill
formed cranium, diseases of the heart, fractures of the
skull, violent mental disturbances, secondary syphilis,
mercurial affections, derangement of the stomach and
bowels, onanism, suppressed eruptions, habitual discharges, and excesses in the use of liquors; prolonged
abstinence from sexual intercourse, as well as its immoderate indulgence; and the sight of other epileptics.
Prognosis. —Epilepsy which occurs in infancy and
childhood, from fright or suppressed eruptions, is curable. When the cause is abstinence from sexual intercourse, a cure may often be effected, by marrying:
on the other hand, those cases which proceed from organic affections within the cranium, from long continued masturbation, and from disease of the heart,
more especially if they occur after the age of twentyfive years, or if they have continued for several years,




DISEASES OF THE BRAIN AND NERVOUS  SYSTEM. 385
are generally incurable. As a general rule, idiopathic
epilepsy is more difficult of cure than the symptomatic.
Therapeutics.-When called to a person labouring
under an epileptic attack, we should at once loose all
of the clothing, in order that the blood may have free
circulation to and fromn the head, as well as in other
parts of the body. We should also place a cork or
some soft substance between the teeth, to save the
tongue and lips from being wounded by the convulsive
movements of the jaws. The patient should be placed
in bed and restrained just sufficiently to prevent him
doing himself personal injury during the convulsions.
When the paroxysm is preceded by an aura, the attack may sometimes be warded off by tying a ligature
firmly just above the part where the aura commences.
It is a general impression amongst homeopathic
practitioners, that anti-psorics alone are capable of
effecting a permanent cure of epilepsy. This is true
with regard to those cases which are connected with
syphilis, mercurial affections, and impurities of the
blood, but when the disease has been caused by injury
to the cranium, by mental excitements, by onanism, or
by excesses in liquors or venery, it is apparent that a
different course of treatment is requisite.
The most important remedies in the treatment of
epilepsy are, belladonna, sulphur, mercurius, stramonium, aconite, china, ignatia, coffea,phosphorus, arnica,
opium, nux vomica, hzyoscyamus, agaricus, ipecacuanha,
cicuta, silicea, argentum, cocculus, cuprum, camphor.
Belladonna.-Hartmann has.found this remedy specific for the following symptoms, viz.: "great irritability of the whole nervous system, so that the patient
is startled at the merest trifle; he becomes peevish
and sensitive, and is affected by tremors and twitchings in the muscles; restless sleep, which is disturbed
by frightful dreams; hyper-sensibility of the eyes,
sparks and flashes before the eyes; also dyplopia and
myopia, stammering speech, with congestion of blood
to the head, and nervous distention; vertigo, with
roaring in the ears; convulsions of particular muscular
parts, subsultus, distortion of'the face," &c. Belladonna
will be generally applicable in those cases which have
been induced by fright, or other mental emotions.
17




386 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Sulphur and mercurius.are proper when there is reason to suspect a psoric or syphilitic taint as the cause
of the malady. These remedies should be persevered
in until all trace of the impure taint has been eradicated.
Stramonium, ignatia, hyoscyamus, or coffea may be
administered during an attack. These remedies are
appropriate in cases caused by chagrin, fright, or mortification.
Camphor is indicated in epileptic attacks caused by
taking cold, or by vexation,-particularly if congestion
of the brain is threatened; when caused by fright,
artemisia, at the first or second dilution, has been found
curative; when occurring in sensitive children, during
the period of dentition, chanmomela. coffea, and hyoscyamus are the specifics; in the epilepsies of nervous
and impressible subjects, with distortion of the limbs
and faice, bloodshot eyes, foaming at the mouth, livid
face, and protracted loss of consciousness, cicuta and
stramonium are our best remedies; epilepsy induced
by unusual excitements, worms, exposure to a high
degree of heat, aid attended with sudden loss of consciousness, and of muscular power, screams, violent
convulsive movements of the limbs, gnashing of the
teeth, frothing at the mouth, livid face and forehead,
bloodshot eyes, and irregular spasmodic twitches in
various parts of the body, may generally be cured by
hyoscyamus, ignatia and cocculus; nux vomrica is an
invaluable remedy when the complaint proceeds from
abuse of stimulants, venereal pleasures, sedentary
habits, undue mental exertion, disordered stomach, or
worms; in the epilepsies of drunkards, opium may
often succeed nux with advantage; frequently recurring epileptic fits have often been permanently cured
by Dr. Dunsford, with argentum nit., belladonna, agaricus, moschus, and silicea; when the fit arises during
the course of an eruptive fever, in consequence of a
retrocession of the eruption, caused by cold, we may
employ ipecacuanha, cuprum, and belladonna.
China and phosphorus should be given in epilepsy
which has followed protracted masturbation, or exe.sses in venery. The latter may also be used in




DISEASES Of THE BRAIN AND NERVOUS SYSTEM. 387
cases proceeding from osseous deposites within the
cranium.
Opium and nux vomica.-For the epilepsies of inebriates these medicines are important, and will often
effect permanent cures, after the previous habits of intemperance are corrected.
When the cause consists of an injury to the head,
arnica is our chief remedy-this medicine should be
used externally as well as internally.
If the paroxysms have been caused by fright, grief,
chagrin, or from some sympathetic emotion, we may
often prevent an attack (homceopathically) by exercising the patient with some more potent mental influence, which shall supersede the original cause. It
was upon this principle that Boerhaave cured a number of epileptics, at the hospital for orphans of Harlem,
who had been attacked in consequence of fright from
seeing an epileptic brought into the hospital during a
paroxysm.- In these instances Boerhaave had a redhot poker kept ready, in order, as he assured these
girls, that he might apply it to their heads, as soon as
there was any indication of an attack. The fright
caused bv this idea entirely overwhelmed the other
cause, and an immediate cure was generally -the result.
Administration.-We commonly advise the lower
attenuations, and administer the remedy once or twice
daily, until a cure is effected.
SECTION VI.
APOPLEXY.
Apoplexy may occur as an idiopathic, or as a symptomatic affection, and in an inflammatory or an adynamic form. We may also, with propriety, divide it
into three varieties, the sanguineous, or extravasation
of blood upon the brain, the serous, or effusion of serum, and finally the simple apoplexy, produced by abnormal distention of the vessels of the brain. The
symptoms will vary according to the extent of the effusion, and the part of the brain in which the extravasation is located. If the fluid is so situated as to make
pressure upon the hemispheres, there will be a sudden




388 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
loss of consciousness, coma, and stertorous respiration.
If the effusion occurs upon the surface of the vertex of
the brain, the symptoms, according to Abercrombie,
will be moderate in the first instance, but as the effusion increases, comatose symptoms come on, and the
patient succumbs; when the effusion occurs near the
base of the brain, there is no coma or loss of consciousness, but we find loss of speech and paralysis. It is
most common at the age of fifty or sixty years, but it
sometimes occurs in subjects of twenty five or thirty
years.
Although this formidable malady is, in general,
sudden and overwhelming in its attack, yet, fortunately, in the great majority of cases, especially of the
inflammatory form, there are well pronounced premonitory symptoms for days, and sometimes for weeks
preceding its onset, such as vertigo, drowsiness,
throbbing pain, or sensation of numbness in the
head, frequent flushing of the cheeks, unusual heat
in the head, and disinclination to bodily or mental exertion. These symptoms, therefore, should always receive prompt attention, when occurring in
those who are predisposed to apoplexy, in order that
the threatened danger may be averted in due time.
Causes.-Apoplexy occurs most frequently in large
towns, amongst the opulent and luxurious. The impure air of cities, acts as a powerful predisposing
cause, and, in connection with the numerous vices
prevalent in a patrician society, as want of exercise,
high living, excesses in the use of stimulants, and the
pleasures of love, affords a solution of the fact of its
more frequent occurrence in towns than in the country.
The most common proximate causes of sanguineous,
and of simple apoplexy, are, want of exercise, excesses
in eating, drinking, love, suppression of an habitual
nasal hemorrhage, unnatural fulness of the blood-vessels of the brain from any cause, violent mental emotions, excessive study, and great physical exertion.
The most favourable condition for the occurrence of
serous apoplexy, is, general debility and innervation,
whether from insufficient nutriment, excessive mental
or bodily labour, sickness, old age, long continued




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 389
intemperance, abuse of drugs, or the depressing emotions.
Frank asserts that it is not rare to find serous and
sanguinous effusion in the same brain, and he has detailed several instances of this kind which have fallen
under his own observation.
Diagnosis.-Inflammatory apoplexy is for the most
part confined to individuals of a sanguine temperament, plethoric, with short thick necks, vigorous circulation, and a great amount of animal heat. The
attack is often preceded by vertigo, unusual heat
about the head, face red and full, eyes injected and
troubled with muscae volitantes. The invasion of the
malady is so sudden, that the patient is struck down
instantly, deprived of all consciousness and power of
voluntary motion. The respiration becomes stertorous,
the cheeks and lips puffed out at each expiration, the
pulse slow and full, pupils dilated, face red or livid,
or purplish, throbbing of the carotid and temporal arteries, eyelids convulsed, either closed or half open,
paralysis of the muscles of one side, or of the face only, and distention of the veins of the head and neck. After a time the breathing becomes less stertorous, the pulse
more soft, and some signs of returning consciousness
indicate convalescence; or, as more often happens, these
symptoms become more grave, and the vital forces
continue to fail, until the patient sinks under the disease.
Some of the marks which characterize serous apoplexy, are, general appearance of debility, face pale
and haggard, pulse below the natural standard in frequency and fulness, surface cool and clammy, pupils
contracted or dilated, loss of consciousness, and paralysis of one or more parts.
If the patient recovers from the more serious symptoms of this malady, there usually remains for a long
time, a paralytic condition of one or more parts of the
body.
Therapeutics.-We commend the following medicines in apoplexy: belladonna, opium, rhus toxicodendron, coffea, phosphorus, laurocerasus, acid hydrocyanic,
and protoxide of nitrogen.
Belladonna.-Externalindications.-Profound coma;




390 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
stertorous respiration; face swollen, bluish or darkred; spasmodic movements of the lips; distention of
the veins of the head and neck; visible throbbing of
the carotid and temporal arteries; dilatation of the
pupils; injection of the conjunctiva; grinding of the
teeth; suppression or involuntary discharge of urine;
paralysis and immobility of one limb, or of one side of
the body.
Physical sensations. —If the patient is sufficiently
conscious to note his sensations, belladonna will cover
confusion of the senses; vertigo; throbbing pains in
the head; loss of memory; heaviness and pressure in
the head; cramp-like pains in the face and limbs;
dimness of sight; double vision: deep-seated pain in
the orbits; roaring in the ears; hardness of hearing;
loss of taste, or putrid taste; constipation; lameness
and weakness of the extremities; painful sensitiveness of the whole surface to the touch; drowsiness,
disturbed sleep; great sensitiveness to cold; aggravation of the pains by movement or by contact.
Mental and moral symptoms.-Despondency; dejection of spirits; apathy; irritability.
Administration.-In grave cases, a drop of the second potency may be given every half hour, or every
hour, until the effect is manifest. When there is only
a predisposition to the malady, a drop once in six or
eight hours will suffice.
Opium.-External indications.-Face red, bloated,
and swollen, or pale and sunken; expression of countenance stupid and besotted; distortion of the mouth;
dropping of the under lip; eyes half closed, pupils dilated, and insensible to light; irregular and snoring
respiration; profound  coma, with stertorous and
rattling respiration; convulsive and spasmodic motions; bluish colour of the lips and nails; general relaxation of the muscles; coldness of the extremities,
with heat in the head.
Physical sensations.-Stupidity, imbecility and dulness of the mental faculties and senses; drowsiness;
vertigo; giddiness; buzzing in the ears; heaviness,
pressure, and tightness in the head; congestion of
blood to the head; visions; dryness of the mouth;
paralysis of the muscles of the throat and tongue;




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 391
constipation, or involuntary stools; suppression of
urine; numbness and insensibility; weakness; languor; general diminution of power throughout the
organism.
Mental and moral symptoms.-High spirits, succeeded by depression; calmness; agreeable reflections;
pleasant fancies; taciturnity; courage; confidence;
contempt of danger, and finally by coma, with stertorous breathing.
Administration. -A drop of the third dilution in
water, or on sugar, and repeated according to the urgency of the case.
Rhus toxicodendron and laurocerasus are applicable in
some cases of adynamic apoplexy, after belladonna or
opium. It is specific for the secondary effects, which
have not been removed by the last named medicines;
like great prostration; paroxysms of fainting; bruised
pains in the affected parts; numbness; stiffness;
paralysis; cramps; great sensitiveness to cold air;
tingling and twitchings in the limbs; irresistible
drowsiness.
Administration.-A drop of the third dilution once
in six or eight hours.
In the adynamic apoplexy of old people, phosphorus
is a valuable remedy. The symptoms which point
to its use are, general appearance of debility and
prostration; face pale and sickly; eyes sunken; torpor of the mental and physical powers; coldness;
paralytic weakness; tremor of the hands, and feeble
pulse.
Administration.-Same as rhus.
Coffea, ignatia, and nux vomica, may be exhibited
to remove the premonitory symptoms of adynamic
apoplexy. The vapour of the nitrous oxyde gas may
be inhaled with advantage in cases which are characterized at the commencement by great exhilaration,
increase of muscular force, constant desire for locomotion, and succeeded by profound sleep, or sleep disturbed by visions. This remedy should be administered in such a manner as to produce a decided impression.




39.2  DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
SECTION VII.
PARALYSIS.-PALSY.
Paralysis is characterized by a partial or total loss
of voluntary motion or of sensation. In some cases
both sensation and voluntary motion are destroyed.
These symptoms occur -without coma, loss of consciousness, or much derangement of the intellectual
powers, if we except an occasional weakness of memory. It may follow apoplexy, or arise from disease
of the spinal marrow. When it succeeds to an apoplectic attack, there is usually a paralysis of one side
of the body, which is termed hemiplegia. Palsy of
the lower part of the body, or paraplegia, may arise
from disease of the brain, or spinal marrow, though
most commonly the former organ is the seat of the
affection. Partial or local palsy affects some particu-.lar part of the body, as an arm, wrist, or the face.
The muscles of the face are most often affected. This
variety may arise from the pressure of a tumour, from
mechanical: injury, or from disease of the portia dura.
We sometimes see a palsied state of the wrists, which
has been termed lead palsy, from the supposition that
it owes its origin to the absorption of lead into the
system. We have no doubt but that the absorption of
lead may induce this palsy of the wrists; but in most
of the cases which have fallen under our observation,
we have been unable to trace the cause of the malady to this drug.  On the contrary, we have in
several instances known it follow long exposure to
cold and wet, in the act of driving. In three instances
this result has occurred in individuals in perfect health.
In one instance, the exposure took place after a course
of blue pills.
Diagnosis.-When there is only a loss of voluntary
motion, the part affected wastes away, and becomes
soft from want of use, while sensation may remain
natural, or, as sometimes happens, there will be a
morbid sensibility, or a bruised and painful feeling in
the part affected. I have known this morbid sensibility in two or three cases to be exceedingly troublesome, rendering it impossible for the patient to move,




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 393
or be moved, without great pain. In some cases, there
is an entire loss of sensation, as well as voluntary motion. Often, when the sensibility of the part is only
partially destroyed, formication is experienced in the
parts affected.
The loss of muscular power and of sensation will in
all instances bear a direct ratio to the extent and severity of the original affection and the part affected.
*Therapeutics.-Rhus toxicodendron, arnica, nux vomica, ruta, st4lphur, electro-magnetism.  All of these
medicines, with tho exception of ruta and sulphur,
are made use of as chief remedies by allopathic, as
well as homceopathic practitioners.
Rhus may be used in cases of paralysis, when there
is great sensitiveness to cold air; general debility;
tingling or itching in the paralyzed parts; languor;
constant desire to lie in bed; fainting fits.
Arnica may be given to paralytics with feeble or
impaired constitutions, whose pains are aggravated by
motion or talking; with painful sensitiveness of the
whole body; tremors of the limbs; relaxation and
general debility; hemiplegia.
Nux vomica is suitable for paralysis occurring in
sanguine or choleric  individuals.  The indications
for its use are, paralysis, especially of the lower extremities; trembling of the limbs; painful contractive sensations; cramps and spasmodic twitchings in
the parts; languor; heaviness and stiffness of the
limbs; great sensitiveness to cold air; paralysis
which has been induced from abuse of stimulants,
coffee, or narcotics; or where the predisposing cause
has been want of exercise, with severe and protracted
mental labour.
Ruta has been highly extolled as a remedy for
rheumatic paralysis of the tarsal and carpal joints. It
is also indicated in local paralysis, which has followed
surgical operations, or which is owing to injury or
pressure upon some particular nerve.
We have found sulphur of eminent service in cases
of paralysis, accompanied by great irritability and
sensitiveness of the rectum, and causing excruciating
pains during every attempt at an alvine evacuation.
In all of those cases of palsy which have resisted
17*




394  DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
our treatment by internal remedies, we should have
recourse to electro-magnetism. This agent, when properly and perseveringly applied, will often effect
cures after all other means have failed. This potent
remedy should always be applied, however, under the
direction of a judicious physician; for it is an agent
capable of doing serious injury when improperly employed.
We also suggest baryta carb., cocculus, lachesis,
plumbumipulsatilla, bryonia, conium maculatum.
Administration.-The remedies may be exhibited at
from the first to the third attenuations,-a dose once or
twice daily.
SECTION VIII.
DELIRIUM TREMENS.-MANIA A POTU.
Dr. Solly, in his treatise on the human brain, classifies delirium  as an anamic affection of the brain.
Amongst other reasons for this conclusion, he asserts
that in all cases which he has examined after death,
he "has invariably found the hemispherical ganglion
pale and bloodless; the venous canals were generally
full; and occasionally the arachnoid thickened, as if
it had been the subject of chronic inflammation."  A
judicious distinction is made by this author, and some
others of recent date, between the delirium  which is
produced by the sudden withdrawal of stimulants
after a long and free indulgence, and that which may
be excited in any person by an excessive temporary
use of stimulants. The former he terms true delirium
tremens, which depends upon an anemic condition of
the hemispherical ganglion; and the latter, delirium
ebriosorum, depending upon a congested state of the
same structure.
Dr. Solly enumerates the following as a few of the
marks of distinction between the two maladies. "The
head and skin generally are cool and moist in delirium
tremens, dry and hot in delirium ebriosorum. The pupil varies in both according to the stage; in the early
stage of both it is generally contracted, in the latter
stage dilated. The conjunctiva red and injected in
delirium ebriosorum; the reverse in delirium tremens.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 395
The mental derangement in the former is more allied
to an exalted, excited state of intellect; in the latter
it approaches fatuity and depression. The tongue is
generally pale and furred in delirium tremens, sometimes unnaturally clean and red; in delirium ebriosorum it is usually dry, and sometimes brown, but this is
no certain guide. The pulse is most uncertain; but,
upon the whole, there is less power in the beat of the
artery, and that more varied, in delirium tremens than
in delirium ebriosorum."
Diagnosis.-True delirium tremens is characterized
by a wild expression of countenance; eyes fixed intently and earnestly upon some imaginary object in
the room; constant endeavours to grasp or to avoid
these visionary images; motions sudden and rapid;
tremour of the hands and limbs, also of the tongue
when protruded; tongue flabby and moist; pulse
nearly natural; skin cool and often covered with
perspiration; constant desire to move about; inability
to concentrate the thoughts for any length of time;
entire inability to sleep; mind wandering and delirious; bowels regular; face bloated; absence of
thirst, heat, and other febrile symptoms; general appearance of debility.
Delirium ebriosorum may be recognised by the unnatural heat and dryness of the skin; face flushed;
conjunctiva red and injected; expression fierce and
excited; pulse frequent and full; tongue dry and red,
or brown; boisterous delirium; increase of muscular
strength; strong pulsations in the carotid and temporal arteries; pupils first contracted, afterwards dilated;
inability to sleep night or day.
Causes.-Excessive and protracted use of poor
liquors, abuse of opium, and other narcotics. The
proximate cause of the malady is the sudden withdrawal of the accustomed stimulant. Delirium ebriosorum arises from an excessive temporary use of
liquors. Alcohol, being decidedly specific in its action
upon the brain, is manifestly capable, when abused,
of producing an inflammation of this organ, and, consequently, the symptoms which characterize delirium
ebriosorum. A long continued abuse of this stimulant induces an anaemic condition of the brain and




396 DISFASES OF THE BRAIN AND NERVOUS SYSTEM.
nervous system, thus developing the legitimate secondary effect of the article, while its temporary abuse
induces the legitimate primary effects which we observe in delirium ebriosorum.
Therapeutics.-Opium, nux vom., belladonna, hyoscyamus, stramonium, ether vapour, chloroform, protoxide
of nitrogen.
Opium.-External indications. —Skin cold and covered with sweat; tongue moist and red; wild and
staring expression; motions rapid and constant; grasping at imaginary visions; pulse rather below the
natural standard; tremour of the hands and limbs;
unsteadiness in moving about; face pale and bloated.
Physical sensations.-Tormented with frightful or
fantastic visions; giddiness; confusion of ideas; inability to compose or to concentrate the mind, or to
sleep; sensation of numbness or prickling in different
parts of the body.
Mental and moral symptoms.-Deliriuml; frightful
or fantastic visions; confusion of ideas; stupefaction;
gloomy feeling; inclination to commit suicide.
NAux vom.-External indications.-Trembling of the
limbs; spasmodic twitchings in different parts of the
body; countenance pale and bloated; tongue white
and moist; vomiting; surface covered with sweat.
Physical sensations.-Constant uneasiness, anguish,
and desire to run away; troublesome visions; pressure and burning at the stomach; constipation; vertigo; headache; cold extremities; head cold or hot;
sensation of debility or faintness.
Mental and moral symptoms.-Silent; apprehensive
of death; confusion of ideas; depression of spirits;
desire to be in the open air.
Belladonna is well adapted for the cure of delirium
ebriosorum, occurring in individuals of a full, plethoric habit, and presenting the following symptoms: congestion of blood to the head; heat and pain in the
head; flushed face; injected eyes; boisterous delirium; insomnia; strong pulsations of the carotid and
temporal arteries; great nervous erethism; tongue
and mouth red, hot, and dry; thirst; trembling of the
limbs: cramplike pains; starting suddenly  from




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. -397
sleep; failure of memory; pain in the neck and limbs;
sparks before the eyes; visions.
Stramonium and hyoscyamus may be exhibited in
cases complicated with epileptic paroxysms, when
there are, convulsive movements; subsultus tendinum; fainting fits; muttering delirium; picking at
imaginary objects; suppression of the secretions;
extreme irritability; constant and rapid motions;
contraction and stretching of the limbs; irascible;
noisy, and difficult to manage.
Administration.-In urgent cases, the remedies may
be given at the second or third attenuations every
hour until the symptoms begin to yield.
The vapour of sulph. ether, of chloroform, and the
nitrous oxyde gas, may be inhaled with advantage in
cases which are characterized in the commencement
by great mental exhilaration; increased muscular
force; constant desire to move about rapidly, to dance,
to sing, to leap, to fight, or do something extravagant;
flushed cheeks; accelerated respiration; frequent
pulse, succeeded in a short time by profound sleep, or
sleep disturbed by visions; general insensibility to
external impressions, with pallid and deathlike expression of countenance.
These remedies are admirable specifics in this affection, and we have known their exhibition in several instances of serious mania a potu, effect the most
speedy and happy cures. They should never be administered except through the advice, and under the
personal superintendence of a medical man.
SECTION IX.
INSANITY.
If it be true, that the cortical substance of the brain
is the exclusive seat of the intellectual faculties, it
follows, that diseases of this structure must be succeeded by more or less mental disturbance.
Insanity is supposed to be hereditary, and, so far as
a general similarity between parent and child, relating to physical conformation and temperament, is
concerned, there may be an hereditary influence; but
the inheritance by children of the mental and moral




398 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
imperfections of parents, appears to us to admit of
much doubt. When the infant enters the world, his
physical organization is complete, and all of the organs exercise their functions in a healthy and uniform
manner, while for a long period there are but few, if
any, of those manifestations denominated intellectual.
On the contrary, the intellect, as it gradually manifests itself in the child, even until its full development
in the adult, constantly exhibits the influence and the
impressions which have been produced by circumstances, as early associations, parental example, education, habits of action and thought, poverty, riches,
hardships, indulgence, &c. The proximate cause of
insanity is not a derangement of the mind, but an actual disease of the cortical substance of the brain, and,
in order to avoid the consequences of this diseased
condition, it is only necessary to avoid all of those
causes capable of producing inflammation or irritation of this structure. So, in effecting a cure, it is
necessary to act with our medicines upon the organ
diseased, rather than upon the mental aberration.
My respected preceptor, Dr. Brigham, in his sixth
Annual Report to the Managers of the New York
State Lunatic Asylum, inculcates the importance of
early physical and moral education, in order that insanity may be averted in those who are physically
predisposed to it. Doctor Brigham observes: "Great
pains should be taken to form a character not subject
to strong emotions, to passions, and caprice. The utmost attention should be given to securing a good
bodily constitution. Such children should be confined
but little at school; they should be encouraged to run
about the fields, and take much exercise in the open
air, and thus secure the equal and proper development
of all the organs of the body. They should not have
the intellect unduly tasked. Very early cultivation of
the mind, and the excitement of the feelings by the
strife for the praise and the honour awarded to great
efforts of mind and memory, are injurious to all children, and to those who inherit a tendency to nervous
diseases, or insanity, most pernicious. In after life,
persons thus predisposed to insanity, should be careful
-to avoid engaging in any exciting or perplexing busi



DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 399
ness or study, and should strive, under all circumstances. to preserve great equanimity of temper."
The impression has always obtained, until within
the last century, that insane persons were possessed
of evil spirits, and that all remedial measures must
be directed towards expelling from the body the tormenting demon. It is only of very recent date that
correct doctrines have been inculcated in regard to
the true nature and seat of this grievous malady; but
the researches of Pinel, Esquirol, and Connolly have
conduced much to enlighten the profession upon this
previously mysterious subject, and to point out successful modes of treatment.
The different varieties of mental alienation have
been classified as follows:
L.-MANIA,
Consisting of an entire perversion and derangement
of the intellectual and moral qualities. The patient
seizes at the same time upon topics the most dissimilar, passing from one to the other without order or arrangement, and reasons, draws inferences and forms
opinions, without any regard to logic or common sense.
The intellect is deranged on all subjects, and the moral
qualities indicate their perversion, by ferocity, unnatural hatreds, rage, quarrelsomeness, continual desire
to do mischief, and an urgent propensity to carry into
immediate effect any fancy which may strike the imagination. At the same time the patient is perfectly conscious of his identity,-has a kind of an idea of right
and wrong, and is fully aware of what he is doing:
but the mind operates through a diseased organ, the
healthy equilibrium is lost, vague and absurd fancies
take the place of reason, and the individual is impelled to obe.y the dictates of his diseased imaginings.
Mania is usually unaccompanied by fever, except, perhaps, at its very commencement, although there is a
great exaltation of the mental and muscular powers.
It has also been observed that maniacs are capable of
enduring the most severe bodily inflictions, and the
most intense cold, without evincing much consciousness of pain,-also extreme and protracted hunger and
thirst, without serious inconvenience.




400 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Dr. Brigham remarks, that "insanity often commences in a very insidious manner. Some appear to
be deranged only as regards their feelings or moral
qualities. They are noticed to be different from what
they formerly were; to be more restless and sleepless,
or unnaturally morose and irritable. Some manifest
an unfounded dread of evil, say but little, shun society,
and are suspicious of their dearest friends and relatives, while others are unusually vivacious and pleasant, or quarrelsome and abusive. Such changes of
character and habits, will usually be found to be subsequent to some reverse of fortune, loss of friends, or
sickness, and should excite alarm. Persons thus affected, will converse rationally, and in company, or
before strangers, will conceal their peculiarities, and
thus are known to be insane but to very few, until
some violent act leads to an investigation, and then
it is found they have long been partially deranged.
This is the case with most of those who commit suicide. Often insanity exists, in a slight degree, for
months, and is only noticed by the most intimate
friends or relatives, and then suddenly assume an
alarming form, leading, in some instances, to homicide,
and in others, to self-destruction."*
Frank asserts, "' that mania may alternate with hypochondria, melancholia, or dementia. That it may
be continued, remittent, or intermittent. Intermittent
mania returns every eight days, every month, every
three months, every year, every two years, &c." According to the same author, " mania may terminate
by various crises: mucous or bloody stools, vomitings,
ptyalism, leucorrhmea, epistaxis, re-establishment of
the menses or of suppressed hemorrhoids, varices,
eruptions, erysipelas, and boils. It may terminate by
continued or intermittent fevers. It may degenerate
into melancholia, or dementia.  The diseases with
which maniacs finally succumb, are cerebral fever,
apoplexy, inflammation of the meninges, phthisis pulmonalis, and ulceration of the intestines;" complete
exhaustion, also, of the physical and mental forces, is
a common termination of insanity.
*Dr. B.'s Eighth Annual Report.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 401
2.-MONOMANIA,
Is characterized by derangement upon some particular subject which constantly occupies the thoughts to
the almost entire exclusion of everything else. When
the patient's attention is diverted from the subject of
his insanity, he reasons correctly and converses rationally upon all other topics presented to him; and even
upon the subject of his derangement, he reasons consistently upon his false data. Monomania may be of a
gay or of a sad character, but in a majority of instances, the monomaniac dwells upon a painful train of
ideas. Sometimes a prey to the most absurd fears
and dreads, as of poverty, being violently killed, suicide,
homicide, of having committed the unpardonable sin, or
of some serious impending calamity; sometimes he
imagines himself a clock and stands in a corner of the
room through the day, swinging his arms like a pendulum; or an animal, and imitates, as far as he is able,
its peculiarities; or that he has no legs or arms, and
therefore refuses to walk or help himself; or that he is
full, and therefore cannot eat or drink any more; or.
like J. J. Rousseau, that all men are his enemies, and
are seeking to ruin him. At other times he imagines
himself to be the Saviour, or a great prophet, or the
emperor of the world, or some renowned statesman,
philosopher, or general, and swells about issuing orders suitable to his fancied dignity.
Monomania may exist in a light form for a long
period, without attracting particular attention. We
have at the present time, under our care, two patients
who have tormented themselves a good part of the
time, for years, and have reduced themselves to a
wretched state of health, with the dread of committing
suicide or homicide, and yet they have had the firmness to conceal their morbid condition from their
friends. We have known other individuals who have
been thrown into phthisis pulmonalis, by silently
brooding for a long time over some apprehended misfortune, like loss of' property. The mind, like the body,
requires rest and diversion; one set of muscles cannot
be constantly exercised without becoming impaired in
their functions, nor can the mind dwell upon a single




402 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
train of ideas exclusively and for a long time, without
becoming deranged.
This malady, like mania, may be continued, remittent, or intermittent. The cure is generally preceded
by some crisis, either physical or moral. The physical
crises are, eruptions, sweats, vomitings, and diarrhceas,
tumours, fevers, acute inflammations of the brain.
The moral crises consist of all those emotions or passions which, by violently impressing the brain, are
capable of exciting a new action which shall supersede
the morbid affection. Under this head may be ranked,
sudden and startling news, fright, rage, violent grief,
&c.
3.-DEMENTIA.
In this variety of insanity, the intellectual faculties
are all impaired- the power to concentrate the
thoughts, to arrange and compare ideas, or to draw
inferences, is lost. The past is a blank to the unfortunate victim, and thus, family, friends, home, the associations of early years, as well as the cares and
pleasures of maturity, are all forgotten. Yet the irritation of the cerebral structure often incessantly impels the patient to move about, and to give utterance
to the random and incoherent images which are constantly passing through his brain. Some are silent
and almost insensible to everything around them. If
articles are presented or topics of interest broached for
their attention, apparently no impression is produced,
but the mind still pursues its incoherent wanderings.
This form of insanity is more difficult of cure than
either of the others, for the causes are usually so gradual And insidious that the cerebral mass becomes hopelessly disorganized, or the meninges permanently thickened and adherent to~ the cranium, before serious
alarm is taken. If, however, the malady is attacked
within the first few months or the first year, hopes of
cure may be entertained. Dr. Brigham asserts that " insanity is rarely cured after it has uninterruptedly continued two years, though there is always hope if the
patient is vigorous and the form of insanity varies."
Causes.-In exaihining the tables of the supposed
causes of insanity, as published in the reports issuing




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 403
from  the different insane hospitals of Europe and
America, we find a very great variety; but we agree
with Dr. Brigham that the general causes of insanity
may, with propriety, be divided into moral and physical. Under the head of physical causes should be
included, injuries to the brain, from falls,- blows upon
the head, &c.; all morbid or medicinal substances
which, when absorbed, exert a specific action and -are
capable of powerfully impressing the cerebral organs,
like irritating gases, as carbonic acid, and nitrous oxyde
gas; vapours, like ether vapour and chloroform; also
alcoholic liquors, opiates, and other narcotics; mercury, electric shocks, sun strokes, excessive labour,
violent exertions, straining, masturbation, protracted
sea sickness, exposure to violent heat, sudden exposure
to cold water, other diseases, repelled eruptions, excesses in sexual pleasures, drying up of old ulcers, or of
accustomed issues, turn of life, suppression of the
menstrual or lochial discharge, metastases of rheumatism, gout, or other disease, syphilis.
The moral causes comprise, over-exertion of the
intellectual powers, violent emotions, excessive and
protracted grief, mortification, disappointed love and
ambition; jealousy, remorse, anxiety, exclusive and
protracted thought upon a single subject, or a single
train of ideas, religious enthusiasm, vivid and unrestrained imagination, improper mental education.
Amongst the physical causes enumerated, it is well
kinown that many of them exercise a decidedly specific
action upon the brain, as for example, opium, belladonna, alcoholic liquors, the nitrous oxyde, and carbonic
acid gases, the vapours of ether and chloroform, &c.
Opium eating is set down in works upon insanity as
one of the causes of the malady, and yet this remedy
has often effected cures, both in the hands of the allopathist and the homceopathist.  The vapours of ether
and chloroform have caused insanity, and they have
also effected cures. Alcohol causes one kind of derangement, (delirium tremens,) and yet it is an efficient
remedy in effecting cures, in the hands of all practitioners. Taking these facts into consideration, we can
easily explain the modus medendi of these cures, viz.,




-404 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
the application of remedies in accordance with the only
true principle of cure, similia similibus curantur.
Want of sleep is ranked by Dr. Brigham as the " most
frequent and immediate cause of insanity, and one of
the most important to guard against."
Dr. B. dwells upon this cause with much earnestness, and endeavours to impress upon all, the vast importance  of "securing sound and abundant sleep."
" Long continued wakefulness," says Dr. B., "disorders the whole system. The appetite becomes impaired,
the secretions diminished or changed, the mind dejected, and soon waking dreams occur, and strange
phantoms appear, which at first may be transient, but
ultimately take possession of the mind, and madness
or death ensues." —(Sixth Annual Report of the NewYork Lunatic Asylum, by Dr. Brigham.)
Pathology of insanity.-Induration of the brain
from long continued sub-acute inflammation, is a frequent cause of insanity. In recent and slight cases of
this malady, the intellectual faculties exhibit no very
prominent derangement, but as the induration progresses and extends, the hallucination becomes more
strongly pronounced, until eventually complete fatuity
is the consequence. Solly believes that chronic inflammation of the dura mater is a very frequent cause
of insanity. In post-mortem examinations of those
who have died demented, Esquirol has observed softening or increase of the density of the brain, adherences of the arachnoid, thickenings, atrophy and defective organization of the brain or cranium.
In monomania, Pinel, Frank, and Esquirol assure us
"that organic lesions of the lungs and abdominal
viscera, are more frequent than alterations of the
brain."
The latter writer supposes displacements of the
transverse colon, to be amongst the most common of
these derangements, and this is supposed to account
for the constipation and the pains in the epigastric
region, which are usually present in this variety
of insanity.
Many cases have been reported, in which no organic
lesions have been found after death, either in the brair
or the abdominal cavity, and on this account some




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 405
authors recognise a nervous or vital monomania. It is
probable, however, in all cases of mental derangement,
that either the brain or its membranes are in a diseased
condition, although our ordinary modes of examination may not enable us in all cases to detect it.
Therapeutics.-Our means of cure are, moral and
medicinal. We have seen that a majority of the proximate causes of mental alienation consists in undue
exercise of the emotions and passions. It is then
reasonable to suppose that suitable moral influences
may conduce much towards removing the morbid impressions.
Our general course of moral treatment should consist in calming and soothing the mind, and by presenting an entirely new train of associations and ideas,
gradually divert the mind from its morbid channel,
until the diseased encephalon shall recover its tone,
and the impressions made upon it, produce their legitimate results. So important is it to abstract the mind
from all accustomed associations and thoughts, that it
is a matter of extreme difficulty to cure deranged persons so long as they are permitted to remain with their
friends or in their usual residences. For this reason
alone, an early removal to an insane hospital should
be insisted upon, in order that proper restraints may be
imposed, and the ideas directed in such a manner as to
fill the mind with new impressions- to the,exclusion of
the old ones.
In order to accomplish this object effectually, it is
essential to investigate the peculiarities of each particular case, so that new and different trains of thought
may be perseveringly kept before the patient.
We take occasion in this place to translate the
admirable remarks of Frank upon this point: "The
physician should endeavour to substitute a new passion
in the place of the dominant one: for example, hope
ror despair,mildness for rage, etc. He should carefully
prohibit monomaniacs from listening to mystical lec-;ures or conversations, and all religious discussions. In;he mean time, when the delirium consists in the fear
)f the judgments of God, or want of confidence in his
nercy, we can sometimes cure the patient by instructng him in the true principles of religion. But it is:




406 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
not necessary to insist, if the melancholic, instead of
relishing the solid reasons which we give him, finds
in these conversations a new aliment to his delirium.
The consolations of religion are always useful to persons whom reverses of fortune, domestic chagrins, unfortunate love, etc., have plunged into a melancholic
state. We have seen a case of melancholia with propensity to suicide, fixed by excess of study and of
onanism; the patient suffered moreover much from
hypochondria.  Voyages, distractions, and rigid diet
produced only momentary relief. The consolations of
religion, a rigorous observance of continence and of
other christian virtues, gradually operated a cure. We
have re-examined this patient at the end of six years:
he enjoys perfect health, and when a sad idea comes
to darken his imagination, the most simple practice of
religion suffices to restore to his mind calmness and
serenity. Religion is capable of operating similar
cures daily; it acts upon the heart of man with much
more force than all the arguments of philosophy. But
its happy influence is unknown to the incredulous, and
as we do not think that the proofs of religion can be submitted to the discussion of a lunatic, we reserve the
succours contained in the evangelical moral, to pious
minds, or at least to believers, whom different causes
have plunged into melancholy. As for unbelievers,
we can only offer them beautiful maxims, and the cold
consolations of philosophy."-(Mledecine Practique; par
J. P. Frank.)
Monomaniacs may sometimes be cured, however,
by indulging them in their delusions, and encouraging
them in the hope of being able to remove the cause.
The late Dr. George McLellan once had a case in
point: a highly intelligent merchant was firmly possessed with the idea that there was a living eel in his
stomach, and he so tormented himself with the delusion, that he became seriously ill, and was obliged to
abandon his business. He had employed many eminent physicians, who all ridiculed his delusion, and
endeavoured to convince him of its absurdity, but all to
no effect; the idea continued firmly fixed, and his
general health continued to suffer, when as a last resort, and in disgust at the ignorance and obstinacy of




DISEASES OF THE BRAIN AND NERVOUS SYSTEM, 407
all physicians, he called in Dr. McLellan, who, on
investigating his case, decided to indulge the patient
in his delusion, and accordingly assured him that he
had a monstrous living eel in his stomach, but that he
could give him a medicine which would destroy the
animal, and carry it off by way of the bowels. Accordingly a long prescription was written, amounting
to a powerful drastic purgative, and the patient directed to take it. At its operation, the attendant was
advised to slip a mutilated eel into the vessel, and convince the invalid that it had passed from him. The
stratagem  succeeded admirably, and the man was
directly restored to health, mental and bodily.
Frank mentions the case of an individual " who
did not wish to urinate for fear of' producing a new
deluge: he was told that if he persisted in his sad resolution, a fire would occur and burn up the universe.
He hastened to urinate, and his delirium vanished."
Another monomaniac believed himself damned: one
of his friends, habited as an angel, entered his chamber during his sleep, holding in one hand a flambeau,
and in the other a glistening sword. He announced to
him, in behalf of God, the pardon of his crimes, and
the patient was restored to health. Another monomaniac imagined that there were rabbit-burrows in
his head. To cure this illusion, they made a crucial
incision in his scalp, and showed him bloody rabbits,
which they told him had retired by the wound."
Much, however, must depend upon the peculiar circumstances attending each particular case, in applyihg our moral treatment; but as a general rule, uniform kindness, respectful treatment, proper discipline,
and a perseverance in all of those means which tend
to direct the mind into new channels, like games,
music, gymnastic exercises, mechanical or agricultural
labour, exhibitions, etc., will enhance very materially
our success in the treatment of this class of maladies.
The employment of baths are highly recommended
by some authors. As the daily habit of general
bathing is considered at the present day not only essential to health, but to personal cleanliness and decency, we deem it as unnecessary to allude to the
habitual attention to this important duty, as it would
be to allude to the importance and propriety of other




408 DISEASES OF THE BRAIN AND) NERVOUS SYSTEM.
personal habits, like washing the hands and face,
or changing the linen. Tepid or cold baths may be'
employed, as the condition of the patient demands;
but as the healthy function of the skin is so often deranged in insanity, and as nothing conduces so much
to restore and preserve this function as frequent bathing, its importance will be readily appreciated. During the first stages of mania, or at other periods when
there exists great excitement, with hot skin and frequent pulse, the cold shower-bath, or the cold dash.
may be employed with decided advantage. Some
discrimination, however, is requisite in using these
more powerful applications.
The most certain specifics which we possess for the
cure of insanity, are, opium, belladonna, nux vomica,
aconite, ignatia, hyoscyamus, stramonium, pulsatilla,
veratrum, platina, conium, helleborus, aurum mur.
Opium is suitable in cases of dementia, attended with
stupefaction of the senses; general loss of mind and
sensation; indifference to pain or pleasure; strange
visions; laborious respiration; constipation; face
pale, or red, or brownish; diminished temperature of
the skin; full and slow pulse; spasmodic motions and
trembling of the limbs.
Belladonna. - External indications. - Furious and
violent derangement, or ierry and silly craziness;
face red and hot; expression gay, or ferocious with
fixed look; eyes brilliant, pupils dilated; head hot;
spasms; startings; sanguine choleric temperament;
impressible nervous system.
Physical sensations.-Vertigo; headache from congestion of blood to the head; sleeplessness, with great
uneasiness and anguish; frightful dreams, starting
one suddenly from sleep; spasms or stiffness of the
limbs; constant inclination to change the position of
the limbs; visions; thirst; general sensation of uneasiness and discontent.
Mental and moral symptoms.-Furious mania; rage;
or sadness, despair, and fear of death.
Pathological anatomy.-Congestion of the vessels of
the brain; injection of the vessels of the dura mater,
pia mater, and substance of the brain with black
blood.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 409
Nux vomica is suitable for suicidal monomania, attended with great anguish, and desire to go from place
to place; also in nervous'hypochondria, arising from
derangement of the stomach and liver;' also mental
derangement, arising from abuse of liquors; from
mortification; from excessive study; from suppressed
haemorrhoids. It is sometimes useful to remove the
constipation which is so frequently present in insanity.
When there are frequent and full pulse, hot and dry
skin, thirst, and other febrile symptoms, with congestion of blood to the h'ead, and a general exaltation of
the muscular and mental powers, aconite may be employed to remove this condition.
Ignatia is recommended in melancholy and fixed
mania, occurring in individuals of a mild disposition,
sad or cheerful, and occasioned by fright, despair, anguish, grief, chagrin. A relaxed, exhausted, and feeble
condition of the body also requires it.
Pulsatilla is indicated in puerperal melancholy, and
when it occurs during pregnancy, with anxiety, pain in
the head, sleeplessness, pressure at the heart, general
uneasiness, vague desire to escape, incoherent talk,
sadness and distrust.
Stramonium is applicable in derangement with
spasmodic symptoms; in puerperal mania; in timid
mania, with staring look, desire to escape, screeching,
frightful visions, heat, redness and moisture of the
skin; in loquacious mania, with great mirthfulness,
laughter, high-flown speeches, and ridiculous motions;
also in 7religious monomania, with great depression of
spirits, despair of salvation, and desire to converse
upon the subject. It is also sometimes useful in
" rage, with furious delirium."
Veratrum is proper in hypochondriac, suicidal, and
religious melancholy; in puerperal mania; in mania
with lewdness and lascivious speeches, and in some
cases of furious mania. This remedy is especially
indicated when the derangement partakes of an intermittent character.
For the, treatment of suicidal monomania, accompanied with extreme depression of spirits, unrefreshing sleep from'frightful dreams, dread of some impending calamity, loss of ambition and energy, dimi18




410 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
nution of virile strength, and a constant disposition to
dwell upon imaginary ailments, muriate of gold is a
remedy worthy of the very highest consideration.
Indeed, in cases of this description, no other medicine
can bear any comparison with it.
Platina is excellent for females of excitable temperament, and with strong sexual desire. It has cured
melancholy, with great timidity and depression of
spirits, all persons seeming to be demons; or with
vanity; trembling of the hands and feet; anguish at
the heart; absence of mind; dread of death; furor
uterinus; constipation; small and feeble pulse.
There are other remedies which may be consulted
in the different varieties of insanity, like the vapours
of ether and chloroform, the nitrous oxyde gas, &c.
But as we have not had sufficient experience in the
use of these, we shall not now attempt to point out the
symptoms which demand their use.
Administration.-As a general rule, the above medicines may be given at the first or second attenuations, every twelve or twenty. four hours until there is
a medicinal aggravation, or an amelioration of the
symptoms.
SECTION X.
INFLAMMATION OF THE SPINAL MARROW, AND ITS
MEMBRANES.
Under this head we include tetanus and hydrophobia.
1.-TETANUS.
We understand by the term tetanus, sudden morbid
contractions or cramps of many muscles of the body,
with rigidity and loss of voluntary motion in the aft
fected parts. This morbid contraction and rigidity
may affect the muscles of almost every portion of the
body, or it may be confined to the muscles of a single
part, like the lower jaw, when the affection receives
the name of trismus; or to the extensors of the back,
giving rise to recurration of the body, when it is termed
opisthotonos; or to those of the front part of the body,
causing incurvation, termed emprosthotonos; or to the
muscles of the side, causing a lateral curvature, and
called pleurothotonos.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 411
Tetanus is much more common in hot than in temperate latitudes, and generally selects for its victims
individuals of a nervous and irritable temperament,
or those whose constitutions have been impaired by
the abuse of stimulants, or exposure to a vitiated atmosphere.
There are two varieties of tetanus, the traumatic,
and the idiopathic. The usual exciting causes of the
former are, punctured and lacerated wounds, causing
injury or partial division of the nerves; and of the
latter, general debility of the nervous system  from
long continued illness, or protracted derangement of
the different functions of the organism.
Diagnosis. —This malady generally commences with
uneasiness at the pracordia; stiffness and tension in
the muscles of the back of the neck, back, and loins,
and some difficulty in deglutition and in articulation.
This contraction and stiffness gradually increases;
the sensation of uneasiness in the chest becomes
changed to violent and painful contractions about the
ensiform cartilage; the pains and cramps extend to the
back, jaws, and limbs; the appetite fails; the countenance assumes a flushed and anxious appearance; the
bowels are constipated; the mind remains sound until
the last stage of the disease, and the body will be
rigidly drawn into such a position as will enable us to
decide what particular class of' muscles are affected,
and which of the varieties of tetanus is present.
Traumatic tetanus is always a dangerous affection,
but hopes of cure may be entertained when unusual
pains in the wound or cicatrix, with pains extending
along the limbs in the direction of' the contracted
parts, occur simultaneously with the first symptoms of
the complaint. But if the symptoms continue to make
steady progress, while the original wound is cicatrized,
and no pain or disturbance is experienced either at
this point, or extending from it, the case may be
looked upon as highly dangerous.
Idiopathic tetanus proceeds from  constitutional
causes, and is far less dangerous than the traumatic
variety. Its approach is also more gradual, and attended with less pain, but when the contraction and
rigidity of the parts take place, they remain in this




412 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
condition a longer time than in the other form of the
disease. The violent contractive pains about the ensiform cartilage, and in the nape of the neck, which
are so characteristic of traumatic tetanus, are also
absent in this variety. Indeed, we have seen cases
where no pains or uneasy sensations were experienced
in any part of the body, except from the constrained
positions of the parts affected with the morbid contraction.
Causes. —Punctured and lacerated wounds, which
partially divide one or more nerves, is one of the most
common causes. The admission of cold air into
wounds, sudden check to the perspiration after long
and fatiguing exercise under a hot sun, the irritations
of splintered bones, or other foreign substances in
contact with nerves and tendons, amputations, and
blows upon the spine, are all occasional causes of
traumatic tetanus.
The exciting causes of idiopathic tetanus are, suppressed menstruation, or other habitual discharge,
low fevers, over-exertion of mind or body, too close
confinement in small and ill ventilated apartments,
sitting in unnatural and constrained positions, tight
lacing.
Therapeutics.-A preliminary step in the treatment
of tetanus, should always be to remove, as far as possible, whatever causes may have operated towards
inducing the disease, or which may continue to exert
an irritating effect after its full formation. The causes
of this character are, the presence of irritating spicula
of bone, of needles, of dirt, of rust, or any other foreign substance, in contact with the nerves and tendons; abuse of stimulants, the wearing of too tight
clothing, foul air, exposure to sudden changes of temperature, especially from intense heat to coldness and
humidity. When there is reason to suspect the presence of a foreign body in a cicatrized wound, after
the appearance of tetanic symptoms, we should at
once cut down and endeavour to extract the obnoxious
substance; and in case nothing can be found, to apply
spirits of turpentine, or some escharotic, in order to
ensure suppuration in the wound. This important
surgical resource should always be resorted to in




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 413
cases of this description. for it is not an uncommon
occurrence to perceive the immediate disappearance of
incipient tetanic symptoms, on the removal of a foreign substance from the wounded part.
The remedies most appropriate in the treatment of
tetanus, are, nux vomica, belladonna, arnica, stramonium, cicuta, hyoscyamus, opium, pulsatilla, sulphur.
Nux vomica, from its decidedly specific action upon
the spinal marrow, and its membranes, as well as
from its pathogenesis, and the appearance of individuals who have been poisoned with it, is evidently a
remedy of importance in this dangerous malady. It
is especially called for when the spasms are frequent
and short, consciousness is perfect, and there are
cramp-like pains in the region of the stomach, constipation, and loss of appetite, and when the patient
has been addicted to the abuse of stimulants.
Belladonna, succeeded by pulsatilla, may be given
in idiopathic tetanus which has arisen from deranged
menstruation, or other causes connected with the
utero-genital system, and where the extremities are
for the most part affected with the morbid contractions. It may also be sometimes given in the last
stages of traumatic tetanus, when there is delirium,
dilated pupils, and great mental anguish.
Arnica should be used both internally and externally, in all injuries which threaten to lead to tetanus.
This remedy possesses the power of warding it off,
when it might otherwise have occurred without its
use, and should always be resorted to when danger is
anticipated from a wound.
When we find great rigidity of the extremities,
contraction of the thumbs or fingers, wild and fixed
look, painful and difficult respiration and deglutition,
we may give stramonium in alternation with hyoscyamus or cicuta.
Many writers speak in favourable terms of warm
baths in the treatment of this affection. We have
seen the most unequivocal advantage follow general
bathing, and a thorough application of fomentations
to the affected parts, and to the spine. We can call
to mind two cases where life was apparently saved
by the persevering application of these hot fomenta



414 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
tions, together with frictions along the course of the
spine.
We take occasion in this place to suggest to the
profession the use of the saliva of rabid animals as a
remedy in this affection. It has been found by Majendie and Brechet, that if this saliva be introduced under the skin, or into the blood of animals, that the
animal so impregnated contracts the hydrophobia.
Why should it not then be employed in those maladies
which are characterized by symptoms similar to those
of rabies?
Other medicines which may demand attention are,
veratrum, moschus, phosphorus, china, ignatia, lachesis,
acid hydrocyanic, camphor, plumbum.
Administration.-We advise from the third to the
sixth attenuations in this affection-a dose every hour
until the system responds in a satisfactory manner,
after which we must be governed by circumstances.
2. —HYDROPHOBIA.
The term hydrophobia, or dread of water, is given
to that dreadful malady which follows the bite of a
rabid animal, and the introduction of its saliva into
the blood. A dread of water is commonly a prominent and characteristic symptom of the disease, but it
is by no means one which is invariably present. Cases
are reported by Hunter, Frank, and Eberlg, in which
no unpleasant consequences followed the use of drinks,
from the commencement to the fatal termination of
the disorder. We, ourselves, have seen a rabid dog
that would, without hesitation, plunge into water and
drink during the whole course of the disease, without
exciting spasmodic contractions, or any other disagreeable symptom.
Rabies originates spontaneously in animals of the
canine species, like the dog, the fox, the wolf, &c., and
appears to consist of a morbid deterioration of the
saliva. The precise nature of this deterioration, or of
the specific poison which this fluid contains, is at present entirely unknown; but in regard to its specific
action upon some portion of the nervous centres, there
remains no doubt, although morbid anatomists have
hitherto failed to detect the peculiar diseased appear



DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 415
ances to which it gives rise. Perhaps this may be accounted for when we call to mind the proneness of
pathologists to regard congestion of the blood-vessels,
redness, effusion, softening, or induration, as the only
morbid appearances indicative of previous disease,
while in point of fact, if we may trust the pathological
investigations of Dr. Hugh Bennett, by means of the
microscope, " important changes may take place in the
cerebral substance, spinal marrow, &c., inappreciable
to the naked eye, but clearly discernible with the
microscope."-(Ed. Med. and Surg. Jour., vol. 58, p.
58 and 60."
The redness of the fauces and oesophagus which is
often observed in men and animals dead of hydrophobia, is attributable rather to the irritation consequent
upon the intense and unindulged thirst which was present during the attack, than to any specific action of
the virus upon these parts.
The virus of rabies is formed and is active, for
the most part, in the saliva, but a sufficient quantityis
absorbed into the general circulation to produce the
morbid impression upon the spinal marrow which constitutes the chief fact of the disease. Could we confine the virus to the saliva of the mouth, and prevent
its admission into the circulation, no evil effects would
result; but place the smallest quantity in a position
where absorption can take place, and it will be conveyed with unerring certainty to the part which possesses a specific affinity for it, and there produce its legitimate morbid impression.
Some writers suppose that the poison does not enter
the general circulation, because the N. American Indians, the inhabitants of the country of Mantone, &c.,
often eat the flesh of hydrophobic animals with impunity; but this proves nothing, for the lacteals and
absorbents of the digestive apparatus, reject this substance as an irritant, and it is carried off with the feeces, without producing any impression.
McIntosh believes that tetanus is often mistaken for
hydrophobia, when dread of liquids is one of the
symptoms of the former; and when we reflect that the
teeth of dogs usually inflict such punctured or lacerated




416 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
wounds, as often give rise to tetanus, the opinion seems
plausible.
Hydrophobia usually makes its appearance in from
twenty to sixty days after the bite, although well authenticated cases are recorded in which the virus has
remained dormant in the system for years, when it has
finally developed itself from some constitutional disturbance, and the patient has succumbed with all the
symptoms of hydrophobia.
Diagnosis. —At an uncertain period, varying from
three to nine weeks from the reception of the wound,the
first symptoms of hydrophobia make their appearance,
usually in the bitten part, which presents a livid and
slightly swollen appearance, and attended with burning heat or shooting pains which dart from the seat of
the injury to the neighbouring parts. These symptoms are speedily succeeded by rigours, lassitude, great
depression of spirits, anxiety, watchfulness, irritability,
giddiness; eyes red, brilliant and sensitive to light, uneasy sensations at the stomach, tension at the chest,
difficulty of deglutition, and slightly oppressed respiration. As the disease advances, the cramps about
the throat, neck, and chest, become more and more violent, until the mere sight of a liquid, or of a shining substance, will produce the most painful paroxysms:
there is a viscid saliva constantly secreted which compels the victim to be continually spitting, while at the
same time he is tormented with a dryness in the mouth
and throat, and an intense thirst, which he is unable
to allay, on account of the spasmodic contractions
which occur whenever drinks are presented to him.
The skin is hot and dry, the cicatrix opens and presents an unhealthy appearance, the respiration becomes more and more difficult, the voice becomes
changed, the pulse nearly natural, the body affected
with tremours or slight spasmodic twitchings, vague
pains extend up from the lower part of the spine to
the head, and finally the countenance becomes pale
and haggard, the eyes sunken yet still brilliant, there
are palpitation of the heart, wandering delirium, constant inclination to bite, extreme anxiety and uneasiness, sinking of the pulse, loss of voice, clammy sweat,




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 417
and finally, the sufferer sinks into a lethargy, or into
convulsions, and dies.
The disease commonly terminates in from two to
eight days from its first approach.
Therapeutics.-The most certain preventive means
after the bite of a rabid animal, is to excise immediately and thoroughly, the wounded part. This severe measure can only prove available unless resorted
to within a very short period-say fifteen or twenty
minutes after the infliction of the bite. If a longer time
than this has elapsed, we should advise free incisions upon the wounded points, and after they have bled freely,
and been suitably washed and cleansed, the application of the caustic alkali. Some surgeons speak in
high terms of the application of the red-hot iron, of
the butter of antimony, of corrosive sublimate, of chloride of zinc, &c.; but in my opinion, the prompt use
of the knife, and of caustic potash, will prove more
efficient and less painful than the other applications,
Nor do I give this advice from theory alone, for I
had occasion, some five years since, to test the practical
operation of these severe measures upon my own person. In July, 1844, I was bitten in the leg, without
provocation, by a dog which came tearing past me at
a furious rate, with fierce and brilliant expression of
the eyes, tail pendant between the legs, foam at
the mouth, and hair standing erect upon the back.
Without any delay, I excised the bitten part, and
applied the caustic potash to the wound, in the most
thorough manner; after which, I dressed and bound
up the limb,. congratulating myself on my promptness, and probable escape from this most dreadful malady.  Inquiries were now instituted to ascertain
something respecting the course and the whereabouts
of the " mad dog," when to my surprise, and indeed
I may say indignation, I was informed that the animal was not rabid, but "dreadful ugly."  The course
adopted, however, was a prudent and safe one, and I
should most certainly do the same again under similar
circumstances, on the principle " that an ounce of prevention is worth a pound of cure." As the matter actually turned out, I was tormented with a painful limb
for two or three months unnecessarily; but had the
Io to.




418 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
animal proved to have been rabid, then the result
would have been the saving of my life.
No specific has yet been discovered for the cure of
hydrophobia, although many articles have been at different periods brought into notice by the old school,
as for example, mercury, burnt lichen, and black pepper,
the purple-flowered anagallis, oil of valerian, opium,
musk, ignatia, camphor, cantharides, stramonium, nux
vomica, and belladonna.
Professor Munch has given the last named medicine
to several who had been bitten by rabid dogs, and not
one was attacked with rabies. Hahnemann also administered it with success, both as a prophylactic and
as a curative remedy.
In consulting the pathogenesis of belladonna, we find
amongst the most prominent symptoms to which it
gives rise, are dryness and constriction of the mouth
and fauces, accumulation of a tough mucus about
the mouth, deglutition difficult or even impossible, injected and glassy eyes, articulation difficult, voice
changed, giddiness, trembling and weakness of the
whole body; mouth and jaws spasmodically affected,
intense thirst, nausea, and finally, previous to death,
"a feeble pulse, cold extremities, subsultus tendinum,
tremours, deep coma or delirium, and sometimes convulsions."
From the above description, it is apparent that this
medicine induces a close correspondence to the most
marked symptoms of hydrophobia, and therefore it is
entitled to our earnest consideration, when called to
cases of this description.
When the disease is fully formed, and there are, severe convulsions, with sense of impending suffocation,
dryness of the mouth and fauces, extreme difficulty
of deglutition, dread or horror even at the sight of
liquids, delirium, rage, and fury, we may likewise
consult stramonium, nux vomica, hyoscyamus, lachlesis,
cantharides, and veratrum.
The medicines may be administered in the same
manner as advised in tetanus.




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 419
SECTION XI.
CHOREA.
Chorea occurs, for the most part, in girls of feeble
constitutions and of irritable nervous temperaments,
and between the ages of five and fourteen. The disease is recognised by almost constant involuntary
movements of the muscles affected, while in the waking state, either with or without derangement of the intellect. From its resemblance to raphania, it has been
sometimes confounded with it. It also presents many
marks of similarity to epilepsy and hysteria, and is
probably somewhat analogous to these maladies in its
location and nature. The affection is not usually attended with danger, and terminates at the period of
puberty; but when it has existed for a number of years,
accompanied by perversion of the intellectual faculties, permanent idiocy, or at least an impaired understanding, may result. Finally, the disease may occasionally occur at any period of life, and in individuals of both sexes.
Diagnosis.-Generally, for months previous to the
occurrence of the involuntary motions which characterize this disease. it will be found that the child has
suffered from constipation, oppression in the region of
the stomach and chest, vertigo, and other bad feelings
in the head, appetite morbidly increased or depressed,
occasional flushes of fever during the night, palpitation of the heart, nervousness, irritability, and coldness
of the feet. The involuntary motions commence by
slight twitchings in the muscles of the face, which soon
become strongly pronounced and extend to a greater
or less extent to other parts of the body, as one entire side, or one arm or leg. When the limbs are affected, the walk becomes awkward and unsteady, and
the arms fail to obey the commands of the will, while
involuntary gestures and motions are continually made
without reason or point, thus causing the individual
to present a most ludicrous appearance. The patient
may remain in this condition for years, without the
occurrence of any other serious consequences, unless
the intellect becomes impaired, when a total loss of




420  DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
mind may result. Some cases are attended with difficult respiration, dysuria, vague pains in the limbs,
confusion of ideas, and failure of memory.
Causes.-A naturally delicate constitution or one
which has been impaired by abuse of medicines, and a
nervous temperament, are conditions most favourable
to the production of chorea. Probably, the most frequent exciting ~cause is the. repercussion of some
chronic cutaneous eruption. Many facts are on record which go to prove this; as, for example, the
cases cited by Hahnemann, Stapf, Pouchet, Frank,
&c., where the malady has arisen in consequence of
sudden drying up of tetter, plica polonica, herpes,
scald-head, psora, or some habitual discharge. Other
exciting causes are, the depressing passions, fear and
terror, masturbation, irritation of the bowels from
worms and frecal accumulations, cold, insufficient
nutriment, and excessive loss of blood.
Therapeutics.-In all cases of chorea the patient
should be removed to the country, where she may enjoy pure and salubrious air, abundant exercise, and a
plain, but highly nutritious regimen.
The remedies for chorea are, stramonium, belladonna,
cuprum acetat, sulphur, calcarea carb., hyoscyamus, rhus,
nux vomica, ignatia, lycopodium, phosphorus, china,
ferrum.
If the disease has been caused by fright or terror,
and we find great contortions of the face, eyes, and
limbs, head thrown back, or drawn frequently to the
left side, oppressed respiration, wild and staring expression, convulsive laughter or weeping, restlessness, convulsive twitchings of the muscles, anxiety,
pale face, features sunken, small pulse, and delirium,
we may select one of the following medicines: stramonium, belladonna, hyoscyamus, and ignatia.
When the symptoms have followed the drying up of
chronic cutaneous eruptions, cuprum acetate, sulphur and
lycopodium, will be called for; if they have set inl after
measles, calcarea carb. is proper; if the cause can be
traced to onanism,phosphorus and china are applicable;
if they have arisen from constipation, and collections
of fecal matter in the intestines, nux vomica and sulphur are the best remedies; if the malady has been




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 421
induced by excessive loss of blood, or by general debility, we advise, ferrum, china, acid phosph., acid
nitr., and rhus toxicodendron.
Administration.-In chorea, the whole nervous system is in a morbidly impressible condition, and will
generally respond readily to the higher attenuations.
We usually commence with the twelfth dilutions, and
administer a dose once or twice daily, until a suitable
impression is made upon the symptoms.
SECTION  XII.
HYSTERIA.
Sydenham, Stahl, Van Swieten, Sprengel, and Frank,
regard hysteria and hypochondria as substantially the
same affection. The two maladies unquestionably
bear a very close resemblance to each other in many
respects; as, for example, the almost infinite variety
and similarity of the symptoms which they present,
and the proneness of the subjects of both diseases to
exaggerate trivial or even imaginary ailments into
disorders of magnitude.
But there are marks of distinction between them
equally important, which refute conclusively the opinion respecting their identity.
Pure hypochondria almost invariably occurs in individuals of a lymphatic and bilious temperament.
Their dispositions are generally gloomy and morose,
and ever inclining to " look on the dark side." Hope,
confidence, cheerfulness, enter but sparingly into their
dispositions; they are not addicted to "building
castles in the air;" never behold anything bright,
agreeable, or desirable in the future; but, looking
with distrust and aversion upon mankind, and obstinately fixing their thoughts upon some dreadful impending calamity, which they are sure will overtake
them sooner or later, they either drag out a miserable
existence, suffering mentally almost every evil, or
terminate their woes by suicide.
Hysteria, on the contrary, usually occurs in females
of a nervous, or nervous-sanguine temperament, with
cheerful, lively, and ardent dispositions, vivid imaginations, and highly impressible organizations.




422 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Hypochondria is uniform and continuous in its
course, and presents but slight variations from day to
day. Hysteria occurs in paroxysms, with intervals of
greater or less duration, of passable bodily health and
excellent spirits.
Hypochondria is always connected with disorder of
the stomach and liver. Hysteria is owing to an irritation or erethism of the whole nervous system.
Writers have always regarded the seat of hysteria
as in the uterine and sexual organs, because it has usually been associated with derangement of the functions
of these organs. It occurs after the period of puberty,
in females of a nervous, or nervous-sanguine temperament, with strong sexual propensities, and is accompanied with deranged menstruation, dysuria, sexual
excitement, or pains in the pelvic region. Yet the
malady is, in my opinion, one of a purely nervous
character, consisting of an erethism of the whole,
nervous system, and capable of being brought into active operation by any exciting cause which may operate upon the economy, like deranged menstruation,
the depressing emotions, fright, terror, mortification,
dread, chagrin, disappointed love, undue excitement of
the sexual organs, &c.
This peculiar irritable condition of the nervous
system  may exist for an indefinite length of time.
without any actual development of proper hysteric
symptoms, provided the above named exciting causes
do not operate.
Diagnosis.-Sometimes the first symptoms of hysteria are flatulency, pains, or distressing sensations in
the stolnach, bowels, chest, head, and back; faintness,
vertigo, bitter taste, eructations, dysury, anxiety, depression of spirits, difficulty of breathing. sense of suffocation from  something like a ball rising in the
throat, (or globus hystericus), ringing in the ears, delirium, or loss of consciousness. Symptoms of this kind
take place in individuals of a feeble and purely nervous temperament, and the delirium and loss of consciousness appear to take the place of convulsions.
In others, of a nervous-sanguine temperament, with
robust constitutions, the convulsive paroxysms come
on by slight twitchings of the muscles of the mouth




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 423
and eyes, with wild expression, eyes rolled up, convulsive laughing, crying, or sobbing, constant attempts
to pull out the hair, to strike the breast or some other
part, and to bite; difficult and laborious respiration,
succeeded in a short time by the most violent convulsions.
In other instances the paroxysms are preceded by a
croupy-cough, or colic pains, oxr pains in the head,
chest, back, or pelvis.
In some cases the paroxysm takes place suddenly,
without any warning symptoms, and the patient may
suffer a series of dreadful convulsions, with only brief
intervals of consciousness, for many hours, and then
be restored speedily to all her mental and bodily
faculties.
It would be useless to attempt a detail of all the
phenomena which may occur in hysteria, and we shall
in conclusion only observe, that the peculiar condition
of the nervous system upon which the disease is dependent, and the convulsive paroxysms to which this
morbid state gives rise, should command our principal
attention in the treatment of the malady.
Causes.-The predisposing causes are, a delicate,
nervous temperament, too much confinement in close
and heated apartments, the frequent perusal of exciting works of fiction, attendance on theatrical exhibitions, tight lacing, want of exercise, premature tasking of the mind to the neglect of the body, habitual indulgence in lascivious thoughts, nervousness, luxurious living.
Amongst the exciting causes may be mentioned,
violent mental impressions of any kind, whether produced by the sight of disagreeable objects, or the smell
of disagreeable odours, or the hearing of sudden noises,
discordant sounds, or by terror, fright, anger, rage,
grief, chagrin, mortification, and disappointed love or
ambition.
Hamilton supposes the presence of irritating and
indigestible substances in the intestines is a common
exciting cause of hysteria.
Other exciting causes are, sudden suppression of
the menstrual discharge, too profuse evacuations, and
leucorrhEra.




424  PISEASES OF TIlE BRAIN AND NERVOUS SYSTEM.
Therapeutics.-For the cure of hysteria arising from
a torpid state of the bowels, and an accumulation of
undigested faecal matter, and attended with putrid or
sour taste, bitter or acid eructations, flatulency, fulness, distention and pain in the epigastrium, constipation, nausea, weakness, languor, faintness, headache, giddiness, confusion of ideas, strong tendency to
convulsions, nux vomica and sulphur are the proper
remedies.
When the attacks appear to have been excited by
derangement of the uterine functions, the most suitable remedies will be pulsatilla, sabina, and silicea.
If the exciting cause has been terror, fright, anger,
disappointment, mortification, or any violent mental
excitement, ignatia, hyoscyamus, aurum, belladonna,
coffea, will each cover most of the symptoms.
Administration.- The remedies should be administered at the third dilution, during the paroxysm, by
placing a drop upon the tongue at short intervals, or
by smelling; but during the intervals, a drop once
in twelve hours, until the desired impression is produced.
SECTION XIII.
NEURALGIA.
By the term neuralgia, we designate all of those
painful affections, in different parts of the body, of a
purely nervous character. This disease may attack
every system of nerves, and every structure of the organism, whether external or internal.  Different
names have been given to it, derived from the
particular structures affected, but as the real nature of the disease is always the same, in whatever
part it may be located, and as the points of its attack
are almost innumerable, there is a manifest difficulty
and impropriety in endeavouring to effect a minute
classification. The most common seat of neuralgia
is in the first, second and third branches of the fifth
pair of nerves, and in the portio-dura. When the disease is confined to the facial portions of these nerves, it
is recognised under the name of tic douloureux; when
its location is in the nerves of the stomach,gastrodinia;




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 425
when in the first branch of the fifth pair of nerves,
nervous headache; when in the nerves of the feet and
legs, neuralgia pedis; when in those of the mammae,
neuralgia mammae; when to those of the heart, angina
pectoris, &c. But as these various names only tend
to complicate our classification, and render complex what is in reality simple, we shall treat of all
these nervous attacks under the general appellation of
neuralgia.
Diagnosis. —The following are the general characteristics of neuralgia: sudden paroxysms of exceedingly acute pain in some particular nerve, with violent lancinating pains extending along the ramifications of the nerve in different directions, attended with
turgescence of the blood vessels in the vicinity of the
part chiefly affected, but without fever. The pains
are so sudden and severe as to resemble electric shocks,
and they often give rise to spasmodic contortions or
twitchings of the muscles of the face when the
branches of the fifth and the facial branch of the
seventh pair of nerves are the seat of the pains. The
pains are sometimes aggravated by the slightest movement, or by the gentlest touch, although firm pressure
causes no pain. The particular nerve or nerves involved, can always be pointed out with exactness,
because the principal seat of the attack is always in
some portion of a nerve, and radiates thence along
its different ramifications; and from this circumstance
surgeons have occasionally excised with success portions of nervous trunks to effect cures; but this severe
measure should never be resorted to, when suitable
homceopathic specifics can be so readily procured.
In facial neuralgia, there are often lachrymation;
increased flow of saliva; spasmodic twitchings of the
mouth, cheeks, and eyelids; spasmodic closing of the
eyelids; unusual heat and tension in the side affected;
stiffness in the jaw and neck; increase of pain by
light, noise, motion, touch, talking, or eating; heat or
coldness of the body; vertigo; and confusion of
ideas.
When the head is the seat of the attack, we may
have violent periodical pains in some part of the head,
darting along the nervous ramifications; nausea;




426 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
vomiting; extreme sensitiveness to the touch, cold air,
sounds and light; humming in the ears; sense of heat
and fulness in the affected part; floats before the eyes
on the slightest attempt to use them; aversion to
food; confusion of ideas; disinclination to converse,
or to listen to others.
When neuralgia affects the superior or inferior
extremities, back or mammae, the symptoms will
be fewer on account of the less number of sympathetic
connections existing between these parts. In these
instances, the violent lancinating pains, occurring in
paroxysms, and increased by the slightest contact, and
by motion, and unaccompanied with actual inflammation, are the symptoms which especially mark the
complaint.
For the symptoms of neuralgia affecting internal
organs, we refer our readers to the articles upon gastrodinia and angina pectoris.
Causes. — Pathological researches have as yet
thrown but little light upon the nature of neuralgia.
Many excellent observers have instituted rigid autopsical examinations, in order to ascertain its precise
nature and location, but their labours for the most
part have proved fruitless; since no lesions or other
marks of diseased action have been discovered, either
in the nerves or their envelopes, at all sufficient to
account for the symptoms.
Dr. Macculloch believes neuralgia to be a malarious
disease; this opinion is founded upon the fact of its
frequent occurrence in marshy districts, and in locations where intermittent fever abounds. It is probable,
however, in these cases, that the miasmatic influence
operates merely to excite or to call into active operation a diseased condition of the nerves, latent it is true,
but already existing. The malaria operates in these
instances, as the immediate exciting cause, and in a
manner similar to impure air, errors in diet, excessive
mental or physical labour, abuse of narcotics or stimulants, over-excitement, fatigue, exhaustion, great loss
of fluids, and the depressing emotions. The remote
cause and the real nature of the disorder remain unexplained. A conclusive fact in refutation of the views
of McCulloch respecting the malarious origin of the




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 427
disease, is its common occurrence in New England,
where intermittent fevers do not prevail.
Neuralgic pains sometimes arise from the pressure
of tumours and exostoses, the irritation of decayed
and ulcerated teeth, and also from mechanical injuries. In these instances we may generally remove the
cause by surgical means, and thus cure the disorder.
Therapeutics.-The specific medicines for the cure
of neuralgia, are, arsenicum, belladonna, colocynth, nux
vomica, aconite, china, arnica, bryonia, calcarea carb.,
hepar sulph., phosphorus, acid hydrocianic, pulsatilla,
sepia, sulphur, spigelia, stramonium, mercurius.
Arsenicum.-External indications. - Temperament,
leuco-phlegmatic, lymphatic, or bilious and choleric,
or nervous, with disposition to melancholy; general
appearance df debility and exhaustion; countenance
pale and sunken, or bloated and red; features distorted; lips bluish; twitchings of the muscles of the face,
lips, and eyelids; tongue white; coldness of the extremities; anasarca; emaciation; trembling of the
limbs; cramps in the extremities; pulse small.
Physical sensations.-Paroxysms of excruciating
pain in the head, particularly in the forehead over the
root of the nose,-over the left eye,-in one side of the
head,-in one eye: pains aggravated from the slightest movement or touch; scalp sensitive to touch or
to motion of the hair; roaring in the ears during the
pain; mouth dry; thirst or adypsia; bad taste in the
mouth; aversion to food; nausea, eructations, hiccough; pressure, heat or burning, or cramplike sensations in the stomach; drawings and cramps in the
arms and legs; cramps in the fingers; rigidity of the
hands; violent lancinating pains in different parts of
the body, aggravated by movement or touch, attended
with paralytic weakness, contractive sensations, faintness, coldness, shuddering and trembling.
Mental and moral symptoms.-Fits of violent anguish; fear; dread, with tremours; impaired memory;
inability to think or collect the thoughts; dizziness;
vertigo; general uneasiness.
Administration.-A dose of the second or third trituration, every half hour until an aggravation or amelioration of the symptoms occurs.




428 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Belladonna.-This medicine is well adapted to the
"diseases of women and children, whose nervous systems are in a state of erethism." The external indications are, sanguine and choleric temperament; general appearance indicative of a full and plethoric
habit; cheeks red and swollen; eyelids spasmodically
closed; spasms and startings in different parts of the
body; distortion of the face; trembling and rigidity
of the limbs.
Physical sensations.-Great sensitiveness to cold air
and light; headache, compelling to close the eyes;
acute throbbing pains in the forehead; semi-lateral
headache; pains aggravated by movement, noise,
light or cold air; lancinating pains in the orbit; spasms
of the eyes; violent stitches in the parotid gland, extending to the external and internal ear; roaring in
the ears; paroxysms of tearing, digging toothache;
toothache of pregnant females; neuralgic pains darting from the side of the face to the teeth and ears, of
a tearing, or lancinating, or digging character, with
heat and redness of the part affected; toothache occurring after eating, from contact with cold air, from
study, from pressure upon a decayed tooth, from eating, and from swelling and ulceration of the gums;
darting pains in the lower jaw, and in the glands of
the affected parts, from a decayed and hollow tooth;
toothache with drawing in the ear; neuralgia affecting the crural nerve; cutting, darting, and tearing in
the left thigh when sitting; lancinating pains in the
right thigh when sitting; tearing and lancinating
pains in the region of the tibia, extending to the calf
of the leg and sole of the foot; neuralgic pains in the
back and shoulders.
Mental and moral symptoms.-Anguish; despondency; great irritability; vertigo; confusion of ideas;
delirium; inclination for firm pressure upon the head,
which affords relief, while slight touches increase the
pains.
Administration. —A drop of the second or third dilution on sugar or in water every half hour, until a
decided impression is produced.
Colocynth.-Dr. Watzke remarks as follows respecting the therapeutic action of colocynth in neuralgic af



DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 429
fections:-" The curative sphere of action of colocynth
in the new system, is almost confined to a few neuralgia and hyperesthenice, and of these, almost exclusively those which affect the trigeminus, the cteliac plexus,
and the lumbar and femoral nerves. First: the hemicrania and prosopalgiae which colocynth cures, proceed from an exaltation of sensibility dependent on
rheumatic, gouty, or gastric irritation, or on congestion of the fifth pair of nerves, in all cases on a purely
functional affection of the sensitive filaments. Colocynth is of no use in organic prosopalgiae, from growing out of the teeth, hypertrophy of the bones of the
skull or face, tumours, &c.
"Second: the neuralgia of the celiac plexus and
its branches, are particularly likely to be quickly and
permanently removed by colocynth when they occur
as substantive affections, not caused by derangements
of the stomach, but by cold, vexation, or anger, occurring during the period of evolution; complicated with
spinal irritation and neuralgia of the great nerves of
the thigh, with haemorrhoids, chronic diarrhcea, or vermicular symptoms."
Colocynth is adapted to dry, bilious and cholericmelancholy temperaments. It is especially suitable
in cases of neuralgia, confined to certain parts of the
left side of the body. The paroxysms are usually attended with spasms, twitchings, and contractive sensations; and the lancinations are sudden, violent, and
extend to a distance from the starting point.
Administration.-A drop of the third dilution in water, every hour, until its effects are apparent.
Nux Vomica.-External indications.-Temperament
sanguine or choleric; disposition lively, artful and
malicious; face pale or highly coloured; contractions
of the hands and feet; coldness of the body, especially
after drinking; trembling of the limbs; fainting fits,
spasmodic twitchings in different parts of the body;
better adapted to males than females.
Physical sensations.-Periodical and intermittent
pains; excessive sensibility of the affected parts to
external impressions of all kinds; periodical headache every morning after rising, increasing until noon,
then gradually diminishing until night, when the pain




430 DISEASES OF TIlE BRAIN AND NERVOUS SYSIT1EM1
ceases the pains are drawing, tearing, compressivef
affecting the whole head, or the forehead, or the part
just above the root of the nose; headache accompanied with confusion of ideas, nausea, bitter eructations, vomitings, constipation; scalp painful and sensitive to touch or cold air; tearing pains in the facial
and infra orbital nerves; ringing in the ears; toothache in sound and decayed teeth; pains of a sticking,
drawing, tearing, jerking, or digging character, aggravated by cold air and drinks, by study and meditation,
and relieved by rest and warmth; toothache from
cold, and from extraction of a tooth; drawing toothache in several teeth; looseness of the teeth; swelling
of the gums; drawing toothache in a hollow tooth,
with pains extending to the face and temples; gastrodynia attended with violent, cramp-like, contractive
and tearing pains in the stomach; pleurodinia; contractions and cramps in the hands, feet and limbs;
coldness of the hands and feet; painful contractive
sensations throughout the body; faintness; languor,
and indisposition to mental or physical exertion.
Mental and moral symptoms.-Great sensitiveness to
external impressions; melancholy; sadness; apprehension; anxiety; petulancy; indisposition to mental
exertion.
Administration.-This medicine may be employed
in the same manner as Belladonna.
We have occasionally employed Aconite with advantage in neuralgia, accompanied with great erethism of the vascular system, flushes of heat, congestion of the head, chest, and heart. Whenever the
function of the heart appears to be affected in neuralgia, this remedy will generally prove useful.
When neuralgia has arisen from excessive loss of
the fluids of the body, we may refer to china,phosphorus,
calcarea carb., and sepia.
When the disease appears to he connected with
scrofula, exostoses of the bones, chronic cutaneous affections, abuse of mercury, constitutional syphilis,
glandular and other tumours, reference should be
made to sulphur, mercurius, hepar sulph., sepia and
aurum muriaticum.
In neuralgic attacks of the heart, or stomach, or




DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 431
uterus, our best remedies are nux vomica, acid hydrocyanic, pulsatilla oand colocynth.
Neuralgia from mechanical injuries, will commonly
yield to arnicac, aconite and calendula.
For a more particular description of the neuralgic
symptoms pertaining to special organs, and the mode
of treatment, we refer to the diseases of the different
organs and tissues in other parts of this work.
Administration.-A  wide range of attenuations
should be employed in neuralgia, in order that we may
adapt our remedies precisely to the degree of erethism
present in each particular case. When the pains are
very acute, the dose may be repeated every hour until
relief is obtained, or until a medicinal aggravation
admonishes us to discontinue the medicine.




432
CHAPTER XXVI.
DISEASES OF THE URINARY AND GENITAL ORGANS.
SECTION I.
NEPHRITIS.-INFLAMMATION OF THE KIDNEYS.
Diagnosis.-Inflammation of the kidneys commences with the ordinary febrile symptoms, like slight
chills, hot and dry skin, thirst, frequent and hard pulse,
either, accompanied from the first, or speedily succeeded by deep-seated, aching pain in the region of the
kidneys, which soon becomes acute and pulsative;
urine scanty and high-colored; entire inability to lie
upon the healthy side or upon the stomach; position
mostly upon the back when reclining, or on the affected side, with the dorsal and lumbar muscles flexed;
inability to lie upon the diseased side with the muscles
extended; severe pains upon rising up to the erect
posture, or from the concussions arising from riding,
walking, or running; when the disease is strongly
pronounced, there are, absolute inability to walk, or
even to stand upon the feet; pressure over the inflamed kidney does not cause pain, but any motions which
call into exercise the deep-seated dorsal or lumbar
muscles, excite acute pain; the inflammation generally attacks the left kidney; both kidneys are rarely
affected at the same time in the first instance; the
pain at first is aching, compressive and dull, but often
becoming, in severe cases, violent and lancinating;
the pains extend along the ureters to the bladder, or
follow the spermatic cord to the testicles  the urine is
very scanty, bloody, purulent or red, or watery; constant desire to urinate; there are nausea, eructations,
vomitings, flatulence, constipation; pains in the rectum, from contiguous sympathy; tenesmus; swelling
and heat over the affected side; when complicated
with calculi, there will be retraction of the testicle;
numbness of the thigh; anxiety, and more severe constitutional disturbance.




AND GENITAL ORGANS.            433
Nephritis may readily be distinguished from lumbago, inflammation of the psoas muscle, and neuralgia,
by the character and direction of the pains which follow the ureters to the vesiculce seminales, or the spermatic cords to the testicles; also by the nausea, vomiting, constant desire to urinate; thepartial, and in
some cases almost entire suppression _of the urinary
secretion; the sympathetic pains in the rectum; and
the increase of pain whenever any of the muscles
which bear upon the kidneys are extended.
The terminations of nephritis are, resolution, sup.
puration, induration, schirrus, or gangrene. The duration of the acute stage is usually from six to nine days,
when one of the above terminations usually obtains.
Its termination in resolution is indicated by a gradual return of all the functions to a more healthy
state; increased secretion of urine, which deposits an
abundant sediment; moderate and general perspiration; subsidence of the pains; ability to lay on either
side, or to walk without difficulty.
When suppuration has taken place, the pains become less severe; there are chills, or shiverings; dull
throbbing in the region of the kidneys; sometimes appearance of pus inr the urine; a sensation of numbness
and weight in the affected side; a partial subsidence
of the febrile symptoms; and occasionally an abscess, which may be recognised by swelling and fluctuation in the part.
The purulent matter may be discharged by the
ureters into the bladder, or find its way between the
lumbar, or the internal crural muscles, to the thigh, or
it may find its way by ulceration into the cavity of the
spleen, the liver, or the colon, or it may burst externally.
In these cases fistulous passages are apt to remain
for a long period, giving issue to the pus and urine.
In a very few instances, after the acute symptoms
have subsided, there remains a chronic induration of
the kidneys, which in the end degenerates into a true
schirrus. In other rare instances, when the inflammation has been exceedingly violent, and suitable remedial
measures have not been employed, the vitality of the
19




434           DISEASES OF THE URINARY
part becomes destroyed, and gangrene is the result.
The occurrence of gangrene is recognised by the pale,
sunken, and deathlike expression of countenance, cold,
clammy sweats, universal prostration, constant vomiting, delirium, small and frequent pulse, absence of
pain, hiccough, and dark and fcetid urine. Whenever
either of the last described occurrences take place, no
hopes of cure should be entertained.
Causes. —External injuries, strains from violent exercise or. lifting heavy weights, the irritation of calculi,
sudden check to the perspiration from cold, abuse of
medicinal or morbid substances which operate specifically upon the kidneys.
Therapeutics.-Frequent external applications of
cold water over the inflamed kidney will be of great
service in abstracting the superfluous animal heat, and
thus allaying the inflammation. The water should be
applied quite cold, and repeated until the temperature
of the part is permanently diminished, and the pain
has in a measure subsided.
The specific medicines are, cantharides, cannabis,
tussilago petus., aconite, copaibce, terebinthina, belladonna, arnica, nux vomica, and pulsatilla.
As soon as we are called to a case of nephritis, we
should have immediate recourse to aconite, either
alone or in alternation with one of the other specifics,
and continue it until the febrile symptoms have subsided. In slight cases, aconite alone as an internal
remedy, together with thorough external applications
of cold water, will suffice.
If the inflammation be of a severe grade, and there
are tearing, drawing, and pulsative pains in the regioln
of the kidneys, extending to the bladder and testicle,
constant desire to urinate, scanty secretion of' highcoloured urine, inability to lay on the affected side,
tenesmus, colic-pains, urine tinged with blood, painful
micturition, aconite in alternation with the third dilution of cantharides, or cannabis, or terebinth, or tussilago petus., or bals. copaib., may be exhibited.
Arnica is suitable for inflammation of the kidneys,
caused by external injuries, concussions, sprains from
lifting, &c.




AND GENITAL ORGANS.            435'When there is reason to suspect that suppuration is
about commencing, sulphur, sepia, and lycopodium, may
be used with advantage.
SECTION II.
CYSTITIS.-INFLAMMATION OF THE BLADDER.
Diagnosis.-Inflammation of the bladder commences
like nephritis, with shiverings or chills, frequent pulse,
-hot and dry skin, anxiety, thirst, urine scanty and
high-coloured, nausea, vomiting, eructations, and constipation. In a short time, the patient experiences
deep-seated lancinating pains in the hypogastric region, frequent desire to urinate, each effort giving rise
to increased pain, great anxiety, and uneasiness. As
the inflammation extends, the pains become more severe, and there are a continual burning sensation in the
bladder, with painful pulsations; acute pain on making pressure in the vicinity of the inflammation, and
when attempting to urinate; sense of weight in the
hypogastric region; acute or dragging pains in the
loins, the ureters, the perineum, and the anus; swelling and distention of the abdomen; great difficulty in
voiding the feces, on account of the sympathetic inflammation of the rectum; all movements of the muscles which bear upon the bladder excite increased
pains; and finally rigours, cadaverous expression, cold
extremities, delirium and convulsions. If the inflammation be confined to the neck of the bladder, there
will be an almost entire suppression of the urinary
discharge; constant ineffectual and exceedingly painful efforts to urinate; and violent pain in the perineum.
If the ureters become involved, pains are frequently
felt as high as the kidneys; the secretion of urine
becomes more deranged, the suppression is more decided, and the attempts to void the urine still more
painful. When the whole interior surface of the bladder is affected, the urine is red and tinged with blood,
and a severe burning and throbbing pain is experienced. Occasionally the external surface of the organ
becomes inflamed, either on one side, on its anterior
or posterior, or its superior or inferior part; in which




436          DISEASES OF THE URINARY
cases the symptoms will be in correspondence with the
location of the malady.
Cystitis may terminate in chronic inflammation of
the bladder, in resolution, suppuration, or gangrene.
The signs which indicate these different terminations, are similar to those described under nephritis.
Causes. —njuries resulting from child-birth, from
the use of instruments during accouchement, from
blows, concussions and falls, from gravel, stone, abuse
of diuretics, metastases of erysipelas, rheumatism, or
gonorrhea, the use of stimulating injections into the
urethra, prolonged retention of urine, introduction of
catheters and sounds into the bladder, suppression of
the menses, and extension of inflammation from neighbouring parts.
Therapeutics.-Aconite, cantharides, cannabis, thuya
occiden, terebinthina, copaibca, tussilago petus., and
asparagus, are our best specifics. They may be employed at the first, second and third attenuations,
either alone or in alternation with aconite, and the
doses repeated as the urgency of the symptoms shall
require.
SECTION III.
DIABETES.
Numerous hypotheses have been offered respecting
the seat and nature of' this singular malady, but
neither of them appears to afford a satisfactory explanation of all its phenomena. The affection has been
referred to a morbid condition of the kidneys alone,
also to derangement of the stomach, of the liver, to
a defect in the fluids, to suppressed perspiration, to
an imperfect animalization of the blood, to the retrograde action of the lymphatics, and to an unnatural
waste of the body, thus calling into increased activity
the digestive and assimilative functions to supply the
waste. Galen, who saw but two cases of diabetes
during his life, supposed that it was caused by an
inflammation of the kidneys," which made them draw
much serum from the emulgents." Aretaeus attributed
it to a feeble and relaxed condition of the kidneys,
"which weakens the retentive faculty."  Actius be



AND GENITAL ORGANS.            437
lieved that the cause consisted in " an afflux of sharp
or salt humours, which continually stimulated the
veins to expulsion." Van Helmont attributed it to a
paralysis of the muscles of the bladder. Willis, who
first pointed out the saccharine character of the urine,
thought it was caused by " the dissolution and overlax frame of the blood, whereby it loses its serum
before it has done its office." Sylvius says: "the
disease arises from a sharp volatile salt, either received from without, or inbred in the parts." Cullen,
Sydenham, Rollo, and Home, regarded the affection
as " dependent primarily on a disordered state of the
digestive organs, in conjunction with a defect in the
assimilating functions."
This last opinion is probably the correct one, and
much credit is due to Bouchardat for having first
pointed out the changes which certain aliments undergo in consequence of this disordered state of the
digestive apparatus. Dr. B. broached the opinion,
that" in diabetes, starch was converted in the intestines into sugar, which passed into the blood and
urine."  Hence, a diet composed chiefly of neutral
azotised substances, to the exclusion of starch, has
been recommended for the cure of this disease, and,
in some instances, with success.
It may, then, be safely assumed, that the primary
cause of diabetes consists, first, in a morbid state of
the digestive and assimilative organs, which favours
the formation of dextrine, or sugar, from the starchy
or farinaceous substances introduced into the alimentary canal, and its absorption into the blood and urine.
The following are a few of the reasons for this
opinion: Diabetes is usually attended from the first,
with a disordered state of the digestive organs, as is
indicated by uneasy sensations in the stomach after
eating, impaired or morbidly increased appetite, eructations, nausea, vomiting, bad taste, and dryness of the
mouth and tongue.
The function of the stomach is exceedingly complicated, and is inflamed, perhaps, more than any
other organ of the body, by the numerous natural or
artificial circumstances which constantly operate
upon living beings. When the organism is in a sound




438            DISEASES OF THE URINARY
condition, and no disturbing causes exercise an influence, the digestive apparatus elaborates thoroughly
a certain amount of chyle, and the assimilative organs
take it up and appropriate it in a certain manner.
But these functions may be impaired, suspended, or
even unduly increased, by moral and physical causes.
Ill news, grief, chagrin, mortification, disappointment,
anger, fear, dread, apprehension, and disagreeable
sights, often suspend both digestion and assimilation.
These functions may also be impaired or suspended
from the abuse of drugs, stimulants, tobacco, coffee,
tea, sedentary habits, excessive bodily fatigue, want
of sleep, the irritation of vitiated bile, or of the gastric fluid, or of acids, excesses in eating, or the use of
indigestible food, inflammation, &c. They may also
be morbidly increased by tonics and stimulants, like
bark, the preparations of iron, the bitter infusions,
wine, alcoholic liquors, cordials, and condiments.
In the malady under consideration, the digestive
organs are in a peculiar condition. The thirst is intense, and the appetite voracious, yet the digestive
function is perverted, the aliments are imperfectly
converted into chyle, a superabundance of saccharine
matter is elaborated, while the activity of the absorbents is astonishingly increased.
That farinaceous aliments are really converted into
sugar in the stomachs of diabetic patients, is evident
from the fact that traces of it have been detected in
the matters ejected by them after the use of farinaceous food. It is also proved from the circumstance,
that when this kind of food is withheld, both the secretion of urine and its saccharine character is materially diminished.
Matteucci has demonstrated, that "starchy substances, when introduced into the stomach and intestines of diabetic patients, are converted into dextrine,
or sugar, by the saliva, or pancreatic juice, and are
then absorbed directly into the blood, either in this
form, or after having been converted into lactic acid."
The experiments of Dutrochet, Cuna, and Matteucci have proved that different liquids may pass
through the stomach, membranes, skin, and other animal tissues, by absorption, imbibition, endosmose, or




AND GENITAL ORGANS.          439
exosmose, the activity and direction of these pheno.
mena depending upon the character and position of
the fluid used, and the physiological condition of the
structure acted on.  Thus, "azotised neutral substances dissolved in the stomach by the acid liquid,
or by the catalytic action of pepsine, pass into the
blood merely by the imbibition of the coats of the
capillary bloodvessels of the stomach." Water, and
alcoholic drinks, introduced into the stomach, are also
absorbed; they do not pass beyond this viscus, nor
are they to be found in the chyle, yet they reach the
blood."
In diabetes, the digestive organs appear to have
lost the power to elaborate healthy chyle, and also
the absorbents of resisting the entrance of the saccharine fluids formed by this perverted action.
Whether the nature of this morbid condition is of an
inflammatory or non-inflammatory character, whether
dependent upon exalted action or laxity, loss of tone
or paralysis of the affected parts, is somewhat problematical, although we incline to the opinion, that the
disease is essentially dependent upon a relaxed and
enfeebled condition of the digestive and assimilative
functions.
But an objection will be urged to the above views,
because the quantity of sugar found in the urine of
diabetic persons is not at all proportionate to that of
the fecula taken as aliment; but this argument fallsto the ground when we reflect that the uric acid and
the urea derived from the rapid metamorphosis of the
tissues, is likewise converted into sugar, and passes,
with the fluids arising from these changes, through
the blood and kidneys, thus contributing to make up
the enormous quantity of saccharine fluid which is
observed in this affection. Prout has shown that the
constituent elements of urea and sugar are the same,
and exist in similar proportions; from which fact, we
can readily comprehend the change from one substance to the other, and the affinity exercised by the
saccharine fluid circulating in the blood, upon the
urea arising from the transformation of the tissues.
Second. As a consequence of this primary derangement of the digestive and assimilative functions, the




440         DISEASES OF THE URINARY
saccharine fluids formed, are transmitted rapidly
through the blood, absorbing, during their course, the
changed urea, and, finally, eliminated by the kidneys.
It is the office of the kidneys to separate from the organism all substances incapable of further use,
whether such useless substances are the product of
the natural secretions, or of the transformations of
the tissues. Now, as sugar is a substance foreign
and injurious to the blood, it is taken up as fast as
formed, and conveyed speedily to the kidneys, which
separate it, after which it passes off through the bladder. This is evident from the fact, that when a solution of sugar is injected into the veins of an animal,
it does not remain in the blood, but makes its appearance very speedily in the urine. It is on this account
that it is so difficult to detect sugar in the blood of
diabetic patients, although traces of it have been found
by Dr. Capezzuoli, not only in the blood, but in the
contents of an abscess of a diabetic patient.
When more saccharine matter is absorbed than can
be speedily eliminated by the kidneys, it is highly
probable that it passes off through the liver, the salivary glands, the pancreas, and even into abscesses,
rather than remain in the mass of the blood.
Third. The kidneys themselves being constantly
acted upon by a fluid unlike their natural stimuli, become irritated, their vessels enlarged, and thus excited
into unnatural activity. This fluid also often gives rise
to an inflammation about the orifice of the urethra.
Diagnosis.-In tracing the progress of diabetes, and
noting carefully the symptoms which are especially
characteristic, it will be found that a very intimate
connection necessarily exists between these symptoms
and the pathological conditions above described.
In the first instance, there are indications of derangement of the digestive apparatus, as morbid appetite, distress in the stomach after eating, flatulent
distention, acidity, eructations, nausea, heartburn,
lassitude, and debility.
When the disease is fully formed, the prominent
symptoms are, urgent and insatiable thirst, voracious
appetite, hot and harsh skin, and the elimination of an
unusually large quantity of urine abounding in saccharine matter.




AND GENITAL ORGANS.           441
As the disease advances, the tongue is clammy and
white, or clean and red; there is distress after eating;
a peculiar hay-like odour issues from the body and
lungs; there are pain and weakness, and sometimes
swelling, in the loins; anxiety; peevishness; despondency; impaired memory; vertigo; constipation; inflammation about the glans penis and the orifice of
the Urethra; rapid and great emaciation; loss of
strength; impotence; coldness of the extremities;
difficulty of breathing; dropsical effusions; weak and
frequent pulse; great prostration of all the powers.
Diabetic urine is of a straw colour, of a disagreeable odour, and a sweetish taste. The quantity voided
in different cases varies very much, some patients
voiding as much as fifty or even one hundred pounds
in twenty-four hours, while others pass only eight or
ten pounds during the same period. The average
quantity voided in twenty-four hours may safely be
placed at about fifteen pounds.
Diabetes usually continues for months, and sometimes for years, before it terminates fatally. Hitherto
it has been almost invariably fatal; but may we not
hope that the discoveries which have been recently
made, and which are still being made, in organic
chemistry, as well as in the practice of medicine, will
enable us yet to understand and conquer this singular
and intractable malady?
Therapeutics.-If the theory which we have advanced respecting the nature of diabetes is correct, it
follows as a consequence, that one of our most important therapeutical indications consists in pointing
out a proper system of dietetics. We have seen that
through a perverted action of the digestive apparatus,
all the farinaceous or starchy substances consumed
become converted into sugar, and thus afford material
for the perpetuation of the malady. A rigid abstinence from everything of a feculent nature should
therefore be insisted on, while, at the same time, a
diet as nutritious as possible should be enjoined, consisting of beef, mutton, venison, fowls, game, fish,
animal soups, jellies, and articles of this nature. We
commend most strongly as valuable auxiliary means
in this affection, sea voyages, and frequent applica19*




442          DISEASES OF THE URINARY
tions to the whole surface of the body, of salt water.
The free use of ice, gradually dissolved in the mouth,
will also prove serviceable in allaying the intense
thirst which consumes the patient.
The internal remedies which have been found most
successful in this disease are, acid phosphoric, carbo
vegetabilis, nux vomica, acid muriatic, baryta muriate,
belladonna, uva ursa, rhus rad., conium mac., digitalis,
and opium.
Our experience has been so limited in the homceopathic treatment of diabetes, that we shall refrain
from extending our observations respecting the especial indications and the practical employment of each
particular remedy, but refer our readers to the
provings, and mode of employment, by different medical men, for further information and suggestion upon
the subject.
SECTION IV.
ENURESIS.-INCONTINENCE OF URINE.
Diagnosis.-This affection may be recognised by a
partial or total loss of power to retain in the bladder
the secreted urine. When the loss of voluntary power
over the muscles concerned is total, the urine continues to dribble away as fast as secreted, becoming thus
an incessant source of trouble and annoyance.
If the loss of power be only partial, the urine can
be retained until a given amount is accumulated,
when the patient is suddenly compelled to yield to the
pressing demand, sans ceremonie. In other instances,
the incontinence is troublesome only during sleep, and
appears to be excited by dreams, constrained positions, &c.
The malady is unaccompanied by febrile symptoms
or pains, and usually occurs as a symptom of some
other disease.
Causes.-Complete enuresis may be caused by paralysis of the sphincter of the bladder from constitutional causes, from external injuries, from tedious and
protracted labours, from the pressure of tumours, from
calculous deposits, and from abuse of diuretics.
Partial enuresis is a common complaint amongst




AND GENITAL ORGANS.             443
children, and is particularly troublesome in the night
during sleep. It has too often been attributed to
habit, and negligence of proper efforts to restrain the
discharge on the part of children, and for this reason,
external applications, in the form of "spanking," and
" essence of birch," have been employed, but so far as
our knowledge extends, without advantage.  The
disease in these cases is undoubtedly associated with
irritation at the neck of the bladder, originated by
acrid urine, gravel, the irritation of worms in the rectum, etc.
Therapeutics.-Cantharides, cannabis, uva ursa, nux
vomica, cicuta vir., sulphur, calcarea carb., pulsatilla,
and rthus, are the chief remedies.
For the cure of paralytic enuresis, recourse should
be had to cantharides, nux vom., rhus and uva ursa.
When the disease occurs in children, our best remedies are, cantharides, calcarea carb., and sulphur.
When from external injuries, difficult accouchements,
or the irritation of calculi, we may prescribe arnica,
pulsatilla, rhus, and cicuta virosa.
Administration. -The remedies should be used at
the first or second attenuations, and a dose given once
or twice daily as long as necessary.
SECTION V.
SUPPRESSION ANI) RETENTION OF URINE.
The causes capable of giving rise to suppression or
retention of urine are so various and diversified, and
the circumstances attending the course and progress
of different cases so numerous, that our description
must necessarily be confined to the more prominent
symptoms and occurrences connected with the malady.
By the term retention of urine, we mean to include
all of those cases in which the urine is secreted by the
kidneys as usual, but where the power to evacuate the
bladder is lost; while suppression of urine corresponds
with the affection known as ischuria renalis, in which
the secreting function of the kidneys is either partially
or totally destroyed.
Ischuria renalis is always attended with danger,
from the peculiar tendency which exists in the brain




444          DISEASES OF THE URINARY
to take on diseased action. When there is an entire
suppression of the urinary secretion, from paralysis of the kidneys, coma and effusion upon the brain
occur very speedily. In cases of this description, the
saliva, the sweat, the pulmonary exhalations, the bile,
the pancreatic and gastric fluids, become impregnated
with a fluid possessing the appearance, taste and
odour of urine. It has also been observed, that the
liquid effused upon the brain, possesses a decidedly
urinous smell. In cases of the disease dependent on
inflammation of the kidneys, we shall have febrile
symptoms, hot and dry skin, thirst, nausea, vomiting,
rapid pulse, tenderness of the abdomen on pressure,
swelling and pain in the region of the kidneys, frequent desire to urinate, and the passage of the small
quantity secreted, causing great pain, urinous taste in
the mouth, urinous odour of the sweat, anxiety and
general uneasiness. If the suppression be total, the
symptoms will be still more grave, and there will be
early indications of serious cerebral disorder, in the
form of delirium, rapidly succeeded by coma and
effusion.
On the other hand, in suppression, depending upon
paralysis of the kidneys, the febrile symptoms may be
very slight, and there may be an entire absence of
pain and uneasiness in the region of the kidneys or in
the abdomen, and no desire to urinate. In these
instances, the danger is no less imminent than in the
other variety, for fatal oppression of the brain almost
invariably ensues, if the malady persists more than
two days. Cases, however, are recorded, of almost
total suppression for two or three months, in which the
patients have been restored to health, but such instances are of rare occurrence, and should only be
considered in the light of exceptions to the general
law of the disease.
Suppression now and then occurs from the presence
of calculi or gravel in the structures of the kidneys, thus
causing a mechanical obstruction to the healthy performance of their functions. In these cases the foreign bodies may operate by causing inflammation,
spasms, induration, or ulceration. They give rise to
swelling, pains, sensation of weight and uneasiness in




AND GENITAL ORGANS.            445
the vicinity of the kidneys, to numbness of the thighs,
retraction of the testicles, abdominal tenderness, constipation, frequent inclination to urinate, pain and
tenesmus in passing water, anxiety, irritability, febrile
symptoms, nausea, vomitings, hiccoughs, pain in the
lumbar region, pain and tension in the perineum, scalding in the urethra, pulse full and frequent, difficulty of
breathing, sighing, delirium, convulsions.
Ischuria may be distinguished from retention of
urine from the circumstance, that in the latter disease,
the bladder is distended and rises up above the pubis,
offering to the pressure of the hand a firm and resisting body, while in the former complaint this viscus is
empty, falls down below the pubis, and affords no
resistance or fluctuation.
Retention of urine may arise from inflammation, from
stricture of the urethra, from paralysis of the bladder,
from enlargement and inflammation of the prostate
gland, from mechanical injuries to the bladder, from
abuse of stimulating diuretics, from inflammation of
the rectum, from the pressure of tumours, from displacements of the uterus, from calculi, from the lodgement of gravel or a stone in the ureters or in the
urethra, from thickening and obstruction of the ureters,
from too long continued retention of the urine, and
from spasms.
The general symptoms of retention are, distention of
the bladder, and its elevation above the pubis, pains
in the region of the bladder, with pressing desire and
frequent ineffectual attempts to urinate, anxiety, general uneasiness, and more or less constitutional disturbance.
As retention is generally but a symptom of some
other malady, we are often presented with constitutional disturbances during an attack, in no way dependent upon this affection. We may cite as examples of this kind, diseases of the brain and spinal
marrow, which may have preceded the retention for
months, protracted calculous affections, chronic inflammations of the bladder and of the prostate gland,
constitutional effects of onanism, retroversion of the
uterus, and the effects of previous mechanical injuries.
From these facts it is apparent that there may exist an




446          DISEASES Or1 THE URINARY
almost endless variety of symptoms during the progress of the different cases of retention which are constantly occurring.
When the malady arises from simple inflammation
of the neck of the bladder or of the bladder itself, not
complicated by any previous disease, the symptoms
are, hot skin; frequent and hard pulse; thirst; pain
in the region of the bladder and in the perineum, increased by pressure; restlessness; anxiety; constipation; frequent inclination to pass water, with violent,
painful and ineffectual straining; shooting pains extending up the ureters towards the kidneys, or along
the spermatic chords towards the testicles; headache;
nausea; oppression at the prwecordia; and general
feeling of fulness and distention of abdomen.
Retention caused by paralysis, on the other hand, is
accompanied by but few of these symptoms. Indeed,
many cases are recorded, where the accumulations of
urine have reached an enormous amount, before the patients were aware of it. Other instances are mentioned
where the distention has been so gradual and painless
as to cause it to be mistaken for ascites, and in more
than one instance of this description, paracentecis abdominalis has been resorted to as a curative means.
In cases like these, fifteen or twenty pints have occasionally been drawn off by the catheter at a single
operation. It is not an uncommon result in these overdistentions, for the bladder to become united by adhesive
inflammation to the umbilicus, and afterwards to discharge itself through this part by ulceration. The
same occurrence sometimes takes place into the rectum, vagina, and even into the abdominal cavity. In
these cases, the danger from peritoneal inflammation,
and from gangrene, is imminent.
Retention may arise from spasmodic contractions
about the neck of the bladder, giving rise to most violent and painful attempts to urinate, bearing-downi
pains, frequent painful erections, great sensitiveness
of the urethra and perineum. In this variety of retention, it is always very difficult and sometimes absolutely impossible to pass a catheter, without previously allaying the irritation by fomentations or by
the employment of suitable medicines.




AND GENITAL ORGANS.           447
Spasmodic retention, although sudden and violent
in its onset, is not usually a dangerous affection. The
essence of the disease consists in an irritation about
the neck of the bladder, and is dependent upon inflammation of the prostate, of the rectum, of the urethra, or some other neighbouring structure, from
which it has been propagated by contiguous sympathy.
But the most difficult cases of retention with which
the physician meets, are those caused by strictures of
the urethra, and enlargements of the prostate gland.
The practitioner, during his professional career, will
sometimes be called to cases of each of these maladies,
where nothing but an incision into the membraneous
portion of the urethra, through the stricture, or the
puncture of the bladder, will save life. In these cases,
greatjudgment, decision, and surgical skill, are indispensable to the safety of the patient. This will be conceded when we think of the rapidity with which retention may terminate in fatal cerebral disease, ulceration,
and gangrene. By these observations, we by no means
desire to deter the physician from the employment of
every medicinal means in his power, so long as they
can be applied without endangering the life of the patient; but there is a point beyond which we cannot
safely pass without resorting to one of the operations
just alluded to, and in making up a correct decision
upon this point, the best judgment and the highest
professional knowledge are requisite. I cannot better illustrate this subject than by detailing the history
of a case which came under my observation during an
early part of my professional career:
Mr. B., aged forty years, of robust constitution, had
been operated upon fourteen years previously, for
stricture in the membraneous part of the urethra. An
incision had then been made through the strictured
part, a catheter introduced and allowed to remain
a good portion of the time for several weeks, but for
some unknown reason, the opening made by the knife
did not heal, and a fistulous passage was formed,
through which the urine has passed for the most part
of the time since that il;,riod. For two or three years
previous to his coming under my care, this fistulous




448          DISEASES OF THE URINARY
passage had been gradually contracting, and he experienced, at times, retention, which could only be
obviated by baths, fomentations, injections, relaxing medicines, and the skilful use of the probe.
Several times, however, I succeeded in relieving him
of the attacks, by these means; but on one occasion,
being in the country, and having contracted a cold
from wetting his feet, the retention recurred, accompanied with unusual inflammation and tumefaction in
the fistulous tract. Persevering efforts were made by
his medical attendant, to allay the inflammation, relax
the parts, and to draw off the water by means of catheters and probes, for nearly two days, but without
success. The symptoms now becoming very urgent,
he returned home and placed himself under the care
of Dr. Brigham and myself. We found great distention of the bladder, constant desire to urinate, bearingdown pains in the region of the bladder, expression
exceedingly anxious and care-worn, eyes sunken,
mouth and throat dry, thirst, pulse rapid and feeble,
great prostration, nausea, hiccough, delirium, frequent
sighing, exhalation from the surface of the body of a
urinous smell, coldness of the extremities, and a sluggish and unhealthy appearance at the orifice of the
fistula.
After resorting to the usual remedies in such cases,
and making repeated attempts with the catheter and
probe, we decided, although it was then midnight, that
an incision must be made through the perineum without further delay. This was speedily effected, and
the patient's life thus saved, while had we delayed a
few hours more, gangrene or congestion of the brain
would probably have resulted.
We also have in mind, a case of retention, from enlargement of the prostate, which proved fatal in consequence of an absolute refusal, on the part of the patient, to submit to the operation of puncturing the
bladder. In this instance, the swelling and inflammation of the gland were so great, together with a constant tendency to spasmodic contraction of the neck of
the bladder, whenever the catheter came in contact
with the part, that all efforts at introduction, aided by
baths, fomentations, and relaxants, were of no avail.




AND GENITAL ORGANS.           449
Here, a timely puncture of the bladder, would have
saved the patient's life.
We are well aware of the practical skill and tact
necessary to effect an introduction of a catheter in
these cases, and of the importance of securing the services of a skilful and experienced surgeon; but cases
sometimes occur which baffle the most eminent surgeons in their attempts to pass a catheter by an enlarged prostate.
Retention sometimes occurs from obstruction of the
ureters, by gravel, calculi, by thickening and induration of their walls, by.hydatids and other unnatural
formations, by the pressure of tumours in their vicinity,
and by occlusion from adhesive inflammation. The
following signs indicate the existence of this variety of
disease: unusual fulness, pain and sensation of weight
in the vicinity of the kidneys, tension along the track
of the ureters, nausea, vomiting, retraction of the testicles, pain along the spermatic cord, collapsed state
of the bladder, no resistance to the introduction of the
catheter, absence of urine in the bladder, and more or
less constitutional disturbance. When the obstruction
is complete, the ureters and the kidneys become so
much dilated that urine to the amount of two or three
pints, sometimes accumulates in them, before congestion, ulceration, or gangrene supervene.
Retention not unfrequently arises in females, from a
retroversion of the uterus, from the presence within the
vagina of polypi, hydatids, of schirrous enlargements,
from injuries arising during difficult accouchements,
from the irritation caused by acrid secretions, from the
presence of hardened feeces in the rectum, and from
adhesion occurring between the walls of the vagina,
in consequence of inflammation and slcutghing of the
mucous membrane.
Causes.-The most frequent proximate cause of retention, is inflammation of some portion of the bladder.
Amongst the more prominent causes of this inflammation, are, metastases of gout and rheumatism, abuse of
diuretics, mechanical injuries, injections, venereal diseases, calculi, acrid urine, strains, and extension of inflammation from neighbouring parts.
The causes which rank next in importance, are




450           DISEASES OF THE URINARY
strictures of the urethra. They occur at all periods of
life, and always require the interference of the surgeon for their removal.
Enlargement of the prostate gland, is a frequent cause
of retention in old men. The remote cause can generally be traced to excesses in sexual indulgence
during early life. This gland may become enlarged
from mere inflammation and engorgement of its structure, or from schirrus degeneration. Affections of the
prostate are usually called into activity by undue exposure to cold and wet, by abuse of stimulants, and
by neglect of timely urinary evacuations.
Other causes, some of which have already been alluded to, are, retroversion of the uterus, obstruction of
the ureters from foreign bodies, occlusion of the ureters
from adhesive inflammation, paralysis of the bladder,
from injury or disease of the brain or spinal marrow,
from undue retention of urine, from mechanical injuries, from abuse of drugs, from  metastases of gout,
thickening o the mucous membrane of the bladder,
tumours and e  rescences near the neck of the bladder,
repercussed eruptmns, pressure upon the bladder by
tumours in its vicinity, schirrus of the bladder or rectum, accumulations of hardened feces in the rectum,
suppression of the menses, phymosis, ulcers, external
injuries, blows, contusions, and falls, leucorrhcea and
gonorrhwa.
Therapeutics.-In all cases of suppression or retention, where there can exist a possible doubt in regard
to the true nature of the case, we should avail ourselves, without delay, of the use of the catheter. If
this instrument passes without difficulty into the cavity of the bladder, and no discharge of urine follows
its introduction, we may be certain that the cause and
seat of the difficulty is not in this viscus; while if a
free discharge takes place through the catheter, affording immediate relief to the distention, pain, and other
unpleasant symptoms which had previously existed,
we may be assured that the bladder, the prostate
gland, or some part of the urethra, is the seat of the
complaint.
To ensure an accurate diagnosis, then, we in the first
instance ascertain whether or not a catheter can be
passed into the bladder.




AND GENITAL ORGANS.          451
Second. If it can be, whether easily or otherwise.
Third. How large an instrument can be passed.
Fourth. If a discharge of urine follows the introduction.
Fifth. If the operation is attended with pain.
Another important step in forming our diagnosis,
consists in procuring from the patient or his friends, a
minute history of his case, and every circumstance
connected with the individual, which might have a
bearing upon it. Thus, if we are called to an old man,
whose malady has approached gradually, who has had
no febrile symptoms and little pain, where no resistance is offered to the introduction of a full-sized catheter, and where a large quantity of urine flows off,
affording immediate relief to the uneasy feelings, we
may with confidence pronounce the cause, paralysis of
the bladder. The same law obtains in cases of retention succeeding injuries, or diseases of the spinal
marrow.
If we have a case where the catheter -passes into
the bladder with great difficulty, on account of some
obstruction near its neck we then inquire whether
there exists a stricture, a pasmodic contraction of the
neck of the bladder, or an enlarged prostate gland.
The following circumst ces will enable us to decide
the question satisfactorily:
Stricture approaches gradually, as is indicated by
the gradual contraction of the stream of urine, the
frequent and sometimes constant presence of a gleety
discharge, and a sensation, after passing water, as if
a few drops still remained behind.
Enlarged prostate occurs, for the most part, in old
men, is attended with pulsative pain over the bladder,
weight in the perineum, constant inclination to urinate, with much straining, fever, and general uneasiness. By introducing the finger into the rectum, we
may often detect the enlargement by actual touch.
Spasmodic contraction of the neck of the bladder
usually proceeds from inflammation of some neighbouring structure, as the prostate gland, the rectum,
and the urethra. Spasms of this part may arise also
from the irritation of gravel and calculi. The pre



452          DISEASES OF THE URINARY
vious history of the case will enable us to decide as to
the real cause of the spasmodic affection.
Retention, from stricture of the urethra, can only be
permanently cured by the gradual dilatation of the
contracted part by bougies. Temporary relief may
sometimes be afforded by the use of medicines, but the
only permanent cure is by artificial dilatation. But
much may be done towards effecting cures in cases of
diseased prostate, by a judicious employment of specific medicines. Many cases of this description owe
their origin to scrofula, or to a venereal taint, or to
abuse of' mercury, or to schirrous degeneration, for
which reason our prescriptions should be made with
reference to these peculiar states of the system, as
well as to the more immediate symptoms of the complaint.
With regard to the other causes of retention, the
importance of a minute investigation into all the circumstances of each case, cannot be too strongly insisted on; for much of our success will depend upon
an early removal of those causes which have operated
to induce the retention, and which perhaps continue
to exist to perpetuate the malady.
If a retention has been caused by a metastasis of
gout or rheumatism, our selection of remedies should
be made with reference to these general diseases, as
well as to the more urgent local symptoms. If the
cause can be traced to a displacement of the uterus, to
impacted feeces in the rectum, to inflammation of any
of the surrounding tissues, to the presence of ascarides in the rectum, to excrescences about the neck of
the bladder, to imperforate hymen, to unnatural adhesions within the vagina, to the impaction of a stone
in the urethra, our attention should be immediately
directed towards the removal of these remote causes.
The following medicines will cover all of the symptoms which occur in suppression or retention of urine:
cantharides, cannabis, uva ursi, solidago virga aurea,
acid phosphoric, rhus rad., aconite, pulsatilla, nux vomica, arnica, belladonna, oleum terebinthina, tussilago
pertuss., camphora, agnus castus, arsenicum, sulphur,
iodine, electro-magnetism.
Cantharides and cannabis are indicated in suppres



AND GENITAL ORGANS.           453
sion from chronic inflammation of the kidneys, and in
retention from long continued irritation of the neck of
the bladder. They may also be employed in suppression and retention from acute inflammation of the
kidneys and bladder, after the febrile symptoms have
been subdued by aconite. Hahnemann advises them
in retention from paralysis of the neck of the bladder,
and in cases of chronic retention arising from thickening and induration of the mucous membrane.
Arnica is our best remedy when the functions of the
kidney and bladder have been impaired or suspended
by mechanical injuries, falls, contusions, sprains,
blows, and concussions, or by the irritation of calculi.
Rhus rad., belladonna, and solidago virga aurea, are
applicable when the disorder has proceeded from metastases of gout or rheumatism. These medicines
may be alternated with aconite when the inflammatory symptoms run high.
Agnus castus is an excellent specific in retention
in consequence of paralysis of the bladder. Nux
vomica, tussilago, arsenicum and oleum terebinth., are
remedies which should command attention in paralytic retention.
Spasmodic retentions are readily cured by camphor,
belladonna, and aconite.
When gravel or calculi are the exciting causes of
the affection, we advise the employment of uva ursi,
solidago virga aurea, and belladonna.
Affections of the prostate gland may be met by
pulsatilla, sulphur, aconite, rhus rad., arsenicum  and
iodine.
Retention from onanism, or excesses in venery, are
treated best with acid phosphoric, agnus castus, cantharides, cannabis, rhus rad., and arnica.
Administration.-The lower attenuations should be
employed in these affections, and the doses repeated
every two, three, or four hours, until the medicinal
effect is perceptible. Auxiliary to the above medicinal treatment, we make a thorough use of warm
baths, fomentations, bland, diluent drinks, injections
by the rectum, and lastly, though by no means the
least important means, electro-magnetism. This powerful remedy should only be employed after the inflam



454          DISEASES OF THE URINARY
matory symptoms have been reduced, and then with
extreme care and moderation.
SECTION  VI.
DYSURIA.
Diagnosis. —In this complaint the urine can be
voided at will, but it usually passes away in a small
spiral, or divided stream, or drop by drop, each act
being attended with burning and cutting pains at the
neck of the bladder. There is a frequent inclination
to urinate, and sensations of pressure and tenesmus,
which constantly urge the patient to void his urine.
The inflammation is confined to the neck of the bladder, and does not often give rise to constitutional disturbance.
Causes.-Perhaps the most frequent cause of dysuria
is the absorption of cantharides.  This substance
exercises a specific influence so decidedly upon the neck
of the bladder, that even a sufficient quantity may be
absorbed from the external application of blisters to
cause the malady. Other causes are, stimulating injections, abuse of stimulants and condiments, onanism,
extension of gonorrheal inflammation, cold, turpentine, worms in the rectum, gravel, and calculi.
Therapeutics.-Camphor is the specific against dysury caused by the absorption of cantharides. When
arising from other causes, cannabis, uva ursi, digitalis,
solidago virga aurea, cantharides, and terebinth, are
worthy of confidence.
Administration.-Same as in retention, &c.
SECTION VII.
URINARY CALCULI.
There is not space in a manual of this description for
the careful consideration which is demanded for this disease by its importance; but we shall endeavour to glance
hastily at the most prominent doctrines at present in
vogue, with a view of attracting attention more particularly to the subject, rather than from any expectation of affording a satisfactory explanation of the
phenomena attending the formation and development




AND GENITAL ORGANS.           455
of calculous concretions. Chemistry has indeed afforded us much accurate knowledge respecting the
composition of the different varieties of calculi, but
we still remain in ignorance of the real causes and
nature of the abnormal action, the peculiar condition
of the organism requisite to originate this action, and
of the specific medicines capable of effecting cures.
The data upon which modern physicians have founded their prescriptions, may be more scientific and accurate than those of the ancients, but we are not aware
that the practical results which they have obtained are
in any degree more decided or favourable. The ancient allopathists attributed the formation of stone to
the union of the " terrestrial and tartarous parts of the
blood with the clamminess of the viscous lympha, that
continuallyflows by with the urine, and further compacted together by the salts with which the urine is
loaden."- And for the cure, they prescribed venesection,
ofiates, mercurials, diuretic infusions and decoctions,
and " lithontriptics," or "stone-dissolving remedies."
Modern allopathy attributes calculous depositions to
a superabundance of uric acid, of the phosphates of
lime, magnesia, and ammonia, oxalate of lime, &c., in
the blood and urine, and they also prescribe blloodletting, opiates, mercurials, diuretics, and "stone-dissolving remedies," but with no more success than their
heathen predecessors. To what extent homeopathy
may be able to combat this formidable disease, time
alone can determine; but so far as the limited observations and experience of our practitioners extend,
in this class of affections, our method of practice has
been highly satisfactory. Our system is especially
adapted to correct those peculiar diatheses upon
which the formation of calculi depend.
Calculous affections have been observed to prevail
in some countries more than others: even in some
portions of the same country they may be common,
while in other sections they will be unknown. The
disease is rarely seen in very cold or very hot latitudes.
English surgeons assert that it never originates in the
East Indies, and it is supposed to be of very rare occurrence in the northern kingdoms of Europe.
* Salmon.




456          DISEASES OF THE URINARY
Children and old people are most subject to the disease, and it seizes especially upon those in whom gout
is hereditary. Indeed this gouty diathesis is so common in individuals afflicted with calculi, that many
suppose that the urine exercises but little if any influence in their formation, but that metastases of gout to
the mucous membrane of the urinary passages, determine the formations of these calculous concretions.Thus, Frank, in his " Traite de Prac. de Med.," p. 367,
vol. ii," says: "The attacks of calculous affections,
like those of gout, are preceded and accompanied by
languor of the stomach, nausea, oppression, eructations, borborigmi. In inveterate gout, this phlegmasia gives rise to calcareous concretions, formed of a
material combined with uric acid, and which do not
differ from urinary calculi except in consistency and
form. Suppose now that fixed gout, which produces
calcareous concretions in the articulations of the
great toe, attacks the mucous membrane of the bladder, may it not become the source of calculi in this viscus?"
Calculi have been found in the brain, lungs, liver,
spleen, gall, bladder, uterus, the articulations and the
soft parts of nearly every portion of the organism, but
the urinary organs are by far the most common seat
of these formations. Several years since I saw taken
from the upper part of the left lobe of the lung of a
miller, two concretions of a chalky appearance, but
hard and tough, and of the size of a goose-egg. Concretions of lithate of ammonia are also common in all
parts of the body; in gouty patients.
Prout has divided the mechanical deposits from the
urine into three classes: First, Pulverulent, or amorphous sediments. Second, Chrystaline sediments, usually denominated gravel. Third, Solid concretions or
calculi,formed by the aggregation of these sediments.
The sedimeiits of the first class are held in solution
by the urine until it is discharged from the bladder,
when they are gradually deposited in a state of fine
brown or yellow powder. These sediments are generally composed of "two species of neutral saline
compounds; viz., the lithates of ammonia, soda, and
lime, tinged more or less with the colouring principle




AND GENITAL OBGANS.            457
of the urine, and with the purpurates of the same bases, an d constituting what are usually denominated
pink and lateritious sediments; and secondly; the
earthy phosphates, namely, the phosphate of lime, and
the triple phosphate of magnesia and ammonia, constituting, for the most part, sediments nearly white.
The two species of sediments are frequently mixed together." —(Prout.)
The sediments of the second class, or gravel, are
found in the urine in regularly crystallized grains, varying in form and colour in accordance with the constituents of which they are composed. The lithic acid
crystals are much the most common, and may be distinguished by their red colour. The crystals of the
triple phosphate of ammonia and of magnesia are of
a white colour, while those of the oxalate of lime are
black or dark green.
Prout supposes that two-thirds of the whole number
of calculi originate from lithic acid; and when we bear
in mind the constant presence of this acid in the urinary organs, and its proneness to form hard, inodorous
concretions of a yellowish or brown colour, the supposition will not appear unreasonable.
Chemists have described many different varieties of
calculi, amongst which the following are the most common:First, The lithic or uric acid calculus, formed by concentric lamellae, presenting a light brown or reddish
colour, and a general appearance something like wood.
These calculi are infusible by the blow-pipe, but may
be slowly evaporated, until a slight residue of white
ash remains. They are soluble.in alkaline solutions,
which, on this account, are supposed to be valuable as
remedial agents, but they are not dissolved by muriatic or sulphuric acids. The lithic acid diathesis prevails in childhood and at about the age of forty or fifty,
and the urine voided in these cases is generally acid,
and the sabulous sediment of a red colour.
Second. The calculi of most common occurrence after the variety lasf described, are those composed of a
triple combination of phosphoric acid, magnesia, and
ammonia. They are of a lightish gray colour, indistinctly laminated, with an " uneven surface and cov20




458          DISEASES OF THE URINARY
ered with small shining crystals." This variety is
not soluble in alkaline solutions, but may be partially
dissolved by muriatic, nitric, and sulphuric acids, and
imperfectly fused by the blow-pipe. The urine in these
cases is very fetid, and the sediment deposited of a
white colour, " resembling mortar." Sir Astley Cooper
asserts that this kind of calculus is very apt to be reproduced after lithotomy, and on this account advises
the postponement of operations in these cases until the
morbid diathesis is corrected.
Third. Not a very uncommon variety is the mulberry calculus, of a dark brown colour, uneven surface,
and very compact, heavy and hard. It consists of oxalate of lime, and is partially soluble in muriatic and
sulphuric acids, but the alkaline solutions have no effect upon it.
Fourth. The phosphate of lime calculus is in a few
instances found pure, but usually it exists in combination with uric acid and phosphate of magnesia and
ammonia. It is laminated, polished, of a pale brown
colour, soluble in muriatic or nitric acid, and may be
fused by the blow-pipe. They are of small size, and
are generally found in the prostate gland.
Fifth. The cystic oxyde calculus is another variety
of rare occurrence, of a yellowish hue, not laminated,
soluble in acids and alkaline solutions, and emitting
under the blow-pipe a fetid odour.
Sixth. There is also the fusible calculus, composed
of a mixture of the triple phosphate of magnesia and
ammonia, and of the phosphate of lime; of a white
colour, and fusible by the blow-pipe. This kind of
calculous deposit is occasionally seen between the
foreskin and glans-penis in old cases of phymosis.
Seventh. The constituents of the different kinds of
calculi are sometimes deposited in distinct alternate
layers in the same stone, when it is called the alternating calculus.
Other varieties have been described, like the compound calculi, the carbonate of lime calculus, the lithate
of ammonia calculus, &c.
The presence in the bladder or kidneys of any solid
substance, whether introduced artificially, or formed
naturally from lithic acid concre!ions, or clots of blood,




AND GENITAL ORGANS.           459
favours the formation of calculi. Whether the cause
of these deposits in the urinary organs, is attributable
to the peculiar composition, or the compact structure,
or the comparative temperature of the nuclei, we
are unable to determine: but all are aware of the fact,
that catheters, bullets, splinters, or other solid substances, accidentally introduced into the bladder, become
speedily coated over with the urinary sediments, which
are converted into hard crusts.
Calculi are more frequently observed in the male,
than in the female sex; but this circumstance has
been attributed to the difference in the structure of the
urethra in the two sexes, rather than to a difference in
the original diathesis. The urethra of the female being short and easily dilated, gives passage without
difficulty to gravel and small calculi, which in the long
and contracted male organs would be obstructed either
by causing spasmodic contractions, or from an actual
want of room to pass.
It is said that the right kidney is far more commonly the seat of these formations than the left, that their
form is generally spheroidical, and that their average weight is from one to two ounces. Sir Astley
Cooper, however, expresses the opinion that a majority of urinary calculi weigh less than one ounce each.
Calculi may originate in the kidneys, the bladder,
or the prostate gland, but the first organ is the primary seat of a large majority of cases, as is evident from
the fact that the pains are almost always confined to
the region of one of the kidneys in the first instance.
It is probable that the nuclei of' most stones found in
the bladder, are first formed in the kidneys, and then
conveyed through the ureters into this viscus, to serve
as the foundation of still farther deposits from the
urine.
Diagnosis.-A calculus may remain in the kidney
or bladder for a long time, without exciting much pain
or uneasiness. The patient experiences perhaps a
more frequent inclination to urinate than natural, and
after violent exercise on horseback or in a carriage,
has temporary pains in the region of the organ affected, but in other respects he feels well. This state of
things may exist for an indefinite length of time, when,




460           DISEASES OF THE URINARY
if the stone is situated in the kidney, some exciting
cause may operate, and give rise to what is denominated a "fit of the stone."  In these instances the patient is usually attacked suddenly, with severe cutting
pains in the region of the kidney, which increases as
the stone passes along the ureter to the bladder, sometimes extending to the groin, the cremaster muscle,
oralong the crural nerve, as it passes over the nerves
connected with these parts. During the paroxysm,
the pain is often of the most violent and intolerable
character, and is accompanied with continual nausea,
vomiting, inability to. retain any thing upon the stomach, frequent desire to urinate, high coloured and
sometimes bloody urine, bent position of the body, with
the muscles flexed as much as possible, heartburn,
painful retraction of the testicle, irritable bladder,
and- febrile symptoms. There is often a remission of
these symptoms for a longer or shorter period, during
the descent of the stone through the ureters, and the
paroxysm now and then comes on, and subsides suddenly and permanently, the stone not having effected
an entrance into the ureter.
After the stone has passed into the bladder, we
have the following train of symptoms: frequent inclination to urinate, "the patient making the first portion with ease, and complaining of great pain coming
on when the last drops are expelled."-(Earle.) Sudden stoppage of the current of urine, in consequence
of the stone moving in front of the urethra, itching
and tingling at the extremity of the penis, difficulty
or absolute inability of retaining the faces when urinating, on account of the sympathetic irritation of
the rectum, "sense of weight and pressure at the
lower part of the pelvis," dull pain at the neck of the
bladder, bloody, mucous, or purulent urine, pains in
the region of the bladder increased by exercise, especially riding on horseback or in a jolting carriage,
febrile symptoms, irritability, loss of appetite, emaciation, inability to sleep or rest quietly, night or day.
In boys, the prepuce generally becomes much elon-.gated, from their constant habit of pulling at it, to
-relieve the itching in the glans. After the stone has
continued in the bladder for a considerable time, this




AND GENITAL ORGANS.          461
organ becomes very much contracted, its coats become thickened and diseased, and the patient sinks
under the constitutional derangement consequent
upon the protracted irritation of the foreign body.
It will be observed that all of the symptoms which
we have enumerated, are. similated by the affections
of the urinary organs. Thus, simple nephritis gives
rise to the symptoms of calculus in the kidneys; and
inflammation of the prostate gland and bladder, to
those of stone in the bladder. But in some instances
the patient can actually feel the motion of the calculus, as he turns over from one side to the other. This
circumstance, taken in connection with the abrupt
stoppage of the stream when urinating, in consequence of the stone getting before the urethra, and
the occurrence of severe pain after the urine has been
mostly evacuated, in consequence of the stone coming
into more direct contact with the walls of the bladder,
will enable us to decide with much certainty respecting the presence of a stone.
But the only positive indication of a calculus is our
ability to strike it with a sound introduced into the
bladder, and a prudent surgeon will never cut for the
stone unless he can feel it with his sound immediately
before he commences his operation.
Therapeutics. —Our therapeutical measures may be
classed under four heads.
First. To correct the diathesis on which the morbid sediments depend.
Second.. To relieve the distress and suffering attendant on the presence in the urinary organs of gravel or stone.
Third. To dissolve the stone.
Fourth. To extract it, either by lithotomy, or by
the aid of Civiale's lithotriptor.
The first object may be attained by removing the
causes upon which the diathesis depends. Some of
the more prominent of these causes are, errors in diet,
including quality and quantity of food, and irregularity in hours of taking meals, abuse of stimulants,
use of water abounding in lime, excessive mental or
bodily fatigue, undue exposure to atmospheric vicissitudes, insufficient nutriment, the depressing passions,




462         DISEASES OF TIlE URINARY
tendency to gout and rheumatism, dyspepsia, and disease of the urinary organs.
When the depositions depend upon a lithic acid diathesis, every thing of an acid nature should be avoided; a large quantity of animal food should be enjoined, and baths, frictions, and abundant exercise
taken, to ensure a healthy action of the skin.
The phosphatic diathesis may depend upon a loss of
tone in the digestive organs, too free use of animal
food, profuse sweats, use of lime water, and overexertion, mental or physical.  Here a farinaceous
and vegetable diet, and a free use of fruit and acids,
should be advised. If the depositions arise from gout
attacking the mucous membrane of the bladder, the
suitable medicines will speedily dissipate the morbid
condition, When the diathesis appears to proceed
from general debility, or derangement in the digestive or assimilative functions, our dietetic regulations,
as well as our medicines, should be prescribed with
reference to these conditions.
In all calculous affections, a cheerful state of mind,
with country air, or a sea-voyage to a hot or cold latitude, will prove serviceable.
To fulfil the second and third indications as far as
possible, we shall, farther on, point out those remedies which we deem most suitable. But it is matter
of much doubt whether there are at present any
remedies known, capable of dissolving a calculus
in the urinary organs after it has attained a considerable size.  We may be able to correct the
diathesis upon which the morbid sediments depend,
and to enable the urinary organs to expel calculi
of small size; but the dissolution of a large stone
in the bladder has never yet been effected.  Such
can only be removed by crushing them according
to the method of Civiale, &c.,. so that the fragments
will pass off by the urine, or by the operation of
lithotomy.  For the details concerning these important operations, we refer the reader to the standard
works on Surgery.
The principal medicines in the treatment of urinary
concretions, are cannabis, uva ursi, nux vomica, sarsaparilla, lycopodium, calcarea carb., phosphorus, aspara



AND GENITAL ORGANS.          463
gine, monarda punctata, alchemilla arveusis, chininum
sulph., alisma plantago.
Cannabis and uva ursi are excellent remedies during a fit of the gravel, accompanied with painful micturition; discharge of slimy, purulent or bloody urine;
burning in the bladder and urethra during and after
micturition; and itching at the extremity of the glans
penis.
Dr. Gross has highly commended the employment
of nux vomica and sarsaparilla for the cure of gravel
and calculous affections. So far as the former remedy
is concerned, my own experience coincides with that
of Dr. Gross. I have in several instances prescribed
nux vomica with unequivocal benefit, in calculous affections which apparently originated from chronic
derangement of the digestive organs. In one case,
likewise, where the patient experienced the most severe spasmodic pains from the passage of a calculus
from the kidney to the bladder, with constant nausea,
vomiting, painful and bloody micturition, and highcoloured urine, the most prompt and happy results followed the use of nux.
This remedy is decidedly indicated when lithiasis
arises from dyspeptic symptoms, sedentary occupations, abuse of stimulants, excesses in eating, and also
for the acute constrictive and spasmodic pains which
proceed from the irritation of a calculus when passing
from one point to another.
Lycopodium is adapted to patients of a lymphatic
temperament, and who have been subject to chronic
affections of the mucous membranes. The lycopodium
pains occur mostly in the urethra and perineum, and
are of a burning, smarting, or cutting character during
micturition. The urine is of a dark colour, very fetid
and deposites a red or yellowish sand.
Calcarea carb. is suitable for the calculous affections of scrofulous or chlorotic children. It is indicated when the pains in the urinary organs, and the
desire to pass water, are worse during the night, and
the urine is of a dark colour, fbetid, and deposites a
white sediment. Calcarea is also indicated in debility
of the assimilative functions, emaciation, and great
weakness and exhaustion of the whole system.




464          DISEASES OF THE URINARY
Phosphorus may be given in lithiasis occurring in
broken down constitutions from loss of fluids, and in
old and debilitated subjects. The phosphorus symptoms are characterized by loss of power over the urinary organs, involuntary passing of urine and faeces
at the same time, sudden interruptions of the course of
the urine, desire to urinate, with dull pains in the
hypogastrium, emission by the urine of an ammoniacal
odour, and deposites of a whitish or brick-dust sediment.
We have exhibited asparagus in two cases of lithiasis dependent upon a gouty diathesis with marked
success. - In one of these cases the calculous symptoms
all disappeared in a few weeks after commencing the
medicine, and the morbid character which the urine
had presented for several-years, was entirely changed
to a healthy condition. We are inclined to believe
that asparagus is a remedy of much greater power in
urinary affections and in dropsies, than has ever been
attributed to it. Our experience with it in those
maladies has been somewhat extensive, and generally
of a most satisfactory character. It is especially
called for when there is frequent inclination to urinate;
burning and cutting in the urethra and kidneys; dull
drawing pains in the groin; tenderness and pain in
the perineum; sensation as if urine was passing off,
after all has been discharged; urine straw-coloured
or brown, with a very offensive smell, and a whitish
sediment; palpitation of the heart; rapid and oppressed respiration on the slightest exertion.
Monarda punctata, alchemilla arveusis, and alzsma
plantago, also cover most of the symptoms enumerated
under asparagus, and may sometimes succeed this
remedy with advantage.
Chininum sulph. is recommended when there are minute crystallized grains in the urine, of a reddish or
yellowish colour; increased flow of acrid and offensive
urine; emaciation; irritability and much constitutional disturbance.
Administration. -During the violent paroxysms
which occur in calculous diseases, we may employ
the medicines from the first to the third attenuation,
and repeat every hour until the desired impression is




AND GENITAL ORGANS.           465
produced. But under ordinary circumstances, a dose
once in twelve or twenty-four hours will suffice.
SECTION VIII.
URETHRITIS.-INFLAMMATION OF THE URETHRA.
The term gonorrhaca, derived from two Greek words,
vow, semen, and usw, to flow, is very generally used by
American and English physicians to designate this
malady. Dr. Swediaur, perceiving the erroneous imnpression which this definition might convey, substituted another term no less etymologically inaccurate,
blennorrhoea, or blennorrhagia, derived from two other
Greek words, BAd'izs, mucus, and'e, to flow. But as
modern researches have demonstrated that the involuntary discharge which is a characteristic of this
disease, does not consist of semen or mucus, but of a
purulent and infectious matter, we think the erroneous terms commonly employed to designate the complaint, should be abolished. Many reasons may be
adduced against naming the affection from the supposed character of the discharge; for, notwithstanding as a general rule it is decidedly purulent, cases
occasionally occur where, from the intensity of the
inflammation, there is no discharge at all, and constituting that form of the disease denominated by French
writers, "blennorrhagie seche."  The matter is likewise sometimes composed of a mixture of pus, mucus,
semen and blood. For these reasons we prefer to
make use of the more general term, urethlritis. Inflammation of the urethra may indeed arise from other
causes than the application of infectious matter during
an impure connection, and present all of the symptoms peculiar to the venereal inflammation, but the
malady is none the less urethritis on this account, although the secretion accompanying the inflammation
is not infectious. So may an inflammation of the eye
owe its origin to the application of venereal matter,
external irritants, atmospheric changes, injuries, scrofula, and abuse of stimulants, and yet notwithstanding these different causes, the disease is none the'less
ophthalmia.
All secreting surfaces are liable to he irritated when
20*,




466          DISEASES OF THE URINARY
operated on by certain unnatural stimuli. The mucous membrane of the throat, the bronchia, the lungs,
the nostrils, the frontal sinuses, and the conjunctiva of
the eye, are all subject to different grades and kinds
of inflammation, and their secretions to become changed
in quality and quantity, according to the morbid cause
which has been in operation. The lining membrane
of the urethra is also subject to the same laws: it may
become inflamed and pour out a purulent discharge
from the presence of calculi in the bladder, from gout
and rheumatism, from acrid urine, from the absorption
of certain diuretics, from ulcers, from mechanical injuries, and finally from the application of infectious
matter during an impure coition. In a very large majority of cases, urethritis arises from the cause last
enumerated. This morbid virus induces a specific inflammation in the urethra, of so troublesome and inveterate a character as often to baffle all the remedial
measures of the most skilful and experienced medical
men. The inflammation is supposed by some to be of
the erysipelatous kind, and generally attacks the
lacunae of the urethra.
All who have had much experience in this disease,
will agree with me that it is one of the most intractable with which we have to deal: Mackintosh assures us "that he has been more annoyed and disgusted in conducting the treatment of gonorrhcea than
of any other affection."
We are at present in ignorance respecting the
primary source of infectious urethritis, but the doctrine
entertained by the ancients, and so strenuously advocated by John Hunter, and his cotemporaries, in regard
to the identity of the gonorrhceal and syphilitic virus,
is now universally abandoned. The disease under
consideration, is one of a purely local character, and if
left to itself, under favourable circumstances, will ultimately terminate in spontaneous recovery. It is a
matter of doubt whether ulcers of the urethra ever
proceed from this inflammation, when entirely uncomplicated, but it is probable that the few cases which
have been reported by Sir Astley Cooper and others,
in which the malady was connected with ulcerations,




AND GENITAL ORGANS.            467
were attributable to the application of the virus of
both affections.
We have, in several instances, inoculated individuals with the matter of infectious urethritis, but have
never been able to produce a chancre or any wellmarked constitutional symptoms. We have, in one
instance, also witnessed the intro'u -tion of the gonorrhweal virus into the blood, but without giving rise to
any appreciable effects. While on the other hand, it
is well known, that if syphilitic virus be inoculated
or introduced directly into the mass of the blood, the
symptoms of syphilis speedily result. The application
of gonorrheal matter to the eye, gives rise to a very
violent and dangerous purulent ophthalmia; while the
application of syphilitic virus to this organ, causes an
ulcer generally circumscribed, and unaccompanied by
violent or dangerous inflammation of the surrounding
parts. The application of the former to the anus,
causes inflammation, with augmented secretion, and
change in its character from mucus to pus; the application of the syphilitic poison, causes chancre and
its concomitants.
1Urethritis is often suspended during attacks of acute
disease, but it invariably reappears again after the
subsidence of the febrile symptoms.
From these facts it may be fairly inferred, that
gonorrheal matter contains a specific morbid principle,
capable of producing a peculiar inflammation and discharge, when brought in contact with: mucous surfaces. This.inflammation and discharge present a
uniform appearance quite unlike what occurs in leucorrhcea, in several particulars.: The matter of the
former is infectious, while that of the latter is non-infectious; the inflammation of the former is of the erysipelatous kind, while the condition of the mucous membrane in the latter is more allied to relaxation and
debility than to inflammation; the former can only
arise from the contact of gonorrhceal matter with a
mucous surface, while the latter never proceeds from
any cause of this kind, but from constitutional weakness, confinements, excesses in venery, want of exercise, and other debilitating habits.
We may also infer, from what has been observed,




468          DISEASES OF THE URINARY
that the syphilitic matter likewise contains a specific
morbid virus, sui generis, and only capable of exciting
chancre, when applied to abraded or delicate surfaces.
It should always be remembered, that every morbid
substance capable of impressing the organism, contains a certain specijic morbid principle, which usually
operates in a definite manner, causing a uniform train
of symptoms, and requiring a certain specifie medicinal
agent to effect a prompt cure. These morbid principles only exist in infinitesimal quantities in their
media, and on this account we are'unable to detect
or analyze them, but we ought none the less to acknowledge their presence, appreciate their influence, and endeavour, if possible, to discover their specific antidotes.
Diagnosis. —The ordinary period at which infectious urethritis makes its appearance after an impure
connection, is from two to four days. We have known
it to commence in a few instances, in eight or ten
hours after exposure, and we have likewise occasionally observed an interval of six weeks to elapse before
its onset. Some constitutions possess the power of
resisting the action of the poison to such a degree as
to constitute an almost entire exemption from the disease. Other individuals are so little susceptible, that
if pains be taken to urinate and perform thorough ablution soon after the sin, no ill consequences result.
Others again are so highly susceptible, either from
natural organization, or from abuse of stimulants, that
almost the very touch of a contaminated female
speedily communicates the inflammation.
The disease commences by a tingling or itching
sensation at the orifice of the urethra, which is noticed
especially when urinating. In a short time, the lips of
the urethra become red and swollen; the blood-vessels
of the organ distended; the inflammation increases
and extends up the passage for an inch or two; there
is a burning or scalding pain on passing water; an
increased secretion takes place from the part affected,
at first of a mucous character, but as the inflammation
increases presenting a purulent appearance, of a yellow colour, or if the disease is violent, green and sanious. The urine, which often contains some threadlike substances, arising from the inflammatory action,




AND GENITAL ORGANS.           469
flows from the urethra in a diminished, spiral or divided stream.
In afirst attack, the inflammation does not usually
confine itself to the extremity of the urethra, but extends along the canal to the prostate gland, and even
to the bladder itself. Not unfrequently it attacks the
glans penis and the fraenum, in which case it often
occasions an effusion between the foreskin and glans,
and phymosis.
When the inflammation is intense, and extends up
as far as the neck of the bladder, there is a frequent
and urgent desire to urinate, the ardor urine becomes
more extensive and painful, involuntary and painful
erections occur, chiefly during the night, and sometimes cause distressing emissions of semen; sympathetic irritation is communicated to the perineum, occasioning painful sensations when evacuating the
bowels, or the bladder; there is more or less inflammation and effusion of lymph into the corpora spongiosa, giving rise to those adhesions and painful contractions termed chordee; the glands of the groin become irritated and enlarged, and there is a partial or
even total suppression of the discharge, in which latter case the disease is termed dry urethritis, or the
"blenorrhagie seche " of the French.
In old sinners, the inflammation is quite prone to
attack the prostate gland, and give rise to those unpleasant symptoms which we have enumerated when
alluding to affections of this structure.
As we have before remarked, if the disease be left
to itself, and the patient is strictly prudent and temperate, a spontaneous recovery will eventually take
place; but from improper medical treatment, undue
exposure, or excesses of different kinds, the disease
often terminates in gleet, strictures, abscesses, diseased prostate, irritable bladder, hernia humoralis,
inflammation of the testicle and epididymis, or bubo.
The acute stage of urethritis, under ordinary circumstances, terminates in from one to three weeks,
when, if suitable remedies have been employed, the
discharge ceases, and the parts speedily recover their
tone; but in the majority of instances, the acute




470          DISEASES OF THE URINARY
stage runs into a chronic inflammation, when it receives the name of
CLEET.
In this stage of the disorder, the painful symptoms
peculiar to the first period, ardor urinae, frequent -inclination to urinate, chordee, spasmodic pains in the
region of the perineum, and the heat and swelling of
the penis, subside, and we observe little else than an
increase and alteration in the character of the secretion from the urethra. This discharge, which during
the acute symptoms was purulent, and of a yellow or
greenish colour, now presents a light mucous appearance, sometimes transparent and ropy. The character of this discharge, however, is often temporarily
changed again to a purulent matter of a yellow or
even green colour, sometimes sanious, from over-exercise, excesses in drinking or eating, sexual intercourse, and exposure to protracted heat or cold. The
discharge of a simple gleet usually proceeds from
the lacunae of the urethra. Some writers have promulgated the dangerous doctrine, that the matter of a
gleet is not infectious; but this is an error, for we have
known many well authenticated instances where
virulent urethritis has arisen from the application of
gleety matter.
When a gleet has been permitted to continue for a
long time, and particularly if the case has been injudiciously treated by inordinate doses of copaibae, cubebs, turpentine, and the endless train of irritating
injections, there often supervenes a
STRICTURE OF THE URETHRA.
A stricture may occur during the height of acute
urethritis, from tumefaction of the mucous membrane
of the canal, or from the irritation caused by improper
or unskilful introduction of bougies, and by strong
injections. The obstruction in some cases of this
description is so complete, that very painful retentions of urine, with its accompanying symptoms, supervene, requiring the most prompt remedial measures in order to ward off the necessity of puncturing
the bladder. This variety of stricture may be re



AND GENITAL ORGANS.           471
moved in a short time by proper medicines, without
the aid of a surgeon.
There is a second variety of stricture not necessarily connected with infectious urethritis, termed spasmodic stricture. The disease consists in a sudden
spasmodic contraction of some portion of the urinary
canal, which impedes the flow of urine, and sometimes
causes a partial retention. These spasmodic contractions may arise from mechanical injuries, diseased
prostate, or stimulating diuretics, but they are for the
most part connected with permanent stricture.
The third variety of stricture, which is by far the
most common and serious, is termed the permanent
stricture. Its approach is so gradual and imperceptible, that individuals rarely suspect anything of the
kind, until it has made considerable progress. The
disease arises from a gradual thickening of the mucous membrane of the urethra, from badly treated or
long continued inflammation.
The first symptoms observable in this stricture are,
a sensation after urinating as if a few drops remained
behind; stream diminished in size, and issuing from
the urethra in a spiral form, or split in several parts;
straining to pass the water more rapidly through the
obstructed canal; aggravation of all the symptoms
an wetting the feet, taking cold, over-exercise, fatigue,
and venereal excesses. In this stricture, there is
always more or less discharge of a ropy kind of mucus, which is often temporarily changed by excesses,
into a purulent or bloody matter. This complaint is
quite apt to induce inguinal hernia, from the straining
efforts employed in urinating.
It is probable that two-thirds of the cases treated
as simple gleets, and which so frequently baffle the
physician, are, in reality, dependent solely on this
kind of stricture.
In bad cases of permanent stricture, the urine is
passed drop by drop, the distention and pain in the
region of the bladder become very severe, much constitutional irritation occurs, and the patient is unable
to rest day or night. Whenever this state of things
obtains, immediate recourse should be had to bougies.
The removal of a permanent stricture can only be




472          DISEASES OF THE URINARY
accomplished by means of the knife, or the application of caustic, or by gradual dilation by means of
bougies. The cure by the latter means is, at the present time, almost universally recommended.
Almost all strictures are located far up the canal of
the urethra, behind its bulb, but they may occur near
the extremity of the penis, or three, four, or five inches
above this point.
An occasional consequence of stricture is,
FISTULA IN PERINEO.
When the contraction is so great as to cause considerable obstruction to the passage of the urine, this
fluid is forced by the frequent and violent efforts at
expulsion, into the parts back of the stricture, in such
a manner as to form a kina of cul de sac, which, from
constant distention, eventually ulcerates an opening
externally, and a perineal fistula is formed.
Abscesses also arise sometimes from inflammation
and tumefaction of the lymphatic glands in other
parts of the urethra. These little swellings may
open into the urethra, or discharge themselves externally. The most common seat of these abscesses is
near the frienum, or opposite the scrotum.
DISEASED PROSTATE,
May also be ranked amongst the occasional consequences of repeated attacks of urethritis. During the
continuance of the latter affection, not only the
urethra, but the prostate, the bladder, and the testicles, receive an unusual supply of blood, in consequence of which they become irritated, and often enlarged, from depositions of coagulable lymph. This
condition of things may exist without attracting much
attention until the individual is advanced in years,
when a scirrhous degeneration, or an abscess, is exceedingly apt to result. Either lobe of the prostate
may become enlarged separately, or the whole three
may be involved; but the most troublesome symptoms
arise from an enlargement of the middle lobe, on account of its proximity to the orifice of the urinary
canal.
Sir Astley Cooper was of opinion, that enlargement




AND GENITAL ORGANS.          473
of this gland is attributable to advanced age, rather
than disease; but from the fact, that persons who
have been afflicted in this manner have almost invariably been subject to repeated venereal attacks in
early life, we may fairly infer, that a predisposition is
always established in the structure, which renders it
liable to take on diseased action when the powers of
the organism have become impaired by age.
Enlargement of the lateral lobes of the prostate
may be readily detected by introducing the finger into
the rectum. The middle.lobe may always be felt by
the catheter when much enlarged, and it will generally be found exceedingly difficult to pass it by the
gland into the bladder. By directing the point of the
instrument, (which should be of medium size,) slightly
upwards, and depressing the handle at the proper
time, the object may usually be accomplished. But
of all others, these cases require great delicacy of
touch and practical tact, to enable the operator to
succeed facilely, and without doing injury to the
irritated parts.
Diseases of the prostate are quite liable to become
aggravated by over-exertion, riding, acrid urine,.exposure to wet and cold, and stimulating drinks.
Another exceedingly unpleasant consequence of
neglected or badly treated urethritis, is the disease
termed
IRRITABLE BLADDER.
This affection arises from long continued inflammation,which in the end so impairs the function of the bladder, that the presence of a very small quantity of urine
forces it to contract, and thus forms an incontinence
of urine. Although this condition of the bladder may
arise from numerous causes which have already been
enumerated, it not unfrequently proceeds from extension of urethritic inflammation to this organ, and
from protracted use of diuretics. The malady is
readily distinguished from stone, by the relief which
always follows the evacuation of the bladder, while
this operation aggravates the painful sensations in
the latter affection.
This disease generally baffles all the resources of




474          DISEASES OF THE URINARY
allopatlhy, but we take pleasure in appealing to the
philosophic practice whether the same remark is just
with reference to homceopathy.
The next malady to which we shall allude in connection with urethritis, is
TIERNIA HUMORALIS.
During the acute stage-of urethritis, the inflammation sometimes extends even to the spermatic chord,
the epididymis, and the testicle. This is very apt to
occur when the discharge is suddenly arrested by irritating injections, especially when the inflammation
pervades the whole extent of the canal. When the
substance of the testicle becomes involved, the pain
is very severe, and febrile symptoms more or less
grave, set in. This inflammation may terminate in
resolution, suppuration, or chronic enlargement and
induration.  In those instances where suppuration
occurs, the abscesses usually break externally, and
form fistulous passages which are difficult to cure, on
account of the continual irritation kept up by the secretion of semen, a portion of which is constantly
being discharged through these ulcerated openings.
Chronic enlargements of the testicles should command our early attention, on account of their strong
tendency to terminate in scirrhous degenerations.
In urethritis, and other affections of the urino-genital apparatus, the prudont physician will always advise the use of the suspensory bandage, as a precautionary measure.
When the urethritis is so severe as to affect the
lymphatic glands of the penis, the disease may be
propagated to several of the glands of' the groin,
when we have a
BUBO.
These buboes are called sympathetic, in contradistinction to those which proceed from syphilitic infection.  The frequent occurrence of such tumours
during the course of urethritis, probably first led
medical men to confound this disease with syphilis. But,
on close examination, the sympathetic bubo will be




AND GENITAL ORGANS.           475
found to be composed of several enlarged glands, while
that of syphilis is an enlargement of a single gland.
The sympathetic bubo is not usually attended with
great pain, nor does it run on to suppuration, unless
the patient is decidedly scrofulous; while syphilitic
bubo is attended with much inflammation and pain,
and is very prone to advance to the suppurative stage.
A very large majority of sympathetic buboes subside
spontaneously, and require no medicinal treatment.
In females, all of the symptoms of the disease are
lighter than in the male sex. Indeed, the similarity
between this affection and leucorrhlea is so great, that
it is sometimes a matter of great difficulty to distinguish them.
Mr. Travers asserts, that the urethra itself is rarely
affected in females, but that the inflammation attacks
the clitoris, the inferior commissure of the labia and
rapha, the nymphae, and the parts (Cowper's glands)
around the orifice of the urethra.
In the worst form of the complaint, as it occurs in
women, the labia, the nymphae, and the clitoris, become swollen and painful, the inflammation extends
to the womb and bladder, and there will be frequent
inclination to urinate, severe scalding by the water,
and a purulent, irritating discharge. But all of these
symptoms are often met with in inflammatory leucorrhoea, and the discharge itself even acquires so acrid
a character as to become capable of propagating a
similar discharge by contact with the male organ.
We have, in more than one instance, been consulted
by parties of the highest respectability, in relation to
purulent discharges, and scalding of the urine, which
have been contracted from the wife, but by explaining
the circumstance just alluded to, have been able to
dissipate the most unjust suspicions, and to restore
confidence and harmony which must have been utterly
destroyed without such explanation.
The following are the surest diagnostic marks, with
which we are acquainted, between the two diseases:
leucorrhea is gradual in its progress, and may be
generally traced to constitutional debility, or to difficult and protracted labours, or mechanical injuries
during accouchement. It is usually accompanied also




476          DISEASES OF THE URINARY
by prolapsus uteri, or dragging pain, or tired feeling in the left side, bearing down pains, and general
feelings of relaxation and debility.
Gonorrhmeal inflammation is sudden and rapid in
its approach, and attacks individuals in the soundest
health: the symptoms acquire their greatest severity
in one or two weeks, and the discharge causes a deepcoloured (yellow or greenish) stain upon the linen,
surrounded by a palish yellow border.
A careful attention to the history of each individual
case, will aid us materially in forming a correct diagnosis.
Therapeutics.-Infectious urethritis is at the present
time almost universally looked upon as a purely local
disease, —confined in its first stages to a small portion
of the mucous membrane of the urethra. It is true
that the inflammation often extends up the urinary
canal to the prostate gland, and to the bladder; but
it is highly probable that these secondary symptoms
are owing to bad treatment, or imprudence on the
part of patients, rather than to the natural and legitimate tendency of the malady. We adopt this opinion
from having often observed spontaneous cures occur
in six or eight weeks without medicine of any kind,
and without any structure but the urethra becoming
affected,-the patients having simply placed themselves under a rigid dietetic regimen.
It may be questioned whether any internal remedy
is now known, which can be considered a true and
certain specific for the cure of this local inflammation.
Many medicines have been brought forward by both
schools as worthy of our entire confidence, but not one
of them has yet stood the test of practical experiment,
-not one has been able to control the symptoms, or
remove the complaint with any degree of certainty.
On the contrary, many of them have repeatedly been
observed to aggravate the inflammation, causing it to
extend to the -neighbouring structures, and thus seriously to complicate this naturally simple disease.
The ordinary plan of treatment, according to the
old-school method, is in the first stage to bleed, leech,
foment, physic' with mercurials, or the neutral salts,
and to nauseate, sweat, and prostrate the system with




AND GENITAL ORGANS.           477
antimonials. In other words, it is deemed necessary
to punish the whole organism;-to inflame the bowels
with cathartics,-to impair the tone of the stomach
by nauseating doses of antimony,-to debilitate the
capillaries by profuse sweats,-to abstract the lifegiving principle from the veins,-and to reduce the
patient to a state of prostration and positive illness,
in order to reach a little circumscribed inflammation
in the urethra! After the patient has been reduced
secundem artem, the custom is then to administer enormous doses of balsam copaibce, cubebs, turpentine, lyttae,
iodine, and nitre, internally, and to make- use of stimulating injections of zinc, lead, copper, mercury, nitrate
of silver, oil of vitriol, chloride of lime, and diluted
sulphuric acid, ad libitum.  Balsam -copaibce is the
medicine employed in most instances, and as it operates specifically upon the stomach and the respiratory
organs; we often observe the most serious affections
of these organs arise in consequence of its free and
protracted use. Who that has made use of this remedy
to any great extent, has not witnessed the occurrence
of troublesome dyspeptic symptoms, of hemoptysis, of
cough, and other indications of dangerous pulmonary
disorder, from it?
Cases however occur, in which the symptoms of
urethritis cease under the use of this, and the other
diuretics alluded to, but such instances are rare, and
the remark of the celebrated Dr. Forbes respecting
allopathic remedies in general, will hold good here,
viz.: that " the patient gets well in spite of the doctor."
We shall not discuss the propriety of the antiphlogistic course adopted during the acute stage, for we
believe that all whose prejudices will permit them to
exercise that admirable requisite, common sense, will
perceive at a glance the folly'of tormenting and prostrating the whole body for the sake of acting upon a
simple local i{nflammation, which, when left to itself,
never terminates in ulceration or disorganization of
the tissue affected, but in spontaneous recovery.
And what shall we say of the homreopathic remedies which are usually employed in the treatment of
this complaint? Why, simply that the true specific




478          DISEASES OF THE URINARY
has not yet been discovered. We have tested these
medicines in numerous instances, both the high and
low attenuations, and we regret to announce as the
result of our observations, that they have proved but
little more successful than the pernicious applications
of the old school.
We are quite aware that it is much easier to find
fault with prevailing methods of practice, than to propose and introduce better new ones. But if we succeed in attracting the attention of physicians more
particularly to the subject, and putting them on the
qui vive to find out a positive specific, our object will
be accomplished. In the mean time we shall point
out the course of treatment which we have found most
successful in the different stages of the malady.
For therapeutical purposes the disease may be
classified as follows:
First. The preventive period,-or that which intervenes between the exposure and the first symptoms of
the malady. The average duration of this period is
about three days.
Second. The forming stage, —or the period which
elapses from the commencement of the prickling, tingling, or itching sensation, with slight redness and
swelling of the lips of the urethra, and a slight oozing
of mucus or limpid matter, up to the period when the
inflammation has extended to the fossa navicularis, and
become strongly pronounced, with a purulent discharge of a yellow or greenish colour. This stage
usually lasts from twelve to forty-eight hours.
Third. The acute or inflammatory stage,-including
the period which commences at the termination of the
last stage, and the subsidence of the ardor urine, the
acute inflammation of the urethra, the swelling and
tenderness of the penis, and the change of the yellow
or greenish secretion, to one of a light transparent and
ropy, or a muco-purulent character. The natural duration of this stage, when proper restrictions are used
as to diet, stimulants, and exercise, is from one to two
weeks.
Fourth. The chronic stage, or that form of the malady termed gleet.
Now, as our object, in accordance with the homce



AND GENITAL ORGANS.           479
Pathic doctrine of cure, is to pr6duce in the tissue morbidly affected, a new and healthy medicinal action,
which shall supersede the morbid inflammation, we
apply our remedies directly to the diseased part,
instead of bringing them in contact with it through
the stomach, blood, and kidneys. The malady is not
constitutional,-there is no other structure of the
economy affected, or upon which we wish to act, —but
our sole object is to prevent or to remove a simple
local inflammation.
Our remedies then, during the first or preventive
period, are the occasional injections into the urethra,
of a solution of nitrate of silver, (in the proportion of
two or three grains to the ounce of distilled water.) or of
sulphate of zinc, in the proportion of four grains to the
ounce of water. The occasional use of these injections
after an impure coition, with strict temperance and
quiet, will usually prevent the occurrence of the disease. These remedies neutralize the absorbed virus
before it has time to impair the function of the membrane with which it is in contact, and thus its power
to do injury is summarily destroyed.
There is also a certain and speedy cure for the second orforming stage. The symptoms of this stage,
as we have seen, are a tingling or itching at the end
of the urethra, with a slight redness, and a slightly increased secretion of mucus. The remedy for this stage,
is a saturated solution of nitrate of silver, a small quantity of which is to be applied, by means of a small
glass syringe, or by a small bit of sponge, to the urethra for an inch in extent. The solution should be delicately and rapidly applied, and a quantity used just
sufficient to give the portion of the membrane touched,
a white cast. This causes a smart but healthy medicinal inflammation which subsides in about 24 hours,
leaving the structure cured. This course is strictly
homeopathic, for we impress directly the tissue affected, produce a powerful medicinal aggravation of the
symptoms, and overwhelm the disease by substituting temporarily, another inflammatory action. No
unpleasant consequences ever result from the use of
this remedy, when it is employed before the commencement of the third or acute stage. Our experience




480          DISEASES OF THE URINARY
with this solution has "been extensive, and we therefore confidently recommend it as a perfectly safe and
sure remedy in this stage of the complaint.
During the third or acute stage, it is a question whether any remedies, either general or topical, can be
employed with any material advantage, with the exception of the internal use of aconite, which may be
given to shorten the inflammatory stage. This medicine is particulary applicable when febrile symptoms
are present. Throughout this stage, the patient should
be restricted to the most rigid vegetable or farinaceous diet, to cold water, and prohibited from taking
much exercise. Ablutions with cold water, should be
often employed, in order to keep the parts as free as
possible from the irritating discharge. After the urgent symptoms have subsided under the use of aconite,
and the other means we have just pointed out, and
the fourth or chronic stage has commenced, we may resort to injections composed of one grain of sulphate of
zinci to: viii. of water.  These injections, in order to
be efficient, must be repeated every half-hour during
the day, until the discharge ceases. It will be of no
service to use this solution three or four times in the
day, for the chief object is to wash out the urethra as
fast as the matter forms, and thus prevent the constant
reabsorption which would otherwise take place.
The principal reason why urethritis is so difficult to
cure, when once fully established, is, that the matter
itself being infectious, and liable to be constantly reabsorbed, thus operates as a continual exciting cause.
If at any given instant the whole urethra could be
restored to perfect health, a single drop of the morbid
secretion which it had been pouring out, applied to
the part, would be sufficient to re-excite the disease in
all its violence. It is evident, then, that the discharge
must be arrested abruptly by the remedy employed, or
we must use our injections sufficiently often to dilute
and remove the virus as fast as formed, and at the same
time to change the morbid action of the membrane to a
healthy medicinal action.
In regard to the plan'of making an application to
the urethra, of a medicine so powerful as to arrest-the
discharge suddenly, like the solution mentioned under




AND GENITAL ORGANS.           481
our second head, it is attended in this stage of the affection with many dangers. The canal of the urethra
is generally affected so high up as to render the certain application of this or any other sfficienfly powerful solution entirely impracticable.
But the other method, to which we have alluded, is
one of entire feasibility and safety, and is for the nost
part attended with success, when the discharge'is entirely;unconnected with a stricture. It is proper to
observe that, in all cases, the patient should urinate
previous to the use of injections. Another injection
which we have sometimes used with marked success
in this stage, is a mixture of calomel and alive woil, in
the proportion of a drachm to the ounce, once or twice
a day, until the cessation of the diseased action.
If, however, notwithstanding the thorough and persevering employment of the zinc solution and the mixture of calomel and oil, the discharge still continues,
recourse should be had to the introduction of bougies,
either plain or smeared with a cerate containing a
sufficient quantity of pulverized nitrate of silver. These
should be carefully introduced two or three times a
week, until we have stimulated the diseased membrane to a natural and healthy action.
The above plan of treatment, we believe to be more
efficient, safe, and consonant with the true principle of cure, than any other which has yet been
promulgated: yet, we do not claim for it infallibility.
We can only assure our readers that we have thoroughly tested every theory and process which has been
proposed by either school, and that after all of this
practical experience, we have presented them with
what we deem the best method of treatment in this
disgusting malady.
For the information-of those who desire to make use
of internal remedies either alone or in combination
with injections, we name the following medicines as
the best with which we are at present acquainted:
cannabis, cantharides, tussilago pertus., cubebee, mercurius sol.,petroselinum, aconite, acid nit., sepia, terebinth.,
copaibae, pulsatilla, nux vomica, sulphur, ferrum.
The remedies which should be consulted in irritable
bladder,:are, cantkarides, cannabis, lycopodium, mercu21




'48          DISEASES OF THE URINARY
rius, uva ursa, terebinthina, pulsatilla, copaibce, cubebba,
sulphur, iodine, and camphor.
Inflammation of the testicles and epydidimis:Our first care in this complaint, should be to suspend
the inflamed organ by means of a suitable apparatus,
in such a manner as to afford complete support in all
positions, and thus prevent the enlarged gland from
dragging upon the spermatic chord. The recumbent
posture should be strictly enjoined, and we should
have constantly applied to the parts, cloths wet with
cold.water, As soon as the cloths are warmed by
contact with the inflamed testicle, they should be again
dipped and reapplied until the heat and inflammation
have disappeared.
If the disease has arisen from sudden suppression of
urethritis, or from the use of powerful injections during
the acute stage, we may give mercurius, aconite, nux
vomica, spongia, clematis, or iodine.
When it has been caused by the injudicious introduction of bougies, arnica, aconite, and pulsatilla, will
be found applicable.
In cases where the inflammation has degenerated
into a chronic induration of the testicles, our best remedies are, aurum, acid nitric, rhododendron, sulphur, mercurius, spigeliac, iodine, and cicuta.
SECTION  IX.
SYPHILIS.
Much discussion has taken place respecting the first
introduction of this disease into Europe. Some maintain that the followers of Columbus brought it with
them from America; others that it was communicated
by the Spaniards to the French, during the siege of
Naples, by Charles VIII., in 1495. It appears, however, that occasional allusion is made in different parts
of the scriptures, to a disease of the sexual organs,
capable of being propagated by coition, contact, &c.
In Leviticus, Moses mentions such an affection, and
speaks of those afflicted as being polluted and unfit
to associate with the healthy. David also describes
one variety of syphilis in the thirty-fourth psalm. Hetoditus, too, speaks of an affection of the sexual organs




AND GENITAL ORGANS.          483
which the Scythians contracted from the women with
whom they had connection, after profaning the temple
of Venus Urania. Later writers, Salicetus, Gordoneus,
and Valereus, who flourished about the year 1250, allude to an infectious disorder of the genitals, proceeding from the copulation of men with unclean prostitutes. Many reputable authors have entertained the
opinion that the ancient leprosy was nothing more than
syphilis, rendered severe by exposure, hardship, insufficient nourishment, and improper medical treatment.
But an objection has been urged against this view, from
the supposition that leprosy could be communicated
by contact with an infected person,-by drinking from
the same cup, by inhaling his breath, or even sitting
at the same table with him. It is no less true that syphilis occasionally presents a character equally virulent and diffusible. During a great portion of the sixteenth century, it was so contagious in some parts of
Europe, that it was communicated by lying in the
same bed, by the clothes, gloves, money, or breath of
the patient. A variety of syphilis also prevailed in
Canada some years ago. of so virulent a nature, that it
was communicated by the breath, and by contact.
We fully concur with Dr. Thompson, who "thinks it
probable that the disease has existed, more or less, and
under different grades of severity, in all ages, and that
it has been thousands of times generated de novo by
impure sexual intercourse."
The causes which may have conduced to vary its
character at different periods, are numerous; and we
suggest the following as a few of them.
It has been observed that exposure of the body to
a cold, humid atmosphere, excessive fatigue, changes
of diet and of climate, unwholesome food and neglect of cleanliness, favour the rapid progress and
destructiveness of the malady; while a dry, warm and
equable temperature, cleanliness, nutritious food, and
comfortable lodgings, are circumstances which conduce to render it comparatively mild. These facts
go far to explain the reason of its great violence
amongst those ancient tribes who were accustomed to dwell in tents, and to move about from place
to place; and who were so negligent in their habits of




484          DISEASES OF THE URINARY
living, their food and their persons, that Moses
deemed it necessary to make rigid laws in regard to
the selection of food and the habit of personal ablutions. When we reflect that persons who were supposed to be leprous, were immediately driven out of
the camp-away from  all intercourse with the
healthy-and thus forced to undergo every exposure
ih respect to raiment, shelter and food, we cannot be
surprised that the disease, supposing it to have been
syphilis, should so often have assumed a frightful
aspect.
Its violence during the siege of Naples in 1495,
may also be explained, when we bear in mind the
forced marches, the changes of climate and of diet,
and the constant excitement and fatigue to which the
soldiers were exposed. The same severity marked
its prevalence in the British army in Portugal. while
the natives themselves were but slightly affected, although exposed to similar contamination.
One of our army surgeons recently informed me
that the same difficulty was experienced among our
soldiers during the Mexican campaign in 1847 and
1848: they contracted the disorder, while the Mexicans experienced but slight inconvenience, although
exposed to the same virus. The argument also holds
good with respect to sailors who are so constantly
subjected to the vicissitudes of temperature, the noxious air of vessels, and the stale, salt regimen which
is used at sea.
May it not, then, be fairly inferred, that whatever
causes impair the forces of the organism, serve also
to render it less able to resist the deleterious influence of the syphilitic poison?
In regard to the doctrine of Hahnemann respecting the identity of syphilis and sycosis, we agree with
Hartmann, that the mass of evidence upon the subject renders it almost conclusive that the two diseases are distinct in, their nature.  The origin
of each is in a specific morbid poison capable of
impressing the organism in a distinct and peculiar
manner.
Diagnosis.-There are unquestionably a great variety of ulcers which make their appearance upon




AND GENITAL ORGANE.          485
the genitals after impure connections, which are not
syphilitic, and which will heal over without causing
constitutional symptoms, simply by the aid of mild
dressings. The true syphilitic chancre is now. of rare
occurrence, but the great majority of those intract,
able ulcers which are looked upon as real venereal
chancres, are nothing more, primarily, than simple
non-infectious sores, which have been converted into
an unhealthy condition by the use of mercury. Who
can doubt this fact when he contemplates the dreadful effects which a course of mercury often produces
on the healthy organism? Who could be tempted, in
health, to take the enormous quantities of this drug
which are deemed necessary for the cure of syphilis?
Let the provings of it —let the horrible consequences
which its accidental absorption sometimes occasions upon the surface,-in the mucous membranes,
-the bones,-the glands and the nervous system,
answer. For our part, we would prefer the foul
syphilitic poison itself, rather than the uncontrollable
ravages of such an enemy as mercury, in allopathic
administrations, is admitted to be by the fair-minded
of those even who most earnestly defend its use.
In order to be fully convinced that many of the effects of mercury are improperly attributed to the
action of the syphilitic virus, it is only necessary to
regard carefully the symptoms which are constantly
presented to our observation in what are called ve-.
nereal affections, and to notice the opinions of many
of the most eminent medical observers.
Thus, Sir Astley Cooper,* in his lectures, used to
observe, "do not think that it is a rare occurrence
for the penis to be destroyed by mercury; no, a
chancre that has remained weeks in a healthy state,
shall become irritable, and, by maltreatment, by the.
injudicious and improper use of mercury, shall
slough, and end in the destruction of the penis; this
is not a rare case, and is attributed to the venereal
disease, but in reality is an effect of the improper use
of mercury." The great Hahnemann, in his-remarks
upon syphilis and sycosis, constantly alludes. to the
*Castle's Manual of Surg., p. 280.




486          DISEASES OF THE URINARY
pernicious results of the abuse of this drug in the hands
of the allopathist.
There can be no question that those dreadful mutilations of the penis, of the nose, the palate, the eyes,
of the surface of the body, and the nodes and caries
of the bones, which we occasionally observe, are all
effects of mercury and not of syphilis; and it is
in the highest degree probable that the immunity enjoyed by the Portuguese, the Mexicans, and certain
other nations, from the severe forms of this malady, is
attributable solely to the fact that they use no mercury in its treatment.
Chancre.-The primary chancre usually presents
itself on some part of the genital organs, in from
three to seven days after contamination, in the form
of a darkish red pimple, attended with slight itching,
and surrounded with an erysipelatous blush. In a
short time matter forms in the centre of the pimple,
and an excavated ulcer, with a yellowish surface,
hard and ragged edges, and an indurated base, makes
its appearance, marking the sore as a true chancre.
The most common seat of primary chancre is on the
inside of the foreskin and the corona glandis, but
it occasionally occurs on the glands and the external parts of the genitals.
Many varieties of venereal chancre have been described by authors, as the simple, the indolent, the irritable, the sloughing, the indurated, the phagedenic of
Carmichael, the superficial of Mr. Evans, the tHunterian, &c.; but as these diversities in the appearance
of the chancre are not owing to any difference in
the character of the virus, but to the condition of the
patient as regards constitution, temperament, and
mode of life, at the period of contamination, we should
abstain from making those minute classifications
which some writers have attempted.
The circumstances which may operate to modify
the character and appearance of a simple chancre, or
which may conduce to develop primarily an intractable
and destructive one, are numerous.
Individuals whose constitutions have been impaired by abuse of stimulants, undue exposure,
hardship and fatigue, and insufficient nourishment,




AND GENITAL ORGANS.          487
are liable to be attacked from the first with that
variety which is denominated the indurated sloughing chancre.
Those whose systems have been loaded with mercury, and enfeebled by previous disease, are peculiarly
subject to that description which is termed irritable and
sloughing. Persons who go from temperate to tropical
climates, are especially in danger of the phagedenic
variety. Scrofula and scurvy also predispose the
system to this form of it.
The simple chancre is by far the most common, particularly in temperate latitudes, and usually occurs to
individuals of a sound constitution. Some have supposed the cause of this variety to consist in "gonorrhmal matter, and other morbid vaginal secretions," brought in contact with the penis during
coition; but of this there is no proof. The simple
ulcer very often becomes converted into an irritable,
sloughing, or erysipelatous one, by some excess or
imprudence which impairs the vigour of the body, or
by the abuse of mercury. On the other hand, so long
as the constitution remains sound and unimpaired,
resistance is offered to the action of the virus, and the
secondary impression which it makes will be very
slight, and in some instances imperceptible. It is in
cases of this description that we sometimes witness
spontaneous cures of what was originally true syphilitic contamination.                  ~
The most certain marks of a true syphilitic chancre
are, the excavated surface, the hard, ragged edges, and
the indurated base. These appearances, taken in connection with the previous history of the case, will generally enable us to decide with sufficient certainty
respecting the character of the sore; but where any
doubt exists, we would most strongly commend the
practice discovered and successfully adopted by Ricord
of Paris, of inoculating a sound part with the matter
from the suspected ulcer. In case a second chancre
is produced by this operation, there will no longer remain a question in regard to the true nature of the
malady.
After the syphilitic poison has passed from the
chancre through the absorbent glands of the groin,




488          DISEASES OF TEE URINARY
into the blood, it possesses a  specific affinity for
only three parts of the body, viz., " the mucous membrane of the throat and nose; the skin, or surface of
the body; and the bones, with their periosteal coverings.':' Thus, it will be remarked, that the internal
organs are never impressed by this virus; and this
fact should induce the allopath to pause before he
loads-the system with a poison which spares scarcely
a single structure during its operation.
The secondary, or specific effects of the syphilitic virus,
after its entrance into the blood, are:
First. Upon the mucous membrane of the mouth
and throat, which becomes red and inflamed, and
covered in some parts with pimples, which soon degenerate into ulcers, resembling in many respects the
primary simple chancre. These ulcerations extend
into the nostrils, and sometimes even into the larynx
itself, giving rise to loss of voice, severe cough, violent constitutional disturbance, and death. In cases
which have been improperly treated, the bony palate
and the nasal bones become affected, and exfoliate,
And thus cause those disgusting mutilations of the nose
and face which so often stare the old school physician
in the face.
Second. Another part of the body acted on by the
absorbed virus is the skin. Its manifestations in this
case are, slightly elevated copper-coloured eruptions
of different sizes, attended with uneasy or itching
sensations, sometimes covered with a kind of scurf or
scale, or, in other instances, with incrustations and
ulcerations. These eruptions make their appearance
on the face, head, breast, palms of the hands, and
arms. Eruptions which are called tubercular, often
appear on the scalp, the eyebrows, the breast,. back,
and  arms, and ultimately  form  very troublesome
ulcers. In healthy subjects these secondary eruptions
are not very troublesome, being simply  copperqlotQured blotches, covered with a thin scurf; but in
irritable and impaired constitutions they often assume
the character of foul and sloughing ulcers. The particular variety of these secondary eruptions will be
* Sir A. Cooper's Lectures.




AND GENITAL ORGANS.            489
determined by the peculiarities of constitution in each
individual case, and  not from any original difference
in the virus itself.
Third. Another, and the last portion of the organism:
capable of being impressed by the absorbed venereal
poison, is the osseous structure, with its periosteal
covering.  The morbid inflammation in the first instance seizes upon the periosteum, causing severe
nocturnal pains, and some tumefaction in the affected
region.  If the malady continues to increase, an
osseous deposit will be formed between the periosteum and the bone, constituting what is termed the.
venereal node. This node, in its early stages, does, not:
usually give rise to much inflammation of the surrounding skin, nor is it attended with a great amount
of pain, but after it has existed for a considerable time,.
and particularly if the patient has been drugged with
mercurial preparations, it becomes quite painful, especially during the night. The ordinary location of
venereal nodes is on the anterior portion of the tibia,
or on the surface of the cranial bones.
We believe that the above-enumerated symptoms
constitute all of the legitimate effects resulting from
the action of the absorbed syphilitic virus. The great
variety of eruptions and ulcerations described by
Hartmann and others, are attributable to other causes,
operating either by themselves, or in conjunction with
the venereal poison. It is of vast importance in affections of this description, to distinguish with all
possible accuracy between the syphilitic action and
that of mercury, scrofula, and other causes. Far.
ther on we shall endeavour to make this distinction as
clear as possible.
Bubo.-Another primary manifestation of syphilis
consists in an enlargement of one or more of the absorbent glands of the groin, termed bubo. This en-.
largement usually succeeds the chancre, and is caused
by the absorption of the virus of the latter. It. is rare
in real syphilis that more than one gland in each
groin becomes affected with the virus, although some
of the other glands now and then become slightly
swollen from  sympathy.  The swelling ordinarily
partakes of an inflammatory character, and if not op21#




490          DISEASES OF THE URINARY
posed by appropriate remedies, runs on to suppuration, and sometimes to sloughing.
The disease has been supposed to be purely local,
until after the swelling in the groin has proceeded to
the suppurative stage; but this is evidently erroneous,
from the fact that secondary symptoms not unfrequently occur, without there having been any previous enlargement of the gland in the groin.
Bubo sometimes makes its appearance without the
previous existence of a chancre, but such instances
are by no means common. Swellings of a nonvenereal character may likewise occur in the groin
from a strain, or from too great violence during the
indulgence of sexual passion. But as chancre for
the most part precedes the bubo, there will rarely occur any difficulty in our diagnosis.
Therapeutics.-Hahnemann, Gross, Hartmann, Hunter, Abernethy, and many other distinguished members
of the profession, entertained the opinion that the constitutional symptoms of syphilis are always progressive, and never disappear, unless opposed by medicine;
but the fact is now completely established, not only
that mercury is not necessary for the cure of either the
primary or secondary symptoms, but that they often
terminate in a spontaneous cure without any medicine.
W.e are assured by Dr. Fergusson and other surgeons
who have observed the disease in Portugal, that the
natives cure themselves permanently of the primary
symptoms by simple topical applications; and of the
secondary effects, by decoctions of sarsaparilla and
sudorifics. They remark, that "the virulence of the
disease has there been so much mitigated, that, after
running a certain course (commonly a mild one)
through the respective order of parts, according to the
known laws of its progress, it exhausts itself, and
ceases spontaneously."-(Med. and Chir. Trans., vol. iv.
pp. 2-5).  This is still further corroborated by the
numerous cures of the primary and constitutional
symptoms recorded by Messrs. Rose, Dease, Hennen,
Guthrie, Good, and Whympor, without mercury, or
any other means than simple dressings. In the cases
which they describe, no caries of the bones occurred, as
is so' commonly observed when mercury is used, " and




AND GENITAL ORGANS.            491~
in no instance was there that uniform progress, with
unrelenting fury, from one order of symptoms, and
parts affected, to another, which is considered as an
essential characteristic of true syphilis."-(Med. and
Chir. Trans., vol. viii., p. 422).
Hahnemann, and most of his disciples, as well as
Hunter and other eminent allopathists, entertained an
opinion that the chancre is simply the vicarious symptom of the internal disease, and that by removing this
ulcer by external applications, " the disease is forced to
embody itself externally, in the more troublesome and
speedily suppurating bubo. And after this, too, has
been-removed, as is foolishly done, by external treatment, the disease is forced to manifest itself throughout the organism with all the secondary symptoms of
a fully developed syphilis. This unavoidable development of the internal syphilitic disease generally takes
place after the lapse of two or three months."-(Hahnemann's Chronic Diseases, p. 116).
We speak advisedly when we pronounce this last assumption altogether erroneous; for we have repeatedly
seen true venereal chancres cured by topical treatment
alone, while the patients have remained entirely free
from any secondary manifestations for years afterwards.  When a student of medicine, the author
passed some time at the United States Marine Hospital, Chelsea, then under the superintendence of the
able and accomplished Dr. Stedman.  In this institution, the internal use of mercury had been dispensed with in the cure of syphilis, for several years
previous to my entrance; and I ascertained that it was
a very rare occurrence to observe secondary symptoms
in those who had been cured at this hospital, although
patients were constantly returning with other complaints, who had been cured of chancre years previous. The treatment chiefly relied on consisted of
topical applications of a mild and simple character, the
internal use of decoctions of sarsaparilla, and a rigid
regimen. The ordinary period for the cure of primary
chancre, was from three to four weeks; and for bubo,
from six to eight weeks.
So long as a chancre exists, the matter generated
in the contaminated part continues to be re-absorbed,




492          DISEASES OF TBIE URINARY
and thus to supply new fuel to the mass of the blood;
it is therefore imnportant to change the morbid action
of the ulcer, and heal it up as soon as possible. The
matter formed in ulcers of the mucous membrane of
the throat, which have arisen from the constitutional
effects of syphilis, is also capable of propagating the
disease by contact with abraded surfaces, or by being
directly re-absorbed into the blood. There is reason
to believe, therefore, if all these ulcers be speedily
healed by topical treatment, so that the blood shall
only contain a given quantity of the virus, this limited
amount will gradually become diluted, by the constant
addition of new and healthy blood, and by its frequent
circulation through the lungs, so that its power to impress the structures is finally lost, and the parts which
have already been affected, gradually recover their
health and tone.
In advocating the practice of topical applications,
however, we by no means wish to be understood as
placing entire reliance upon them, to the exclusion of
internal remedies. We only assert that local applications are capable of effecting speedy cures of chancres,
thus of destroying these sources of contamination, and
placing the blood in the most favourable condition to
be purified by the inspired oxygen, by the newly formed
blood, and by remedial agents. A morbid action is
set up in the chancre, which causes it to generate
matter of a virulent quality. This is evident from the
fact that the matter of buboes and other venereal
abscesses, as well as the blood of syphilitic persons,
is incapable of causing contamination in the healthy.
We repeat, then, heal the chancres as soon as possible,
by destroying their morbid action, with some local application which shall induce a healthy medicinal action,
and we have already done much towards abridging
the power of the disease. Our admirable specifics
will, then, readily accomplish what remains to be
done in perfecting a cure.
The remedial agents which we have found most
useful in the management of syphilis are, (topical,)
nit. argenti., acid nit., zinc chlorid., hydrg., praecip,
rub. creosote, and (internal,) the preparations of mercury,




AND GENITAL ORGANS.            493
aurum mur., thuya, acid nit., sulphur, hepar sulph.. sarsaparilla, silicea, mezereum, hyd. potassa.
In the treatment of chancre, our attention should be
directed in the first instance to the cauterization of the,
sore, in order to change as speedily as possible the
morbid action. For this purpose, either of the first
named medicines may be employed, although in most
cases we prefer the nitrate of silver in substance.
After a healthy action has been excited: in the ulcer,
by these applications, lotions of simple water may be
employed until the cure is established. It will be well
to keep a dossil of lint moistened with water constantly upon the ulcer. This course, in conjunction with
the remedies advised below, will generally effect
speedy and permanent restoration.
Of the internal remedies, mercury is the most important. By comparing the pure effects of the different preparations of this drug upon the healthy human
organization, with the constitutional effects of the
syphilitic virus, it will be observed that the former
are capable of causing all the symptoms of the latter,
as well as many others which are peculiar to the drug.
According to Pereira, the following are the effects of
mercury in large doses:
First. On the mucous membrane of the nose and
throat: ulcerations of the mouth, gums, throat, tonsils,
and nose, which are often followed by extensive
sloughing of the parts.
Second. On the skin or surface of the body:eczema
mercuriale, erythema mercuriale, lepra mercurialis, erysipelas mercuriale, spilosis mercurialis, miliaria mercurialis, and other cutaneous eruptions which bear a-close
resemblance to herpes, impetigo, psydrasia,  and the
copper-coloured eruptions of syphilis.
Third. On the bones and their periosteal coverings:
"inflammation of the bones or periosteum, and the
consequent production of nodes (symphoresis periostei
mercurialis.")
By the above it will be seen that all of those parts
capable of being impressed by the venereal virus, are
also. acted on by mercury- That the operation of the
latter is often more violent and destructive than the
former, will not at this day be questioned.




494          DISEASES OF THE URINARY
But in addition to the symptoms just enumerated,
mercury, in large doses, causes almost innumerable
other symptoms, which have no bearing upon the subject of this chapter, except as indicating its danger in
the hands of allopathists.
We have quoted above from an eminent allopathic
writer, in order that every reader may be convinced
of the analogy between the effects of the venereal
poison and of mercury, upon the human constitution,
and to show the difficulty of distinguishing between
syphilitic and mercurial symptoms, in the old school
mode of practice.
For an accurate and complete description of the
pure effects of mercury upon the healthy organism,
we refer to the provings of Hahnemann and other
homceopathists.
Hahnemann preferred the fluid quicksilver, carried
up to the decilionth degree, over all other preparations,
in the treatment of both primary and secondary
syphilis.
For the cure of primary chancre, Hartmann recommends the first or third trituration of mercurius sol., in
doses of one grain, night and morning. If no improvement occurs within the first eight days, he gives a
lower trituration, or, if necessary, a low trituration of
merc. praccip. rub., in doses of one-sixth of a grain, two
or three times a day. In the Hunterian, phagedenic,
and the elevated indurated chancres, Hartmann employs the red precipitate, in its lower attenuations, from
the first.
Dr. C. Miller, of Leipsic, is also most decidedly in
favour of the red precipitate or the hydr. sulph. rub., in
the treatment of syphilitic chancres and buboes, in
whatever state they may present themselves. He
advises a grain of the first trituration, to be given
twice a day until the ulcers have nearly healed. For
painful nodes and other syphilitic affections of the
bones, hydriodate of potash is advised.
I have also made use of the precipitate at the third
attenuation, with marked advantage, in uncomplicated syphilis. I have known the best results, also, from
the hydr. mur. cor., in both the primary and secondary
forms of the malady. For the cure of troublesome




AND GENITAL ORGANS.            495
secondary symptoms, in the forms of cutaneous eruptions, glandular enlargements, and nodes, theprotiodide
of mercury has extraordinary power. Speedy cures
have been effected by it after the other mercurial preparations had failed. It may be used at the third
attenuation, in doses of a grain, twice a day, until the
eruptions disappear.
When syphilis is complicated by psora, scrofula, or
any other chronic disease, suitable remedies should be
alternated with the mercurials.
Mnuriate of gold ranks next in importance to mercury,
as a remedy in secondary syphilis. The late Dr. Taft,
of New Orleans, employed it in secondary ulcers and
eruptions which would not yield to mercury, with the
most gratifying results. In syphilitic eruptions of long
standing, we have often administered it with entire
success. The second or third trituration may be employed, in half grain doses, night and morning, as long
as necessary.
Nitric acid will be serviceable in many cases of
ill conditioned chancres, which seem to withstand the
curative force of mercury. It is also of great value in
protracted secondary cases, accompanied with emaciation, debility, caries of the bones, unhealthy ulcers
upon the surface, and great derangement of the nervous system. If these symptoms have been aggravated by abuse of mercurials, the indication is still
stronger for the acid. The first, second and third dilutions are to be preferred in these cases, a dose to be
given twice daily until the disease yields.
Sulphur, hepar sulph., and hydr. sulph. rub., are the
proper specifics when the chancre occurs in psoric
constitutions. As a general rule, the two first should
be alternated with some mercurial preparation.
Hyd. potassce is eminently worthy of consideration
in the indolent glandular swellings which sometimes
originate from a combination of syphilis and scrofula.
It is also an efficient medicine in the treatment of
venereal nodes.
Silicea, mezereum and sarsaparilla are often valuable
auxiliaries in syphilis complicated with scrofula.
These medicines should also be given in alternation
with some other suitable specific.




496          DISEASES OF THIE URINARY
In conclusion, we call attention to the following reliable mark of cure, alluded to by Hahnemann in his
Chronic Diseases: "So long as the original spot upon
which the chancre bad been developed, exhibits a reddish morbid-looking, red, or bluish scar, we may be
sure that the internal disease is not completely cured;
whereas, if the chancre has been removed by the internal remedy, the original spot of the chancre can no
longer be traced, on account of that spot being covered
by as healthy-coloured a skin as the rest of the body."
SECTION X.
LEUCORRHE A. —FLUOR ALBUS. —WHITES..
Diagnosis.-This disease is characterized by a discharge, from the utero-vaginal structure, of a mucous
or purulent character, of a white, yellow, or greenish
colour, either thin and watery, or of the consistence of
starch or gelatine. This discharge, in contradistinc-,
tion to that of gonorrhea, arises from a benignant morbid action, and is non-contagious. The assertion of
Hartmann, respecting the identity of gonorrhceal and
leucorrhceal inflammations-the difference, in his view,
consisting only in the location of the disease —is evidently erroneous. This author defines gonorrhea to
consist of an inflammation of the female urethra, and
leucorrhcea of a similar inflammation of the mucous
membrane of the vagina or uterus. The opinion falls
to the ground when we reflect that the latter disease
not unfrequently extends to the urethral mucous membrane, giving rise to ardor urine, burning pain on passing water, heat, fulness, and swelling of the part, and
a purulent discharge, which is non-contagious, Leu-.
corrhceal inflammation always originates from causes:
which havb impaired the healthy tone of the mucous
membrane; gonorrhceal inflammation, on the other
hand, may arise from the simple contact of a drop of
gonorrhceal matter with the most sound and healthy
membrane. The former is the result of an ordinary
inflammation, which is analogous in its character to
that of catarrh and chronic bronchitis: the latter proceeds only from the application of a specific infectious
matter, which developes a particular morbid inflammation, and a contagious purulent secretion.




AND GENITAL ORGANS.          49'7
The character of the discharge and of the symptoms,
will depend upon the location of the disease, its causes,
and the amount of inflammation present. Inflammation of the cervix uteri, for example, causes a discharge
of'"white mucus, and when the inflammation is intense, tinged with blood." — (Hall.). Acute vaginal or
urethral inflammation gives rise to a purulent discharge of a yellow or greenish colour, sometimes tinged
with blood. A more chronic affection of the same
parts induces a thinner, more glairy, and muco-purulent
secretion. Scirrhus uteri causes an ichorous, bloody
and fcetid discharge. In chlorotics, with deranged
menstruation, the secretion is thin, serous, acrid, and
of a lightish or straw colour. The discharge which
often accompanies pregnancy, is thick, glairy, and
white or yellowish; but in some instances after accouchement, more particularly in scrofulous and cachectic subjects, the matter is ichorous and highly irritating to the parts with which it comes in contact.
Inpolypi of the uterus or vagina, the discharge is at
first mucous, but when the tumours have attained some
size, it becomes tinged with blood, and in some cases
of this kind profuse hsemorrhages occur. The signs
which denote the existence of these tumours, are, sense
of weight and fulness in the uterus, dragging pains in
the small of the back, bearing down pains, and turns
of profuse haemorrhage.
In light cases of leucorrhcea, the discharge is usually
thin, glairy, transparent, and starchy; but when the
disease is thoroughly seated, and the patient is of a
delicate or cachectic habit, the fluid may be mucopurulent, serous, sanious, and of a white, yellow, or
greenish colour.
As a general rule, the discharge is worse about the
period of the monthly sickness, owing probably to the
increased determination of blood to the parts during
this natural phenomenon.
The diseases which are ordinarily accompanied by
leucorrhmea are, amenorrhcea, chlorosis, polypus and
scirrhus uteri, dysmenorrhcea, menorrhagia, prolapsus
uteri, and chronic inflammations of the uterus, vagina
or urethra.
When the affection is inveterate, and attended with




498          DISEASES OF THE URINARY
an abundant discharge, the whole system becomes
injuriously affected: the face assumes a pale or sallow colour; the eyes are surrounded with dark or
leaden-coloured circles; the functions of the stomach
and bowels are impaired; the patient experiences a
weary and dragging sensation in the left side; there
are also dull pains in the back, loins, and abdomen;
cold extremities; nausea; palpitation and dyspncea
after exercising; lassitude; debility; feeble pulse;
loss of physical and mental energy; partial or total
suppression of the menses; increase or diminution of
the sexual propensity.
These are the symptoms to which protracted and
severe attacks of leucorrhcea give rise; but the malady may exist for years, in a mild form, without the
development of any of these consequences.
This disease is far more common in cities amongst
the rich, indolent, luxurious, and dissipated, than in
the country. Indeed, the small number of births, and
the frequent miscarriages occurring in large towns,
are attributable in a great measure to the very common prevalence of this weakness.
Leucorrhmea has been considered as one of the symptoms of prolapsus uteri; but we are of opinion that in
very many instances, the latter is a consequence, rather
than a cause of the former. This opinion derives support from the fact that fluor albus often exists for years
before the signs of prolapsus manifest themselves:
and it is probably from this circumstance that the
tone of the uterus becomes impaired, and the muscles
and ligaments gradually lose their strength and contractility.
Leucorrhmea occurs at all periods of life, but is most
common after puberty, and previous to the " change
of life," when so many causes are constantly conspiring
to induce free determinations of blood to the uterogenital organs.
Causes. —The conditions which predispose to attacks
of leucorrhaea, may be enumerated as follows: a lymphatic temperament; a scrofulous dyscrasia; general
debility and relaxation of the muscular and membranous structures, whether from natural organization, or
previous disease.




AND GENITAL ORGANS.            499
Amongst the more immediate causes may be mentioned, an inactive and luxurious mode of life; immoderate sexual indulgence; abortions; congestions
and inflammations of the uterus and vagina; menstrual derangements; want of cleanliness; a humid
atmosphere; scirrhus uteri; polypi and other abnormal growths in the uterus; metastases of rheumatism;
herpes; hemorrhoidal, catarrhal, and bronchial inflammations; the uterine debility and relaxation consequent on parturition, and too early exercise after
confinement; neglect of mothers to exercise the office of nursing; and finally, according to Marshall
Hall, undue lactation.
All of these causes doubtless exercise an influence in
the production of fluor albus, but in the vast majority
of cases the disease may be justly attributed to the
combined operation of several of these influences,
rather than to any single one. We may almost predict beforehand, that the child, born of parents who
have always lived in compactly populous cities, and
have indulged in their artificial habits, will sooner or
later be afflicted with leucorrhwea. This is but one
of the signs which indicate the gradual but sure progress of degeneration to which the luxurious and dissolute habits of large towns inevitably lead. In the
first instance, indolence, stimulating drinks, overheated apartments, exciting theatrical exhibitions,
romances, pictures, statuary, etc., all tend to divert
the mind towards sensual enjoyments. Deprived in a
great measure of those pure and sublime pictures
which nature has so lavishly scattered throughout the
country, to please the sight, to elevate the mind, and
to ennoble and purify the whole being; and of the
thousand sources of happiness which pertain to country life; they turn to artificial pleasures, and reap the
fruits which are ever entailed by a violation of natural
lawvs.
Is it strange then that fluor albus is so common in
cities? that the degenerate offspring of these artificial
human beings should grow up so puny, so weak, mentally and physically; so prone to disease, and soincapable of performing properly those functions for which
nature has designed them? If any one doubts the in



500          DISEASES OF THE URINARY
ferences which these remarks suggest, let him but observe the families of the wealthy and luxurious, who
have inhabited large cities for two or three generations, and he will doubt no longer.
Prognosis. —Leucorrhcea often leads to prolapsus
uteri, amenorrhcea, menorrhagia, abortion, anasarca,
hysteria, and general debility, but it very rarely terminates fatally. By impairing in a gradual manner
the energies of the system, it predisposes it to take on
serious disordered action from slight causes, and thus
becomes indirectly an important morbid agent. When
the complaint is recent, and occurs in females of a robust constitution, from some temporary congestion,
difficult parturition, or mechanical injury, we may expect to remove it, by the aid of suitable remedies, in a
short period; but if the patient be of a lymphatic temperament, of a delicate, lax and scrofulous constitution,
and subject to irregular menstruation, the disease will
most probably baffle our best curative efforts, and persist, with a greater or less degree of severity, during
life. In individuals of this description, the most insignificant causes are capable of inciting and perpetuating the weakening discharge, so that, in many cases,
it will prove a hopeless task to attempt to remove all
the influences which exercise an injurious bearing upon the case. Even when the affection exists as a
mere symptom of some other disease, it seldom subsides with the other symptoms, but is quite prone to
degenerate into a chronic fluor albus.
Therapeutics.-There are several conditions which
are absolutely essential to the successful treatment of
" whites," the most important of which are, abundant
active exercise in the open air; an avoidance of all excesses in venery, and in the pleasures of the table; a
withdrawal of the thoughtsand affections from exciting
spectacles, from crowded balls and parties, from lascivious imaginings, from romances, and intrigues; and
lastly, frequent daily ablutions, in order to ensure the
most perfect cleanliness of the utero-genital organs.
The vast importance of this last point cannot be too
strongly insisted upon, for without a rigid attention to
cleanliness, all our efforts will prove futile. The morbid secretion is at best sufficiently irritating, but when




AND GENITAL ORGANS.           501
it is permitted to accumulate and remain for a long
time in contact with the mucous membrane, it becomes partially decomposed, fetid, and highly pernicious to the well-being of the parts. On this account4
the constant and thorough use of local applications of
tepid or cold water, as circumstances require, should
be strictly enjoined. We may then carry out our remedial measures in all their details, with a reasonable prospect of success.
We call attention to the following remedies: Calcarea carb., sulphur, stannum, sepia, iodine, pulsatilla,
alumina, lycopodium, phosphorus, cocculus, sabinca, secale
cor., china, arnica, bovista, aconite, mercurius, nux
vom., silicea, psoricum, copaibce, mezereum, and manganum.
Calcarea carb. is suitable in chronic leucorrhcea,
affecting weak, scrofulous and cachectic females, and
particularly indicated when the menses are too frequent and too profuse. The discharge is milky, transparent, mucilaginous, starchy, unirritating, and accompanied with itching of the parts, especially the
pudendum; also lassitude; depression of spirits; pains
in the chest and back; cough; and general debility.
When the complaint arises from a scrofulous, or
psoric taint, antipsorics, like sulphur, stannum, and iodine, will be required. The discharge in these cases
is thin or yellowish, and highly irritating to the parts
with which it comes in contact. The strength is also
much impaired, and there are indications of pulmonary and scrofulous disorder, such as hectic fever; emaciation; loss of appetite; wandering pains in the
chest; cough; profuse mucous or purulent expectoration; feeble and rapid pulse; night-sweats.
Sepia is suitable for females who are naturally delicate and sensitive, with clear and transparent complexions. The discharge is mucous, white, yellowish,
or watery, mild or acrid in its nature, most abundant
just before or just subsequent to the menses, and attended with itching and stitching pains in the genital
organs.
Pulsatilla is an admirable remedy in leucorrhcea
accompanying pregnancy. It is also useful when the
disease occurs about the period of the monthly courses.




502          DISEASES OF THE URINARY
The discharge may be thin, acrid, and burning, or
thick, white, and tenacious, like the white of eggs.
Shifting flatulent pains in the abdomen still farther
point to pulsatilla.
Alumina has proved successful in several varieties
of fluor albus; but is particularly indicated when the,
discharge is very profuse and acrid, most abundant
during the day when walking, and previous to the
menstrual periods, and attended with a burning and
itching sensation in the genital organs and rectum.
Fluor albus brought on by masturbation, and occurring at intervals, with a milky, serous, ichorous, or
reddish discharge, will be best covered by lycopodium,
phosphorus, or cocculus. These remedies are suitable
to lymphatic temperaments, to those who are highly
sensitive to cold, and subject to catarrhal affections,
and whose nervous systems have been morbidly excited.
Sabince and secale cornutum are proper in fluor albus depending upon weakness of the utero-vaginal
structure; also when arising from suppression of the
menses; from miscarriage; from severe and protracted labours; polypi, and prolapsus uteri. The discharge
is attended with itching of the pudendum. and inordinate sexual propensity.
China will serve our purpose when the complaint
originates from excessive loss of blood, or other animal fluids, extreme debility from fevers, acute inflammations, abuse of drugs, insufficient nutriment, and
respiration of foul air.
Bovista is applicable in fluor albus occurring after
the catamenia, with discharge of a thick, glairy, and
tenacious matter, of a yellow or greenish colour, and
highly corrosive.
Arnica is indispensable in leucorrhea originating
from mechanical injuries during accouchement, from
polypi, hydatids, and other morbid growths in the
uterus or vagina, prolapsus uteri, and undue mechanical pressure from without.
Aconite corresponds to plethoric and sanguine constitutions, and to females who are subject to congestions and hernorrhages from different organs. The
discharge is purulent, yellow or greenish, and attended




AND GENITAL ORGANS.           503
with ardor urinae, heat, pain, and fulness in the genital organs, quick and full pulse, hot skin, and other
febrile symptoms.
When there is reason to suspect that the discharge
is from a syphilitic origin, whether it be mucous,
watery, or purulent, mild or corrosive, mercurius is
our best remedy.
Nux vom. is recommended when the disease arises
from irregular menstruation, abuse of stimulants, rich
and indigestible food, with a very profuse sanguineous
or yellowish and fetid mucous discharge, and attended
with cramplike pains in the abdomen, constipation,
sinking at the stomach, and palpitation of the heart.
Cases may occur which will require the use of silicea,psoricum,copaibae, mezereum, manganum, nitric acid,
to which the reader is referred.
Administration.-We advise the employment of the
first, second, and third attenuations, the dose to be
repeated once in twenty-four hours until primary or
secondary medicinal symptoms appear, when we may
await the result for some days, or so long as the
amendment continues. When the symptoms become
stationary, we may again resort to the remedy.
SECTION XI.
AMEN ORRH(CE A.
General description.-Many of the symptoms of
this complaint bear a close resemblance to those of
chlorosis, and it is on this account, probably, that
some authors have confounded the two maladies. As
retention or suppression of the menses is a very commoll and prominent symptom of chlorosis, it is not
surprising that it has been deemed a cause of chlorotic
symptoms, rather than as a mere &ymptom. But the
fallacy of this doctrine will be evident, when we reflect that chlorosis occurs in males, in young children,
and in females whose catamenial functions are regular through the whole course of the disease.
Two kinds of menstrual irregularity are generally
included under the above head: first, retention of the
catamenial flux beyond the natural period, from con



504          DISEASESS OF TIE' URINARY
stitutional causes or mechanical obstruction; and
second, partial or total suppression of already established courses, from phthisis, chronic hepatitis, general
debility, chlorosis, fevers, and exposure to cold and
dampness.
It is not improbable that the same causes which'
contribute to the development of chlorosis, also operate to prevent the usual menstrual flux at the period
of puberty, and thus to establish one variety of amenorrhcea. Natural delicacy of constitution, a highly
impressible nervous system, and a lymphatic temperament, are, general conditions which precede and accompany both maladies, although amenorrhea sometimes occurs in the most robust females.
The revolution which nature causes in the female
organism at the period of puberty, ought always to
become manifest in the menstrual flux; but the causes
which often operate to retard it, and thus to thwart
the kind efforts of nature, are numerous and diversified.
Singular phenomena are sometimes observed at the
period of puberty in relation to this periodical evacuation; for, in the place of the usual uterine secretion,
fluxes now and then take place from the top of the
head, the ends of the fingers, the soles of the feet, the
stomach, intestines, nose, and other parts of the body,
and apparently assuming the place of the monthly
periods. Occasionally the supplementary secretion
occurs in the form of ulcers, enlargement and irritation of certain veins, and eruptions.
The menstrual discharge'varies much in its quantity and character. In hot climates, puberty arrives
earlier, and the discharge is more abundant, than in
temperate latitudes.
When the discharge comes on at the proper period,
but is deficient in quantity, or is composed of serum,
mucus, or pus, other parts of the economy suffer, as
by pains in the back, pelvis, limbs, and head, until
the period has passed, after which the sufferings abate
until the succeeding epoch, and are then renewed.
This deficient secretion may continue for months and
even years, without giving rise to any structural lesion, or any other symptoms than those enumerated,
when some new circumstance, like marriage, a sea



AND GENITAL ORGANS.           505
voyage, or change of climate, may rebstore the function to its natural condition.
Puberty, with its usual abcorpaniment, the menstrual flux, does not occur in cold regions until the age
of fifteen or sixteen years, while in tropical countries,
it arrives at the age "of eight, nine, and ten years.
Frank* records cases where the courses appeared in
children of one, three, and four years. This physician
also treated, at Pavia, a woman who had given birth
to three children without ever having had a menstrual
or lochial discharge. Many cases of this kind are
mentioned by other writerS, who also allude to the
masculine organization and characteristics of these
women, such as firmness of muscle, harshness of voice,
and smallness of the breasts.
Prom these facts we infer with Frank and others,
that the menstrual function is not absolutely essential
to the occurrence of conception, and that a woman
may go through' her whole term  of pregnancy, and
finally give birth to a healthy child, without any development whatever of the catamenial function.
Frank, in his Practice of Medicine, expresses the
same opinion: " Nous concluons de ces observations
que l'apparition des menstrues est, a la verite, un des
principaux signes qui annoncent le d.veloppment de'organe uterin et l'abord du sang dans ses vaisseaux,
mais que la conception et la nutrition du foetus peuvent egalement s'operer, quoique cette fonction periodique he soit pas encore @tablie; que la f6condite
depend d'une autre cause, d'un principe analogue a
celui dont elle derive chez les femelles des animaux;
que la nature a soumis en general toutes les femmes
bien organis6es au tribut menstruel, mais qu'elle ne
l'exige pas toujours avec la meme rigueur sous peine
de sterilit6."
In regard to the natural duration of the catamenial
discharge, nothing definite can be advanced, since so
much depends upon the constitution, the climate, and
the habits of life; but the average duration is about
three or four days.
Diagnosis.-As the period approaches when the girl
T* rait6 de Med. Practique, vol. ii.,q. 253.
22




506          DISEASES OF THE URINARY
is to become a woman, new ideas, new thoughts, and
new desires take possession of her mind. Instead of
amusing herself with her doll, she prefers to enjoy,
although with much coyness and timidity, the society
of an attractive young friend of the other sex; instead of the romping freedom of the child, we now
observe the retiring manners and the burning blushes
of the maiden. Her physical developments, also,
become more symmetrical, perfect, and pleasing to
the eye, and she looks forward into the dim vista of
life with deeper interest, higher aspirations, and a
more proper appreciation of the responsible duties
she may be called upon to fulfil.
If, in conjunction with these physical and moral
changes, the catamenial discharge makes its appearance naturally and regularly, the girl retains her
health and vigour; but if the period passes by without the usual development of the monthly tribute, we
are presented with the following symptoms of
RETENTION OF THE MENSES.
Pale, waxlike, or sullen and sickly countenance;
furred tongue, and foul breath in the morning; variable and sometimes morbid appetite; nausea, general
debility, lassitude, and sense of fatigue; pains in the
small of the back, pelvis, abdomen, head, side, and
limbs; disinclination to mental or physical exertion;
coldness of the feet; constipation; leucorrhcea; depression of spirits; sad and weeping mood; distress
in the stomach after eating; distention of the abdomen; faintness; palpitation of the heart after exercise; rapid pulse; headache; vertigo; roaring in the
ears; nightly wakefulness; hysteric symptoms; peevishness and irritability; hamorrhages from the nose,
stomach, lungs, and rectum; supplementary discharges from certain parts of the body.
SUPPRESSION OF THE MENSES,
May arise from a natural cause, like pregnancy, or
from general debility resulting from excessive loss of
blood, chronic and acute diseases, inordinate mucus,
purulent and seminal discharges, polypi, venereal excesses, constant and severe muscular exertion, and




AND GENITAL ORGANS.         507
mechanical obstructions; or it may occur suddenly
during the flux from violent emotions of the mind,
exposure to cold and dampness, cold baths, or any
other cause which abruptly shocks the system.
The symptoms which follow suppression are usually
more acute and dangerous than those of retention of
the courses. It is not uncommon for the former to
induce serious hemorrhages from the lungs and stomach, also inflammations and congestions of the brain,
lungs, uterus, and liver; while in the latter, the symptoms arise so gradually, that the organism in some
measure adapts itself to the morbid condition, and
thus escapes the inflammatory and febrile attacks
which are so common in suppression.
Suppression occurs in the most sound and robust
constitutions, as well as in those that are weakly: retention but rarely happens in healthy and vigorous
subjects, but follows usually as a consequence of original delicacy of constitution, or of some long standing chronic affection. The symptoms of the former
are more violent than those of the latter, but upon the
whole, less dangerous to life, and more readily controlled by medicines.
In cases where the monthly secretion takes place,
but is retained in the uterus from some mechanical
obstruction, the blood often preserves its fluidity and
freshness for a long period. This is owing to the exclusion of the oxygen of the air, the presence of which
is essential to the process of decomposition.
Causes.-Natural or acquired delicacy of constitution, combined with a lymphatic temperament, and a
highly sensitive nervous system, is by far the most
common cause of retarded menstruation. A certain
amount of stamina, of physical and nervous energy,
is essential to the healthy performance of the functions, ant so long as the organism is without the
proper supply of this force, all of the functions must
be imperfectly executed.
Structural lesions which give rise to profuse purulent, mucous, or sanguineous discharges, operate both
as causes of retention and suppression. In this class
may be included, tuberculous ulcerations of the lungs,




508          DISEASES OF THE URINARY
chronic bronchitis, abscesses of the liver, and lumbar
abscess.
Other causes of retention, are, malformations of the
uterine organs, or the vagina, like imperforate os
tinese, imperforate hymen, malorganization of the
ovaries or fallopian tubes, unnatural growths in the
uterus or vagina which oppose an obstruction to the
passage of the menstrual secretion.
Dr. McIntosh divides the mechanical obstructions to
the discharge of the menstrual fluid, into two classes,
viz.: " those occasioned by cohesion of the sides of the
vagina and labia, and an imperforate hymen, and those
caused by an imperfect or imperforated state of the os
uteri itself. All these cases are comparatively rare,
but few men can have been in extensive practice for
twenty years, without meeting with several, and therefore they require some notice in this place. In the
first set of cases, in addition to the constitutional symptoms and local pain already mentioned, there is great
fulness, distention, and a sense of weight in the passages, accompanied sometimes with severe pain, and
a feeling of bursting,; straining at stool and micturition, together with enlargement of the abdomen, which
excites suspicion of pregnancy. The nature of the
case can only be determined by examination, and can
be relieved only by the knife.
" In the second set of cases, there is greater difficulty
in detecting the state of parts, from the natural impediment to an examination which exists at the orifice
of the vagina; but I may mention, at least as a curious
coincidence, that in the only two cases of imperfbrated
os uteri which have fallen within my observation,
there was no hymen, and the passages easily admitted
the introduction of two fingers." Dr. M. punctured
the os uteri, in one of these cases, and afterwards dilated the passage with bougies, until theodischarge
found free exit, when all of the unpleasant symptoms
subsided, and the patient was restored to perfect regularity and excellent health. The other patient, whose
delicacy forbade the operation, gradually sank under
her symptoms and died. I have met with one case of
retention, from adhesion of the walls of the vagina.
The patient was a healthy young married lady whose




AND OENITAL ORGANS.           509
menstruations had been regular until she became pregnant, after which they ceased, and she advanced as
usual until the fifth month, when she had the misfortune to miscarry. During the delivery of the foetus,
so much violence occurred to the parts, that inflammation and sloughing of the vagina followed, adhesions
took place between the vaginal walls, and the passage
became entirely closed to the escape of the menstrual
fluid. The patient experienced f6r many months most
severe pains in the pelvis, abdomen,back, and especially
at the monthly periods; many severe constitutional
symptoms set in, and she became reduced to a very
low state of health. A free incision through the cicatrix, gave vent to a large quantity of fluid blood, ex-a
hibiting but slight signs of decomposition, and the patient speedily regained her health.
The most harmless cause of suppression, is that
which arises from pregnancy. But although this is a
natural cause, its constitutional effects are manifested
in the form of frequent nausea, morning sickness,
ptyalism, &c. These symptoms, although quite troublesome and annoying to the patient, serve the important
purpose of guar4dng the brain, lungs, and other vital
parts, from dangLFous inflammations and congestions.
One of the most notable causes of suppression during the flow of the courses, is abrupt exposure to cold.
This obstruction is apt to arise-in going suddenly from
a warm room after exercise, and when the pores are
open, into the cold air. It is also caused by plunging
the limbs or body into cold water during the period.
Insufficient clothing and thin shoes may also be mentioned as common causes.
Violent emotions of the mind, vehement anger, terror, sudden joy, intense grief, revolting sights, and
electric shocks, may likewise be reckoned as frequent
causes of Obstruction or suppression of menses during
the period.
It has been asserted that severe physical exertion
often induces suppression, and the fact that habitual
dancers are subject to but slight catamenial discharges, has been adduced as a proof of the assertion. We
are inclined to credit this statement, from reflecting
that operatives who labour long and hard, have but a




510          DISEASES OF THE URINARY
very slight seminal secretion, and consequently but
little inclination for sexual enjoyment; while he who
enjoys his otium cum dignitate, abounds in this secretion, and experiences frequent amorous desires. The
same result may happen to females, with reference to
their monthly secretion, and yet no unpleasant consequences arise from the diminution or suppression of the
discharge, since a sufficient amount of the vital stimuli
has already been expended in severe muscular exercise.
Prognosis.-Retention proceeding from a natural
lack of constitutional vigour, is always difficult to
cure; but where no serious organic difficulty exists,
we may generally hope for ultimate success. In cases,
however, which are complicated with chronic pulmonary disease, dropsical affections, and organic disease
of the heart or liver, the prognosis must always be unfavourable. Retention from imperforated os uteri, or
hymen, and from vaginal adhesions and polypi, are all
readily cured by surgical means.
When suppression arises as a symptom of some
chronic disease, especially if it has persisted for several months, we shall, for the most part, find the case
incurable; when, on the contrary, it-has arisen from
an acute disorder, the cure may be easily accomplished.
Obstructions which are consequences of anger, grief,
fright, jealousy, or exposure to wet and cold, may also
be speedily restored by suitable specifics.
In forming an opinion respecting the probable termination of amenorrhea, it should always be borne in
mind, that it is almost invariably either a symptom of
some other disease, or that it owes its origin to a general lack of constitutional vigour. Much, therefore,
depends upon the general condition of the system, and
upon the curable or incurable nature of the malady
which causes the menstrual derangement, as to whether our prognosis be favourable or otherwise.
Therapeutics.-In the management of amenorrhcea,
our first attention should always be directed to the removal of the cause upon which it depends. Those
cases of retarded menstruation dependent upon a want
of constitutional vigour, will derive material benefit




AND GENITAL ORGANS.           511
from well regulated exercise, nutritious diet, change
of scene and of climate, sea air, sea voyages, and bathing. Retention from mechanical obstructions, can only be cured by the aid of the surgeon.
But in suppression or obstruction, unattended with
any serious local complication, and originating from
exposure to cold, mental emotions, suddenly checked
perspiration, cold drinks, fevers, &c., we may afford
the most prompt relief by the employment of suitable remedies.
We call attention to the following medicines: pulsatilla, sabinae, china, calcarea carb.,ferrum, graphites,
conium, serpentaria virg., sulphur, sepia.
Pulsatilla. is adapted to females of a mild, timid, and
amiable disposition, who are easily excited to tears or
to laughter. It may be used in cases where menstruation is delayed a few days beyond the natural period,
in abrupt suppression of the courses, from cold bathing, wet feet, sudden suppression of perspiration from
cold air, violent passions and emotions, and in fevers,
in alternation with other suitable medicines. It is
also valuable in partial obstructions, accompanied
with dyspeptic and hysteric symptoms. The general
indications are, lassitude, weariness of the limbs, unpleasant arterial pulsations in different parts of the
body, congestion, anxiety, and oppression of the chest
and heart, after exercise, and in the night when in the
recumbent posture: variable appetite; coldness of
the feet; sleeplessness; pains in the back; weeping
mood; vertigo or giddiness; colicky pains in the abdomen.
Sabina is only useful in that irregular variety of
amenorrhcea in which the menses appear too soon, and
too profusely for a few hours, and are then suppressed
either temporarily or permanently. The kind of
amenorrkaea in which this medicine is applicable, is
for the most part induced by a hyposthenic condition of
the uterus.
China and ferrum are especially serviceable in retarded menstruation dependent on constitutional debility, whether natural or acquired. The general indications for their use, are, pale, sallow, or cachectic
countenance; emaciation; muscles soft and flabby; ra



512          DISIASES OF THEI URINARY
pid circulation; rapid and difficult respiration after
exercise; palpitation of the heart, excited by mental
emotions, exercise, or eating heartily; lassitude, debility, and general indisposition to think or act; transient pains in the chest, back, side, pelvis, and limbs;
swelling and pain in the.hepatic region; bitter taste;
feeble appetite; impaired digestion; nightly restlessness; leucorrhcea,
Calcarea carb., sulphur, graphite, conium, and sepia,
are indicated in the catamenial irregularities of scrofulous, rickety, and syphilitic subjects. The history of
each case will enable us to decide respecting the pre-.
cise nature of the disease upon which the amenorrhea.
is dependent, and thus render it easy to select an antipsoric which shall gradually remove the original causeof disorder, and cure the patient. As a general rule,
cacarea carb. agrees best with young persons whose
monses appear too soon, while sulphur, graphite, conium and sepia may be exhibited at all ages, but for the
most part, in cases of retarded and suppressed menstruatiQn.
Serpentaria virg.-We have often used this medicine in suppressed and obstructed menses, from cold,
violent emotions, and the debility consequent on fevers, with marked success. A recent cure of amenorrhoea, verging on chlorosis, has also come under my
observation, which, taken in connection with the other
examples alluded to, convince me that it is a specific
of much value in disorders of this character.
As a majority of the cases of amenorrhcea have their
origin in some inherent constitutional vice, and are, in
reality, but mere symptoms of some other affection, it
is of importance that our attention be directed to all
of the remote and slight symptoms which may exercise an influence upon the economy, as well as to the
more immediate and visible signs of the mala4y.
Administration.-When the menstrual derangement
has approached gradually, and is evidently a symptom of some general disease, like scrofula, chlorosis,
phthisis pulmonalis, dropsy, or chronic hepatitis, the
remedies must be selected with reference to these maladies, and the same attenuations and repetitions emplayed as advised under these different affections.



AND GENITAL ORGANS.           513
As a general rule, in these cases, we employ the first,
second, and third attenuations, and repeat the dose
but rarely; but in abrupt obstructions, occurring in
females of a robust constitution, from undue exposures, or over-excitement, we make use of the first or
second attenuations, and repeat every two, three, or
four hours until we are satisfied with the effect produced.
SECTION XII.
DYSMENORllHEA.-PAINFUL MENSTRUATION.
Diagnosis.-Painful menstruation is of most common occurrence in females of sanguineous and robust
constitutions, and of ardent and animated temperaments. The monthly flux makes its appearance at
the usual period, but generally in small quantity, often
becoming entirely suppressed for several hours, and
then reappearing to a greater or less'extent, perhaps
again to be suppressed. Females subject to dysmenorrhoea, are almost invariably troubled with constipation, and frequent headaches, from rush of blood to
the brain, in the interval between the catamenial periods.
The usual symptoms attending dysmenorrhcea, are,
severe bearing-down pains in the uterine region, similar to the pains of labour, and coming on in paroxysms; constant aching in the small part of the back,
the loins, the pelvis, and the limbs; accelerated action of the heart and arteries; flushed cheeks; headache; cutting and pressing pains in the abdomen;
flatulence; spasmodic sensation in the region of the
stomach; nausea; eructations; oppression in the
chest; anxiety and irritability; scanty discharge of
blood whi;h is not coagulable, and containing lymph,
and shreds of a membranous structure, or clots of dark
blood.
Causes.- The chief causes of dysmenorrhmea, are, an
inflamed condition of the secretory vessels of the uterus, an unnaturally small os tincce, and inveterate constipation. Of these causes, the first is the most common, and occurs in females of a full plethoric habit,
of fancies easily excited to activity, who are fond of
22*




514          DISEASES OF THE URINARY
the pleasures of the table, of love, and shows, and who
preferto pass their time in heated parlours, or crowded
ball-rooms, rather than in active exercise out of doors.
When we reflect upon the habits and the mode of life
which the customs of refined society impose upon
young.females, we shalL no longer wonder that this
important function of the uterus should so often become disordered. The foolish mother, anxious that
her child should grow up according to the laws of
a false elegance, with a shape of body moulded to suit
the code of fashion, rather than in those once approved
proportions which the Creator gave her, envelopes her
in corsets and stays, pressing the abdominal viscera
downward upon the bladder and uterus, and the thoracic organs upwards towards the throat, and thus
moulds a waist sufficiently small and wasp-like to meet
the requirements of a sham gentility. In carrying out
this wicked whalebone and buckram system, the important functions of circulation, respiration, digestion,
and menstruation are of no sort of consequence to the
deluded victim or her friends, when compared with
the imperative demands of fashion. God made the
human body of precisely the right proportions for the
healthful exercise of all the organs; civilized woman
baffles this ordination by mechanical devices, and
makes of the form an artificial thing, recognised and
known as a specimen of gentility, the functions of
which are subject to continual derangements, by consumption, chlorosis, dysmenorrhcea, amenorrhcea, constipation, and organic affections of the heart. After
the innocent young girl has been thus-cheated, not by
" dissembling nature," but by a fashionable mother,
" out of her fair proportions," it is deemed necessary,
in order to complete her education, to prim her up
within the crowded walls of a boarding-school; to
cram her mind with some- ten or twelve studies at a
time, including, of course, music, and the current literature; and to neglect active exercise, wit, fun, mirth,
and other health-promoters, as vulgar. In this manner the countenance acquires that pale and distingue
cast so much coveted, and the body that frail and enfeebled state so common in cities.
Another cause which occasionally gives rise to pain



AND GENITAL ORGANS.           515
ful menstrual ion, is an unnaturally small os tincea,
Dr. Mackintosh supposes this to be a very common
cause of dysmenorrhcea, and details numerous cases
of the kind which have come under his own observation. When the painful symptoms do not yield readily to the proper remedies, an examination should be
made, and if the fault is in the os tincam, our efforts
should be immediately directed to the dilatation of
the part with bougies.
The other causes which should be particularly noticed, are collections of indurated faecal matter in the
colon and rectum, uterine polypi, exposure to cold,
and rheumatic affections of the uterus.
Therapeutics.-Abundant active exercise in the open
air, regular hours, a plain regimen, abstinence from
wine, coffee, and green tea, and a temperature not exceeding 680 Fahr., within doors, are prime conditions
to the successful treatment of dysmenorrhcea. By attending rigidly to these important points, constipation
will be obviated, the circulation of the blood equalized, the animal heat uniformly diffused, and all undue
determinations of blood prevented. If, however, obstinate congestions have already set in, a few doses of
a suitable specific will soon restore the organism to
its normal condition.
The medicines to which we call attention, are aconite, pulsatilla, secale cornut., belladonna, nux vom.,platina, ferrum, cocculus, sabinae, conium, graphite.
Dysmenorrhaea arising from an inflammatory condition of the uterus, and attended with marked febrile
symptoms, quick pulse, hot skin, thirst, rapid respiration, headache and general restlessness, demands the
employment of aconite.
If the menses are scanty, and accompanied with
cutting pains in the uterine region, abdomen, back,
and loins, vertigo, loss of appetite, chilliness, nausea,
and discharge of thick, black blood, alternating with
short discharges of bright red blood, we may resort to
pulsatilla. If the pains shift about from one point to
another, the indications are still stronger. Pulsatilla
also operates best when the derangement has arisen
from fright, grief, mortification, or from exposure to
wret and cold.




516          DISEASES OF THE URINARY
When the menstrual irregularity proceeds from
uterine congestion, and presents us with the following
tableau of symptoms, viz., violent spasmodic, or bearing-down pains from the small of the back to the ute.
rus, with tenesmus and pressure on the bladder and
rectum, coldness of the extremities, rapid and feeble
pulse, frequent and severe contractions of the uterus,
secale cornutum should be employed.
Belladonna is an admirable remedy when the patient is of a plethoric habit and sanguine temperament, and the disorder has originated from some
violent mental emotion, and is attended with serious
determination to the brain. It may sometimes be
employed with advantage in alternation with aconite.
Nux vomica is valuable in scanty and painful menl
struation, from uterine congestion, arising from scybalous accumulations in the colon and rectum. The
pains are of- a spasmodic character, and extend from
the uterus to the neck of the bladder, and into the abdomen.  Considerable gastric derangement usually
attends this variety of dysmenorrhcea.
Platina, ferrum, or sabinae, are applicable in that
variety in which the menstrual discharge is sufficient,
or even inordinate in quantity, but is attended with
severe bearing-down pains in the uterine region, cutting pains in the back, loins, and thighs, pressure in
the groins, cramps in the abdomen, blood dark, and
containing membraneous shreds, and too frequent ap-.
pearance of the menses.
For uterine and abdominal spasms, nausea, faintness, impeded respiration, and a scanty discharge of
coagulated blood, mixed with mucus, we may give
cocculus or conium.
Graphite is an important remedy when the menses
appear too late, and are too scanty. The uterine dis —
charge is thick and dark, there are severe labour-like
pains in the pelvis, also cutting pains in the abdomen,
small of the back and hips, vertigo, constipation, chil-:
liness, cold hands and feet, flatulence, and general
lassitude and debility.
Administration.-_The medicines may be employed
at the first, second and third attenuations, and repeated
every two hours during the more severe symptoms.




AND GENITAL ORGANS.           51 
The remedy should also be given once in two or three
days during the intervals between the monthly epochs.
SECTION XIII.
MENORRHIAGIA. UTERINE HMEMORRHAGE.
Diagnosis. —Profuse uterine hanmorrhages may take
place at any period of life from puberty to extreme
old age, and in every variety of constitution. But the
most common kind of menorrhagia to which the attention of the physician is called, is that which happens during the monthly periods, from 4 congestion
or relaxation of the uterine secretory vessels. A certain amount of menstrual fluid is secreted each month,
and this natural quantity is determined by the temper,
ament, constitution, and habits of life of each particular subject. Thus, robust and plethoric females,
who live richly and drink wine, may lose a large
quantity of blood at each period, and suffer no inconvenience from it; while individuals of delicate and relaxed constitutions, would immediately experience ill
effects from  so profuse a flow.  It is when this
healthy, natural flux becomes morbidly augmented,
that we apply to it the designation of uterine katmorrhage, and deem it necessary to employ medicinal
means.
Dangerous uterine hmmorrhages often occur during
pregnancy, from disturbance or rupture of the membranes or of the placenta, and also from concussions,
blows, violent exercise, fright, anger, cathartics, and
emmenagogues.
The symptoms which precede menorrhagia, oceurring at the menstrual periods, are, general uneasiness
and dissatisfaction, petulancy, lassitude, sense of fulness and oppression in the head, weariness and wandering pains in the back, loins, and inferior extremities, sense of weight and pressure in the pelvis,
chilliness, unnatural determinations of blood, cold
feet, rapid pulse, and impaired appetite.
The symptoms attendant on the flux, will depend
entirely upon the nature of the case, the constitution,
and the amount of blood lost in each instance, In
light cases of menorrhagia, the patient only experi



518           DISEASES OF THE URINARY
ences a general sense of lassitude, debility, and
weariness, faintness, tired and uneasy sensations in
the back and limbs, indisposition to exercise, a faint
and deathlike feeling at the pit of the stomach, paleness of the face, cold extremities, and feeble and unsatisfactory respiration.
In more serious cases the patient becomes almost
exsanguineous; the face, lips, and surface become
blanched; the muscular strength entirely prostrated;
every attempt to move or converse induces immediate
syncope; there is more or less determination of blood
to the brain, as is evinced by sharp pains, delirium,
ringing in the ears, and throbbings of the carotid and
temporal arteries; the vision is impaired, floats circulate before the eyes, respiration is oppressed, palpitation of the heart ensues from exercise or emotions;
pulse rapid and extremely feeble; general coldness of
the surface; great and undefinable uneasiness and
nervous irritation. The blood gushes upon every exertion to change position, and on coughing, sneezing,
or vomiting. - After the patient has become reduced
by its loss to a very low state, frequent and protracted fainting turns come on; respiration and circulation become almost suspended; the blood clots at
the mouths of the uterine vessels, and thus the flooding is temporarily arrested. As soon, however, as the
organism reacts, these clots are liable to be expelled
by the contractile efforts of the uterus, and the flowing to re-appear. These different conditions may occur several times during the progress of the disorder,
until finally the patient is so completely prostrate,
that there is no re-action, the clots are not expelled,
and time is allowed for the uterine vessels to recover
themselves sufficiently to resist any further morbid
secretion. Cases of this description are not uncommon, and the cures are often erroneously attributed to
monstrous doses of opium and sugar of lead, rather
than to the kind offices of nature in inducing syncope,
and a consequent coagulation of the blood in the
uterus.
We have enumerated amongst the symptoms of the
complaint, determination of blood to the head, and inflamniation of the brain. These symptoms have beoen




AND GENITAL ORGANS.            519
so often observed in connection with profuse harmorrhages, and the question has been so often discussed,
in regard to the propriety of blood-letting for the cure
of a cerebral inflammation which has been caused by
excessive loss of blood, that no one will deny the fact,
that these symptoms actually occur as a direct consequence of menorrhagia. Examples of this kind should
teach the important truth, that excessive loss of blood is
always a powerful predisposing cause, and in very many
instances a direct exciting cause of inflammations of
the brain, lungs, and other structures. It ought also to
induce the exercise of a little reason in therapeutical
measures, rather than a persistence in the empirical
routine of the old school, of venesection, opiates, and
astringents.
Menorrhagia originating in organic derangements
of the uterus, like indurations, cancers, tumours, and
ulcers, will be accompanied with the symptoms peculiar to these different maladies, in addition to their
ordinary signs. Cases of this description will require
careful attention, both in a diagnostic and in a therapeutical point of view. Thus, if the disease be dependenlt on a scrofulous or psoric diathesis, or a
syphilitic taint, our remedies must be directed as well
to these original and general causes, as to those which
are more immediate and local. By this means we
may strike the silent and invisible enemy, while subduing others which are manifest to our senses.
Causes.-We include among the remote causes of
this affection, improper physical and moral education,
excesses in eating and drinking; insufficient nutriment; scrofulous, syphilitic, or psoric taints; pressure
of the abdominal viscera downwards upon the uterus,
by mechanical contrivances; an ardent sanguine
temperament, and a plethoric habit, or a lymphatic,
venous temperament, and a relaxed habit.
The proximate causes are, irritation, congestion, or
inflammation of the secretory vessels of the uterus;
the various disturbances and injuries occurring during
pregnancy, and from accouchement, cancers, ulcers, tumours, indulgence in the pleasures of love, and of
stimulating drinks during the catamenial period.
Pro gnosis. A favourable termination may be ex



520          DISEASES OF THE URINARY
pected when no organic affection exists, if the patient
is moderately robust, and the disease depends upon
simple local inflammation, or the accidents arising
from  pregnancy and accouchement. Many of the
floodings, however, which proceed from miscarriage,
from abnormal positions of the fetus and placenta,
and from accidents during delivery, require prompt,
bold, and judicious efforts on the part of the accoucheur to rescue the patient from fatal prostration.
But no woman need bleed to death under any of these
circumstances, if there is proper knowledge and deeision on the part of the physician.
The circumstances which must render our prognosis unfavourable are, chronic induration or softening of the uterus, cancerous and other incurable ulcerations and tumours, and morbid growths within the
viscus. But even in these apparently hopeless cases,
we should never despair, for the resources of homceopathy sometimes surpass our most sanguine expectations.
Tkerapeutics.-After having removed, as far as possible, all disturbing causes, a suitable remedy may be
selected fromplatina, pulsatilla, belladonna, ipecacuanha,
sabina, secale cor., ferrum met., arnica, china, chamomela,.
sepia, bryonia, nux vom., carbo animal., acid phos.,
hyoscyamus, crocus sat., creosote.
Platina is particularly suited to females of a sensitive and impressible organization, and who suffer from
too frequent and too profuse catemenia. The flow is
accormpanied, and occasionally preceded, by cutting
and pressing pains in the abdomen, back, and pelvis;
dull pains in the groin and thighs; sensation of fulness in the uterus; chills alternating with flushes of
heat; unusual sensitiveness of the genital organs;
headache; sadness; debility; restlessness; leucorrhcea; menstrual discharge red and fluid, or dark,
thick, and coming away in clots. This remedy is applicable in menorrhagia arising from induration or.
cancer of the womb.
Pulsatilla is useful in menorrhagia occurring in females at the' turn of life," or from schirrus uteri, or
from simple passive congestion of the uterus, or during
pregnancy and accouchement. The blood is generally




AND GENITAL ORGANS.           521
dark and coagulated, and is expelled only at intervals,
but in large quantities.  In profuse hemorrhages
after delivery, when the uterus does not contract,
and the patient is much prostrated from  pain and
loss of blood, pulsatilla is an excellent remedy. It
may also be given in menorrbagia characterized by
inconstant and shifting pains in the back, loins, abdomen and pelvis.
Belladonna is our best remedy in superabundant
menstruation proceeding from irritation and active:
congestion of the uterine vessels, and also in uterine
inflammations consequent upon abortions, violent
passions, or protracted continence. It is an invaluable
remedy in cerebral inflammations arising from excessive uterine habmorrhage.
The general indications for belladonna are, a plethoric habit; ardent, sanguine temperament; frequent
determination of blood to the head; strong passions;
pressing pains in the small of the back and the abdomen; sense of filness in the uterus; full and rather
rapid pulse; vertigo and pains in the head; nausea;
ringing in the ears; partial loss of consciousness; inflammation of the womb; profuse discharge of bright
red blood; flushed cheeks; brilliant and congested
eyes; schirrus uteri. Belladonna has been advised in
alternation with arnica or platina, when the pains
resemble those of labour, and there is a profuse discharge of bright red blood.
Ipecacuanha may be exhibited when the catamenia
appear every two or three weeks, attended with pressure in the uterine region, and profuse discharge of
fresh blood.
Sabina is indicated in menorrhagia during and after
miscarriage, and at the menstrual period. The flooding is accompanied with bearing down pains in the
abdomen and pelvis; abdominal spasms; pain in the
uterus; ardor urinea, and profuse discharges of dark
and coagulated blood, or of fluid red blood. Sabina is
especially useful in protracted uterine haemorrhages
arising from a loss of tone in the vessels of the uterus,
whether from previous disease or the weight and pressure of the faetus in utero.
Secale cornutum is recommended in hoemorrhages




522.         DISEASES OF THE URINARY
arising from passive congestion of the uterus, cachectic habit, and debility, and want of tone in the uterus,
from difficult parturition or disease. The general indications are, pale face; cold surface; feeble pulse;
white lips; pains and tenesmus in the rectum and
bladder; discharge of dark and offensive blood, increased on motion, coughing, or sneezing; great prostration; numbness; spasms; humming in the ears;
obscuration of vision; loss of contractive power in the
uterus.
Ferrum met. is indicated in profuse hemorrhages
after parturition and at the monthly epochs. The discharge is attended with spasmodic and labour-like
pains in the loins and uterine region; flushed cheeks;
hard and full pulse; hot skin; headache; hot and
scanty urine; constipation; shudderings.
Arnica is our remedy in menorrhagia, originating
from mechanical injuries during pregnancy or delivery,
or from blows, falls, contusions, strains, etc.
China is applicable in hemorrhage proceeding
from an asthenic condition of the uterus.  It is especially useful in enfeebled and cachectic females, who
flow too profusely after parturition, from an atonic
condition of the uterus and its non-contraction. A
general appearance of debility and exhaustion;
blanched countenance; discharge of serous or thick,
dark, and clotted blood; pale, sunken countenance;
restlessness; constant fainting turns; soft and flabby
muscles; coldness of the extremities; and rapid and
feeble pulse, point to this remedy.
Chamomela is adapted to bilious and nervous constitutions, and may be employed in menorrhagia, attended with pains and pressure in the pelvis; ardor
urinwa; tearing pains in the small of the back, uterus,
and legs, with frequent discharges of coagulated blood.
It has also been highly commended in uterine haemorrhages occurring at the change of life. Females of
an angry, violent and quarrelsome disposition derive
most benefit from this drug.
Sepia may be used in cases proceeding from scrofulous and schirrous affections of the uterine organs.
It is likewise advised in protracted chronic cases




AND GENITAL ORGANS.            523
where the system has become much exhausted from
previous disease and suffering.
Bryonia agrees with bilious and choleric females,
and is commended in menorrhagia attended with
stitching pains in the head, back, and pit of the stomach, when stooping, or stepping.
Nux vom. will apply in cases of menorrhagia from
uterine congestion, accompanied with spasmodic pains
in the uterus, and a discharge of clots of dark red blood.
Carbo animal. has been successfully used in a few
cases of moderate uterine hemorrhage, from chronic
induration of the uterus.
Acid phosph. is specific in too profuse menstruation,
attended with swelling and pain in the liver.
Hyoscyamus is specific in superabundant menstruation of hysterical females, who experience before and
during the continuance of the flow, general spasms,
convulsive laughing or weeping, twitching or trembling of the limbs, headache, and occasional delirium.
The discharge is bright red.
Crocus sat. corresponds to active or passive uterine
hemorrhages. It is useful after miscarriage, when
the discharge is very profuse, dark, and viscid, and the
patient is anxious, feeble, chilly, faint, sick at stomach,
restless, thirsty, and annoyed with palpitation of the
heart, vertigo, impaired vision, vague pains in the
back and pelvis, and unpleasant dreams. Movement
and coughing increase the haemorrhage.
Kreosote is advised in passive uterine hemorrhages
originating in scirrhous degenerations of the uterus, or
in general laxity of the uterine vessels. The menses
appear too early, are too profuse, and accompanied
with a leucorrhmeal or ichorous discharge, which irritate the parts with which it comes in contact.
Administration.-In urgent cases of uterine hamrorrhage, we give the first attenuations. and repeat every
half-hour until medicinal symptoms appear, or the
flooding abates. In less dangerous cases, we repeat
every two, three, or four hours, so long as is necessary.
With the internal remedies, cold water may be applied to the pelvic region by means of cloths. The
hips must be elevated and supported, while the head
and shoulders are lowered, and the patient be kept
cool, quiet, and free from excitement.




524
CHAPTER XXVII.
DISEASES OF THE FIBROUS AND MUSCULAR SYSTEM.
SECTION I.
ACUTE RHEUMATISM.
Diagnosis.-Acute rheumatism usually commences
after an abrupt suppression of perspiration, in consequence of exposure to wet, cold, or to a highly variable
temperature. It first manifests itself in the form of
slight chills, lassitude, and general uneasiness, which
are soon succeeded by swelling, redness, pain, and
augmented heat in the part affected. The pains vary
much in character, being sometimes aching and gnawing, at others, lancinating and darting, or dull and
throbbing, or numb, pungent, and prickling, and aggravated by movement, by exposure to drafts of cold
air, and by the pressure, or touch of the hand. In the
first instance, rheumatism seizes upon the fibrous textures, but as the inflammatory action becomes developed, other tissues become involved, the capillaries of
the neighbouring parts become distended with red
blood, and the usual phenomena are present. The
larger joints are more subject to rheumatic inflammation than other parts of the body, although it is not
uncommon for the inflammation to commence in the
head, neck, chest, arms, or legs, and gradually extend into the neighbouring joints. The more common
accompanying symptoms of acute rheumatism are,
bitter taste in the mouth, coated tongue, rapid and full
pulse, moderately hot skin, thirst, scanty, high-coloured
and sedimentitious urine, intense pain on moving the
affected part, anxious and distressed expression of
countenance, and occasional perspiration.
Rheumatic inflammations are liable to shift from
joint to joint, and sometimes to fix upon important internal organs, like the brain and its membranes, the
pulmonary structures, and the heart and its appendages. So long as the malady confines itself to the
joints, or to the external parts of the body, it is unat



DISEASES OF THE FIBROUS, ETC.    525
tended with danger to life; but when metastases occur
to important internal organs, the disease becomes in
an eminent degree perilous.
Acute rheumatism occurs for the most part, in young,
healthy, and robust subjects, and can be generally
traced to undue exposure to cold, or to a wet and variable atmosphere.
Chronic rheumatism differs from the acute form in
many respects; as for example, absence of febrile
symptoms; the fixed character of the pains; no perceptible swelling or redness in the affected parts; the
pains sometimes aggravated, and at other times ameliorated by walking, and other exercises; great sensil
bility of the diseased tissues to changes oftemperature,
to humidity, and to cold; dryness and inactivity of
the skin; rigidity in the parts, most apparent when
attempting to move, or to walk, after having been
quiet for a considerable period; sedimentitious urine; 
weakness, trembling, or numbness of the disordered
parts.
Therapeutics.-We enumerate as the principal remedies, rhus, bryonia, aconite, colchicum, belladonna, pulsatilla, dulcamara, mercurius, nux vomica, phosphorus,
calcarea carbonica, veratrum, hepar sulphur, arnica,
colocynth, lycopodium, sulphur.
Rhus tox. —External indications. The integuments
about the joints swollen and red; surface of the body
hot and moist; tongue dry and red; pulse frequent,
and hard; urine dark, or red, and turbid.
Physical sensations.-Drawing and tearing, or tensive stinging and dragging pains in the affected parts,
increased by exposure to cold, by rest, and by movement after having been for some time quiet; rigidity,
lameness, and weakness of the muscles in the vicinity
of the diseased textures; increase of the febrile symptoms, and of the pains, at night, in bed; perspiration,
especially during the pains; pains alleviated by exercise; throbbing, and burning in the knees, or anricles;
painful involuntary contractions of the muscles of the
calves of the legs; chronic rheumatic pains occurring
early in the morning, and disappearing on moving
about.




526          DISEASES OF TIHE FIBROUS
Mental and moral symptoms. —Intellect unimpaired;
disposition irritable and impatient.
Administration.-One drop of the first dilution may
be given in a dessert spoonful of water, every two or
three hours, until the pains begin to subside, or until
a medicinal action is produced upon the inflamed tissue.
Bryonia. —External indications.-Swelling and redness of the inflamed textures; countenance pale or
sallow, or flushed and hot; tongue covered with a
white or yellow fur; hot and dry surface, or perspiration of an acid character after exercise; considerable
thirst, frequent and soft pulse; red or yellowish urine;
position such as to relax the muscles bearing upon
the diseased parts.
Physical sensations.-Pains of a tearing, throbbing,
or lancinating character, aggravated by movement, by
the touch, by the contact of cold air, and by eating;
a relaxed state of the muscles, and perfect rest, affords
almost entire relief from  suffering; bitter taste, or
dryness of the mouth, with thirst; nausea; bilious
vomiting; severe pulsating headache; morbid sensibility of the whole surface to the touch; stitching
pains in the region of the liver, and in the intercostal
muscles; symptoms worse during the night.
Mental and moral symptoms. —General uneasiness,
anxiety, and irritability; sleeplessness.
Administration.-The second or third dilution may
be employed-a dose.every two, three, or four hours,
as the symptoms appear to require. For the active
febrile symptoms which occasionally accompany the
affection, we are in the habit of prescribing aconite
and bryonia in alternation, with satisfactory results.
Colchicum is a valuable remedy in both acute and
chronic rheumatism.  The pains are lancinating,
jerking, or tearing, worse in the night, and increased
by care, anxiety, or movement: or, there may be only
stiffness and lameness in the joints, when attempting
to walk, with edematous swellings of the parts in the
vicinity of the inflammation. Dr. Schroen commends
colchicum in those cases which resist the clearly indicated medicines, provided the skin is moist, and the
urine is turbid. Dr. S. advises it to be given in the




AND MUSCULAR SYSTEM.          527
form of vini seminis colchici, and in doses of twelve
drops daily. We have found a single drop of the first
dilution, repeated once in from three to six hours, according to the acute or chronic nature of the case,
very efficacious, in several obstinate cases which had
resisted the action of other medicines.
Belladonna will prove an excellent remedy, in rheumatic attacks accompanied with a high degree of nervous
irritability, and a morbid activity of the cerebral organs. The pains are very severe, especially at night,
increased by touch, or by remaining too long in'one
position.
Pulsatilla is indicated when the pains shift rapidly
from one part to another, and are unattended with
any great swelling or redness of the integuments; also, in chronic rheumatism characterized by weakness,
rigidity, coldness, and sensation of weight in the disordered structures.
Dulcamara often proves speedily curative in rheumatic inflammations which have been caused by exposure to cold and dampness. The affected parts usually feel as if bruised or beaten, and after remaining
for some time in one position, are attacked with severe pains which do not subside until the patient
moves about. The pains are most common in the
back, and in the joints of the arms and legs.
In cases of frequently recurring rheumatism, of
scrofulous or psoric subjects, we must use one or
more of the following medicines: calcarea carbonica,
sulphur, lycopodium, mercurius.
When the disease has become chronic and inveterate, ana abnormal depositions occur about the joints,
with thickening of the membraneous tissues, and permanent rigidily, weakness, and tenderness on motion,
a persevering employment of rthus, or hepar sulphur,
or nux, or phosphorus, or veratrum, or lachesis, will induce curative results of the most satisfactory character.
Other medicines which have occasionally proved
successful in rheumatic affections, are, colocynth, iodine, ferrum, china, arsenicum, arnica, carbo vegetabilis,
and hyoscyamus.
Administration.-In the acute form of the malady,




528          DISEASES OF THE FIBROUS
we employ from the third to the sixth attenuations,
and repeat the doses every two hours until a medicinal
impression is evident.  In chronic rheumatism, we
prefer the first attenuation, and prescribe a dose once
or twice daily.
SECTION II.
ARTHR'ITIS.-GOUT.
Although rheumatism  and gout are described by
authors as different diseases, it is altogether probable
that the nature of the inflammatory action is the same
in both instances. When this peculiar inflammation
seizes upon the young and robust, and pervades the
larger joints and the muscular structures, it receives
the name of rheumatism; but when individuals advanced in life, are the subjects of attack, and it appears in the small joints, it is recognised as gout.
A fit of the gout is almost always preceded by some
gastric or intestinal derangement, like impaired appetite, furred tongue, bitter taste, acid or bitter eructations, flatulent distention of the stomach and intestines,
and occasionally diarrhcea. The inflammation is, for
the most part, situated in the ball of the great toe, but
it may attack any of the smaller joints, and as the disease advances, the veins in the vicinity of the lpain
become distended; the integuments swollen, cedematous, and of a bright scarlet colour; the pains become
severe, of a darting, throbbing, or a persistent aching and burning character, increased by contact or by
movement; there is an almost entire loss of muscular
power of the affected parts; the pains are worse during the night, and accompanied during this period by
active febrile symptoms; nearly all the functions of
the organism are sympathetically deranged; the urine
is small in quantity, high coloured, and becomes turbid on standing; the patient is restless, irritable, and
morbidly selnsitive to moral and physical impressions.
The disorder usually arrives at its maximum of intensity, in two or three days from the commencement of
the inflammation. At this period, the whole toe, and
sometimes the foot itself, become edematous, and the
numbness and prickling are frequently experienced in




AND MUSCULAR SYSTEM.           529
the swollen textures, especially during the day: the
pains and the nightly febrile exacerbations, now commence subsiding, until at the end of from seven to ten
days, the active inflammatory symptoms have disappeared and left the patient with a debilitated and
edematous limb.
When the paroxysms of acute gout occur very frequently, they serve, after a time, to impair the constitution, to cause permanent thickenings of the articular membranes, or cretaceous deposits about the joints,
and to induce that condition of the parts which leads
to chronic gout. This form of the complaint is characterized by dull, burning, or tensive. pains, cedema,
thickening of the membranes of the affected joint,
with rigidity, weakness, and partial loss of muscular
power; more or less gastric derangement, augmented
sensibility of the mind and body to external impressions, depression of spirits, and general restlessness
and irritability.
Causes.-Gout is generally supposed to be hereditary, although cases are constantly occurring in which
no natural predisposition can be traced. There is no
doubt, however, that in the majority of instances, an
hereditary predisposition exists. The exciting causes
of gout, are, high-living, want of sufficient exercise,
abuse of stimulants, especially wines, and general irritability of the nervous system, from loss of' rest, and
irregularity in eating.
Therapeutics.-The principal remedies for acute gout,
are, bryonia, nux vomica, colchicum, bell., aconite, rhus,
pulsatilla, actaea spicata, actaea racemosa, guaiacum, arnica, arsenicum, china, ledum, sabince, cantharides. For
chronic gout, the best remedies are, calcarea carbonica,
sulphur, phosphoric acid, aurum muriate, iodine, hepar
sulphur, phosphorus, mercurius, sepia, silicea.
It will very commonly happen that several of these
medicines will cover most of the manifest symptoms
which are usually present in gout, but in making our
selection, the strictest regard should be had to all remote and exciting causes which may have exercised
an influence in originating the malady, in order that
we may strike deeply at the foundation of the disturb23as




530             HYDROPS.-DROPSY.
ance, as well as at the more immediate and visible
phenomena.
In prescribing for gout, we may be, governed by the
general indications for the different medicines, as
pointed out in the last section.
CHAPTER XXVIII.
H Y D R O PS.  D R OP S Y.
SECTION I.
General description.-Dropsy is generally but a mere
symptom of some other affection. Its proximate cause
consists in an inflammation, congestion, or exalted
action of the capillary extremities of the arterial vessels of the serous and cellular membranes, and a torpor or inactivity of the venous absorbents of the same
parts.
The remote and general causes of dropsy are, excessive loss of blood, and other animal fluids; general
debility resulting from disease, mechanical injuries,
obstructions of the liver, spleen, kidneys, veins, lungs;
abuse of drugs and stimulating drinks. At first view,
an inflammation or congestion of the serous exhalents, would seem  to be incompatible with general
debility, arising from excessive loss of blood, and diseases of the liver, kidneys, lungs, spleen, &c., but the
fact is now well established, that these circumstances
actually favour the formation of these very capillary
inflammations and congestions.
Some writers rhaintain that serous effusions do not
occur until the active inflammatory symptoms are passing off, and a state of sub-acute inflammation obtains;
while others, like Laennec, and Johnson, lay it down
as a fundamental law of serous membranes, "that
they begin to effuse the moment they become inflamed."  It is true that acute inflammations of serous
membranes often occur and subside without leaving
any traces of effusion, but this is owing to the fact,




II YDROPS.-DROPSY.           531
that, during the general febrile excitement, the venous
absorbents of the affected cavities, being equally
irritated with the exhalents, exercise their functions
with preternatural activity, thus conveying off the
fluid as fast as exhaled,' and securing the equilibrium
between exhalation and absorption. After the inflammatory symptoms have subsided, if the exhalents and
absorbents both recover their tone, health returns;
but, as frequently happens, if the latter remain feeble,
while the former return to their normal state, the
healthy balance is lost, and dropsy is the result.
In health, " the cellular tissue and all of those cavities lined by serous membranes, are continually lubricated by a fluid which exhales from the capillary extremities of the arterial vessels."-(Frank.) This
fluid serves to render the parts soft, pliable, and mobile, and to prevent the adhesive inflammation which
would otherwise occur from friction during the movements of the body. These exhalents give out nearly a
given quantity of vapour, and a due equilibrium is
established between the amount secreted for -the use
of the organism, and that which is afterwards taken
up by the venous extremities, and thrown off by -the
skin, kidneys, salivary glands and intestines. So long
as this proportion is maintained, all goes on well; but
whenever any of the serous membranes, like the peritoneum, the pleura, the pericardium, or the arachnoid,
secrete more fluid than is required for the wants of the
economy, or than can be absorbed by the venous extremities, then drafts are made upon other and healthy
parts to supply the increased demand. On this account the perspiration becomes suppressed, and the
skin dry and husky, the saliva scanty and viscid, the
urinary secretions small, high-coloured, fetid, and sedimentitious, the stools scanty and difficult, and the
functions generally deranged.
In cases of dropsy arising from excessive loss of
blood or starvation, the normal physical condition of
this fluid is changed,-the impression it produces upon
the structures is altered, and a superabundance of
serum is poured out into the cavities and the cellular
tissue. This increased exhalation may be due either
to the greater affinity which the serous membranes




532             HYDROrS.-DROPSY.
exert upon the altered blood, or to an irritation of the
capillary extremities which induces an exaltation of
their exhaling function. The experiments of Matteucci teach us, that different fluids pass through the
animal membranes in definite quantities and with
certain degrees of rapidity, according to the character of the fluids used and the condition of the tissue
operated upon. These different phenomena are termed
endosmose and exosmose, and it is by no means improbable that some varieties of dropsy may be partially dependent upon this peculiar action.
Another very important circumstance connected
with the formation ofdropsies, is alluded to by Eberle,
in his Practice of Medicine, viz., "I have already
observed, that immfiediately after a profuse loss of
blood, absorption goes on with unusual activity.
The blood-vessels are rapidly replenished with crude
fluids; for the absorbents being extremely active,
nearly all the aqueous fluids, received into the stomach, are speedily absorbed into the circulation; and
this is especially favoured by the very great thirst
which almost always occurs after excessive sanguineous losses. The blood being thus inordinately supplied
with a crude and watery fluid, becomes more irritating
to the heart and capillaries, and diluted to such a degree
as to pass off more rapidly by the exhalents." Direct
experiments on animals have proved that artificial
dropsies may be produced, by abstracting blood, and
drenching them with water. On the other hand, Majendie and Matteucci have equally demonstrated, that a
fulness of the blood-vessels very materially retards, and
in some instances, entirely suppresses the function of
absorption.
We think, then, it may be safely concluded, that
in every case of dropsy, there are two simultaneous morbid conditions present, namely, increased
exhalation, and decreased absorption, and that, although
irritation and congestion of the exhalents are generally
indispensable conditions to this morbid action, yet that
effusion may result in certain cases simply from an
alteration in the character and quantity of the blood,
by endosmose.
Dropsies are acute or chronic, primitive or seconda



HYDROPS.-DROPSY.            533
ry, simple or complicated; and the character of the
effusion is dependent upon the age, sex, and constitution of the patient, and the nature of each particular
case. Generally, however, the fluid is composed of
albuminous matter dissolved in more or less water,
with different phosphates and carbonates and a little
sulphur, (Frank,) of an oily character, of a citron,
orange, or straw colour, and of a consistency semigelatinous, or like the white of eggs. But these appearances are sometimes subject to variations, as cases
are reported in which the liquid was brown, white,
green, purulent, bloody, saccharine, urinous, and in
some instances containing substances like hydatids,
and bits of membrane.
Much light is sometimes thrown upon the nature
and causes of dropsy, by an examination of the urine.
In certain cases of anasarca, for example, it is found
that the urine coagulates on the application of heat,
and from this circumstance we may suspect the existence of the disease so ably described by Dr. Bright,
under the name ofgranulated kidney. The application
of heat in these cases, first causes the urine to become
milky, and afterwards to present a curdled, or flaky
appearance. "In hydrothorax following scarlatina,
the urine is mixed with cruorine; in hydrothorax depending upon degeneration of the spleen and liver, the
urine contains a large quanity of urea and uric acid,
rosic acid and purpurate." —(Hartmann.)  In other
instances we find the urine loaded with albumen.
In acute dropsies the effusion does not occur until
the active inflammatory symptoms are passing off,
and a condition of sub-acute inflammation supervenes.
In these cases, also, the exhalation takes place with
more rapidity, and is attended with more painful
symptoms, than in the chronic varieties. Now and
then slight accumulations take place, which remain
stationary for years, when they entirely disappear, or
the morbid condition of the exhalants returns, and the
disease advances to its full development. Instances of
this description are often observed in hydrocele, and
in ovarian dropsy.
An excellent diagnostic arrangement of the dropsies




534             IIYDROPS.-DROPSY.
has been made by Marshall Hall, founded upon their
causes, viz:
"; 1.-INFLAMMATORY DROPSY.
"First. The history.-This form of dropsy generally
takes place rather suddenly, and is to be traced to
exposure to wet and cold."
" Second. The symptoms consist in the appearance
of diffuse, tense anasarca, generally with dyspncea,
and frequently with the signs of effusion into the head,
thorax, or abdomen, and wvith a coagulable and occasionally a sanguineous condition of the urine."
" Third. The morbid anatomy varies according as the
dropsy is confined to the cellular membrane, or extended to the serous membranes; in the latter case there
is frequently the effusion of coagulable lymph, as well
as of serum, from the serous surfaces. The kidney,
in protracted cases, becomes disorganized, granular,
scabrous, etc."
" 2.-EXANTHEMATOUS DROPSY.
"First. The history.-This form of dropsy succeeds
to some exanthematous diseases, but by far most frequently to scarlatina."
" Second. The symptoms are similar to those just detailed as designating inflammatory dropsy; there is the
same disposition to effusions into the brain, thorax
and abdomen."
" 3.-DROPSY FROM EXHAUSTION.
"First. The history and symptoms. — This form  of
dropsy is known by being traced to the loss of blood.
It occurs in the form of anasarca, and of effusion into
the cavities. I do not know  whether the urine be
coagulable."
" Second. A similar form of dropsy is induced in
cases of neglected chlorosis."'4.-DROPSY FROM DEBILITY.
"First. The history and symptoms sufficiently establish and distinguish this form of dropsy. The patient
has frequently had returns of dropsical affection, and




HYDROPS.-DROPSY.              535
has a pale and cachectic appearance. The urine
coagulates into brownish flakes by exposure to heat."
"5.-DROPSY FROM OBSTRUCTION IN THE FLOV;
OF VENOUS BLOOD.
" This form of dropsy arises from"First. Disease of the heart, especially of the valves."
" Second. Disease of the lungs."
"Third. Disease of the liver, especially the' cirrhose.'"
"Fourth. Pressure, or disease, of the veins themselves."
" The history and symptoms.-This kind of dropsy is
distinguished by ascertaining the seat and nature of the
original disease. Like the rest, it assumes the form of
anasarca, and of effusion into the serous cavities, and
into the cellular membrane of the internal organs, as
the lungs, intestines, &c.  The urine is not coagulable."
"s 6.-DROPS.FROM DISEASE OF THE KIDNEYS.
"For the detection of this species of dropsy, the
profession and mankind are indebted to Dr. Bright."
" First. The symptoms.-It is distinguished by the
coagulable condition of the urine. The urine is apt
sometimes to be sanguineous."
"Second. The complications.-There is, in this kind
of dropsy, occasionally"First. An attack of apoplexy; and frequently,
"Second. Inflammation of the serous membranes, and
especially of the pleura."
" The liver is usually found free from disease.' The morbid anatomy.-Dr. Bright describes three
kinds of this disease of the kidney. In the first, the
kidney loses its usual firmness, and becomes of a yellow mottled appearance externally. The size of the
kidney is not materially altered. In the -second, the
whole cortical part is converted into a granulated texture, and there appears to be a copious morbid interstitial deposit of an opaque white substance. The
kidney is generally rather larger than natural. In the
third, the kidney is rough and scabrous externally, and
rises in numerous, projections not much exceeding a
large pin's head, yellow, red, and purplish; it is hard
and inclined to be lobulated, and its texture approaches




536             HYDROPS.-DROPSY.
to a semi-cartilaginous firmness; there appears, in
short, a contraction of every part of the organ, with
less interstitial deposite than in the last variety."
General diagnosis.-The symptoms most commonly
observed in dropsy are, sensation of weight, oppression,
fulness, and uneasiness in the part affected, with more
or less disturbance of the neighbouring tissues; dyspncea and sense of suffocation after attaining the horizontal posture, and after active exercise; general
feeling of debility, and disinclination to bodily or mental exertion; partial, and in some instances, almost
total suppression of the urinary, salivary, and perspiratory secretions; impaired appetite; feeble digestion;
rare and scanty alvine discharges; thirst; countenance
pale, sallow, or cachectic; emaciation; " diminution
of animal heat, sensation; and motion," (Frank,) general derangement of nearly all the functions.
In cellular dropsy, the affected part is swollen, the
skin presents a smooth and shining appearance, with
blue veins traversing it in different directions, and pressure with the finger causes a deep indentation or pit,
which remains for a considerable time. There is also
an apparent diminution in the temperature of the part,
and a sensation of weight and tension is experienced,
rather than of acute pain. The accumulation of
serum becomes so great in some instances as to burst
through the integuments, and thus partially discharge
itself.
In acute dropsies of the serous membranes, the symptoms are more active. Here we have general febrile
disturbance; acute tenderness and pain in the disordered part, especially on pressure, or contact of light
clothing; urgent thirst; hot and dry skin; urine very
scanty and high-coloured; saliva viscid, tenacious,
and small in quantity; loss of appetite; furred tongue;
rapid sinking of the physical energies. These acute
symptoms often subside, and leave the inflamed membrane in a state of sub-acute inflammation, thus developing a well-pronounced chronic dropsy.
It will be observed in our previous description of
symptoms, that we have included a diminution of the
urinary, salivary, and intestinal secretions. as characteristic of this malady; but these signs are not inva



ItYDROPS.-DROPSY.           537
riably present, for in a few instances we have witnessed an abundant and natural urinary and salivary
secretion during the continuance of the complaint.
So, also, one or more of the other symptoms described
may be wanting, and yet the dropsical affection proceed to a fatal termination; but these circumstances
are rather to be looked upon in the light of exceptions,
than as general occurrences.
Prognosis.-Our prognosis must depend much upon
the cause and nature of each particular case. Simple
cellular or serous dropsies, uncomplicated with disorganization of any of the important organs, are, for the
most part, curable. In this class we may rank exanthematous dropsies, and those which have arisen from
loss of blood, from acute diseases in which no serious
organic derangement has occurred, and from abuse of
mercury and other drugs. In these cases, a speedy
removal of the causes which have conduced to the
disease, with pure air, a generous diet, and a judicious
course of honceopathic medicines, will generally enable us to remove permanently the morbid accumulation.
On the contrary, if the effusion has arisen from an
organic affection of a vital organ, like the heart, the
liver, the lungs, the kidney, or from incurable obstruction in the veins, our prognosis must be unfavourable.
In these cases of complicated dropsy, our remedial efforts must be adapted to the remote general disease,
as well as to the immediate symptoms of the malady.
Although the chances of cure are small in cases of this
description, yet, as recoveries do occasionally take
place in individuals of naturally vigorous constitutions, and in those who are tenacious of life, we should
never prostrate our patients by discouragement and a
grim visage, but constantly point them to a beacon of
hope in the dim distance. By this means, we secure
a powerful auxiliary to co-operate with us in our
efforts to bring about those changes in the organism
which may lead to a cure.
We come now to treat of the different species of
dropsy, viz.:
First. Anasarca.      Second. Ascites.
Third. Hydrothorax.   Fourth. Hydrocephalus,
Fifth. Ovarian dropsy.  Sixth. Hydrocele.




538              HYDROPS.-DROPSY.
1.-ANASARCA. —CELLULAR DROPSY.
Diagnosis.-The term anasarca is used to designate
that variety of dropsical effusion which takes place
from the exhalents of the sub-cutaneous cellular tissue. The malady first manifests itself in the inferior
extremities, particularly after standing or walking for
some time, and it gradually extends upwards until the
whole sub-cutaneous cellular tissue of the organism
becomes involved. The tumefaction is usually soft,
doughy, and inelastic, pitting on pressure, and the
skin is white, shining, and below the medium temperature. The swelling disappears, in a great measure,
after the patient has been for some time in the recumbent position, but returns again when he has resumed
the erect posture.  Cellular dropsy' may exist for
years without causing serious inconvenience, when
confined to the inferior extremities, but it is rare that
the whole cellular surface becomes involved, unless
some vital disorganization exists, or the energies of
the system have become dangerously impaired.
The cases of anasarca attended with the least danger, are those arising from scarlatina, pregnancy, loss of
blood, debility consequent upon convalescence from
acute diseases, abuse of arsenic and mercury, enlarged
inguinal glands, the pressure of tumours, or any other
curable cause which operates to prevent the free return of the venous blood.
Effusions of this kind may very properly be termed
passive dropsies, for we agree with Dewees, " that
there are both active and passive dropsies, or rather
dropsies that depend upon an increase of action or of
inflammation, and others where there may be a mere
loss of balance between the exhalation and absorption."
In cases of dropsy arising from venous obstruction, for example, the venous absorbents below the
seat of the obstruction, are preternaturally distended
with blood, and, as a consequence, their powers of
absorption proportionably diminished, while the arterial exhalents exercise their function with the usual
activity. In this manner the equilibrium between exhalation an(l absorption is destroyed, and dropsical




HYDROPS.-DROPSY.            539
accumulations obtain. So in phthisis pulmonalis, and
affections of the heart, the blood being but imperfectly decarbonized in its passage through these diseased
organs, becomes congested in the venous absorbents,
and thus gives rise to diminished absorption, and consequent serous accumulations.
Anasarca is not usually attended with much constitutional disturbance, or with symptoms that are
painful. There are present, however, coldness of the
surface, and diminished secretion of urine and sweat.
The countenance is also pale and sallow, and the
general appearance indicates ill-health. Not unfrequently the effusion continues to increase until the
affected parts become enormously distended, and finally crack and give issue to the accumulated serum.
VVhen this happens in erysipelatous or syphilitic subjects, sloughing and gangrenous ulcers sometimes supervene, which prove highly troublesome and dangerous.
Causes.-The peculiar condition consequent upon
scarlatina, measles, phthisis pulmonalis, chlorosis, and
diseases of the heart; venous obstructions caused by
the gravid uterus, by the pressure of tumours, enlarged glands, ligatures, and mechanical injuries, sudden
and excessive loss of blood, abuse of stimulants,
arsenic and mercury.
2.-ASCITES, OR ABDOMINAL DROPSY.
Diagnosis.-Dropsy of the belly may arise suddenly
in consequence of acute peritoneal inflammation, and
be attended with the ordinary symptoms of other
febrile diseases, or it may make its appearance in a
gradual and imperceptible manner, unattended by any
notable constitutional disturbance. During attacks of
peritonitis, there is an increased exhalation from the
inflamed serous vessels, from the very commencement
of the disease, and so long as the whole organism
labours under the exalted action incident upon the
fever, the venous absorbents dispose of this superabundance of serum; but after the active symptoms
have subsided, a corresponding depression obtains in
all parts of the economy, except,'perhaps, the affected




540              YDROPS. — DROPSY.
membrane, in which there still may remain a subacute inflammation and its consequence, a preternatural effusion of serum. In vigorous constitutions,
the absorbents continue to remove the exhalation as
fast as formed; but in feeble, delicate, or scrofulous
subjects, the function of absorption often languishes,
the equilibrium between the exhaling and absorbing
functions is destroyed, and an ascites is the result.
The signs which characterize abdominal dropsy are,
gradual enlargement of the abdomen, first observed in
the epigastric region, and afterwards extending over
the whole abdomen; tenderness on pressure; difficulty of breathing on taking exercise, and some time
after lying down; distinct fluctuation on percussion;
sallow and unhealthy complexion; dry skin; scanty
secretion of high-coloured and sedimentitious urine;
foul tongue, with a small secretion of viscid saliva;
impaired appetite; constipation, or relax; sensation
of weight and stiffness, particularly when attempting
to move about, or bend the body; general feeling of
languor and debility.
The only diseases which are liable to be confounded
with ascites, are pregnancy and tympanitis; but the
history and circumstances of each case will enable us
to distinguish with sufficient facility and certainty between the different maladies. In ascites, the situation
of the swelling, the fluctuation on percussion, the
suppression of urine, dry skin, and the previous history of the case, will mark the nature of the complaint; and in pregnancy, the gradual swelling at the
lower part of the abdomen, the suppression of the
menses, nausea and vomiting; the absence of fluctuation on percussion, and the motion of the child, will
render our diagnosis accurate. Nor will the acute
physician ever mistake tympanitic distention for
ascites: for percussion, auscultation, and an absence
of the characteristic symptoms of dropsy, will enable
him to decide at once in regard to the real nature of
the case. Indeed, we can hardly conceive how certain eminent surgeons should have been led to perform
the operation of what they have afterwards facetiously termed "dry tapping," when the distinguishing




HYDROPS.-DROPSY.             541
marks between tympanitic and aqueous distention are
so easily recognised.
Authors have described several distinct varieties of
abdominal dropsy, and have named each according to
its precise location; thus, sub-cutaneous ascites, in
which the effusion takes place in a circumscribed
cavity or sac in front of the abdominal muscles; vaginal ascites, arising from a puncture or other injury
to the aponeurosis of the muscles, and causing effusion
into the sheath of the muscle; peritoneal ascites, or
effusion within the serous cavity, and in some rare instances, on the outside of the membrane; hydatid ascites, in which the water is enclosed in one or more
thin vesicles; also dropsy of the epiploon, of the mesentery, of the intestines, of the liver, of the spleen, of
the gall-bladder, and encysted ascites. This minute
classification is, however, quite unnecessary for practical purposes, since ascites is often complicated not
only with several of these varieties, but with hydrothorax, anasarca, and general dropsy. It is so very
rare that we find the above-named organs affected
separately, that we question the propriety of recognising in them distinct species of dropsy, although it
is of some importance to be aware of the fact that
these distinct effusions may occur.
Causes.-The most common causes of ascites are peritoneal inflammation, affections ofthe liver, and abuse of
stimulating drinks. It may also proceed from venous
obstruction, general debility in consequence of disease,
loss of blood, and abuse of drugs.
Prognosis. —Our opinion respecting the probable
termination of ascites will be determined by the following circumstances: old age, and a constitution impaired by previous disease or by excesses, must always render our prognosis unfavourable. Dropsies
complicated with incurable functional derangement of
the liver, or other vital organs, and- venous obstructions, are for the most part beyond the reach of medicine. On the other hand, ascites consequent upon
acute inflammation of the peritoneum, loss of blood,
abuse of stimulants and drugs, and the debility arising
from fevers and other acute diseases, may generally
be set down as curable. When the malady occurs in




542             HYDROPS.-DROPSY.
young and naturally robust constitutions, our prognosis
will be still more favourable, and in some instances,
may afford grounds of encouragement in highly complicated cases.
Paracentesis abdominis, or tapping.-This operation
should always be deferred as long as possible, in order
to allow a reasonable time for the action of medicines.
If, however, the accumulation becomes very great,
and the symptoms are so urgent as to prevent all exercise, destroy rest in a sitting or recumbent posture,
and thus serve to wear out the energies of the system,
the operation should not longer be delayed. At the
same time, the most judicious medicinal treatment
should be perseveringly directed to both the proximate and remote symptoms of the malady. The operation of tapping is of itself simple, and entirely unattended with danger when proper precautions are used;
but as the effusion usually takes place with much
more rapidity, after the serum has been evacuated, than
before, it will be apparent that paracentesis abdominis
should only be had recourse to when the symptoms
are particularly urgent.
3.-HPYDROTHORAX, OR DROPSY OF THE CHEST.
Hydrothorax is either idiopathic, or symptomatic of
some other organic disease. By far the most common
source of the affection, and one which constitutes a
serious complication, is organic disease of the heart.
Another frequent cause of dropsy of the chest, is protracted pleuritic inflammation.. Dropsy of the heart
generally co-exists with hydrothorax, and it is for this
reason that we so often find the pulse very irregular.
The symptoms are most urgent during the night, after
the patient has remained some time in the recumbent
posture. The breathing becomes rapid, laborious, and
grunting, with frequent sighing, sudden starting during
sleep, anxious and distressed expression of countenance, face pallid and wax-like; small secretion of
high-coloured urine; puffiness of the face and extremities; fulness of the chest; dull sound on percussion.
Dyspnoea occurring from  the slightest exercise, or
from lying down, sudden starting up with fright, during sleep, dull sound on percussion, and irregular




HYDROPS.-DROPSY.             543
pulsations of the heart, will enable us to recognise the
affection without difficulty.
Laennec assures us that hydrothorax accompanies
many acute and chronic diseases, and that "its presence announces the approach of death, which it often
precedes only a few moments." That these effusions
do sometimes occur but a short period before death,
from organic affections of the heart, and possibly of
other organs, we entertain no doubt, for several cases
have come under our observation, strongly corroborative of this fact.
As dropsy of the heart is so constant an attendant
on hydrothorax, and the symptoms of each so constantly similate each other, it is unnecessary to enter into
a separate description of this malady. When the effusion originates from an affection of the heart, or the
pericardium, there will always be a predominance of
those symptoms which characterize cardaic disease,
and afford us a sure guide in forming our diagnosis.
Paracentesis thoracis may, in some instances, be resorted to with unequivocal advantage, for the relief of
purulent collections within the thorax, but very rarely
in hydrothorax. We have in two instances saved life by
a prompt resort to this operation, where matter had
accumulated in the chest, and the patients were at the
point of death from suffocation; but in thoracic dropsies, very slight encouragement can be offered from
its performance, although in extreme cases it is not to
be lost sight of, since recoveries have now and then
taken place after the operation.
4.-OVARIAN DROPSY.
In this species of dropsy, the effusion takes place
from the internal face of the membrane which encloses
the ovarium. The swelling is first observed in the
iliac region, in the forni of a small elastic tumour, and
unattended with pain, uneasiness, or constitutional
disturbance. The enlargement generally progresses
very slowly, extending upwards towards the kidney
of the affected side, then crossing the abdomen to the
opposite side, until ultimately it comes to occupy the
whole of the abdomen. No serious inconvenience is
experienced, until the tumour has attained such a size




544            HIYDROPS.-DROPSY.
as to encroach upon the bladder, stomach, diaphragm,
intestines, and the larger blood-vessels, thus giving
rise to difficulty in urinating, sense of weight and uneasiness in the stomach, dyspnmea, colicky pains in the
bowels, paips in the side and chest, diminution of the
secretions, and cedema of the feet and ankles.
The tumour often remains stationary, and almost
punnoticed for twenty or thirty years, when some sudden exciting cause will operate, and the swelling rapidly attain an enormous size.
The contents of ovarian tumours vary much in their
character, being sometimes serous, sometimes albuminous, or purulent, or sebaceous, or fatty, or composed
in part of organized structures. Dr. Clapp, Surgeon
to Exeter Hospital, has recently reported a case in
which the contents of the tumour " consisted of teeth,
hair, bony deposit, some transparent masses of a cellular structure, (as examined by the microscope,) serum, sebaceous matter, and granular fat, which were
contained in numerous small cysts. Teeth were found
in all parts of the tumour, and were counted to the
number of forty-three; some were contained in cysts,
others were imbedded in the semi-transparent masses,
and two or three were growing from the walls of the
parent cyst. In one part, a few were imbedded in a
mass of bone, bearing a strong resemblance to an
upper jaw united in the mesial line."
Fluctuation can rarely be perceived in the swelling
until it has attained a considerable size, but the location of the tumour, and the absence of pain or other
unpleasant symptoms, will enable us to form a correct
opinion in the early stage of' the complaint.
5.-HYDROCELE, OR DROPSY OF THE TESTICLE.
A description of this disease is appropriate to surgery rather than to medicine, but as the usual method
of cure serves to corroborate the truth of similia similibus, we make some allusion to the subject in this place.
The fluid of hydrocele is situated within the tunica
vaginalis testis, commencing at the lower part of the
scrotum, and gradually extending upwards until it
reaches the external abdominal ring. The tumour is
pyriform in shape, firm and elastic to the touch, and




HYDROPS.-DROPSY.            545
unattended with pain. It is only troublesome from its
bulk and weight.
Much difficulty is sometimes experienced in distinguishing this disease from enlargements of the testicle, and in more than one instance, we have seen this
gland destroyed by injudicious attempts to draw off
water from chronic enlargements of the substance of
the gland. Generally, dropsy of the testicle may
be recognised by its peculiar elasticity, its lightness,
form, its origin at the lower part of the scrotum,
and its gradual extension upwards, and, lastly, by its
transparency. By placing the swelling in front of a
lighted lamp in a dark room, its character will be
apparent from its transparency. But in some cases,
from the great thickness of the tunica vaginalis, or the
dark colour and density of the enclosed fluid, no
transparency can be perceived. In these instances,
we must be guided by the fluctuation, lightness, form,
painlessness, and general history of the case.
Accumulations of fluid also occur within the membrane of the spermatic chord, constituting the disease
known as spermatocele. This is a local affection,
analogous in its nature to hydrocele.
Hydrocele occasionally occurs as a congenital disease, arising from an impeffect closure of the tunica
vaginalis, and thus permitting the fluids of the abdomen to descend into its cavity.
Operation.-The most successful means of treating
hydrocele is to evacuate the serum by means of the
trochar and canula, and then to create a healthy medicinal action in the tunica vaginalis, with suitable
injections. Merely drawing off the fluid is of no
avail in effecting a cure, for the morbid condition of
the membrane still remains, and the exhalents again
fill up the cavity. Change then the morbid condition
of the structure, and supersede it by a new and
different action, and you will cure the disease. But
it will be said, that by applying our remedies directly
to the structure, we are obliged to create more inflammation than is necessary in order to effect a cure.
Show us, then, how it can be effected by internal
remedies, with anyJkind of certainty,-point us to a




546             HYDROPS.-DROPSY.
specific which will reach the case, and we will be of
the first to adopt it.
The most reliable medicine we have ever used as an
injection, is a mixture of one part of tincture of iodine
to two parts of water. Let this be injected within
the tunic, and remain for five or ten minutes, or until
sharp pains are experienced in the gland and the
spermatic chord, after which, carefully permit the
fluid to escape from the canula. The use of iodine is
not apt to be followed by sloughing, or undue inflammation, yet it almost invariably suffices to effect a
permanent cure.
Other injections have been highly extolled by surgeons, as solutions of alum, zinc and lead, port-wine,
&c., but they have too often failed in my hands to inspire me with confidence in their virtues, while uniform success has given me every reason to be satisfied
with the iodine,
For an account of hydrocephalus, we refer to
page 381 of this work.
Theraqpeutics.-It has been already observed, that
dropsy is usually but a symptom of some other malady. Some of the causes which induce it, operate for
a certain length of time, and then subside spontaneously, together with -its symptoms of effusion.
Amongst this class of causes may be placed, pregnancy, temporary pressure of tumours, intermittent
fevers, and inordinate doses of arsenic.
Another class of causes which demands the gravest
attention of the physician, consists of functional derangements of important organs, impaired constitutions, protracted debility from excessive loss of animal
fluids, habitual intemperance, general cachectic habit
of body, chlorosis.
The first indication of cure consists in removing,
as far as is practicable,the cause of the dropsy. To do
this successfully, it is necessary to enter into a minute
investigation respecting the private habits of the patient, as well as the present symptoms. By this means,
abuse of stimulants, of drugs, and excesses of all
kinds, may be guarded against, which otherwise
would have operated unfavourably during our curative efforts.




HYDROPS.-DROPsY.             547
As a general rule, pure air, moderate exercise, an
agreeable state of mind, a light and nutritious diet,
and a sufficient quantity of warm clothing, should be
enjoined. A change of location, or a sea-voyage, are
often powerful auxiliaries in the treatment.
When dropsy depends upon incurable organic affections of the heart or liver, much may be done towards palliating the symptoms and protracting the
patient's life, by an avoidance of all those causes
which tend to aggravate the primary source of the
disease, such as undue physical exertion, violent emotions and passions, &c.
Our efforts should also be directed, without cessation, towards changing the morbid condition of the
membrane upon which the dropsy is dependent. Our
remedies, therefore, must cover the remote as well as
the proximate symptoms of the malady.
The remedies which we deem most valuable in the
treatment of dropsical effusions, are, apis mel., arsenicum alb., digitalis, china, hellebore, colchicum, dulcamara, asparagus, cantharides, scille, hyd. potassce, mercurius, uva ursa, elaterium.
In asciles and hydrothorax, the first trituration of
the common honey-bee has proved astonishingly efficacious in our hands. The influence which this remedy
exercises upon the urinary organs, as well as upon
the peritoneum and pleura, is of the most prompt and
decided character. In large doses, it causes a sense
of fulness, constriction, or of suffocation in the thorax;
difficult and anxious respiration; pain and tenderness
of the abdomen, increased on pressure or by contact;
symptoms worse in the horizontal posture; great secretion of urine, which is pale or of a straw colour,
and deposites a reddish or brick-coloured sediment;
frequent desire to urinate, and strangury.
Our method of preparing the medicine is as follows:
Enclose the bees in a close vessel, and expose them to
a temperature of 900 (Fahr.), until all moisture has
escaped from them, and they are sufficiently dry to
pulverize readily; we then triturate five grains of
this powder with one hundred grains of sugar of milk
for the usual period, and administer the trituration in
grain doses from two to four times in twenty-four




548             HYDROPS.-DROPSY.
hours. Whether the active principle of this substance
consists solely of the virus connected with the sting
of the insect, or whether other parts possess active
properties, we know not: our opinion, however, inclines to the former view.
We quote the following case, which occurred in
the practice of Dr. Taft, of Hartford. The patient, a
boy of twelve years of age, was attacked in July,
1849, with dysentery. After several weeks of medication under an allopathic physician, the acute symptoms subsided, and the evacuations gradually assumed
their natural state, but there remained an unnatural
fulness and tenderness of the abdomen, some difficulty
of respiration, especially on assuming the recumbent
position, a dry and harsh skin, and a materially diminished secretion of urine. Notwithstanding the persevering employment of the usual allopathic routine
of cathartics, mercurials, and diuretics, the patient
continued to grow worse, his abdomen became very
much distended with serum, and very tender to the
touch, or from even the pressure of the bed-clothes;
the respiration became exceedingly laborious and
difficult, obliging the sufferer to remain for a good
portion of the nights in his chair; impaired appetite,
an almost entire suppression of urine, emaciation,
debility, small and rapid pulse, anxious expression,
and other signs accumulated.
In this condition he came under the care of Dr. Taft,
who administered digitalis, arsenicum, dulcamara, mercurius, china, sulphur, hellebore, as the symptoms appeared to indicate, but without any amelioration of
the symptoms. In the meantime, the increasing difficulty of respiration, loss of rest, of appetite, and
pain, had reduced the patient to so serious a condition,
that I was called in council with Dr. Taft, in order to
decide respecting the propriety of paracentecis abdominis. In consideration of the urgency of the symptoms, and the inefficiency of the remedies which had
been used, I evacuated the effused fluid, amounting to
sixteen pounds, and advised a second trial of arsenicum
and digitalis. No effects, however, resulted from their
use: the secretion of urine remained the same, the
skin dry and husky, the abdominal effusion continued,




?IYDROPS.-DROP1Y.           549
the oppression of the chest, sense of suffocation and
difficulty of breathing gradually increased, and signs
of thoracic effusion began to be exhibited. Recourse
was now had to the powder above alluded to, and
with the most speedy and marked results. After two
or three doses, a large quantity of urine was passed,
and the symptoms were all ameliorated. After -the
remedy had been continued for two weeks, all traces
of effusion disapp.eared, the appetite and strength began to improve, and the respiration became natural
and easy. The patient continued to convalesce without
any further unfavourable indication, until perfect
health was restored. We have witnessed the effects of
this remedy in two other cases of ascites, in one case
of protracted general dropsy, and in one case of hydrothorax, and with the same favourable results. The
powder of dried honey-bees has long been used as a
remedy in dropsies by the aborigines of our country.
Arsenicum.-External indications.-General appearance of exhaustion and debility; pallid, waxen, and
sickly countenance; cheeks, lips, and eyelids bloated
and puffy, causing a marked alteration in the expression; dropsical swellings of the extremities and abdomen; mouth and tongue dry; tongue tremulous, red,
bluish, or covered with a white coat; urine scanty,
dark, and turbid or slimy; general coldness and dryness of the skin; general anasarca, with discharging
vesicles on different parts of the affected surface;
emaciation; dark coloured spots or blisters on different parts of the body; pulse small, feeble, and intermittent.
Physical sensations.-General sense of prostration;
great nervous sensibility; paralytic feeling in the
swollen parts; palpitation of the heart; turns of faintness; great difficulty of breathing when exercising,
and after lying down; restlessness; anguish and oppression in the thorax and epigastric region; humming and roaring in the ears and head; bad taste in
the mouth; loss of appetite; dryness of the mouth
and tongue; thirst; tenderness of the abdomen on
pressure; difficult and scanty alvine discharges, or
slight diarrhoea; frequent desire to urinate, although
but a small quantity is secreted; anxious, difficult,




550             IIYDROPS.-DROPSY.
and rapid respiration while in the recumbent posture;
heaviness and stiffness of the limbs and body; disturbed sleep, from impeded respiration, dreams;
chilliness, alternating now and then with flushes of
heat; diminution of sensation and power in the
swollen parts; symptoms worse after eating, exercise,
and lying down.
Mental and moral symptoms.-General mental uneasiness; fits of anguish and discouragement; disinclination to remain long in one position; apprehension
that it is impossible to recover.
Digitalis. —External indications.-This remedy has
been found curative in general anasarca, ascites, and
hydrothorax originating in organic disease of the heart;
also, paleness of the face; blue lips; swelling of the
eyelids; coated tongue; scanty secretion of high-coloured urine; strong and visible pulsations of the
heart; irregularity of the pulse; general paleness of
the skin.
Physical sensations.-Vertigo; pressure in the forehead and vertex; ringing and hissing in the ears; want
of appetite; flat taste in the mouth; thirst; pressure
in the stomach; distention of the abdomen, with
stitching pains; pressure at the neck of the bladder,
with frequent desire to urinate; -throbbing in the
chest; sharp stitches in the region of the heart; respiration anxious and difficult on walking or lying
down; lassitude and diminished sensation in the inferior extremities; constant inclination to sleep; disturbed sleep; faintness.
Mental and moral symptoms.-Dulness of intellect;
vertigo; forgetfulness; gloomy, peevish and indifferent.
Remarks.-Digitalis has proved most advantageous
in dropsy consequent on organic disease of the heart,
and in anasarca following scarlatina. Dr. Kurtz considers digitalis in decoction an excellent remedy in
this complaint, and that the dilutions are useless.
Scillce has been employed successfully in ascites
and anasarca, by Hartmann, Currie, Noack and Trinks.
Hahnemann did not entertain a high opinion of this
substance as a remedy for dropsy, since its primary
effect was to stimulate the kidneys and cause a co



HYDROPS.-DROPSY.             551
pious emission of urine, while its secondary effect was
always the opposite of this, viz., to suspend almost
entirely the urinary secretion.
China.-External indications.-Countenance pale or
sallow, sunken and sickly; general appearance of
languor and debility; dropsical swellings in one or
more parts of the body; enlargement and induration
of the liver; emaciation; dryness of the skin, mouth
and tongue; urine scanty, pale or dark coloured, and
depositing a brick-dust sediment; coldness of the
whole surface of the body; skin yellow; tremour in
the limbs when attempting to walk.
Physical sensations.-Exhaustion arising from protracted acute diseases, from excessive loss of blood,
and from abuse of drugs; pain and tenderness in the
region of the liver; heaviness and pressure in the
head, from within outwards; humming and ringing in
the ears; bitter or flat insipid taste; loss of appetite;
thirst for cold water and acids; oppression of the stomach and abdomen, especially after eating or drinking;
constipation; respiration short, rapid, and at times
suffocative; nights restless, and sleep disturbed by
dreams; great sensitiveness to cold; frequent shuddering, when drinking cold water, or when exposed to
the air; swelling and stiffness of the limbs; weariness
of the limbs, with constant desire to change position;
symptoms aggravated by contact, by eating, and at
night.
Mental and moral symptoms.-Low spirited, nervous
and irritable; sometimes anxious, gloomy and apprehensive of evil, and at other times indifferent, taciturn,
and stupid; confusion of ideas; disinclination to
physical or mental labour.
Remarks.- China will be found curative in those
dropsies which are the result of simple debility which
has been caused by loss of animal fluids, protracted
illness, and abuse of cathartics. It may also be exhibited in anasarca consequent on attacks of intermittent and other fevers.
Hellebore.-External indications.-Face and  lips
swollen, and of a pale or yellowish cast; fluctuating
swelling of the abdomen; general anasarca; spasmodic or convulsive movements of the head and limbs




552             HYDROPS. —DROPSY.
twitching of the eyelids; dulness and stupor; coldness
of the surface; suppression of urine.
Physical sensations.-Throbbing or compressive pain
in the head; oppression at the chest and stomach;
cramplike pains in the abdomen; frequent desire to
urinate, with scanty emission; loss of appetite; nausea,
and pain in the stomach and bowels, followed by a
loose alvine evacuation; short, dry cough; difficulty of breathing; sharp stitches in the head, chest and
abdomen; heaviness and rigidity of the limbs; symptoms better in the open air.
Mental and moral symptoms.-Dulness of intellect;
weakness of memory; painful stupefaction of the
head; frequent sighing and moaning; giddiness on
rising up, or walking; confusion of ideas.
Remarks.-Hellebore is particularly commended in
dropsies complicated with intermittent fever, after the
fever has been cured by ars., also in anasarca and
ascites of children, arising from  scarlatina. It has
effected prompt cures of dropsical effusions upon the
brain, attended with convulsive motions of the head
and limbs.
Colchicum. —External indications.-Face yellow and
cedematous; dropsical swelling of the abdomen;
(edema of the feet and legs; visible palpitation of the
heart; skin dry and cold, or alternating with heat during the night; rapid and difficult respiration; pulse
full and hard, or quick and small; urine scanty, and
dark coloured.
Physical sensations.-Nausea, burning and icy coldness of the stomach; distention of the abdomen, with
pressure and colicky pains; abdomen tender on pressure; loose and painful stools; oppression of the chest;
palpitation of the heart; tearing pains and stiffness in
the back, side, and limbs; drowsy during the day, but
restless nights; symptoms worse during the night;
also aggravated by mental labour.
Mental and moral symptoms.-Tendency to exaggerate symptoms; absence of mind; forgetfulness;
dissatisfaction from slight causes.
Remarks.-This remedy is useful in dropsical swellings caused by atmospheric vicissitudes, excessive
mental labour, sudden suppression of the perspiration,




HYDROPS.-DROPSY.             553
and in- anasarca consequent upon scarlatina and
measles.
Dulcamara. —External indications.-Face, abdomen,
and limbs bloated; urine small in quantity, turbid, and
fetid; heat and dryness of the skin; empty eructations.
Physical sensations.-Loss of appetite; dry mouth
and tongue; great thirst for cold drinks; empty eructations after meals; nausea; restless, hot and feverish during the night; constipation; catarrhal symptoms; symptoms worse at night, better on motion.
Mental and moral symptoms.-Irritable and angry
disposition; also scrofulous and phlegmatic constitutions, and great sensitiveness to cold.
Remarks.-Applicable in dropsies which have arisen
from exposure to cold, and general anasarca consequent on fever and ague, scarlatina, and rheumatic
fever.
Asparagus. —External indications. - Countenance
pale, waxlike, and bloated; general expression of anxiety and distress; unusual fulness of the chest; coldness of the surface; suppression of the perspiration;
urine scanty, straw-coloured, and offensive to the
smell; visible throbbing of the heart, especially in
the night; rapid, laborious, and sighing respiration;
pulse feeble and irregular.
Physical sensations. —Feeble appetite; sense of
fulness and oppression after eating or drinking; palpitation of the heart; great oppression of the chest,
and rapid and difficult breathing, increased after being
in bed for some time; sleep uneasy and disturbed by
the oppressed respiration; constant inclination to be
carried about in the arms by a child; great languor
and disinclination to physical or mental exertion;
stitching pains in the region of the chest.
Moral symptoms.-Fretful and peevish; disturbed
by trifles; constant anxiety and apprehension.
Remarks. —In two cases of hydrothorax following
acute attacks of peripneumonia, in children of three
and five years of age, I have found asparagus of sig.
nal service after several other remedies had failed.
One of these cases was complicated with an organic
affection of the heart, and an almost entire removal
of the cardiac symptoms followed the cure of the
24




554              HYDROPS.-DROPSY.
dropsy. We are quite convinced that this remedy
will prove one of great efficiency in the treatment of
hydrothorax and general dropsy, and we respectfully
urge it upon the attention of practitioners. It should
always be advised in dropsies as an article of food.
Cantharides is recommended in dropsy caused by
tonic spasm of the neck of the bladder, and by perverted action of the kidneys. It may also be administered in effusion occurring in the last stages of
acute and chronic diseases, as a palliative.
Hyd. potassea is adapted to Edematous swellings
resulting from the pressure of enlarged glands upon
the veins. It has likewise proved highly beneficial
when administered by me for the relief of dropsy
arising from Dr. Bright's granulated kidney.
Mercurius has been praised as a valuable remedy
in chronic hydrothorax, and in ascites from diseased
liver. It is worthy of attention in ovarian dropsy,
and effusions dependent upon enlargement of the
spleen.
Uva ursa has cured several cases of ascites dependent upon abuse of stimulating drinks, and abuse of
drugs. Its influence in restoring the urinary secretions is usually very prompt and satisfactory.
Other remedies which have occasionally been found
useful in dropsies are, elaterium, rhus tox., lycopodium,
bryonia, ol. tiglii, potassce nit., iodine, solanum  nig.
phosphorus, bacce juniper.
Administration. —ln the treatment of acute dropsies,
we advise the employment of the third to the sixth
attenuations, and a repetition of the dose every two
or four hours until effects from the medicine are apparent. In chronic dropsies, we employ the first to the
third attenuations, and repeat once or twice in twentyfour hours until a suitable impression is produced.




555
CHAPTER XXIX.
CHLOROSIS.
General description.-Young unmarried females, of
delicate lymphatic constitutions, slight figures, and
highly impressible nervous systems, are by far most
liable to attacks of chlorosis. In a majority of instances, it will be bfound that chlorotic girls have been
remarkable, from birth, for delicacy of organization,
daintiness of appetite, feebleness of digestion, and
undue sensibility of the whole system. So long as
this nervous sensibility is not overtasked, and no important causes operate to derange the delicate equilibrium upon which the proper operation of the functions depends, the individual enjoys passably good
health; but when the period of puberty arrives, and
nature calls for- her monthly tribute from the vital
fluid itself, —when new thoughts and new desires
powerfully stimulate the system, —when, in fine, the
important change of the whole organism, during the
establishment of the catamenial function, occurs, then
the frail balance is destroyed, the digestive, absorbent,
and assimilative functions fail, and those symptoms
which mark chlorosis make their appearance.
The disease sometimes attacks married females
even when considerably advanced in years; and it
has likewise been observed in girls of two or three
years of age; but cases of these kinds are of extremely rare occurrence. Men of studious and sedentary
habits, especially those who have never taken much
exercise, have been occasionally subjected to it.
Chlorosis is more common in cold than in warm
climates. This circumstance is attributable, in part,
to the pernicious custom at the north, of keeping children a large portion of the year in close rooms, at a.
temperature of 75 to 800 Fahrenheit, thus preventing
that free development of the body which would result
from pure air and abundant exercise. Another reason
offers itself in the fact, that persons of frail, nervous,
and lymphatic constitutions, cannot often withstand




556                 CHLOROSIS.
the severities of a temperate latitude, without suffering more or less from disorders of the glandular and
membranous structures.
Diagnosis.-The symptoms commonly observed during the forming stage of chlorosis are, derangement
of the stomach and bowels, manifested by a pale and
bloated appearance of the tongue, foul breath, partial
or total loss of appetite, morbid craving for certain
indigestible articles, like coal, chalk, clay, acids, pencils, etc.; torpid state of the bowels; tympanitic distention of the abdomen, accompanied with occasional
griping pains; feacal discharges, composed of crude
and imperfectly digested substances, unnatural in
colour and consistence.
Soon after the appearance of these symptoms, if;he disease continues, the patient becomes listless, irritable, fond of solitude, and disinclined to bodily or
mental exertion; the menstrual function becomes deranged; the face pale and tumid; the lips lose their
colour; the eyelids are swollen and surrounded by a
dark, greenish, or yellowish circle; emaciation commences; the debility and lassitude become more apparent; many nervous and hysteric symptoms manifest themselves; dyspncea, and palpitation of the
heart, or "fluttering about the preecordia," (Hall,)
occur from ascending stairs, from rapid walking, or
violent mental emotions; the patient is troubled with
vertigo, giddiness, and ringing in the ears and head;
sleep is disturbed by unpleasant dreams; the spirits
become depressed, and the ambition and energy are
superseded by apathy and indifference.
As the disease advances, all these symptoms become
more strongly pronounced, and confirmed chlorosis is
developed. The whole surface of the body now assumes a smooth and puffy appearance; the skin is
dry, pale or yellowish, or lead-coloured; the muscles
soft and flabby; the feet and ankles edematous; the
countenance very pallid and waxlike; the prolabia of
a lilac colour; tongue clean, bloodless, and semitransparent; conjunctiva of a clear white colour, or
slightly tinged with blue; pulse feeble and somewhat
rapid; occasional pains in the head, chest, stomach,
side and abdomen; throbbing of the carotid arteries,




CHLOROSIS.               557
perceptible to the sight and hearing; violent palpitation of the heart; dyspncea, and " fluttering about the
precordia," after the slightest physical or mental exertion, and often during the night; catamenial secretion, superseded by a profuse leucorrhceal discharge;
slight hacking cough on rising in the morning, and
after exercise; frequent loose discharges from the
bowels of a dark or black colour, and very fetid;
extreme prostration of all the energies; marked derangement of the functions of' the liver, kidneys, skin,
and, indeed, of nearly every part of the body.
It is not an uncommon occurrence for some of these
symptoms to assume a serious local aspect during the
progress of the complaint, and thus present highly
troublesome and dangerous complications. Marshall
Hall enumerates these complications as follows:
First, pain in the head; second, cough and dyspnoea; third, palpitation of the heart; fourth, pain
and tenderness of the side; fifth, pain and tenderness of the abdomen; sixth, constipation; seventh,
diarrhzea; eighth, meluena; ninth, menorrhagia;
tenth, tendency to haemorrhagy; eleventh, purpura;
twelfth, leucorrh(ea;  thirteenth, hysteric  affections; fourteenth, cedema, anasarca, erythema nodosum.
It should be borne in mind, that all of these complications are nothing more than symptoms of the original malady, and are to be treated only as such. We
have deemed it important to direct special attention
to these symptoms, to guard the inexperienced physician against mistaking them for distinct and independent affections. When either of them is particularly prominent, the careless diagnostician is apt to
form an incorrect opinion of the case. Thus, frequent
pains in the chest, violent palpitation of the heart on
the slightest exertion, and an irregular or intermittent
pulse, have often caused medical men to mistake an
ordinary chlorosis fobr an organic affection of the heart:
so have the cough and dyspncea, and the gastric and
abdominal derangements, which accompany chlorosis,
been mistaken for phthisis pulmonalis and dyspepsia.
We have included amongst the signs of chlorosis,
suppression of the menses, but this is by no means an




558                 CHLOROSIS.
invariable symptom, as numerous cases are reported
in which the catamenial secretion was perfectly natural and regular during the whole course of the complaint. We may safely infer, therefore, that it is not
dependent on retention of the menses, as some writers
have supposed.
We have already seen that many of the symptoms
of chlorosis strongly resemble those of organic affections of the heart, pulmonary phthisis, dyspepsia, liver
complaint, and dropsy, but a minute examination of
the history and symptoms of each case, will always
enable us to form a correct diagnosis. Thus, disease
of the heart is attended with more pain, and more
febrile disturbance, than chlorosis: the expression of
the eyes, and the appearance of the prolabia and
tongue are also widely different. The pure white
colour of the conjunctiva, and the bilious and dark
colour of the feeces, will sufficiently mark the disease
from chronic hepatitis. From consumption of the lungs,
we may also recognise it, by the absence of febrile
exacerbations, the flushed cheek, the copious purulent
expectoration, and the more general emaciation which
occurs in the former. There are also numerous symptoms by which we may readily distinguish'it from
dyspepsia and dropsy.
Causes.-There are several points connected with
chlorosis worthy of much consideration in a pathological and therapeutical point of view, viz.: first, the
prominent gastric and intestinal derangement at the
commencement of the malady; second, the small
quantity of crassimentum in the blood; and third, the
peculiar state of the capillary system, which gives
rise to a hemorrhagic tendency.
From the history of chlorosis, it appears that the
stomach and bowels are the first structures to take on
disordered action. For some time previous to the appearance of the pale, waxlike and tumid countenance,
the puffiness of the eyelids, the loss of flesh, suppression of the menses, and other signs of confirmed chlorosis, we observe an impaired and delicate appetite,
flabby and coated tongue, foul breath, imperfect digestion of the food, unnatural stools, and all those
traits which characterize a feeble and imperfect per



CHLOROSIS.               559
formance of the digestive, absorbent, and assimilative
functions. The symptoms which succeed are such as
naturally result from such gastric and intestinal derangement.
These facts go far towards explaining the small
amount of crassimentum contained in the blood of
chlorotic patients. If digestion, absorption, and assimilation were normally executed, would not the
blood receive its due proportion of crassimentum, and
the muscles and integuments their appropriate supply
of the red globules? The organs of the body are
dependent for healthy action upon-the stimuli of these
red globules, which abound in oxygen, and serve to
communicate to all parts of the organism its animal
heat and consequent vitality. Whenever, therefore,
any cause operates upon the digestive and absorbent
organs in such a manner as to suspend their functions,
the blood must fail of its due supply of red globules,
and a derangement of all the organs ensue.
In some chlorotic patients, there is a peculiar tendency to htemorrhages from the nose, the lungs, the
stomach, and the uterus. Bloody discharges have
been known from the head, the side, palms of the
hands, and limbs, in instances assuming a periodical
form, and taking the place of the menstrual discharge.
On this account, the disease has been attributed by
some to a laxity of the capillaries, and a consequent
inability to exclude the red globules; but this relaxed
condition of these vessels is owing to an absence of
their healthy natural stimuli, the " oxygen carriers,"
rather than to any primary derangement in the capillary vessels themselves.
Other causes which may contribute to the development of chlorosis, in constitutions predisposed to it,
are, close confinement in overheated and ill-ventilated
apartments; studious and sedentary habits; protracted grief, anxiety, or fatigue; parturition, and its after
effects; leucorrhcea;- amenorrhaea; unsatisfied love;
masturbation; prolonged continence; frequent hwemorrhages; crude and indigestible food; chronic inflammation of the intestinal canal; enlargement and
inaction of the mesenteric glands.
Prognosis.-This will depend principally upon the




560                CHLOROSTS.
natural stamina of the patient, and the severity of
the local symptoms. A frail and delicate constitution,
a highly susceptible nervous system, a decided predisposition to glandular and membranous disease, and
an inherent debility of the digestive apparatus, are
circumstances calculated to render the prognosis un.
favourable. Patients of this description are rarely
able to withstand the important changes which the
economy undergoes at the period of puberty, without
serious local disease, and often organic degenerations
of some vital part.
On the other hand, if the patient be of a naturally
robust and sound constitution, even if the chlorotic
symptoms are quite severe, we may generally predict
an ultimate recovery. Here we may trace all the
causes of the malady, and bend our efforts to their
removal with a prospect of success, and thus restore
the system to its original health and vigour; while a
body which "has been sent into this breathing world
before its time, but half made up," cannot be remodelled into one of" fair proportions" and vigour, by
any resources of the physician, although much may
be done towards prolonging life, and securing a moderately comfortable state of existence.
Pathology.-In the autopsical examinations of those
who have died of chlorosis, the most notable signs of
disease are found in the blood, the muscles, and the
surface of the body. The blood of chlorotics appears
to be deprived, in a great measure, of the red material, and its place supplied by a superabundance of
serum. This condition exists to a greater or less degree during the whole course of the.disease, and it
is on this account that the muscles after death present a peculiarly pale and bloodless appearance, and
the skin a palish yellow or waxlike tinge. Unnatural
appearances are sometimes found in the chest and
alimentary canal, in the form of enlargement and dilation of the ventricles of the heart, chronic inflammation of the lungs, the stomach, and the intestines,
flabby and shrunken appearance of the liver and
spleen, and unusual accumulations of serous fluid in
the cavities, and in the cellular tissue.
Therapeutics.-In the treatment of chlorosis, we




CHLOROSIS.                561
find of especial importance, frequent exercise in the
open air, either by gestation or moderate walking, a
highly digestible and nutritious regimen, and fresh or
salt water baths. It is very desirable that chlorotic
patients pass their winters in warm and equable climates, that exercise in the open air may be taken
with advantage at all seasons. This is necessary on
account of their extreme sensitiveness to the cold,
which is often a serious obstacle against exposure to
the low temperature of northern winters. The influence of sea air is often very beneficial to patients accustomed to inland districts, and vice versa. Short
sea-voyages may sometimes be advised in the warm
summer months, but caution should be exercised that
the changes be not too abrupt.
General bathing is also useful when properly employed. We should commence with tepid baths of
fresh or salt water, and gradually diminish the temperature as the strength will admit, until an ordinary
cold bath can be advantageously sustained. Sensitiveness to applications of cold water, will frequently
deter the patient from a persevering use of this powerful remedy, and rigid directions should therefore be
given upon the subject.
A regimen of the most digestible and nutritious
meats, as mutton, venison, beef, game, and fowls, with
rich animal soups, should be enjoined. Other nutritious food which the stomach will digest may likewise be eaten. Wine, porter, and Scotch ale may be
used at meals if agreeable to the invalid. In a word,
all of those articles which are calculated to enrich
the blood with the red globules. may be resorted to.
The remedies best adapted to meet chlorotic symptoms are, china, sulphur, nux vomica, pulsatilla, sepia,
ferrum carb., platina, calcarea carb., conium, arsenicum,
veratrum.
China.-External indications.-Countenance pale or
livid; lips blackish and shrivelled; mouth and tongue
slimy; skin yellowish; cedematous swellings of the
limbs; faeces hard or soft, fcetid, mixed with undigested food, and of a dark or black colour; offensive
breath; copious leucorrhoal discharge; menstrual
fluid scanty, and possessing but little colour; sup24*




562                CHLOROSIS.
pression of the menses; hemorrhages from the nose,
mouth and lungs; pulse feeble and more rapid than
natural; general appearance indicative of an exsanguious and debilitated condition.
Physical sensations.-Vertigo, worse when walking
or during motion; humming in the ears; disagreeable taste in the mouth, generally bitter or insipid;
unnatural appetite; canine hunger; pressure in the
stomach after eating; distention of the abdomen from
wind or water; morbid sexual desire, with nightly
pollutions; difficult and rapid respiration; throbbing
in the sternum; palpitation of the heart; constant incftnation to move the limbs; excessive sensitiveness
of the whole nervous system, with general feeling of
lassitude and debility; great dread of cold air; drowsiness during the day, but restlessness at night; sleep
disturbed by frightful dreams.
Mental and moral symptoms.-Nervous, irritable,
dissatisfied, taciturn, out of humour; indisposition to
mental exertion; suspicious of dislike and abuse.
Remarks.-China is eminently a specific in chlorosis
accompanied or induced by profuse loss of animal
fluids, from epistaxis, haemoptysis, hemorrhoids, masturbation, involuntary emissions of semen, leucorrhea,
and diarrhcea. It is one of our best remedies when
the disease is uncomplicated by any serious local derangement, and where simple debility of the whole
organism is its essential characteristic.
Sulphur. — External indications.-Face pale and
bloated; eyes surrounded by blue or greenish margins;
swelling of the upper eyelid; glandular swellings
about the neck and lower jaw; mouth and tongue
slimy; fetid breath; distention of the stomach and
abdomen; discharges from the bowels brown, and
mixed with undigested food; acrid leucorrhceal discharge; profuse expectoration; short and rapid respiration; edema of the feet and ancles; surface of the
body covered with yellowish or brown spots.
Physical sensations.-Vertigo, dizziness and dulness
in the head; humming or roaring in the ears; putrid
or bitter taste in the morning; loss of appetite; craving for sweet or sour articles only; pressure of the
stomach and abdomen, and dyspncea after eating;




CH~LOROSIS.              563
throbbing at the pit of the stomach, with faintness;
morbid sexual desire, with feeble power of accomplishment; frequent involuntary emissions; menses
too early and too profuse; burning leucorrhcnal discharge; weakness of the chest when talking; short
and difficult breathing on exercise, and on retiring to
bed in the night; frequent palpitation of the heart;
stitches and pains in the chest when moving the arms;
coldness of the feet; drowsiness in the day time, but
wakefulness and restlessness during the night; vivid
dreams; night sweats; constant inclination to change
position; general nervous irritation; sensitiveness to
cold; internal coldness; lassitude and sensations-of
faintness,-all of which symptoms are without acute
pain, and are mitigated by rest, and worse during
motion.
Mental and moral symptoms.-Sadness, despondency,
and inclination to weep without cause; ill humour,
obstinacy, sadness, silence, and frequent moaning.
Remarks.- This medicine is advised for chlorotics of
a lymphatic temperament, and those subject to frequent haemorrhages. Also in chlorosis complicated
with tuberculous ulceration of the lungs.
Nux vomica.-External indications.-Pale, yellowish, or clay-coloured complexion; sclerotica natural;
cheeks and eyelids swollen; tongue white; fetid
breath; fweces fcetid and dark-coloured; discharges of
blood from the rectum; moaning and incoherent muttering during sleep.
Physical senisations.-Vertigo, giddiness, or sense of
intoxication; tenderness of the scalp; ringing and
hissing in the ears; putrid, or bitter, or sour taste in
the mouth; aversion to food of all kinds, and to tea
and coffee; distention and oppression of the stomach
after eating; nausea; bitter or sour eructations;
throbbing sensation in the region of the stomach; flatulent distention of the abdomen, and colicky pains after
eating or drinking; bleeding and painful hemorrhoids;
great irritability of the sexual organs, especially after
waking in the morning; menses too early, and scanty;
frequent turns of nausea and faintness during the menstrual flux; asthmatic respiration when walking, and
at night in bed; palpitation of the heart after a generous meal; painful shocks in the precordial region:




564                CHLOROSIS.
sensitiveness of the whole surface of the body; trembling in the limbs when walking; sleep disturbed by
dreams, and so unrefreshing that the patient feels
worse in the morning than in the evening; coldness
of the feet.
Mental and moral symptoms.-Great sensibility to
impressions; noise, bright lights, and strong odours
intolerable; sad; anxious; quarrelsome; taciturn;
apprehensive of death.
Remarks.-When chlorosis is preceded and accompanied by marked derangement of the alimentary
canal, more particularly if the patient is of studious
and sedentary habits, and has indulged freely in wines,
coffee, or tobacco, nux vomica is indicated. Those
who are naturally somewhat robust, and of a quarrelsome, ardent and vehement temperament, will be
more benefited by it than persons of a mild and
phlegmatic temperament.
Pulsatilla.-External indications.-Face pale; eyelids puffy; tongue white and covered with viscid mucus; pulsation at the pit of the stomach, perceptible to
the pressure of the hand; stools loose, green, slimy, or
bloody; acrid, thin leucorrhcea; scanty menstrual discharge; rapid breathing after eating or on lying
down; coldness of the hands and feet.
Physical sensations.-Vertigo, resembling intoxication; bad taste in the mouth in the morning; loss of
appetite; absence of thirst; nausea; frequent eructations of wind, tasting of the ingesta; beating and
fluttering in the stomach; cutting pains in the side
and abdomen; suppression of the menses, with general coldness of the body and nausea; asthmatic oppression of the chest after eating, or when lying on the
side in the recumbent posture; pain and weakness in
the small of the back; disagreeable pulsation of the
arteries of the whole body; tremulousness; weariness; restlessness during the night; palpitation of the
heart, after eating or talking.
Mental and moral symptoms.-Anxiety; disgust of
everything; sullenness; whimsicalness; dissatisfaction.
Remarks.-Pulsatilla is adapted to chlorotics who
have been irregular in menstruation, and are of a




CHLOROSIS.               565
mild, timid, yielding, or sad disposition. When there
is a total suppression of the menses, with much pain
in the small of the back, frequent turns of chilliness,
and absence of thirst, it will be indispensable, either
by itself, or in alternation with some other medicine.
Sepia. —External indications..-Swollen and puffy
appearance of the whole body; face puffy, pale or
yellow; eyes surrounded by blue or greenish margins;
tongue coated with a white fur; fcetid breath; menses too early and scanty; yellowish, watery, or mucus leucorrhcea; cold feet and hands when in bed in
the evening.
Physical sensations.-Painful beating in the head;
roaring in the ears; no appetite, or morbid desire for
all kinds of food; absence of thirst; pain in the side
and region of the liver; great sexual inclination; frequent dyspnma; cough with mucus expectoration;
stitches in the chest and side; weakness and stiffness
in the small of the back; restless sleep, with frequent
waking; skin tender and sensitive; sweat on walking; sensitiveness to cold air; weary, faint, and discouraged; symptoms worse at night and when at rest;
palpitation of the heart; and intermittent pulse.
Mental and moral symptoms. —Weakness of memory;
inability to think or reason; giddiness from walking;
melancholy, discouragement, and irritability.
Remarks.-Chlorosis of nervous and delicate females,
with a thin and delicate skin, and in whom menstruation has always been irregular, may be cured by sepia. If the patient sweats profusely when walking,
and is particularly sensitive to cold air, this remedy is
still more necessary.
In inveterate cases, attended with extreme prostration, trembling of the limbs, coldness of the surface,
entire suppression of the menses, dropsical swellings,
great difficulty of breathing, palpitation of the heart,
loose state of the bowels, frequent and protracted turns
of faintness, we may examine ferrumn arsen. and veratrum. Carb. calc. and platina are indicated when the
menses are too frequent and abundant. These medicines are especially adapted to young female organisms.
Administration.-The remedies should generally be




566                SCROFULA.
employed at the first, second and third attenuations, and
a dose administered once or twice daily, until there is
an apparent effect. No repetition should be allowed
so long as the slightest amendment is perceptible.
CHAPTER XXX.
SCROFULA.
This disease was described by the Greeks under the
appellation xo~ca0h, from xo7eo5, hog, and by the Latins,
(scrophules from scropha, female swine). This name
had its origin in the well-known fact, that scrofula
was a disease peculiar to the above named animal.
The blood of scrofulous subjects has been found to
differ materially from that of healthy individuals. In
the former, there is a superabundance of serum and a
deficiency of the fibrous portion, and the solids which
are generated from this blood are, in consequence,
lax, feeble, and incapable of resisting exposure, fatigue and disease.
Scrofula is for the most part hereditary, but the physician is frequently presented with well marked cases
of the acquired disease. The circumstances which favour the formation of an original scrofulous dyscrasia,
are, cold and damp habitations, want of healthy and
nutritious food, constant confinement at labour in
close and ill-ventilated rooms, and finally, the use of
pork in all its forms as a principal article of food.
Respecting this last cause, we submit a few remarks:
Since the time of Moses, a large portion of mankind
have looked upon the swine as an impure animal, unfit for food. Its impurity consists of a disorder of a
purely scrofulous character which is inherent and peculiar to it, and is constantly being developed, especially during confinement and subjection to the ordinary modes of feeding. Probably no animal is more
filthy in its habits or more disgusting for its selection




SCROFULA.                567
of food. Let the pork-eater contemplate an instant,
the customary mode of rearing the domestic swine,
and observe what offal, filth, putridity, scourings from
everything foul and corrupt, constantly swell his diseased carcase. Let him see in the slaughter house,
how often the internal organs and the surface of the
vile carcases will be studded with tuberculous formations, or scrofula, and then return to pork " like a dog
to his vomit," if he chooses.
A strong corroboration of our views is found in the
fact, that in all of those countries where the swine is
forbidden to be used as food, scrofula is almost unknown. The same law obtains with the Jews, who,
abiding by the precepts of their religion, inhabit almost
every climate and country, and are scarcely ever
afflicted with scrofula.
It is absurd to argue that flesh contaminated with
the scrofulous miasm, cannot communicate to the
healthy body, after digestion, its morbid particles.
The poison pervades every atom of the affected flesh,
and no washing or digestion can destroy or banish the
noxious quality.
Scrofula is most common in temperate latitudes,
where the changes of temperature are abrupt, and
where the atmosphere is much of the time loaded
with moisture. The miasm operates upon almost
every structure: glands, skin, ligaments, membranes,
muscles, and bones, all succumb to its attacks.
Diagnosis.-The signs which are supposed to indicate the scrofulous habit, are, precosity of intellect;
blonde hair; light complexion; blue eyes; soft and
delicate cheeks; lips thick and red; "frequent swelling of the upper lip and nose;" edges of the eyelids red
and prone to inflammation; scurf and eruptions on the
scalp; large head; sensitiveness to cold; ends of the
fingers blunt instead of tapering; muscles soft and
flabby; strong inclination for venereal pleasures.
These marks are generally supposed to characterize
the scrofulous habit, but it has occurred to us to witness far more cases of scrofula in individuals the very
opposite of this description; but whether or not this
is the result of accident, or whether an erroneous impression has prevailed upon this subject, we know not.




568                SCROFULA.
Amongst the most common and simple manifestations
of scrofula may be ranked, glandular swellings of the
neck.
These enlargements occur very frequently during
childhood, in the form of what are vulgarly termed,
"kernels," on different parts of the neck. They are
excited into activity by taking cold, by currents of air
upon the neck, by measles, scarlatina, and whoopingcough, and either remain for a long time stationary
and inactive, or run on to more violent inflammation
and suppuration. These swellings sometimes attain
a very large size, involving most of the glands of the
neck, and remain in this condition for many years.
More frequently, however, owing to injudicious allopathic treatment, the swellings are dispersedby external applications, the malady is forced to embody itself
upon the lungs, and a fatal phthisis pulmonalis is the
result. Another form in which scrofula developes
itself, especially in children, is that of
Strumous, or Scrofulous Ophthalmia.
This disease is characterized by extreme sensitiveness of the affected organs to light. Even th. slightest ray causes intense pain, and the little patient
makes every effort to avoid exposure. During the inflammation an eruption usually makes its appearance
on the cheeks, in the vicinity of the eyes, and which
often. extends to the very organs themselves, thus
giving rise to troublesome and dangerous ulcers.
These ulcers not unfrequently extend until the structure of the eye becomes so far impaired, that total
blindness ensues.
The next form of scrofula to which we shall call attention, is that in which the joints become affected.
The most important of these affections are the
White Swelling, (Arthrocace), and the Hip-disease.
The approach of these maladies is commonly gradual and insidious. Occasional pains are complained
of in the diseased joint, after exercise; the motions of
the limb gradually become impaired, and vague pains




SCROFULA.                569
are experienced in the neighbouring joints, which
sometimes induce the belief that healthy parts are
the seat of the inflammation. As the disease advances, the ligaments, cartilages, and other structures
composing the joint, become so much thickened by
the inflammatory action, that the limb after a time
becomes stiff, and the joint immovable. In some instances the inflammation is arrested at this point, the
suppurative process is prevented, and a recovery by
what is called anchylosis takes place. But in the majority of cases the disorder proceeds on to suppuration, the whole structure of the joint becomes involved
in this action, a profuse discharge of matter takes
place from the part, constitutional disturbance is
manifest in the form of emaciation, debility, nightsweats, and other symptoms of hectic fever, and the
patient soon succumbs. Scrofulous affections of the
joints are' very difficult of detection in their early
stages.  The pains are so vague and indefinite, as
scarcely to attract attention; there is little or no
swelling or discoloration over the disordered part;
and there is no derangement of the general health
which itedicates that the organism is suffering under
a serious malady. It is for this reason that the disease is allowed to make serious progress before its
true nature is suspected. Like its near relative, the
consumption, it strikes silently, but deeply and fatally.
Another scrofulous disease, common in infancy, is
known as
Strumous Disease of the Mesenteric Glands.
The characteristic signs of this malady are, wasting
of the limbs, pale and attenuated appearance of the
skin, tumefaction and tenderness of the abdomen,
sunken eyes, irregular state of the bowels, variable
appetite, passage of partially digested food, general
irritability. After the disorder is seated, the process
of absorption is suspended, so that only a small
amount of nutriment arrives at the blood, and the
sufferer is soon reduced to that condition which medical men recognise as marasmus.
Although the mesenteric glands sometimes suppu



570                   SCROFULA.
rate, yet much more frequently the victims to mesenterie disease die from  actual starvation. The only
hope of cure in these cases is, a detection of the malady at its onset, and the services of a thoroughly
competent physician.
In a previous chapter, we have had occasion to
treat of another, and perhaps the most dangerous form
of scrofula, under the head of phthisis pulmonalis, or
tuberccular consUanption, to which we refer the reader.
There are numerous other scrofulous affections of
the different parts of the organism, as the brain, the
liver, the skin, the spleen, and the spinal marrow.
The admirable wrorks of Hartmann and Schmnlein
may be consulted wvith advantage,with reference to
this subject.
E-ahnemann has included serofula as a fornm  of
psora, but evidently on insufficient grounds. Psora is
contaoious, scrofula non-contagious. The matter of
a psoric eruption is capable of communicating its
similitude by inoculation; that of scrofula is innocuous when inoculated.  Psora, in its specific development upon the skin, assumes the appearance of a
vesicular eruption; scrofula makes its appefrance in
the:form of' extensive ulcers, abscesses, &c.  The
psoric miasm  exercises its specific affinity upon the
skin; the scrofulous miasm  upon the glandular system.'Psora is no respecter of persons, but attacks all
constitutions, temperaments, and organizations alike;
scrofula is supposed to select its subjects from those
who are (laintily formed, and possess some pecuiiarities of orgoanization; psora is readily cured by antipsorics; scrofula always requires much time, and is
often absolutely incurable by any course of treatment.
Psora cannot be artificially acquired by any particular mode of life, or any particular food; with scrofula
it is the reverse.  Finally, the development of the
psoric miasm, when it is clear and apparent, is always
specific and uniform, viz., in vesicular eruptions of a
peculiar appearance upon the surface, and the mna
lady is unequivocally contagious; while the development of the scrofulous miasm is subject to very great
variations, but for the most part attackino the glands,
ra~ther than the skin, and decidedly non-contagiouls.




SCROFULA.                 571
Causes.-The scrofulous habit is, in most instances,
inherited. In its hereditary subjects we may notice
from birth a radical unsoundness of constitution, an
irritability, sensitiveness to slight exposures, proneness to catarrhal difficulties, and an inability to resist
diseases, which is not apparent in healthy children.
The acquired scrofulous habit is generally amongst
the poor, who are ill-fed, clad, and housed. We have
before alluded to the causes which especially induce
this variety of the disease; they are also the chief
exciting influences of the hereditary dyscrasia. Atmospheric vicissitudes, abuse of stimulants, excesses
in venery, onanism, intestinal irritation, excessive
mental and physical occupation, scarlatina, measles,
abuse of mercury, iodine, and other drugs which unduly stimulate the glandular system, also excite the
latent disorder.
Therapeutics.-It has been observed that scrofulous
persons are peculiarly sensitive to cold, and that
abrupt changes from heat to cold, in a moist region,
are especially calculated to call into active operation
the latent malady. For this reason it behooves those
who arefliable to the affection, whether by hereditary or acquired predisposition, to dwell, if possible, in
a warm and equable climate. When the lungs become affected, this course will often be necessary, in
order to save life. In all scrofulous diseases, too
much stress cannot well be laid upon the importance
of a mild, dry, and uniform temperature.
The food of scrofulous subjects should always be of
the most nutritious character, in order that a due proportion of fibrine may be introduced into the blood.
Fresh meats, like beef, mutton, venison, fowls, and
veal, should constitute the principal articles of food;
and bread, rice, and other farinaceous substances,
should be made to take the place of watery and succulent vegetables. Porter, ale, and light wines may
also be used moderately with advantage.
Much exercise in the open air is also essential. In
taking exercise, it is of the utmost importance that
the mind should be agreeably occupied, for if we walk
or ride as a task, we shall obtain very little benefit.
Bathing, both in fresh and salt water, is also a




572                 SCROFULA.
means of securing a healthy action of the skin, and of
imparting tone and vigour to the whole system.
The clothing should always be adapted to the season, and in temperate and cold latitudes we strongly
advise the buckskin wrapper, to be worn over a thin
linen, silk, or Canton flannel under-shirt. We commend the use of these garments, during the winter,
from personal experience.
The remedies most deserving of confidence in the
treatment of scrofula, in its various forms, are, sulphur, hepar sulph., mercurius, iodine, baryta, dulcamara,
conium, belladonna, lycopodium, sepia, calcarea carb.,
rthus tox., aurum  mur., china, ferrum  iodid., merc.,
oleum jecoris aselli.
Sulphur.-External indications.-Scrofulous ulcers
on different parts of the surface; humid eruptions behind the ears; purulent discharges from the ears;
scrofulous ophthalmia of children, with eruptions
about the eyes, and ulcers on the cornea; chronic
enlargement of the tonsils; enlarged ovaria; swelling
of the axillary glands; swelled nose; frequent nosebleed; swelled upper-lip; swelling of the glands under the lower jaw; enlargement and suppufation of
the inguinal glands; swelling of the posterior cervical
glands; white swelling of the knee; emaciation.
Physical sensations.-Chronic inflammation of the
eye-lids; scrofulous ophthalmia, attended with great
intolerance of light, and sense of fulness and distention of the lids; pulmonary cough, with sticking pains
in the chest, and copious purulent expectoration; inflammation and pain in the knee and hip-joints; itching pimples upon the scalp, and pain at the roots of
the hairs; stitching pains in the ears and in the parotid glands; painful swelling of the upper lip and
wings of the nose; pain in the region of the liver
after exercise; pain in the abdomen on pressure, and
in the inguinal glands; sensation of weariness and
fatigue in all the limbs; want of vitality; sensitiveness to cold; pains worse during cold weather.
Mental and moral symptoms.-Despondency alternating with gayety; irritable, indolent, and discontented.




SCROFULA.               573
Administration.-One grain of the third trituration
every twenty-four hours, until a response is manifest.
Rhus tox. —External indications. —Tinea capitis;
soft tubercles on the-hairy scalp; scrofulous ophthalmia, with photophobia, and an eruption about the
eyes; chronic swelling and induration of the parotid
gland, the axillary, and other glands; enlargement of
the bones; herpetic and moist or dry scurfy eruptions
in different parts of the body; swelling and other
signs of inflammation in the hip and knee joints.
Physical sensations.-Pain in the hip joint, increased
on pressing the trochanter major, and attended with
shortening of the limb, and alternating pains in the
knee; pains of white swelling, and scrofulous affections of the ancle joint; scalp painful to the touch, or
from moving the hair backwards; inflammation and
tenderness of the edges of the eyelids; eyes sensitive
to light; eyelids itch and feel swollen; crusty eruption in the nose, and about the mouth; repugnance.to
bread and other food; stitches in the side; short,
anxious, and painful cough; oppression of the chest;
glandular swellings painful when touched; stiffness
and lameness of the limbs; very sensitive to the open
air; pains worst during inaction, or in the cold air.
Mental and moral symptoms.-Ill humour; languor;
disinclination to all mental or bodily exertion.
Administration.-A drop of the third dilution each
day, as long as may be deemed necessary.
Iodine. —External indications.-Enlargement of the
cervical, parotid, thyroid, and tonsil glands; scrofulous
inflammation of the knee, with swelling, heat and redness; elongated and enlarged uvula; induration of the
os uteri; glandular indurations in different parts of the
body; rough and dry skin; general emaciation; with
hectic appearance.
Physical sensations.-Catarrhal affections of the
mucous membranes depending on scrofula; swelling
and pain in the liver; inflammation in the knee, with
stitches and burning, and increased pain on motion of
the joint or from pressure; contraction of the (esophagus from enlargement and inflammation of the
glands and mucous membrane, with stitching pains
during deglutition; enlarged mesenteric glands; tumid




574                 SCROFULA.
abdomen, with pains on pressure; swelling and pain
in the bronchial glands; glandular swellings about the
neck and axilla, painful, especially on pressure;
itching pimples on the arms and chest; general debility; hectic fever; pains aggravated by exercise, by
contact and by warmth.
Mental and moral symptoms.-Nervous irritability
and increased sensitiveness to external impressions.
Administration.-Same as rhus.
Baryta mur.-External indications.-Chronic induration of the cervical glands; scrofulous eruptions and
ulcerations; tinea capitis; enlargement of the liver,
of the testes, and of the mammae; chronic inflammation of the eyelids.
Physical sensations.-Itching eruptions of the scalp;
general emaciation and debility; scrofulous disease of
the throat, aggravated after every cold; scrofulous
affections of the ears, attended with throbbing and
itching, and discharge of purulent matter; inflammation and suppuration of the tonsils; pains in the affected joints and in the long bones; liability to sore
throat after every cold; disease of the mesenteric glands
in children; pains mostly on the left side, when sitting,
and relieved by exercise in the open air; adapted to
old men and young children.
Mental and moral symptoms.-Imbecility; absence
of mind; impaired intellectual powers.
Administration.-The second or third attenuation
may be selected —a dose daily-until the requisite impression is produced.
Dulcamara.-External indications.-Moist and suppurating herpes, forming crusts, or scurvy, bran-like
eruptions; swellings of the cervical and submaxillary,
and inguinal glands; swelling of the calf of the leg;
emaciation; scrofulous inflammation of the eyelids.
Physical sensations.-Pains in the enlarged glands,
particularly on motion; great susceptibility to cold;
pains in the joints on exposure to cold; pains worse
during rest; paralysis of the upper eyelids; phthisis
pulmonalis, before the tubercles commence softening;
pulmonary symptoms brought on by repeated colds;
pains in the chest; febrile symptoms; lassitude;
bruised sensations.




SCROFULA.                575
Mental and moral symptoms.-Disposition restless,
angry, and quarrelsome.
Administration.-In the same manner as baryta.
Conium mac.-External indications.-Swelling, induration and suppuration of the external glands; malignant scrofula; caries of the bones; scrofulous
photophobia; diseased mesenteric glands in children;
enlargement and induration of the liver and pancreas.
Physical sensations.-Scrofulous swellings, which
evince a disposition to run into scirrhous degenerations; pains in the bones, and in the malignant ulcerations; inflammation, swelling and pain in the ovaries;
painful swellings of the uterus; pain in the region of
the liver, when walking; purulent expectoration from
softened tubercles; intolerance to light, in consequence
of scrofulous opthalmia; dull pain in the knee when
stepping; bruised and sore feeling in the calves of the
legs; pains worse during rest, and in the night.
Mental and moral symptoms.-Dulness of intellect;
want of memory; irritability.
Remarks.-For indurated glands, Dr. Johannsen asserts, that "conium, in the second dilution, stands highest as a remedy, and next to it, mercurius sol."
Administration.-We advise the third attenuationa dose daily until its effects are apparent.
Belladonna.- External indications. - Glandular
swellings, with suppuration; ulcers; emaciation; inflammation and swelling of the bones; eyelids inflamed; ulcers upon the cornea; photophobia; swelling of the lips, nose, tongue, uvula, tonsils; bleeding
at the nose; swollen and spongy gums.
Physical sensations.-Inflammation and pain in the
enlarged glands, and in the periosteum and bones;
diseased mesenteric glands, with atrophy; inflammnation of the eyes, with heat, redness, and great intolerance to light; pain in the ball of the eye; double vision; roaring in the ears; painful swelling of the parotid gland; soreness of the throat; impeded deglutition;
lameness of the limbs when moved; smarting and
burning pains in the hip joint, increased by contact or
motion, and during the night; painful ulcers on the
skin; sensitiveness to cold air; adapted to the scrofu



576                  SCROFULA.
lous affections of children and females of a mild temper.
Mental and moral symptoms.-irritability; amorous,
nervous, excitable, talkative.
Administration.-Same as conium.
Lycopodium.-For the scrofulous dyscrasia, and especially where the periosteum, bones, and cervical
glands are affected. This remedy is adapted to lymphatic constitutions.
Sepia will be found an efficacious remedy in scrofuIous females, who are troubled with irregularities in
the menstrual functions. It has been employed successfully in indurations of the uterus, corrosive leucorrhmea, and in pulmonary phthisis with profuse purulent expectoration.
Calcarea carb.-According to Hahnemann, carbonate of lime is indispensable in those cases where the
menses appear too early and are too profuse. It is
also appropriate in young persons of scrofulous habits.
In children presenting the usual marks of the scrofulous dyscrasia, it is one of our most valuable remedies.
It is highly recommended likewise in the scrofulous
ophthalmiae of children, particularly after ulcers have
formed on the cornea. Also in marasmus arising from
diseased mesenteric glands, it is an admirable remedy
in alternation with iodine. Scrofulous eruptions and
ulcers of children often yield to this remedy, after
sulphur, mercurius, and hepar sulphuris have been used
in vain.
Hepar sulphuris is adapted to the cure of scrofulous tumours in a state of suppuration, to scrofulous
ophthalmia with profuse lachrymation, and much mucous discharge from the meibomian glands, and in
coxalgia, after a purulent discharge has occurred.
This medicine is proper for scrofulous and lymphatic
constitutions.
_7ercurlius. This remedy is advised by Hahnemann
in scrofula combined with syphilis. The glandular inflammations will be characterized by a diffused redness, much swelling, and gnawing, stinging or darting
pains, worse at night in bed. It should be consulted
in affections of the bones, the joints, the eyes, and in
eruptions and ulcers upon the surface. The following




SCROFULA.                 577
preparations of mercurius, we especially commend in
scrofula: merc. sol., iod. merc., and mere. praecip. rub.
Aurum mur., ferrum and china are worthy of consideration in protracted and obstinate cases, where the
strength of the patient has become much impaired,
and but little impression has been made by the previous remedies.
Hartmann observes that he has "derived essential
benefit from oleum jecoris aselli in every form of the
disease, especially in the precursory stage, when no
particular organ was affected: the patient looked pale,
emaciated, the muscles became flabby, the patient
showed an aversion to meat and vegetables, and wanted to eat bread and butter all the time. I gave it in
teaspoonful doses, morning and evening, almost always with success.  In scrofulous affections of
bones it likewise proved useful, but less so in other
forms of the disease."-(Hartmann's Chronic Diseases,
vol. iii., p. 54.)
Dr. J. H. Bennett, of London, has found the cod liver
oil (oleum jecoris aselli) of great service in scrofulous
cases characterized by general or local atrophy. But
in scrofulous affections in which the general health
and strength are unimpaired, and the digestive functions are not deranged, Dr. B. advises iodine. We have
employed the oil in doses of a drachm, three times daily,
with eminent success, in almost every form of scrofula.
For scrofulous ulcers with callous edges, and fistulas,
silicea alone, or in alternation with phosphorus, acidphos.
and conium, was' found by Dr. Johannsen most useful.
When the ulcers are greenish and offensive, carbo
veg. or mercurius dulc., is advised.
In scrofulous ophthalmia, indurated glands, and diseases of the bones, arsenicum, conium, mercurius sol., carbo animal., heparsulph, and aurum, are the best remedies.
" Arsenicum is one of the most important remedies
in scrofula, for removing indurations of the glands,
and deformities of the bones, for regulating the discharges from the bowels, and for restoring the skin to
a healthy state. Also, in scrofulous ophthalmia it is
of great service." (Dr. Johannsen. Homceopathic Joulrnal, vol. 1, No. 11.)
25




578           AFFECTIONS OF THE EYE
Administration.-As a general rule, the first to the
third attenuations should be selected, and the doses
repeated once or twice daily, until a satisfactory impression is produced upon the affected structures.
CHAPTER XXXI.
AFFECTIONS OF THE EYE AND ITS APPENDAGES.
SECTION I.
The eye, in the immediate vicinity of the brain, connected with this organ by the optic nerve, endowed
with numerous delicate membranes, nerves and bloodvessels, with its lens, its aqueous and vitreous humours
to conduct and modify the luminous rays in their passage to the retina,-all disposed in the most consummate manner to serve the end designed,-may be
looked upon as a most complex and perfect optical
instrument. It is the mirror in which are reflected the
various tableaux of external objects, for the satisfaction
of the soul within, causing it to respond to such impressions so that the most indifferent spectator may
look into its depths, and see the manifestations of the
perceptive faculties.
The impressions of external objects, derived through
this medium, constitute our principal sources of knowledge and of pleasure. - Without this faculty, we learn
only by vague comparisons, suggested by touch, taste,
smell, and hearing, by which all our conceptions are
more or less perverted and indefinite. It is through
the medium of vision, that the child first acquires a
just idea of colours, distance, proportion, magnitude,
&c., and begins to reason and act by a comparison of
his different impressions. It is through the eye alone
that we appreciate the infinite variety of expression
in the "human face divine," and become incited to
sympathy, love, pity, charity, admiration, fear, hope,
hate, anger, and other emotions; that we enjoy the




AND ITS APPENDAGES.           579
beauties and sublimities of nature; that we become
acquainted with the wonders of art and science; and,
by contrasting objects with each other, that we are
able to enrich our minds with whatever elevates us in
dignity of being and capacities of happiness.
The eye is, perhaps, more delicate of organization, and
yet, from its situation, more exposed, than any other,
to external causes of disturbance. How important then
that we obtain accurate ideas relative to its structure
and functions, and the disorders to which it is liable,
that we may be able to protect it when well, and
promptly to cure it when diseased.
In our description of the diseases of the eye and its
appendages, we shall adopt this classification:
First. Affections of the tunica conjunctiva, or outer
covering of the eye, including-First, acute ophthalmia; second, chronic ophthalmia; third, purulent ophthalmia; fourth, gonorrhceal ophthalmia; fifth, strumous or scrofulous ophthalmia; sixth, granulated lids;
and, seventh, opacity of the cornea.
Second. Affections of the deeper seated structures
of the eye, including-First, inflammation of the cornea; second, iritis; third, amaurosis; fourth, hydropthalmia, or dropsy of the eye; fifth, cataract;
and, sixth, fungus haematodes, and cancer of the eye.
Third. Affections of the appendages of the eye,
including- First, hordeolum or stye; second, entropium, or inversion of the eyelids; third, ectropium, or
eversion of the eyelids; and, fourth, fistula lachrymalis.
This classification is deemed sufficient for all practical purposes, and much less liable to lead to confusion than one more extended. We shall point out the
prominent affections of each structure of the eye, and
endeavour, in enumerating the causes, to make the
reader acquainted with every thing of interest connected with each particular subject.
Ophthalmia may be primitive or symptomatic, —
acute or chronic,-and its causes, local or constitutional. Its manifestations also may be confined to the
eye itself, or sympathetic symptoms may declare themselves in the head, stomach, and other parts of the




580           AFFECTIONS OF THE EYE
economy. These developments will depend much
upon the constitution, temperament and habits of' the
patient, the causes which have operated to produce
the malady, the severity of the inflammation, and the
tissue affected. It is worthy of note, however, that
when a particular tissue of one eye is diseased, the
corresponding structure of the other eye is exceedingly
prone to a similar morbid action, from sympathy. This
may be accounted for from the fact that the eye receives its nerves and blood-vessels directly from the
brain, by which the sympathetic communication between the two organs is rendered very rapid and intense.
Finally, we direct special attention to the therapeutical connection existing between morbid conditions
of particular tissues, and primitive medicinal symptoms, upon the same tissues, in health. We have
already a few specifics which impress certain structures only, and we trust that the time is not distant
when medicines will be discovered capable of acting
surely and specifically upon each separate part of the
eye or its appendages. Fortunately, a few of our
drugs have a wide range of action upon the visual
organs, so that we shall be able, even now, to find
specifics which correspond with almost any morbid
symptoms that may present themselves.
SECTION II.
AFFECTIONS OF THE TUNICA CONJUNCTIVA.
ACUTE OPHTHALMIA.
Diagnosis. —One of the first local signs of simple inflammation of the conjunctiva, is an injection with
red blood, of a number of the vessels which naturally
admit only a white fluid. This gives to the eye that
slight appearance of' redness and distention of vessels,
which characterizes the first stage of acute ophthalmia.
The eye now becomes more than usually sensitive to
light, smoke, and dust; tears are easily excited; a
feeling is experienced similar to that produced by particles of sand or dust lodged under the upper eyelid,
causing the patient to constantly rub the eye in order




AND ITS APPENDAGES.           581
to remove what he supposes to be a foreign substance;
a sense of heat, fulness, stiffness and tingling is felt in
the globe and edges of the lids; and slight pains begin
to shoot through the eye. At first but a part of the
vessels become injected, but as the inflammation increases, the anastomosing branches become involved,
until finally the whole eye presents a uniform appearance of deep redness, swelling, and turgidity. At this
period of the disease, the functions of the eye are all
more or less perverted; there are acute pains in the
ball; great intolerance to light; a profuse secretion
of scalding tears; disordered vision; agglutination
of the lids in the morning from matter secreted by
the meibomian glands; intense pain on moving the lids;
distressing sense of distention, weight, and rigidity of
the whole organ, and diminished power of motion.
The symptoms thus far detailed, are purely local
and include all of the symptoms which are present
from the commencement to the termination of many
cases of simple acute ophthalmia. But in the majority
of instances, the whole system sympathises with the
local affection, and we are presented with the following additional train of constitutional or sympathetic
symptoms: acute pains extending from the eye into
the temples and anterior portion of the brain; slight
chills, followed by accelerated circulation and respiration; hot and dry skin; determination of blood to
the head and face; nausea; loss of appetite; lassitude; general irritability; physical weakness; and
other indications of febrile excitement.
During the progress of the inflammation, a peculiar
appearance is often observed above the Cornea, in the
form of a circular elevation termed chemosis. This
arises from the precaution which nature has taken to
protect the cornea from the injurious effects of ophthalmia, by fixing the conjunctiva more firmly upon this
portion of the globe, than upon the other parts. By
this peculiar construction, the distention of vessels and
effusions resulting from violent inflammations, are
principally manifested in the first instance, without
the cornea, and thus in some measure protecting this
important part from the injury it might otherwise
sustain.




582          AFFECTIONS OF THE EYE
The severity of the symptoms will depend much
upon the constitution of the patient, and the nature of
the exciting cause. The disease may terminate in a
cure, without any marked alteration in the appearance of the eye, or it may result in effusion, causing an elevation of the conjunctiva above the cornea;
or in adhesion of some portion of the conjunctiva
covering the cornea, and giving rise to those appearances known as nebula, albugo, leucoma, and opacity;
or in suppuration, from the surface of the conjunctiva;
or in ulceration of some part of the cornea; or in
sloughing of the cornea. These appearances will be
more particularly described in our article on opacity
of the cornea.
Causes.-Undue exposure to intense heat or cold;
inordinate use of the eyes by a glaring or dim light;
the application to the eyes of irritating foreign substances; mechanical injuries; extension of contiguous inflammations to the eyes; sudden changes of
temperature; metastases of gout and rheumatism.
Prognvsis. —If appropriate remedies are administered in the early stage of the complaint, and before
any organic lesion has taken place, we may generally predict a speedy and perfect cure. On the contrary, if effusion, ulceration, or the adhesive process
of the conjunctiva over the cornea, has commenced,
we must be more guarded in our prognosis, for under
these circumstances the malady often ends either
in impaired vision, or a total loss of sight.
Much information may be derived respecting the
probable termination of the malady, by a careful examination of the causes which have been, or may still
be in operation, and of the temperament and constitution of the patient. For example, an individual of an
irritable and nervous temperament, and of a delicate
organization, may be affected with the most violent
local and constitutional symptoms for a considerable
period, without endangering the integrity of the eye;
while a sanguine, plethoric, and robust patient might
experience no constitutional effects, and but moderate
local symptoms, and yet speedily suffer from serious
disorganization of one or more of the tissues. Much
will also depend upon our ability to remove all causes




AND ITS APPENDAGES.          583
which may have conduced to the complaint, and to
enforce upon our patients the necessary restraints and
attention during the treatment.
Therapeutics.-The first therapeutical indication is
to confine the patient to an apartment in which the
light is mostly excluded. It must be remembered that
this natural stimulus of the healthy eye, becomes,
during an acute inflammatiorn of its tissues, a powerful
irritant-a morbid agent capable of aggravating and
perpetuating the disease.  As the inflamed stomach
cannot tolerate its natural stimulus, the fobod, so the inflamed eye cannot endure with impunity, its ordinary
stimulus, the light.  Perfect cleanliness should be
enjoined, and an exclusion of all dust, vapours, smoke,
and bright rays of light. In making applications to
the eye, great care should be taken to avoid compression of the. inflamed part, in order that the circulation
may remain unobstructed, and that sufficient air may
be admitted to the parts.
Respecting local applications, we entertain the most
exalted opinion of cold water. This may be applied
by means of a few folds of soft linen cloth, which may
be frequently dipped in the water, and after being
partly wrung out, laid loosely over the eye and the surrounding parts. This application may be persisted
in at suitable intervals, until the active symptoms have
subsided, and a state of sub-acute inflammation occurs,
when recourse may be had, if deemed necessary, to
collyria of a slightly stimulating character, like weak
solutions of zinc, nit. argenti, lead, or copper. In making use of these last named articles, we should only
employ a strength sufficient to create a decided medicinal action, and omit the application when this effect
is apparent, and so long as the consequent reaction or
amendment continues; for external remedies, when judiciously employed, are subject to the same laws of
primary and secondary action, as when administered
internally. We shall say more upon this subject under
chronic ophthalmia.
The medicines to which we call particular attention are, belladonna, aconite, arsenicum, sulphur, digitalis, euphrasia, pulsatilla, arnica, spigelia, mercurius
sol., graphite, lycopodium.




584           AFFECTIONS OF THE EYE
Belladonna. -  External indications. -  Redness,
swelling, and protrusion of the ball of the eye; chemosis; swelling of the lids; frequent discharge of
hot and salt tears, or dryness of the eyes; spasmodic closure of the lids; flushed cheeks; throbbing of
tlie:*-otid and temporal arteries; full and rapid
d dry skin.
tY     s.' }nsations.- Great intolerance to light;':;           and smarting in the eyes; heaviness,.:ei'~ssUj nd throbbing in the ball and lids; sharp
pains:in:the orbits, extending into the brain; tearing
pains in the eyes from within, outwards; dimness and
obstruction of vision; spasmodic sensations in the
eyes.
Mental and moral symptoms.-Nervousness; irritability; disinclination to mental labour.
Remarks.-Belladonna is suitable in ophthalmia occurring in sanguine and irritable persons, from congestions of blood to the eyes in consequence of exposure to cold, excessive use of the eyes, metastases of
rheumatism and gout. It is particularly useful when
constitutional symptoms show themselves in the form
of acute or throbbing pains in the head and temples,
hot skin, rapid pulse, flushed cheeks, dilated pupils,
and perverted vision.
Aconite.-External indications.-Vessels of the conjunctiva injected with red blood; lids red and swollen;
chemosis; dilation of the pupils; lachrymation, worse
on the slightest exposure to light, dust, or smoke; photophobia; flushed cheeks; hard and rapid pulse; hot
and dry skin, and other febrile symptoms.
Physical sensations.-Very great intolerance to light;
pressing, stinging, burning, or exceedingly acute pains
in the eyes; eyeball feels bruised, and pressed into
the orbit; stinging and smarting of the lids; eyes
very hot, and filled with scalding tears, or preternaturally dry; pressure, or sharp, beating, or stinging
pains in the head and temples; impaired vision, as
from a gauze before the eyes; general febrile disturbance.
Mental and moral symptoms.-Much mental excitement; fear and apprehension in regard to the probable
result of the case.




AND ITS APPENDAGES.          585
Remarks.-This remedy is particularly called for
when the local inflammation is very intense, and the
constitutional symptoms run high. It operates most
happily in plethoric, bilious, and sanguine individuals,
who are subject to determinations of blood to the face,
head, and lungs. It is appropriate in ophthalmia
caused by colds, by the introductions of foreign substances into the eye, and by rheumatism and gout.
Arsenicum. - External indications. - Conjunctiva
much congested, and of a dark-red colour; cdematous
swelling of the lids; profuse lachrymation; tears hot
and corrosive to the cheeks; lids dry and red; eyelids
partially closed from the great swelling; nightly agglutination; spasmodic movements of the lids, on exposure.to light; ulcers on the cornea.
Physical sensations.-Sensation as if sand had become lodged in the eye; tearing, burning, or stinging
in the ball and lids, aggravated by motion, or on exposure to light; throbbing in the eyes when lying
down; impaired vision; weakness, weariness, and
tremour of the lids; great intolerance to light; constant inclination to rub the eyes.
Mental and moral symptonms. —Mind weakened, and
whole system rendered nervous and irritable, by pain
and suffering.
Remarks. —Arsenicum is applicable to those cases
which arise in weakly and nervous constitutions,
where the pains are severe, and the disease is unusually
obstinate. In this variety of ophthalmia, the local and
sympathetic symptoms are very troublesome, but there
is much less danger of serious organic lesions than in
most other forms of the malady. It is advised in
ophthalmia arising from cold, rheumatism and gout.
Sulphur.-External indications.-Injection of the
vessels of the conjunctiva; redness and swelling of
the lids; lachrymation, or preternatural dryness of the
eyes; morning agglutination of the lids; photophobia; eyes swollen and prominent; cornea dim; lids
edematous; distention of the conljunctiva from effusion.
Physical sensations.-Pressure of the eyeballs, worse
on moving them; pressure, burning, and itching of
the lids; intolerance to the rays of the sun; twitching
of the lids; trembling of the eyes; painful dryness of
25*




586           AFFECTIONS OF THE EYE
the margins of the lids; bruised feeling of the eyes,
on mnotion; sensation of sand under the upper lid, on
motion; dimness of sight.
Mental and moral symptoms.-Sensitive; despondent; out of humour.
Remarks.-Sulphur is adapted to lymphatic temperaments-a scrofulous or psoric dyscrasia, and may
be employed in ophthalmia caused by repelled eruptions, abuse of mercury, or irritating matters introduced into the eye.
Digitalis.-External indications.-Intense redness of
the conjunctiva; inflammation of the meibomian glands;
swelling of the lids; constant and profuse lachrymation; photophobia; dryness of the nose; morning agglutination of the lids; tears hot and corrosive; countenance bloated.
Physicial sensations.-Aching, throbbing, burning,
pressing, or stitching pains in the affected eyeball,
worse when moving or touching it; feeling as of sand
under the lids; discharge of hot and irritating tears,
on exposure to the open air or to light; intolerance
to light; dimness of sight; eyes constantly hot and
painful; objects all appear unnatural; visions before
the eyes.
Mental and moral symptoms.-The predominant
mental traits are, despondency and mental languor.
Remarks.-Digitalis is suited to sanguine temperaments, and also to persons of a scrofulous habit. It
has been successfully employed in ophthalmiae consequent on colds, scrofula, and gout. Euphrasia also
corresponds to most of the symptoms enumerated under digitalis, and may sometimes be substituted to
advantage in the place of this last remedy, when the
desired effect is not promptly produced.
Pulsatilla is appropriate in catarrhal or rheumatic
ophthalmia, attended with pressure and burning in the
eyes, as if from sand; redness and swelling of the conjunctiva and lids; coryza; profuse lachrymation in
the wind or open air; burning and itching of the eyes,
inducing a disposition to. rub them; photophobia; inflammation, and secretion of mucus from the meibomian
glands; dimness of sight; morning agglutination.
Arnicag is indispensable in ophthalmic inflammations




AND ITS APPENDAGES.           587
caused by mechanical injuries of.the eye, or of the
parts in its vicinity. The remedy may be used both
internally and externally.
Spigelia is especially adapted to rheumatic and arthritic ophthalmia; the pains are of a pressive or
stitching character, and aggravated by movement;
the vessels of the conjunctiva are much congested;
the cornea is dim; aching pains are experienced in
the eye when touched, extending deep into the orbit;
the upper lids swollen and stiff.
Mercurius sol. is proper in catarrhal and rheumatic ophthalmia. Its indications are, inflammation
of the eyes, attended with burning, smarting, heat,
and pressure, worse in the open air; sensation as if
sand were under the upper lid; profuse lachrymation;
photophobia; darting pains in the eyeballs; redness
and swelling of the lids; dimness of vision; pains
worse when moving or touching the eye; boring pains
in the eyes and surrounding parts.
Other remedies are, graphite, lycopodium, nux vomica,
calcarea carb., colocynth, rhus, cocculus, cannabis, and
dulcamnara, to which the reader is referred.
Administration. —In very acute cases, we advise the
third attenuation, and a repetition of the dose every
two hours until the desired impression is produced.
In more mild forms of the disease, we use the first or
second attenuations, and repeat every six or eight
hours, as long as is deemed necessary.
SECTION III.
CHRONIC OPHTHALMIA.
Chronic ophthalmia may arise in consequence of
the subsidence of the active symptoms of the acute
form of the disease, and the persistence of a condition
of sub-acute inflammation, or from causes which operate gradually, and induce an atonic state of the parts,
and a low grade of morbid action. It may continue
in this chronic state for years, without causing any
notable organic derangement, the only difficulty experienced, being a weak, sensitive, and irritable condition of the eyes.
Diagnnosis.-When chronic ophthalmia succeeds the




588           AFFECTIONS OF THE EYE
acute, it will be found that a part of the vessels of the
conjunctiva have recovered their tone and now circulate only the white blood, as formerly, while the larger vessels remain injected with red blood. These
larger vesselb, during the progress of the disorder, become so much distended by the intromission of the red
globules, that a varicose dilatation often remains for
a long period after the acute stage has been passed,
and thus establishes the chronic malady. One of the
prominent local symptoms, therefore, of chronic ophthalmia, as distinguished from the acute variety, is,
the moderately congested state of the vessels, which
renders the conjunctiva partly red and partly white.
The eye is also much less sensitive to light, dust, and
smoke; tears are not so easily excited; vision is improved; there is an absence of pain, burning, and heat;
tears are not so hot and acrid; the swelling of the lids
is diminished, and all febrile and sympathetic symptoms have disappeared. But the eye is more sensitive
than natural to light; the edges of the lids are red or
purple; nightly agglutination occurs; the patient is
unable to use the eyes long at a time; objects often
float before the eyes, obstructing vision; the lids itch
and tingle, mostly in the morning on rising; flow of
tears caused by cold air, light, wind, smoke, dust, and
vapours.
Causes.-Acute inflammation; habitual intemperance; constant exposure to irritating vapours; metastases of rheumatism and gout; external injuries;
repelled eruptions; protracted exposure to cold in a
region of snow; excessive use of the eyes by a strong
or dim light.
Prognosis.-Unless adhesions have taken place between the conjunctiva and cornea, or ulcers, cicatrixes, or effusions, have formed, so as to obstruct the
rays of light, we may expect a ready cure of the disease. If, however, disorganization has already occurred, and vision has become obstructed, we may predict
a cure of the morbid inflammatory action, but only a
partial restoration of sight. Habitual chronic ophthal.
miwe, proceeding from intemperance, constant expo.
sure of the eyes to stimulating vapours, etc., may
readily be cured by removing the exciting causes, and




AND ITS APPENDAGES.           589
having recourse to the appropriate local and internal
remedies.
Therapeutics.-It is in this variety of ophthalmia,
that we may expect to derive most benefit from the
use of stimulating collyria. The object of all remedies,
as has before been observed, is to create -a healthy
medicinal action in the diseased part, which shall supersede the morbid action, and thus secure a cure.
But we have also seen that this medicinal effect must
be two-fold in order to prove curative: or, in other
words, there must be a primary and a secondary effect,
the former analogous to that of the disease, and the
latter, the reverse, or curative. Whenever these two
conditions result from the application of remedies, internal or local, a cure may be expected. Care, however, must always be observed, that the medicines be
so adapted to the nature of the case, that the primary
symptoms shall be of short duration, and succeeded
by the legitimate, opposite, or curative reaction.
In deciding, therefore, respecting the proper strength
of a local application to an inflamed eye, we may follow the maxims of HIahnemann, or, what will answer
as well, adopt the following rule inculcated by Sir
Astley Cooper, in regard to the use of collyria, viz:
" To judge how far the stimulus may be carried, the
criterion is exceedingly simple; if you find that a certain degree of smarting and pain is produced, which
soon subsides and leaves the patient much more easy
than before, you may be convinced that the collyrium
is beneficial; if, on the other hand, the patient experiences a great degree of pain, which does not subside
speedily, and the vessels become turgid, you may be
assured that the collyrium is doing harm, and that the
quantity of stimulus ought to be diminished."
The best local stimulus we ever employed, in clearly
pronounced chronic inflammation of the eyes, is the
wine of opium, (vinum opii), a single drop to be introduced into the eye once or twice in twenty-four hours,
until there is a permanent reaction. When the secondary symptoms do not speedily appear after the
application, we may then have recourse to a weak
solution of sulphate of zinc, or of nitrate of silver. If
these fail, a dilution of aconite may be tried.




590           AFFECTIONS OF THE EYE
The internal remedies are, arsenicum, belladonna,
calcarea carbonica, sulphur, rhus, silicea, nux voinica,
graphite, phosphorus.
The indications for the use of these different medicines will be found under acute ophthalmia. The principal difference between the two forms of the malady,
consists in degree rather than in the quality of the
symptoms.
Respecting the administration and repetition of
doses, we prefer the first, second, and third attenuations, and advise a repetition once in twenty-four
hours, until an impression is produced.
SECTION IV.
PURULENT OPHTHALMIA.
Diagnosis. —This variety of ophthalmia is more violent and destructive, and runs its course with much
greater rapidity, than that which we have described.
It is characterized by a profuse purulent secretion
from the conjunctiva, which collects and hardens
about the lids, gluing them together, and in this way
acts as a constant irritant to the inflamed part. The
disease commences like the simple acute ophthalmia,
with itching, stinging, or burning sensations in the
lids and globe, lachrymation, sensitiveness to light, redness of the conjunctiva, which soon increase to an intense villous redness, swelling of the lids, sensations as
if foreign substances, like sand or sticks, were in the
eye, and more or less indistinctness of vision. These
symptoms augment very rapidly in intensity. The
tingling sensations change to severe pains through the
eye, sometimes extending to the temples, and even the
brain itself; there is chemosis, the lachrymation becomes changed into a profuse secretion of pus, either
yellow or greenish; the intolerance to light becomes
more marked, the lids are very much swollen, and
discharge much puruIent matter, and there is almost a
total obstruction of sight. Constitutional symptoms
frequently occur, as in simple ophthalmia, in the form
of headache, nausea, quick pulse, hot skin, general
prostration, &c.  This acute stage terminates in a
short period in a sub-acute inflammation, or in ulcer



AND ITS APPENDAGES.          591
ation and sloughing. When the former termination
happens. there is a gradual subsidence of all the
symptoms, and the disease remains for an indefinite
period in this atonic state, after which the eye may
recover its tone and healthy function. But if sloughing
takes place, the destructive process may run on to a
total destruction of the part, unless energetic measures are used to arrest its progress.
Causeg.-Sudden alternations from  heat to cold;
endemic and epidemic influences; the irritation of
hot sand introduced into the eyes; metastases of
rheumatism, gout, scarlatina, small-pox, and measles;
abuse of mercury; the morbid vaginal secretion to
which the eyes of new-born children are sometimes
exposed.
SECTION V.
GONORRHBEAL OPHTHALMIA.
Diagnosis. —This variety of inflammation attacks
the conjunctiva also, and is attended with symptoms
very similar to those of purulent ophthalmia, but of
much greater intensity. This disease is supposed to
be the most violent and destructive of any to which
the eye is subject, and it is not uncommon so see it
proceed to the entire destruction of vision, notwithstanding the most early and energetic attempts to cure
it. There is especial danger, in gonorrhceal ophthalmia, of a speedy formation of ulcers of the cornea,
and of rapid sloughing through the tunics of the eye.
Whenever, therefore, we are called to a case of this
description, with intense inflammation and redness of
the eyes, greatly swollen lids, very abundant discharge of pus, or a dry and burning state of the conjunctiva and lids; excruciating pains in the eyes and
head; chemosis; great intolerance to light; hot skin;
nausea; thirst; and other febrile symptoms; it becomes us to exercise the utmost vigilance in our remedial measures, in order to save the eyes from ulceration and sloughing. Farther on we shall detail a
method of treatment which will generally be found
successful, even in the most severe cases. Nothing,
however, but the strictest attention to everv minute




592           AFFECTIONS OF THE EYE
symptom of the case, and a constant watch over
medicinal effects, will ensure success.
The cause of this affection is unquestionably the application to the eyes of gonorrhceal matter, and not, as
some suppose, a metastasis of the disease to the eyes.
Another variety of purulent ophthalmia to which it
is proper to allude, is that which occurs in infants
shortly after birth. This disease is supposed to arise
from the contact.of the vaginal secretion of the matter with the eyes of the child during birth.  The
symptoms generally first make their appearance in
about two weeks after birth, but they may occur before or several weeks after this period. The symptoms are similar to those of purulent ophthalmia, but,
for the most part, the inflammation is less intense, and
there is much less danger of the speedy supervention
of ulcers of the cornea. It is quite true that ulceration and sloughing ultimately occur in these cases;
but a longer time is afforded for our remedial efforts to
take effect, and of course the prospect of cure thus enhanced.
SECTION VI.
STRUMOUS, OR SCROFULOUS OPHTHIALMIA.
Diagnosis.-Scrofulous ophthalmia presents several
symptoms which are quite characteristic, and by the
aid of which we may always form a ready and accurate
diagnosis. The disease occurs in subjects of a scrofulous habit, and is accompanied with the general signs
peculiar to struma, in addition to the local symptoms.
Indeed, these general marks will often aid materially
in forming our opinion, particularly in slight cases.
The light and clear complexion, blonde hair, blue
eyes, tendency to glandular swellings of the neck, the
tumid upper lip, eruptions during childhood behind
the ears and upon the head, sensitiveness to cold, disposition to cough after colds, frequent pains and discharges from the ears, indicate the strumous dyscrasia, which often determine and develop inflammations
of the scrofulous kind.
The peculiar symptoms which distinguish this inflammatiort are, the almost absolute intolerance to




AND ITS APPENDAGES.           593
light; the violent spasmodic closure of the lids on the
slightest exposure of the eyes to it, and the strumous
eruptions which generally make their appearance in
the neighbourhood of the eyes. The light is commonly so painful, and the dread of exposure to it is so
great, that it is exceedingly difficult to make a
thorough examination in children, and, as a general
rule, it is better to trust to the voluntary efforts of the
patient, in a moderate light, rather than resort to
much violence in attempting to force open the eyes.
Usually, by obtaining the confidence of the patient,
we can persuade such a display of the globes as will
sufficiently satisfy us in regard to the case. The
vessels of the conjunctiva are generally much injected; there is a considerable discharge of purulent
matter; the balls are stiff and painful; the lids
swollen; vision impaired by the inflammation, or by
ulcers on the cornea; one or more ulcers form on the
conjunctiva covering the cornea; and, if the symp-*
toms continue to increase, the sight is finally destroyed.
The disease varies much in its progress; is sometimes attended with but little redness of the conjunctiva, but slight pains in the globes, and but a moderate secretion of pus; at other times, during the
formation of an ulcer, all these symptoms increase in
intensity, until the case nearly resembles one of acute
purulent ophthalmia. It is of far more common occurrence in children than in adults.
Causes.-The constitutional cause, as we have seen,
is a strumous dyscrasia.  The local, or exciting
causes are, atmospheric vicissitudes; undue exposure
to cold, light, dust, smoke, and irritating vapours; neglect of cleanliness.
Prognosis. —Severe purulent ophthalmia under the
most favourable circumstances, for the application of
remedies, is highly  dangerous.  The  chief peril
against which we have to guard, is ulceration of the
cornea. Before this has taken place, and especially if
the cornea appears bright, we may entertain hopes of
a favourable termination of the case; but if these
opaque specks form while the inflammation retains its
intensity, we must be prepared for a partial or total




594           AFFECTIONS OF THE EYE
loss of vision. Of the different kinds of ophthalmia,
the gonorrheal is unquestionably the most rapid in its
progress, and dangerous in its character. Here, nothing but the most consummate judgment and coolness, with constant attention, can avert serious consequences. The other varieties of the malady are not
quite so rapid and destructive, but they demand the
most skilful and energetic efforts to ward off injurious results.
As a general rule, if we are called during the
early stages of the complaint,- and exhibit the appropriate specifics judiciously and boldly, little difficulty will be experienced in inducing a speedy and
happy issue to either of the varieties; unfortunately,
however, the physician is rarely called until the disease is so far advanced that ulceration cannot be prevented. It is evident, then, that the prognosis will depend upon the intensity of the disease, the complica*tions which have occurred, the time it has existed,
the constitution of the patient, and the remote and exciting causes.
Therrapeutics.-The only local application which can
be advantageously used during the acute stage of purulent ophthalmia, is pure water, either cold or tepid.
This may be employed as a lotion to the parts, during
the couise of the acute symptoms, as the judgment of
the adviser shall dictate. When the chronic stage
has set in, recourse may occasionally be had to stimulating collyria, like vinum opii, solutions of sulph.,
zinc, nitr. argenti, sulpi., cuprum, acetat., plumbi, and
aconite; but in regard to these applications, the same
rules apply with full force here, that we have presented under the head of simple acute ophthalmia,
when alluding to the use of collyria.
The following remedies will cover all of the symptoms which obtain in the different varieties of purulont anhthblmia -. ni.nvniilm., bellhadonna. sulhur. rhus




AND ITS APPENDAGES.          595
photophobia; pressure and burning pains in the eyeballs, aggravated by moving the eyes; nebulous spots
and ulcers on the cornea.
Belladonna is an admirable remedy in scrofulous inflamrriation of the eyes, with very great intolerance to
light; a constant inclination to remain in the dark, or
to plunge the eyes into a pillow or some other soft
article; purulent discharge; great swelling of the
lids; spasmodic closure of the lids on exposure to
light; chemosis; tearing, throbbing, smarting, or
stitching pains in the eyes; roaring in the ears; hot,
dry skin; thirst; nightly agglutination; throbbing of
the carotid and temporal arteries; pains in the temples and head; ulcers on the cornea: dimness of
vision.  We have cured several cases of purulent
ophthalmia of infants, characterized by great intolerance to light, intense inflammation, throbbing of' the
carotid and temporal arteries, flushed cheeks, hot skin,
and' other indications of inordinate vascular excitement, with belladonna, succeeded by mercurius. We
deem belladonna one of our most valuable medicines
in nearly all of the acute inflammations of the
eye. The effects arising from the application of a
small quantity of the extract to the eyebrows or temples, are sufficient to demonstrate its marked specific
action upon the structures of the eye. We have found
it eminently serviceable in ophthalmia neonatorum,
and in acute ophthalmia.
Sulphur is an invaluable remedy in several kinds of
purulent ophthalmia.  It is adapted to the chronic
forms, with atonic distention of the conjunctival
vessels; swollen and edematous condition of the
lids, with purulent discharge; suppurating ulcers on
the cornea; sensation of itching, bfirning, and heat in
the eyes and lids; troublesome agglutination in the
morning; diminished power of motion of the upper
lids; pustules of the cornea; sensitiveness to the
light of the sun; swollen upper lip; eruptions behind
the ears, and on the scalp and face; pressure and
burning pain in the eyes; impaired vision. Sulphur
is one of those remedies which will be required
more or less frequently in all varieties of ophthalmia, not only to combat those local symptoms which




596           AFFECTIONS OF THE EYE
especially correspond with it, but to correct morbid conditions of a more general and latent character. Sulphur may occasionally be used with decided advantage in alternation with remedies which
appear to cover all of the manifest symptoms, but
which do not produce prompt impressions when given
singly.
Rhus tox. is useful in rheumatic, scrofulous, and catarrhal ophthalmia, with much inflammation and swelling of the lids; redness of the balls of the eyes; profuse
secretion of mucus or pus from the eyes and lids;
edematous swelling of the lids and the parts surrounding the eyes; morning agglutination, with increased
redness of the eyes; pain on turning the balls; lachrymation; photophobia.
Dr. Dudgeon considers rhus toxicodendron one of
the most important remedies in catarrhal, erysipelatous, scrofulous, and exanthematic ophthalmia. Many
allopathic physicians commend the tincture of rhus in
scrofulous ophthalmia. We can bear witness to the
value of this medicine in scrofulous ophthalmia, and
in chronic ophthalmia which is kept up by a dyscrasia
of an erysipelatous character.
Calcarea carbonica has been successfully employed
in every variety of purulent conjunctival inflammation.
Its chief indications are, inflammation, redness, and purulent secretion from the eyeballs; swelling and redness of the eyelids; nightly, and sometimes daily,
agglutination of the lids; great intolerance to light;
nebulous specks and ulcers on the cornea; inclination
to keep the eyes in darkness; scrofulous eruptions
upon the face and scalp; glandular swellings of the
neck; swelling of the upper lips and nostrils; pustules on the cornea; pressing or aching pains in the
eyes; corrosive inflammation in the edges of the lids;
acrid lachrymation; general appearance indicative of
the scrofulous dyscrasia. Dr. Dudgeon expresses the
opinion that calcarea "is one of our most important ophthalmic medicines, and is surpassed by
none in its applicability to the generality of cases
of scrofulous inflammation, whether of the eye itself, or its lids; and is indispensable where there




AND ITS APPENDAGES.           597
is marked scrhfulous diathesis, indicated by swellings of the glands," &c.
Aconite may often precede other remedies in every
variety of purulent ophthalmia, when the inflammation
runs high, and gives rise to febrile symptoms. Intense
redness and swelling of the affected parts; acute
pains; accelerated circulation; violent photophobia;
headache; hot and dry skin; thirst; flushed cheeks;
throbbing of the arteries about the neck, head and face;
loss of appetite; and perverted vision, point to the employment of aconite. In some instances it may be alternated with belladonna to advantage.
lMercurius sol. has proved successful in my hands
in gonorrhoeal, scrofulous, and infantile ophthalmia;
the remedy having been preceded by aconite. The
symptoms were, violent inflammation, and redness of
the eyes; great intolerance to light; profuse acrid or
purulent secretion from the balls and lids; spasmodic
closure of the lids; heat in the eyes; cutting and
burning pains in the parts; ulcers on the cornea; cornea dim and misty; sight impaired; frequent agglutination of the lids; gummy and scurfy matter on the
edges of the lids.
Graphite is one of our best remedies in scrofulous
ophthalmia, with excessive intolerance to light; chronic
congestion of the conjunctiva; purulent secretion from
the balls and lids; frequent agglutination of the lids;
ulcers on the cornea; porrigo in the face; eyelids
much inflamed, red, and painful; inability to open
the eyes before a strong light; constant desire to keep
the eyes covered; symptoms worse by day-light than
by candle-light; general appearance indicative of a
scrofulous diathesis.
Phosphorus is sometimes useful in obstinate and protracted cases of atonic ophthalmite, which have resisted the ordinary remedies. There is generally inflammation and moderate redness of the eyes; considerable secretion of viscid mucus; sensitiveness of
the eyes to light; heat, burning and itching of the
eyes; lachrymation during the day; frequent and sudden attacks of blindness during the day; floats before
the eyes; weakness and indistinctness of vision.
Spigelia is advised in purulent inflammation, prin



598          AFFECTIONS OF THE EYE
cipally affecting the eyelids, with sharp pains in the
lids; pressure and pain in the eyeballs during motion;
distention and paralysis of the upper lids; painful ulceration of the edges of the lids; dimness of the coi'nea; general loss of power over the eyes. Rummel
speaks highly of spigelia in rheumatic and gouty inflammations attacking the cornea.
Digitalis is recommended in conjunctival ophthalmiae arising from colds, with acute inflammation, redness, sharp stitches, photophobia, secretion of purulent matter, and obstruction and dryness of the nose.
Nitric acid an(l hepar sulph. are the best specifics
for' the removal of mercurial ophthalmia, following the
abuse of this drug in syphilis and other diseases. The
symptoms are, inflammation, swelling and redness of
the conjunctiva and lids; secretion of viscid mucus or
pus; burning and smarting sensation in the eyes;
photophobia, dark and unhealthy ulcers on the cornea;
paralysis of the upper eyelids; tears easily excited;
nightly agglutination; muscam volitantes and sparks
before the eyes; difficulty and pain in moving the
eyes; pains in the bones and soft parts of the forehead
and face.
We have employed chininum sulph., at the first trituration, in several obstinate cases of strumous and
chronic ophthalmia, with entire success. When the
malady assumes an intermittent character, it will generally prove promptly curative.
Lobethal has employed euphrasia with much success in rheumatic, strumous, and catarrhal ophthalmia,
where there was "considerable mucous secretion in the
inflamed organ; as also in blennorrhceas of the eyes,
in all which cases I employ euphrasia at once, internally and externally; in the former case. one drop of
the pure tincture; in the latter, as a collyrium, from
two to five drops in four ounces of water."
Lycopodium is well adapted to scrofulous or catarrhal
ophthalmia, and in obstinate cases of ophthalmia
neonatorum. Hahnemann mentions " nocturnal agglutination, and lachrymation by day," as prominent
indications for the use of lycopodium.
We have employed aurum with excellent effects in
several cases of mercurial and syphilitic ophthalrnia.




AND ITS APPENDAGES.           599
Some authors recommend it highly in scrofulous ophthalmia.
Other remedies are, causticum, sepia, silicea, staphysagria, china, and chamomilla.
Administration. —In acute cases, we prefer the first,
second, and third attenuations, and in the chronic stage,
the first attenuation. The remedy should be repeated
in the more violent forms of the complaint, every half
hour, until we are satisfied with the impression; but
in chronic inflammations, a repetition once in twelve
or twenty-four hours will suffice. During the treatment we should never neglect the external use of
pure water, or milk and water, either cold or tepid.
SECTION VII.
GRANULATED LIDS.
Diagnosis.-Fleshy elevations sometimes occur on
that portion of the conjunctiva which lines the eyelids, resembling in all respects granulations, and by
their irritating effects upon the ball of the eye, give
rise to troublesome inflammation, ulceration, and now
and then to loss of sight. This affection has more
frequently baffled the surgeons of the old school, than
any other pertaining to the eye. Venesection, leeching, cupping, blistering, moxas, cathartics, alteratives,
stimulating collyria, and caustic applications, have all
been found entirely inefficient in its treatment, and
the patients are generally doomed to a wretched existence, one or more years, until disorganization of the
eyes, by ulceration, leaves them in perpetual darkness.
By homeopathy, however, a new and healthy action
can be created in the affected structure, which shall
overcome and supersede the morbid action.
These morbid granulations usually arise from an
acute or sub-acute inflammation of the conjunctiva
occurring in individuals whose constitutions have become impaired and tainted by protracted syphilitic,
gonorrheal, psoric, or scrofulous complaints. The
granulations are rough and uneven, secrete an abundance of pus, which serves to irritate and weaken the
eyes, and on every motion of the lids, operate on the
balls as foreign substances, thus keeping up a per



600           AFFECTIONS OF THE EYE
petual inflammation, and sooner or later leading to
ulceration of the cornea. The disease is for the most
part confined to the upper lids, although we have seen,
in some instances, the conjunctiva of the lower lids
rough and granulated.
Occasionally we may detect the true character of
the complaint by the thickness of the lids, and their
roughness and unevenness to the touch; but the only
certain method of investigation consists in turning
over the lids, and thus exposing the palpebral conjunctiva to the sight.
This disease very often proceeds to a fatal disorganization of the eye, without a true knowledge on
the part of the physician, respecting the nature of the
case. It is usually mistaken for one of the varieties
of purulent ophthalmia.
Therapeutics. —The remedies in this disease are
both local and constitutional. The only local specific
is the sulphate of copper in substance, a small piece
of which is to be smoothly polished, and rubbed
lightly over the granulations once or twice a day,
following each application with a camel's-hair brush
filled with pure water,  A persevering use of this
substance will, as we know from much experience in
these cases, cure the most inveterate forms of the
complaint.
In conjunction with the above means, we may employ one of the following medicines: sulphur, calcarea
carbonica, hepar sulph., iodine, graphite, and acid nit.,
as internal remedies.
In selecting our internal remedy, regard must be
had to the cause, as well as the symptoms of the disease. We advise the first attenuations, and the dose
to be repeated once in twelve or twenty-four hours as
long as necessary.
SECTION VIII.
OPACITY OF THE CORNEA.
Diagnosis.-Opacities or specks upon the cornea
vary much in size and appearance. Various appellations have been given to these different opacities,
as nebula, leucoma, albugo, &c., depending upon the




AND ITS APPENDAGES.          601
nature of the cause, and the particular tissue affected.
The opacity may consist of slight misty or opaque
spots, diffused over a part or even the whole of the
cornea, of a light colour, such as are caused by a perverted secretion of the inner lamina, and termed
nebula; or of small and circumscribed spots, of a
pearl colour, and entirely opaque, caused by a kind of
false membrane under the conjunctiva, and termed
leucoma; or of cicatrixes resulting from the healing
of ulcers and wounds of the cornea, and termed albugo.
When the disease consists of a simple diffused
nebulous opacity, we can distinguish through it the
pupil and iris, and the rays of light pass to the retina
so as to give rise to imperfect vision; but the other
kinds of opacity do not permit the passage of luminous rays, and, consequently, when situated in front
of the pupil, destroy or seriously impair vision.
The two first varieties are caused by purulent ophthalmia and granulated lids, and are results most to
be dreaded, especially in constitutions tainted with
scrofula, syphilis, psora, or mercury.
Therapeutics.-The best local stimulus is a collyrium
composed of one grain of sulphate of zinc to four
ounces of water. A few drops of this may be put
into the affected eye from two to four times in twenty-four hours until the opacity begins to disappear,
when we should omit it so long as amendment continues.
The internal remedies most to be relied on are,
calcarea carbonica, iodine, mercurius, sulphur, sepia,
arnica, hepar sulphuris, acid nit., aurum muriaticunm.
Attenuations and repetitions the same as in chronic
ophthalmia.
SECTION IX.
AFFECTIONS OF THE DEEPER SEATED STRUCTURES OF THE
EYE.
INFLAMMATION OF THE CORNEA.
Diagnosis.-Inflammation of the cornea may exist
as an independent affection, or it may occur during
the progress of iritis, and other acute derangements
26




602           AFFECTIONS OF THE EYE
of the internal textures of the eye. Soon after the
inflammation sets in, a number of the serous vessels
are observed to carry red blood; the cornea loses its
brilliancy; the eyes become sensitive to light; a profuse secretion of tears is induced from exposure to
cold air, light, dust, and smoke; tension and pains
are experienced in the eye; yellow spots, composed of
pus, are observed between the lamellae of the cornea
by looking obliquely through the eye; these abscesses,
if the disease continues, eventually burst internally,
and discharge their contents into the anterior chamber, or externally, and form those troublesome ulcers
of the cornea which so often endanger sight. When
these ulcers are small, and confined to the anterior
portion of the cornea, they may often be cured without material injury to the eye; but when the ulceration pervades the whole lamellated structure of the
cornea, it is not uncommon for the aqueous humour to
escape through the opening, and even the iris itself
to protrude.
SECTION X.
IRITIS.
Diagnosis. —This peculiar affection of the eye is
by no means easy of detection, on account of the situation of the iris, and the small number of external
symptoms which characterize the complaint. Inflammation of this texture is, however, more productive of
constitutional or febrile symptoms than affections of
the external tunics. This may in part be owing to
i "he loose attachment of the conjunctiva to the eye,; nd the more ample scope for effusions into the subj acent cellular tissue.
Iritis commences with a dull, pressing, heavy and
d eep-seated pain in the  orbit; contracted pupil;
c hange of the natural colour of the iris to a dark,, Greenish, or reddish colour; a moderate rose-coloured
I flush of the conjunctiva; diminished power of vision,
a nd considerable sensibility to light.
As the disease advances, the pains become acute,
eand extend from the eye into the temples and to the
t op of the head; the contraction is more strongly




AND ITS APPENDAGES.            603
pronounced; sparks and luminous flashes pass through
and before the eyes; the nervous system 4s excited;
the pulse accelerated; the skin hot and dry; the intestinal and urinary secretions are partially suppressed, and there are other indications of constitutional disturbance.
After these severe symptoms have continued some
time, the iris presents an irregular, angular, and thickened appearance, and is covered with specks of yellow
lymph. Small abscesses now form on the iris, which
ultimately burst into the anterior chamber, which is
afterwards usually absorbed. If extensive adhesions
have formed between the iris and the capsule of the
lens, or if the more deep-seated parts have become
involved in the disease, an almost total loss of sight is
the common result.
In some instances, the inflammation extends from
the iris to the retina, the choroides, the cornea, and
finally involves the whole internal structure of the
eye, when the malady will present symptoms characteristic of the inflammation of these different structures. In cases of this description, the symptoms are
of the most violent character, the pains are exceedingly acute and painfully throbbing, there is a very
rapid contraction of the pupil, the sight is speedily
extinguished, the constitutional signs are very urgent,
and the patient is always in imminent danger of rapid
and permanent loss of vision.
Causes. —The most common cause. of iritis is the
abuse of mercury. Syphilis has been often assigned
as a cause of it, but, we believe, without just reason.
It has often been observed during the treatment of
syphilis by mercury, but, we think, never in syphilitic
diseases where mercury has not been employed.
Other causes are, mechanical injuries, rheumatism,
gout, excessive use of the eyes over minute objects.
Therapeutics.-The most appropriate remedies are,
hepar sulphur., acid nit., muriat. aurunz, cocculus, calcarea carbonica, nux vomica, belladonna, conium, lycopodium, staphysagria, arnica, aconite.
Hepar sulphuris, acid nitric, and aurum muriaticum,
are curative in iritis arising from abuse of mercury,
with aching, throbbing, and tearing pains in the orbit,




604           AFFECTIONS OF THE EYE
sometimes extending to the top of the head; pains in
the bones about the eyes; fiery sparks before the
eyes; intolerance to light; contracted pupil; partial
or entire loss of vision; dark or greenish colour of
the iris; spots of yellow lymph, or ulcers on the iris;
febrile disturbance.
Cocculus, nux vomica, and belladonna, are indicated
in arthritic and rheumatic iritis, accompanied with
deep-seated, lancinating, tearing, or contractive pains
in the ball, and extending to the top of the head; involuntary spasmodic movements of the globe; irregular contraction of the pupil; discoloured and puckered iris; photophobia; pains aggravated on moving
the eyes, or stooping'; luminous specks or dark objects
float before the retina; greatly impaired vision; effusion of blood and matter into the anterior chamber
of the eye; indications of gastric derangement, and
of general constitutional disturbance.
Calcarea carbonica, conium, lycopodium, and staphysagria, are appropriate in iritic inflammations connected with a scrofulous diathesis. These remedies
cover greenish or yellowish colour of the iris; pupil
much contracted and distorted; ulcers which have
opened internally or externally; outward distention
of the iris; adhesions of the iris to the capsule of the
lens; moderate participation of all the structures of
the eye in the morbid action; photophobia; vision
destroyed or much impaired; difficulty in distinguishing the iris from effusion of lymph and pus into the
anterior chamber of the eye; great general irritability; aching, throbbing, lancinating, or pressing pains
in the eye; rapid and irritable pulse; restlessness;
hot skin; loss of appetite; mental and physical prostration.
Arnica is necessary when the disease can be traced
to a wound, or to any other mechanical injury of the
eye. It may also be properly employed in cases which
proceed from sudden exposure of the eyes to an intense and glaring light.
Aconite will often be required, either alone, or in
alternation with one of the other remedies, to control
undue febrile excitement, and to remove the violent
congestion which now and then occurs in iritis.




AND ITS APPENDAGES.           605
Adrninistration.-The. remedies may be employed
at the first, second, and third attenuations, depending
upon the age and susceptibility of the patient, and the
violence of the inflammation. The dose should be
repeated in acute cases every two hours, until we are
certain of a medicinal impression upon the diseased
texture. In less urgent cases, a repetition will suffice
once or twice in twenty-four hours.
SECTION  XI.
AMAUROSIS.
Diagnosis.-The partial or total loss of sight which
particularly characterizes this disease, is principally
dependent upon a diseased condition of the optic nerve
and retina, although other structures occasionally participate in the disease. Amaurosis occurs at all ages,
and in-both sexes, but is most common at the period
of the cessation of the menses in females, and at the
age of forty or fifty years in males. The chief circumstances which predispose to it are, a plethoric
and sanguine temperament, hereditary disposition,
tendency to sanguineous congestions to the head and
eyes, and an impaired constitution from abuse of drugs,
stimulating drinks, and excesses in venery.
Physicians of the old school are much divided respecting the nature and treatment of amaurosis, some
supposing it to be a debility requiring tonics and stimulants, while others describe it as an inflammatory
affection, demanding an antiphlogistic course of treatment. In view of these discordant opinions, and empyrical methods, it is not surprising that so few amaurotic patients are cured by allopathy.
Amaurosis may be imperfect or perfect. In the
former there is a partial, and in the latter a total loss
of sight. In the first, the patient sees as through a
gauze, or but half of the object, or double, or only
when the eye is in a particular position with respect to
the object; while in the last, the patient cannot distinguish day from night.
The signs of the approach of the disease are, pain
in the forehead and temples, diminishing with the advance of the arnaurosis, and ceasing when it has be



606           AFFECTIONS OF THE EYE
come complete; vertigo; weakness and cloudiness of
vision, apparent when looking at distant or at minute
objects; sparks and moats, or muscat volitantes, float
before the eyes, annoying the patient, and impairing
the sight; in reading or writing, a stronger light than
usual is demanded; a slight diminution in the brilliancy of the pupil.
After these precursory symptoms, the loss of vision
gradually becomes more complete, until after months
or years, there remains a condition of settled and
more or less perfect amaurosis. In other instances,
the disease advances with rapidity, and terminates in
partial or total blindness in a few days. But it is not
an uncommon occurrence for complete amaurosis to
follow instantaneously, leaving the victim in blindness
so profound that he cannot distinguish light from
darkness. When either of these three conditions obtains, there are usually but few signs which indicate
the presence of so serious an affection, the principal
being, a dilated and immovable pupil, a loss of contractile power in the iris, and occasionally slight strabismus. But even these signs are not uniformly present, for cases of complete amaurosis are reported in
which the pupil remained natural, or became preternaturally contracted and mobile on exposure to light,
and in which the iris and all other visible parts of the
organ were in a normal condition. The colour of the
pupil in this disease is ordinarily jet black, with, perhaps, a very slight diminution of its natural brilliancy,
but it sometimes presents. a red, greenish, or white
andl cloudy appearance. Cases of this last description
are often mistaken for incipient cataract, and when
the loss of sight is but partial, it is not easy to distinguish between the two maladies; but the following
characteristics will afford us material assistance in
deciding the matter. In cataract, the dense white appearance is situated immediately behind the pupil,
while in amaurosis the cloud is more deep-seated. In
the former, the flame of a candle appears to be surrounded by a thin, white, diffused mist or cloud,
"which increases with the distance of the light;"
while in the latter, "a halo or iris appears to encircle
or emanate from the mist, the flame.seeming to be
split when at a distance."-Steplenson.




AND ITS APPENDAGES.           607
The shape of the pupil is usually round, but somewhat more dilated than in the normal state, thus allowing a large number of luminous rays to enter the
eye. In a few cases, it loses its circular form, and
becomes angular.
Amaurosis is attributed by most writers to a paralytic condition of the optic nerve, retina, or to some
disease of the thalami nervorum opticorum; but does
not the peculiar immovable condition of the pupil and
iris, when their natural stimulus, the light, strikes
them, indicate a loss of sensibility and contractility in
these structures? And does not the partial loss of
voluntary motion over the globe, which sometimes
occurs during the complaint, indicate a loss of tone in
the whole organ?
We have mentioned, as one of the precursory symptoms of amaurosis, floats and muscae volitantes before
the eyes.'In the imperfect form of the disease, these
appearances vary much in their character, and are a
source of great annoyance to the patient. Sometimes
a single black speck obstructs the sight; sometimes
there is an appearance as if a dark gauze or net-work
were before the eyes; sometimes as if flies, small objects of different forms, sparks, fireballs, and various
coloured lights, were moving there in various directions. The objects are more troublesome in a strong
light than in dark situations, being in the former of a
black or sombre colour, and in the latter, presenting
themselves in the appearance of sudden flashes of
light or fire.
We are occasionally presented with the disease in
an intermittent form, and, in rare instances, as a temporary attendant of some particular morbid condition
of the system, like pregnancy, disordered menstrua-.tion, hysteria, worms, and the irritation of indigestible
food.
In addition to the symptoms already described, we
sometimes observe in young and plethoric amaurotics,
strongly pronounced determination of blood to the
head and eyes, a constant stupifying headache, more
or less redness and congestion of the eyeballs, sensitiveness of the eyes to light, a full and hard pulse, a
sense of fulness, tension, and pain in the affected eye.




608          AFFECTIONS OF THE EYE
It is a point worthy of note, that black eyes are far
more subject to amaurosis than blue or gray eyes.
Beer supposes that where one blue or gray eye becomes affected with it, at least twenty-five or thirty
black ones suffer. No satisfactory explanation has
ever been suggested for this comparative exemption
of blue and gray eyes.
Causes.-The causes of amaurosis may operate
upon the brain itself, upon the optic nerve, or the retina. They may be divided into constitutional and
local causes. In the first class we include, repeated
and protracted determinations of blood to the head
and eyes, by unusual physical or mental exertion;
pregnancy; suppression of natural or habitual discharges; violent vomiting; excessive indulgence in
venery; onanism; unbridled anger, grief, and other
passions; abuse of stimulants; large doses of opium,
lead, belladonna, hyoscyamus, stramonium; abuse of
bitter medicines, as quassia, cinchona, chamomela,
chicory, &c.; exercise in a hot sun;. general debility;
derangement of the digestive organs; the depressing
emotions; the pressure of tumours upon the vessels
of the neck in such a manner as to prevent the return
of blood from the brain.
We include in the second class, morbid growths
within the orbit; mechanical injuries of the eye;
sudden transitions from darkness to a brilliant light:
lightning; frequent use of optical instruments, like
the telescope and microscope; exostoses within the
cranium; sanguineous effusion upon the brain; injuries of the head.
Prognosis..-When the disease is dependent on some
cause which can be readily removed, if recent, and
the patient is young and healthy, we may predict a
favourable termination. If, however, the cause has
been long in operation, the loss of sight has been very
gradual, the constitution is much impaired, and the.
cause cannot be speedily removed, the prognosis must
be unfavourable. Amaurosis depending on morbid
growths within the orbit or cranium, may be considered incurable; but when it depends upon a slight
effusion upon the brain, or the pressure of a tumour
upon the jugular vein of the neck, we may often effect




AND ITS APPENDAGES.          609
a cure by causing the effused fluid to be absorbed or
removed by an operation, or the extraction of the
offending tumour. We once cured a case of several
months' duration, by removing from the neck a tumour
of the size of an orange, and thus renewing the free
course of blood from the head. The sight returned
almost immediately after the operation. The loss of
sight which sometimes accompanies pregnancy and
intermittent diseases, often subsides spontaneously on
the birth of the infant, or the cure of the disease. A
favourable prognosis may commonly be entertained
in those recent cases which depend on congestion of
the optic nerve, retina, or thalami nervorum opticorum, arising from general plethora, suppressed menstruation, or hemorrhoids. The effects also of mechanical injuries, lacerations, contusions and blows
upon the eye, may frequently be cured.
Therapeutics.-The specifics for the different forms
of amaurosis are, belladonna, nux vom., china, phosphorus, ruta gray., stramonium, sulphur, euphrasia, arnica, cannabis, hyoscyamus.
Belladonna.-External indications. —Pupil dilated
and immovable; strabismus; pupil black and round
or angular; partial or total loss of vision; listless
expression.
Physical sensations.-Power of vision diminished or
extinct; sensation of weight and pressure in the eyeball; throbbing or stupifying headache; objects appear double, or wrong side up, or half concealed, or
blurred, or surrounded by a fog or mist; dark, fiery
and red bodies float before the eyes; bright flashes
before the eyes; the candle seems surrounded by a
halo of different colours, but in which the red predominates.
Mental and moral symptoms.-Mood generally irritable, but high spirits alternating with despondency.
Remarks. —This remedy is called for in amaurotics
of full and plethoric habits, and where the malady
has been caused by inflammation or congestion of the
optic nerve, retina, or some part of the brain.
NTux vomica.-External indications.-Pupils contracted, sometimes dilated; spasmodic motions of the
eyeball; photophobia.
26*




610          AFFECTIONS OF THE EYE
Physical sensations.-Intermittent obscuration of
vision; black or gray moats before the eyes; stupifying headache; weakness of sight, worse in the light
of day; luminous vibrations on the side of the eye;
vertigo.
Mental and moral symptoms.-Disposition melancholic and hypochondriacal.
Remarks. —Nux is applicable in amaurotic complaints arising from excess of study and abuse of
stimulants and opium. It is also indicated for temporary loss of sight, which sometimes accompanies intermittent diseases.
China.-External indications.-Pupils dilated and
insensible, or slightly contracted; a white cloud deep
within the eye; photophobia.
Physical sensations.-Indistinct and confused vision;
muscat volitantes; sudden obscurations of sight; only
the outlines of objects can be discerned; general debility; irritability; morbid sensitiveness of the whole
system.
Mental and moral symptoms.-Disposition cheerful
and languid.
Remarks. —China will apply when the disease is of
a purely atonic character, and has originated from
excessive loss of blood or pus, or from protracted
chronic or acute diseases.
Phosp.horus. —External indications.-Pupils and eyes
natural.
Physical sensations.-Sudden attacks of blindness
during the day; distant objects appear to be envelloped in smoke or mist; black spots before the eyes;
diminished vision; he sees as through a net-work or
gauze; sparks before the eyes in the dark; tremulous
vision; luminous vibrations before the eyes; the
flame of a candle seems to be surrounded by a green
halo.
Mental and moral symptoms.-Spirits gloomy, dejected, and without any cheerful reaction.
Remarks.-In amaurosis consequent upon onanism,
loss of animal fluids, and in impoverished old people,
phosphorus is an excellent remedy.
Ruta grav.-External indications.-Pupils contracted; involuntary movements of the balls of the eyes;
spasms of the lids.




AND ITS APPENDAGES.          611
Physical sensations.-Sense of weight and pressure
in the eyeballs; weakness of the eyes; inclination to
read or write by a very strong light; muscee volitantes; red halo surrounding the flame of a candle;
cloudy vision; weariness of the eyes.
Mental and moral symptoms.-Indifferent, irresolute
and peevish.
Remarks.-Amaurotic complaints arising from abuse
of the eyes with optical instruments, in reading fine
print, or working at small objects, and also from contusions, and other mechanical injuries, will require
the use of' ruta.
Stramonium. —External indications.-Pupils dilated
and immovable; eyes staring, and somnolent or glistening.
Physical sensations.-Sense of weight and tension
in the eyes; obscuration of sight; objects appear
small or double; black colours appear gray; sparks
and specks float before the eyes; objects seem surrounded with a red or light border; cloudy vision;
vertigo; headache.
Mental and moral symptoms.-Disposition irritable
and touchy; hysterical and cataleptic.
Remarks.-Stramonium is suitable in paralytic affections of the optic nerve and retina, connected with
deranged menstruation, hysteria, epilepsy, and catalepsy.
In incipient amaurosis, and frequent and sudden and
short attacks of blindness, we may refer to sulphur,
euphrasia, arnica, cannabis, hyoscyamus, conium, aurum,
digitalis.
Administration.-We are in the habit of employing
from the first to the sixth attenuations. Repetitions
should not be made more than once or twice in the
twenty-four hours. As soon as an impression is apparent, we should await the result before administering again.
SECTION XII.
HYDROPHTHALMIA, OR DROPSY OF THE EYE.
Diagnosis.-This disorder proceeds from the formation of a preternatural quantity of the aqueous or the




612          AFFECTIONS OF THE EYE
vitreous humours, while the absorbent vessels convey
into the circulation only their customary amount of
these secretions; or the humours may be formed as
usual, but owing to some defect or loss of power of
the absorbents, the natural quantity is not taken up
and carried into the circulation. But it is highly probable, in most cases, that the disease is dependent on a
morbid condition of both the secerning and absorbent
vessels, and that the normal equilibrium between secretion and absorption becomes thereby destroyed.
This idea receives confirmation from the fact, that
most dropsies of the eye can be traced to previous
inflammation of the internal textures of the organ.
The unnatural accumulation may be confined to
the aqueous humour in the anterior chamber, or to the
vitreous humour in the posterior chamber, or both humours may be affected at the same time. When the
aqueous humour is alone involved, the disease may
be recognised by the following marks: dimensions of
the cornea larger than natural; increased size of the
anterior chamber of the eye; turbid appearance of
the aqueous humour; partial or total loss of motion
of the iris; pupil natural and immovable; iris less
brilliant than natural; sense of weight and tension in
the eyeball; weakness of sight; perversion of vision,
either in the form of presbyopia or myopia; general
loss of voluntary motion over the ball; partial or total loss of vision.
When there is a preternatural accumulation of the
vitreous humour, the enlargement of the globe is
more deep-seated; the ball assumes a conical shape;
the cornea is unusually prominent; the pupil is contracted; there is a diminution of vision; myopia;
deep-seated pains; tension and heaviness; impaired
motion of the eyeball; and eventually, total blindness.
When the disease consists of an unnatural accumulation of both humours, we shall have a combination
of symptoms including nearly all described under the
aqueous and vitreous varieties of dropsy. After the
vitreous humour has been for some time affected, its
character is changed, and it acquires a soft and usually a watery appearance.
In many cases# the eye attains a size so enormous




AND ITS APPENDAGES.          613
as to protrude far from the orbit, and it is thus rendered quite impossible to close the lids over it. In
this condition the patient has a frightful appearance,
and the organ itself, from its exposure, is constantly
irritated and inflamed.
Causes.-The immediate cause of dropsies of the
eye, is an undue action in the arteries which secrete
the humours, and a diminished action of the absorbent
vessels; or, sometimes, an inordinate aqueous or vitreous secretion, with a normal action of the absorbents.
Hydrophthalmia is generally supposed to depend
upon some constitutional cause, like general dropsy,
hydrocephalus, chlorosis, or secondary syphilis; but
as a general rule, it may be traced to some previous
inflammation of the internal structures of the eye.
In infants and young children, it is often exceedingly
difficult to discover the real cause, especially when
the external indications are obscure, and, on this account, the earlier history of the case can rarely be
ascertained; but in adults, we shall often be able to
discover previous sub-acute inflammation in the internal structures.
Prognosis.-The allopathists deem  this disease,
when fully formed, incurable. They find thatno shedding of blood, no punishment of the stomach, bowels,
salivary glands, skin, or other inoffensive parts of the
body, can cure or palliate it. That the prognosis is
unfavourable, we do not deny; but we believe the
disease may often be cured in its early stages. I have
treated but two cases homceopathically; and but one
with a favourable result. This was of six months'
standing, confined to the aqueous humour, and with
but moderate distention of the cornea: the other case
involved both humours, had continued more than a
year, and had arrived at the condition termed "ox
eye," when the treatment was commenced. In this
instance paracentecis became necessary, and the patient ultimately lost the eye.
So long as the disease is confined to its incipient
stage, and even after the unnatural accumulation has
commenced, provided no serous disorganization has
taken place in the important tissues of the eye, we




614           AFFECTIONS OF THE EYE
may predict a favourable result; but if organic lesions
have occurred, and the accumulation in the anterior
or posterior chamber is considerable, with total loss of
sight, our prognosis must be unfavourable.
Therapeutics.-If the dropsy depends upon a constitutional fault, our remedies must be addressed to
the remote difficulties. So long as these continue, mere
local means will be inadequate to accomplish our object; but constitutional and local remedies may be used
in alternation with probable advantage. If the eye be
much distended, and medicines do not act with sufficient promptness and energy, the operation of paracentesis may be made to evacuate the superabundant
humours, after which, the remedies will generally
prove sufficiently powerful.
We believe the following to be the best at present
known: belladonna, china, pulsatilla, mercurius, hyoscyamus, stramonium, conium, nux vom., arsenicum,
plumbum, aconite, sepia, sulphur.
It is doubtful whether either of' these exercises a
positively specific influence upon the secretory and
absorbent vessels affected in hydrophthalmia, but they
are capable of acting upon the generally morbid condition upon which the local disorder depends, and thus
aid in arresting its progress, and occasionally in effecting cures.
Administration.-In the same manner as advised in
amaurosis.
SECTION XIII.
CATARACT.
Diagnosis.-Strictly speaking, this disease belongs
to the province of surgery rather than that of medicine; but as homoeopathy promises results somewhat
important in a medicinal point of view, we take the
liberty of writing a few words respecting the malady
in this place.
By the term cataract is understood, an opacity of
the chrystalline lens, or its capsule, which causes an
obscuration, or a total loss of vision. Authors recognise and describe several varieties, both of the lenticular and capsular cataract, and amongst these, the
most common are



AND ITS APPENDAGES.           615
First. The firm or hard cataract, peculiar to old
people, and recognised by its amber colour, small size,
and by its density and hardness. Vision is never totally destroyed in these cases, and the structures of
the eye retain their natural contractility.
Second. The fluid or milky cataract, caused by a
change of the lens into a white and semi-fluid mass,
of so large a size as to nearly obliterate the posterior
chamber, impair the motions of the pupil, and prevent
the admission of rays of light.
Third. The soft or caseous cataract, which presents
an appearance somewhat similar to the last variety,
with the lens much enlarged, of a cheesy consistence,
and of a light gray or sea-green colour, obliteration
of the posterior chamber, impaired motion of the pupil and iris, and either partial or total blindness. The
lens, in this variety, always presents an appearance
of more firmness and consistence than in the milky
cataract, and the dark irregular spots or lines which
sometimes traverse it, remain the same in all positions of the head, while those which are now and
then observed in the milky variety, change their location with every motion of the eyes.
Fourth. Capsular cataract, consisting of an opacity
of the capsule of the chrystalline lens. The opacity
commences at the margin of the pupil, in the form
of " distinct, white, shining points, specks or streaks;
its colour, therefore, is always very light, and never
altogether uniform, even when the disease is completely formed."-Beer. When this kind of cataract
occurs in children at or soon after birth, it is called
congenital cataract.
The capsular cataract does not generally continue
for a long period before the lens becomes involved
also in the opacity. When the disease has been preceded by a good deal of inflammatory action, we may
find cohesions of the anterior capsule of the lens with
the urea; or of the posterior layer of the capsule
with the membrana hyaloidea; or of the whole of
the capsule with the lens; or all the three species of
adhesion may exist together."-Beer, p. 318.
Cataract is sometimes complicated with amaurosis.
This complication is not always easy of detection, on




616           AFFECTIONS OF THE EYE
account of the symptoms of these diseases bearing so
close a resemblance. When the lens or its capsule
are alone affected, the opacity is immediately behind
the pupil, the iris and pupil possess some degree of
mobility, and there is some little appreciatioinof light;
but when amaurosis is conjoined with cataract, we
have the same appearance of the lens or capsule, but
a dilated and immovable pupil, an insensible and immovable state of the iris, and an absolute loss of
vision.
The first intimation we have of a forming cataract,
is defective vision when attempting to read fine print,
or to look at minute objects. As the disease advances,
all objects appear indistinct; a mist is constantly before the affected eye; a strong light is required to
read or write; a small speck now commences just
behind the centre of the pupil, and continues to extend
until the opacity entirely obstructs the passage of rays
of light to the eye; when the opacity is complete, a
black ring is seen around the edge of the pupil, and
the sight continues to diminish until blindness results.
Causes.-Frequent and long-continued use of the
eyes in reading fine print, writing, or looking at minute objects by a strong light; congestion of blood to
the eyes, from exercise in a hot sun, in furnaces, and
other places where hot and bright fires are kept up;
exposure of the eyes to irritating fumes and vapours,
like sulphurous acid, chlorine and other gases, and
the vapours of sulphuric ether, alcohol, nitric, sulphuric and muriatic acids, hereditary predisposition, mechanical injuries, wounds of the capsule or lens.
Prognosis.-When the cataract is confined to the
lens, or to its capsule, and no complications exist from
unnatural adhesions, from amaurotic symptoms, or
from serious constitutional disturbance, a favourable
issue may be expected. On the other hand, a dilated
pupil, an immovable iris, a profound blindness, which
has been disproportionate to the gradually forming
opacity, unnatural adhesions of the capsule, and an
irritable and vitiated constitution, will render our
prognosis unfavourable.
Therapeutics.-Before resorting to the operation of
couching, or extraction, as is so often done by the old




AND ITS APPENDAGES.           617
school surgeons, we should always give our medicines
a fair trial. It is quite true that we have but few
remedies which simulate this affection in their pathogenesis, yet the successful results which have been
observed from the use of medicines in a few cases,
render it incumbent on us to avail ourselves of them
on all proper occasions.
After a thorough trial with medicines, if there is no
prospect of amendment, the patient should be turned
over to the surgeon for the necessary operation.
In a few cases of incipient cataract, much benefit
has followed the local employment of sulphuric ether
vapour to the eye, and should our internal remedies
prove fruitless, there can be no objection to a trial of
this substance.
As internal remedies, we suggest, conium, pulsatilla,
magnesia carb., sulphur, cannabis, phosphorus, digitalis,
spigelia, euphrasia.
Conium and cannabis may be exhibited when the
cataract has arisen from a wound, or other injury to
the eye.
Magnesia carb., pulsatilla, digitalis, and phosphorus,
have proved curative in capsulo-lenticular cataract,
either with or without abnormal adhesions, also in
opacity of the lens or capsule alone. These remedies
are useful when the disease has been accompanied
vith ophthalmia.
Sulphur is appropriate in those cases which seem
to be connected with a scrofulous or psoric diathesis.
It has also been found curative in cataract complicated with amaurosis. Euphrasia or spigelia may
sometimes be alternated with sulphur with benefit.
Administration.-The same as in amaurosis.
SECTION XIV.
FUNGUS tILEMATODES, AND CANCER OF THE EYE.
Diagnosis.-Fungus hcematodes has always been
confounded with scirrhus, or cancer, until Burns, Hey,
and Abernethy pointed out the characteristics of the
two diseases, both in respect to their formation and
development, as well as their pathology. They possess several qualities in common, like malignancy, in



618           AFFECTIONS OF THIE EYE
evitable tendency to the destruction of the affected
parts, the power of contaminating the whole system,
and giving rise ultimately to fatal constitutional
symptoms; but in other respects, they are entirely
dissimilar. Fungus hlmatodes is not usually attended with the severe stinging and lancinating pains of
cancer; its texture is spongy and elastic, and is soft
and apparently fluctuating under the touch, while the
scirrhus is hard and stony. When fully formed, the
fungous tumour is of the consistence of brain, is of a
dark and livid hue, and bleeds on the slightest touch,
while the substance of cancer is hard, fibrous, and
cartilaginous; at its commencement, and during its
development, the fungus is knotty and unequal, and'
thus affords a sign which distinguishes it from cancerous and other tumours. Fungus is more prone to
occur in young subjects, while cancer is for the most
part confined to persons past the middle age. Fungus
of the eye commences in the posterior chamber, while
cancer of the eye attacks primarily the conjunctiva
or lachrymal' gland. The progress of fungus is more
rapid and destructive than that of cancer.
The first symptom observed in fungus hmmatodes,
is defective vision, and, on looking into the eye, a
small shining spot is perceived at the bottom of it.
This nucleus of' the disease commences in the retina and optic nerve, is traversed by branches of the
central artery of the retina, and progresses from
within outwards through the vitreous humour, absorbing it in its course, until it arrives near the iris,
when it presents a dark amber or greenish hue, and is
apt to be mistaken for cataract. As the enlargement
increases, the ball of the eye becomes prominent, irregular, and knotty, the cornea ulcerates, and the
disease displays itself externally in the form of a soft,
medullary, and purple fungus, bleeding at the least
touch. The pupil becomes dilated and immovable in
the early part of the complaint, and also somewhat
changed in colour, which becomes a strongly pronounced amber or brown when the swelling arrives
at the iris. The sclerotica soon acquires a dark blue
colour, is crossed by dilated veins, and is sometimes
attacked by the malady as well as the cornea. After




AND ITS APPENDAGES.           619
the fungus has shown itself externally, the absorbent
glands of the jaw and neck become affected with a
medullary degeneration; the countenance assumes a
sallow and cadaverous appearance; general debility
and nervous irritation occur; loss of appetite; impaired digestion; nausea; irritable stomach; restlessness, and the usual symptoms of hectic fever terminate the patient's Existence.
Cancer of the eye, as we have before remarked,
generally attacks p'ersons advanced in life. This
disease, unlike fungus hmmatodes, commences in the
conjunctiva, caruncula lachrymalis, or lachrymal
gland, in the form of a hard warty excrescence, which
continues for an indefinite period, sometimes attended
with twinging and lancinating pains, at other times
free from all uneasy feelings, until finally its interior
structure becomes altered in texture, an ichorous
matter forms within the swelling, which gradually
makes its way to the surface, and thus develops the
first stage of ulceration. When arrived at this point,
vision is destroyed, an irregular fungous mass shoots
up from the ulcerated point, highly vascular, of a red,
brown, or livid colour, and easily excited to hamorrhage. As the mass increases, the tissues of the eye
become distended; the ulceration and sloughing advance; severe lancinating pains dart through the
globe; the appetite is impaired; the patient loses
flesh, strength, and courage; sleep is disturbed; the
countenance assumes an anxious, distressed, and sallow appearance; hectic fever sets in, and the sufferer
speedily yields to the last result.
Hitherto the diseases under consideration have
usually been deemed incurable by internal remedies,
and on this account surgeons have advised the early
extirpation of all suspected tumours, hoping in this
way to eradicate the affection while it is local, and
before the mass of blood becomes contaminated. But
it must be admitted, even when the operation has
been resorted to early, and under the most favourable
circumstances, that a lamentable want of success has,
for the most part, followed all surgical measures.
Stealthy and insidious at their commencement, they
gradually glide along, depositing in all surrounding




620           AFFECTIONS OF THE EYE
textures their destructive and fatal poison, until disorganization begins, when the livid, foul, and destructive phenomena appear in their hideousness, rapidly communicating their influence through the whole
organism, and baffling all efforts of the physician and
surgeon.
But though experience has so little of promise, we
cannot admit that there are no remedies in the whole
range of the materia medica capable of counteracting
this morbid influence. We mat yet find some medicine sufficiently specific to cure these diseases during
their forming stage. We believe, indeed, that homcmopathy will, ere long, accomplish all that we require in
this matter. Only a limited number of well authenticated homaeopathic cures of true medullary fungus,
or of cancer, have been reported; but the results in
these few cases should inspire us with some confidence of success, especially during the early period
of the maladies.
Causes.-The immediate cause of medullary fungus
and of cancer is involved in doubt. Some have suggested the operation of animalculm, others of a subtle
poison, and others of "a kind of unhealthy inflammation caused by some constitutional defect. Sir Astley
Cooper supposes the morbid degeneration always to
be "preceded by a disposition in the constitution to
its production."
There is unquestionably a specific morbid action in
the tumour itself, but whether this is owing to some
poison which acts specifically upon the particular part
alone, or to some constitutional vice, we are undecided. That there are drugs capable of neutralizing
this morbid influence, whether it be constitutional or
local, we entertain no doubt.
The exciting causes are blows, contusions, obstructions of blood from pressure, and mechanical injuries
generally, although the disease often originates without any apparent or traceable cause.
Prognosis.-In our present state of knowledge, the
prognosis must be generally unfavourable; but not
many years will elapse before this state of things will
change, and we shall be able to meet the complaint
with sure and efficient specifics.




AND ITS APPENDAGES.          621
Therapeutics.-Having had but little personal experience in regard to the homaeopathic treatment of
these affections, we shall simply allude to the medicines which appear to us most appropriate, and refer
the reader to the reports of cases which have been
cured by other practitioners.
Belladonna has cured malignant disease of the eye,
attended with violent pains in the eyeball; a red
shining point in the posterior chamber; pupils dilated
and immovable; loss pf vision; unusual hardness of
the substance of the eye; iris of a dark colour, and
covered with injected bloodvessels.
Malignant affections of the eye have also been
cured by conium, carbo vegetabilis, arsenicum, mercurius, acid nit., calcarea carbonica, and iodine.
Administration.-The same as in amauroszs.
SECTION XV.
AFFECTIONS OF THE APPENDAGES OF THE EYE.
HORDEOLUM.-STYE.
Diagnosis.-This is a small boil-like swelling in the
edge of the eyelid, resembling in size and general appearance a barleycorn. It generally commences in
the follicles of Meibomius, near the angle of the eye,
soon assumes a dark red or purple colour, and becomes
quite painful from the violence of the accompanying
inflammation. The inflammation sometimes confines
itself to the cellular membrane, and advances very
slowly to the suppurative stage, thus causing not only
highly troublesome local pains, but a considerable
degree of febrile disturbance. In these cases, gangrene and sloughing of the cellular membrane is apt
to occur, and either protract the cure, or leave the
part in a condition liable to take on a renewed morbid action from the smallest exciting cause. In other
instances, suppuration occurs speedily, the abscess
bursts and discharges itself freely, and a prompt cure
results.
Causes.-Use of highly spiced, fat, and stimulating
food; disordered stomach and bowels; abuse of the
eyes in reading, writing, or sewing by gas-lights;
scrofulous, psoric, and other impurities of the blood.




622           AFFECTIONS OF THE EYE
Therapeutics.-The appropriate remedies are, sulphur, pulsatilla, staphysagria, sepia, lycopodium. We
usually employ the third attenuation, and administer
a dose twice daily until the swelling and inflammation disappear.
SECTION XVI.
ENTROPIUM.-INVERSION OF THE EYELIDS.
Diagnosis. —This affection consists of an unnatural
turning inwards of the whole or a portion of the tarsus and eyelashes, in such a manner as to -keep up a
constant irritation of the globe, and thus generate a
troublesome chronic ophthalmia.  If the disease is
allowed to continue for any length of time, the cornea
loses its brilliancy, its vessels become injected, and
ulcers form; there is continual lachrymation; partial
or entire loss of vision; great pain and annoyance
from the presence of the offending eyelashes.
Causes.-Cicatrices arising from previous ulceration
of the tarsi; chronic ophthalmias; relaxation and
paralysis of the lids; ulceration of the ciliary glands.
ECTROPIUM. —EVERSION OF THE EYELIDS.
Diagnosis.-Eversion of the lids may be caused by
a swelling and relaxation of the lining membrane of
the eyelid, which presses the edge of the lid forward
until it becomes everted, or by a contraction of the
skin of the lid, in consequence of the healing of
wounds, ulcers, carbuncles, burns, boils. etc. The
consequences of eversion are, constant exposure of
the globe to external irritating causes; chronic inflammation of the eye; frequent discharge of tears;
dryness of the ball; photophobia; nebulous spots
and ulcers of the cornea.
Causes.-The principal causes of eversion in consequence of swelling of the lining membrane of the lid,
are, protracted chronic ophthalmias of a scrofulous
nature; relaxation from intemperance or old age; a
diseased state of the follicles of Meibomius; morbid
growths in the part. Other causes of eversion are,
cicatrices on the skin of the lid arising from incisions,
burns, ulcers, smallpox pustules, and carbuncles.




AND ITS APPENDAGES.           623
Therapeutics.-The medicines which have been
commended in these affections are, hepar sulphur,
mercurius sol., calcarea carb., digitalis, borax.
Should these remedies disappoint our expectations,
a portion of the lid should be excised, in such a manner, and in such a situation that the healing cicatrix
will restore the displaced tarsi and cilia to their normal position. The operation is simple, unattended
with danger, and quite efficient. If opacity or ulceration of the cornea has already commenced when we
are first called to the case, it will be advisable to
have recourse to the operation without delay, and
correct all local or constitutional faults afterwards,
with suitable medicines.
The attenuations and repetitions of doses the same
as in amaurosis.
SECTION XVII.
FISTULA LACHRYMALIS.
Diagnosis.-Under this head authors generally include, obstruction of the puncta lachrymalis and of
the lachrymal canals, inflammation and suppuration
of the lining membrane of the lachrymal sac, and
inflammation, thickening, and obstructions of the
membrane lining the ductus ad nasum.
In the most simple form of the complaint, there
will be merely an obstruction of the puncta, arising
from disease of the Meibomian glands, or of the eyelids, and a consequent interruption to the passage of
tears to the lachrymal sac. The manifest symptoms
in this instance will be, a continual watering of the
eye and overflow of tears upon the cheek, weakness
of vision, and an undue dryness of the nostril of the
affected side.
Another form of the complaint commences in the
lachrymal sac, manifesting itself in the form of a
small, hard, and circumscribed swelling, apparently
within the sac. This swelling is quite tender to the
touch, and gradually increases in size until suppuration occurs, when the parts over and around the tumour acquire a red and shining appearance, not unlike erysipelas. During the early period of the in



624           AFFECTIONS OF THE EYE
flammation, the puncta are closed, and tears are
forced over upon the cheek. The inflammation also
extends down the nasal canal, causing a degree of
tenderness, dryness, and obstruction in the duct and
nostril. If the suppurative process continues unchecked, the sac, after becoming much distended,
bursts, and gives gradual exit to the enclosed pus,
thus reducing the swelling, and developing a fistula
of the lachrymal sac. During the suppurative process,
the inflammatory action frequently extends to the external textures of the eye, and if the patient be scrofulous or highly irritable, some constitutional disturbance may be present.
If the disease is permitted to increase, or if injudicious surgical-interference has seriously injured the
affected tissues, we may expect adhesive inflammation between the walls of the membrane of the nasal
duct, and permanent obstruction to the passage of
tears to the nostril, and also a closure of the lachrymal canals. When this state of things happens, the
tears run over the cheek as fast as formed, and we
are presented with the disease termed stillicidium
lachrymarum.
Still another form of the malady consists in a primary inflammation and thickening of the membrane
of the ductus ad nasum, which gives rise to a partial
or total obstruction to the passage of the tears, and
their consequent accumulation in the lachrymal sac.
This undue lachrymal accumulation induces distention of the part, and, after a time, inflammation of its
lining membrane, and the other consequences which
we have before enumerated. This form of fistula is
dependent upon some disease of the nostril, like syphilitic, scrofulous, mercurial, and cancerous ulcerations, or inflammation of the nasal membrane from
other causes.
When the malady is fully developed, it is difficult
to decide in which particular structure the inflammation originated; but our diagnosis will always be
facilitated by carefully considering the causes of the
affection, and the previous inflammations. In whatever part it commences, the inflammation is certain
to extend, sooner or later, to the contiguous structUres.




A.nD II'M APrPErNDACtS.        5
6Ci'tts&.-  Searpe'adv ancea d he  iea, tfid t all far6i's
bif figtlta lachrylalis Wiere adttributabrfe t6  diiea
of the Tniihnte lghnd&s of 0Meibomitnv,    n i inanihiation of the lihiig imnembi-akie of'tfee eeliAy. This iaba
h1s been'pairially i'efuted bv ~eeiMl reine t octilis'ts, but there iA, ih6wtAthsta'hidlh:,   ciihuc  frtith in iie
theory. AXccoirdiag tb b ur own obS6,vat-i0f, %lie
forms of fijtila:hich hAvee oriinated iM rh 0p4icta,
of -ihchti'yl hac, have beei prb'ceidd -by  h ifaakithi;oh of h'e AiVeimb6mia, klahds, o'i- of hih  6iibiditra bif'the 6'elid&; b -tit whi'e. thb dAitae  hdA% 1i&finated in the ductus ad nit, it ynar  e;8iaft be
4isritd thb a phidtou   nfln&  iA i; 1iheIath   hr inJttirf 6to thie m'itcts fmbrilei't e'df'the faihiil.
Th  i-tmbte ea'uigkS whili jipr di~p oe  tb tde itffiction are, a scrofulous, syphilitic, or mercurial ftilit;
general debility and tendency to membranous inflammations; caries of the nasal bones; fractures and
other injuries in the region of the lachrymal sac and
nasal duct; chronic ophthalmia; pressure of tumours
against the lachrymal sac and the puncta.
Prognosis.-Previous to suppuration of the sac,and
if there is only a partial obstruction in the lachrymal
canals, we may anticipate a prompt cure by internal
remedies. But if the puncta and nasal duct be entirely closed, and the suppurative stage in the sac is
far advanced, our prognosis must be unfavourable or
evasive. Much, however, must always depend upon
the condition of the system, and the causes and complications which influence each particular case.
Therapeutics.-Various methods have been proposed by surgeons for the cure of fistula lachrymalis,
but they have proved for the most part unsatisfactory.
The different surgical means which have been most
commended are, the introduction of a tube or style
into the nasal duct; the injection of the sac and nasal canal, through the puncta, by means of Anel's
syringe, and the introduction of quicksilver.  That
cures have now and then followed each of these methods, we do not deny; but the numerous instances of
permanent aggravation of the malady by their employment, render it probable that there has been
altogether more injulry than benefits from  their intro27




626        AFFECTIONS OF THE EYE, ETC.
duction into surgical practice. The same opinion is
at this time entertained by several distinguished ophthalmic surgeons. It therefore becomes us to investigate all of the causes and accompanying symptoms
of each particular case, that we may better select
remedies, and thus combat with a prospect of success
the remote as well as the immediate symptoms.
The following medicines have been found curative
in the various forms and stages of the complaint:
calcarea carb., acid nit., hepar sulph., silicia, aurum,
petroleum. belladonna, iodine, digitalis, lachesis, lycopodium, kali carb., natrum carb.
The lower attenuations are always to be preferred,
and the dose repeated every twelve or twenty-four
hours until the disordered tissues are suitably impressed.
THE END.




INDEX.
A.           PAGE                               PAGE
Abdomen, dropsy of,  -    - 539  Brain, effusion of seium upon, 389
" tympanitic distention of, 259    "   induration of,  -    - 404
Abdominal typhus,          -  190  Bright's granulated kidney, 533,535
Acne,                      - 245  Bronchitis, acute, -    -    - 316
Acute ophthalmia,          - 580        "    chronic,    -    - 317
Acute rheumatism,          - 524  Bubo,-    -    -    -  474, 489
Albugo,    -    -        582, 601
Allopathy, -    -       -      61
Amaurosis, -    -          - 605                   C.
Amenorrhaea,   -          - 503  Calculi,        -    -      - 454
Anasarca,  5-              -   38  Calculi of the bladder, 457,459,460
Angina pectoris,           - 359       "  of the kidneys, -  459, 460
"    tonsillaris,       - 249       "  of the prostate gland, 458,459
"    parotitis,    -   - 252  Cancer of the eye,    -          617
"    maligna, -         - 200  Cardialgia, -         -         267
Apoplexy, -    -    -    - 387  Carditis,   -          -         361
Arachnitis, -           -    -    - 371  Cataract,   -  -        614
Arthritis,                 - 528  Catarrh,   -         -         306
Ascites,                - -   539  Causes of disease, general,  -  36
Asiatic cholera,  -       -    - 286  "  of fever,    -       -  136
Asthma,   -    -    -    - 336  Cellular dropsy,         - -    538
Attenuations of drugs, &c., - 111  Cerebral typhus,         -    183
B.                  Cerebritis, -           -    380
Bilious colic,    -    -    - 280  Cerveau, ramollissement du, - 380
"   fever,    -    -    -  172  Chancre,   -    -    -   - 486
Bladder, inflammation of,   - 435  Chest, dropsy of, -   -       542
"   paralysis of, -  446, 451  Chemosis,  -    -    -    - 581
"   calculi of,   -    - 454  Chicken pox,           - -    217
irritable,    -    - 473  Chlorosis,  -    -          - 555
"   suppuration of,    - 436  Cholera asphyxia,      -    - 286
Bowels, inflammation of,  269, 270     "   morbus, -    -    - 295
"   looseness of,  -    - 297      "   infantum,-    -   -  297
"   torpor of, -    -    - 258  Chorea,       -       - -    419
griping pains of,   - 280  Chronic ophthalmia    -        587
"   hemorrhage from, - 270  Colic, bilious,    -          280
protrusion of, -    - 299    "  flatulent,     -          281
"   flatulent distention of, 258    "  painter's,    -        282
Brain, diseases of,        -  364  Cold, -                    -  306
inflammation of,     - 371  Conjunctiva, acute inflammasoftening of,       -  380                  tion of,    - 580
"   dropsy of,     -    - 381         "      chronic do. do. 587
extravasation of blood                   granulations of, -  599
upon,  -    -    - 387  Constipation,              -    258




628                            lND)EX.
PAGE                                PAGE
Consumption, pulmonary,   - 341  Drugs, attenuations of,        -  111
Continued fever, -          -    - 172  Dysentery, -    -    -    - 270
Convulsions,     -    -  383, 421  Dysmenorrhea,  -            -    - 513
Cornea, inflammation of,    -  601  Dyspepsia,                  -  258
"   ulcers of, -        -    -  582  Dysuria,   -      -       44
"   opacity of,         -  600
Coryza,    -            -    -    - 306.            E.
Cough,      -    -    -       357:  Ecthyma,  -    -    -          242
i  whooping, -             334  Ectropium,        -    -    -  622
Croup,      -    -    -    -  308  Eczema,   -    -    -    - 242
Cutaneous diseases, febrile, - 198  Encephalitis,    -    -. 371...."         chronic, - 235  Enteritis, acute peritoneal, - 269
Cynanche laryngea,   -    -  307       "        "  mucous,    - 270
traciealis,  -    - 308             chronic do. -    - 270
Cystts,                    -  435  Entropium,                      622
Enuresis,   -       -         442
D.                   pilepsy,   -    -    -    - 383
Delirium tremens,     -    - 394. Erpptive diseases, acute,   - 198
Deentia,         -    -    - 402                      chronic,  - 235
Diabetes,  -    -    -    - 436  Erysipelas,-    -    -    - 227
Diagnosis, general,        - 122  Exanthemata,   -    -    -  198
Diarrhcea,  -    -    -    - 297  Eye diseases of, -           -   578
Dilatatio of the heart, -    - 359       acute inflammation of,   580
D seaeso, common causes of, -   36    " chronic      "      "  -  587
Disosesof the cutaneoussystem 198    " purulent   "'          - 590
digestive system, 247    "gonorrheal          "  - 591
respiratory do.  304    " scrofulous              - 592
circulating do.  359'   " dropsy of,  -    -    - 611
Diseases of the brain and ner-        " fungus hematodes, and
vous system, -      -    3- 64         cancer of,     -  617
Diseases of the spinal marrow         " blindness of,  (see cataand its membranes,        410       ract, amraurosis, granuDiseases of the urinary and.             lated lids, opacity of the
genital organs, -    -    - 432       cornea, cancer, etc.)
Diseases of the fibrous and
muscular system,   -        5.24:                 F.
Diseases'of the serous exhal-'e.ver,                          132
eqt vessels,    -    -    - 530      "   intermittent,   -      141
Diseses of lymphatic system,.55:    "  yellow,   -    -    - 159
Diseases of the assimilative, or-  continued,                      172
gans,    -    -    -    - 566        "  infantile remittent,  -  168
Diseases of the eye. and, its          "  typhus,               - 176
appendages,   -    -    - 578        ".  from functional derangeDispepsia, see Dyspepsia.               ment, -    -    -    -  172
Doctrines, medical, &c.    -    1  Fever, from congestion,         174
Does, repetition of,   -    - 111      ".  from inflammation,      173
Dr."psy, general, -    -    - 530      "  hectic,'.  -   - I   - 196'    of the abdomen,    -   358     "  scarlet,   -    -       198
brain,  -       381      "  lung,      -    -    - 322
chest,  -    - 542       "  brain,    -    -    - 371.
"  eye,    -        6.11     ".  miliary,  -    -    - 218
ovarium,    - 543          puerperal,      -    -  278
testicle,    - 544  Fistala lachrymalis,   -        623
Dnugs, primaty:andsecondary           "   in prineo,    -    - 47'action of        -    -  49  Flatulence,'-'-  -            259




PAGE                               PAGt
Flur albus,     -    -   - 496  iysteria,   -    -    -    - 42!
Fungus hmmatodes,   - -    617
G.                 Indigestion,     -   -    - 258
Gaqtritis, acute, -   -    - 253- Ipetigo,  -    -    -    - 24
chronic,    -    - 257  Innammation,   -    -    -    7I
Gastralgia, gastrodinia,    - 267               of the brain, 3- 71
General diagnosis,    -    - 122                "  "  lungs, - 322
dropsy,-    -   - 530           "       "  "  pleura,- 328
Genital organs, diseases of, - 432      "             heat and
Gleet,          -  470                          its appendages, 359
Glossitis,   -       -      -    - 24,7  Inflammation of. the stomach,  253
Gonorrhcea, -                465                "   " liver,  - 302
Gonorrhceal ophthalmia,    - 591                "  " bowels,269,270
Gout, acute,         -       528                "  "  kidneys,  432
chronic,      -         529                "  " bladder,  435
Granulations of the eyelids,   599      "       "' uterus,513,519
Gravel,                      454                "    eye and
Granulated kidney, Bright's 533, 535.           its appendages, 578
Inflammation of the spinal
H.                    marrow and its membranes, 410
H-Ienatemesis,   -    -    - 266  Inflammation of the joints, - 56&
Hgmorrhage from. the lungs,  352'   "'    urethra,  465It''...stomach, 26.6      "      "  " ing.uinal'...." bowels, 270                       glands,   474~..'..' uterus, 517  Inflammation of the. tonsils,  249
" urethra, 4.66                  "' arptid.
IEHmorrhoids,   -    -   - 299                          glands, 252
Hremoptysis,.   -    -    - 352  Infaummation of the tongue,  247
Heart, diseases of,    -   - 359                "   peritonum, 278
dilatation of,  -   - 359         "      "  " prostate
disease of the valves of, 360                     gland, 472".  inflammation of the en-          ".          bronchia,  316;
velop of,   -    -   - 361          "      "  " testes,     482,
Heart, palpitation.of,    360, 361  Incontinence of urine, -    - 44z2
dropsy. of,   -    - 542  Infantile remittent,   -    - 168,
Hectic fever,    -    -    - 196  Influenza,  -                 307
Hepatitis, acute, -   -    - 302. Ileus,                        271
chronic,    -    - 303  Insanity,   -    -   -    - 397
Hernia humoralis,         - 474. Internlittent fever,    -   - 141
Herpes,    -    -    -    - 236  Intestines, inflammation of,: - 270
Hip-disease,    -    -    - 568  Inversion of the eyelids,   - 6222
Honmceopathy,   -   -   -   86. Irritable bladder,      -    - 4,73
Hooping cough, -             334  Ischuria,   -        -    -    -443
Hordeolum,   -  -  - 621 Itch, -                      -         240
IEydatids of the uterus,    - 497
Hydrocephalus, acute,     - 381                   J
chronic,    - 382  Jaundice,  -   -   -    - 303
Hydrothorax,   -    -   - 542
Hyiophobia,   -    -    - 414',
Hy'drocele,     -    -   - 544  Kidney, Bright's disease of, 533, 535
Hy4~ ophal.mia,   -    -   - 6il  Kidneys, inflammation of,,  - 432
Hydops,        ^ -. -    -- 530.      "   suppuration of,   - 433
H'plrtrophy of.the.eaxt,  - 359       "   induration of,    - 433
HEp chpndria,             - 401        "   schirrhus of,     - 433




630                            INDEX.
PAGE                               PAGE
Kidneys, gangrene of, -    - 434  Ovarian dropsy,  -            - 543
L.                                  P.
Lachrymal fistula,    -    -  623  Painter's colic,   -    -       282
Lepra,             - -    -    - 245  Painful menstruation,    -    513
Leucoma,  -               582, 601  Palpitation, -    -    -       359
Lids, granulated,     -    - 599  Papular diseases, -        -    239
Leucorrhoea,     -    - 475, 496  Paralysis,palsy, -    -          392
Lichen,     -    -    -    - 232  Parotitis,   -             -    -  252
Liver, inflammation of. -     302  Pathology, general observaLung fever, -    -    -    -  322       tions on,    -    -          7
Lungs, bleeding from, -    - 352  Pemphigus, -                     238
tubercles of,   -    - 345  Pericarditis,     -             361
"  ulcerations of, -    - 346  Peritoneal enteritis,   -       269
"  hepatization of,     -  323  Peritonitis, acute, -    -     278
congestion of,      -  323       "      chronic,    -       280
purulent infiltration of, 324  Pertussis,  -    -    -      334
Phthisis pulmonalis,   -      341
M.                  Phrenitis,   -    -    -       371
Mania,      -    -    -    -  399  Phymosis,  -    -    -          469
Mania a potu,    -    -    - 394  Piles, -                      -  299
Marasmus, -    -    -    - 569  Pityriasis,  -    -          -    246
Measles,    -    -    -    - 207  Plague,    -       -    -        235
Medical doctrines, &c., -    -    1  Pleurisy, pleuritis,    -    328
Melancholia,     -    -    - 401  Pneumoma, -                   -  322
Menses, suppression of, -    - 503  Porrigo,    -    -    -        244
retention of;,   -    503  Primary and secondary action
"   scanty,  -    -    - 513         of drugs,    -    -         49
"   painful, -          - 513  Prolapsus ani,   -    -         299
"   profuse, -    -    - 517         "    uteri,  -    -       498
Menorrhagia,    -             517  Prostate gland, diseases of, 450,472
Miasmata,  -          -       140  Prurigo,    -    -    -         240
Miliary fever, Miliaria, -    - 218  Psora, -                   -  240
Monomania,       -    -    - 401  Psoriasis,               -       246
Mucous enteritis, -        - 270  Puerperal fever, -            -  278
Mumps,    -    -    -    - 252  Pulmonary consumption,    - 341' affections, -           304
N.                  Purulent ophthalmia, -    -  590
Nephritis,  -    -    -    - 432  Pustular diseases,    -          240
Nervous system, diseases of, - 364  Pyrosis,    -    -    -        258
Nettle rash, -    -        -  221
Neuralgia,  -    -    -    - 424                    Q.
Nebula,    -    -    -  582, 601  Quinsy,    -    -    -           249
O.                                  R.
Ophthalmia, acute,         -  580  Ramollissement du cerveau, -  380
4"     chronic,  -    - 587  Remedial agents, specific ef9"     purulent, -    -.590        fects of,    -    -    -   40
c"     gonorrhceal,    - 591  Remittent fever, -           -  168
t"    strumous, scrofu-          "          "  infantile,   -  168
lous,  -    -    -    - 592  Repetitions of doses,  -    -  111
Opacity of the cornea, -    -  600  Respiratory organs, diseases of, 304
Opisthotonos,    -    -    - 410  Retention of the menses,  503, 506
Os uteri, imperforate,.  508       c"      "  urine, -    - 443
Ovarian disease, -         - 543  Rheumatism, acute,   -    - 524




INDEX.                           631
PAGE                               PAGE
Rheumatism  chronic, -    - 525  Tic douloureux,  -    -   - 424
Roseola,   -               - 220  Tongue, iuflammation of,    - 247
Rubeola,   -    -    -    - 207  Tonsils, inflammation of,    - 249
Rupia,     -    -             243  Tonsilitis,   -    -   -    -  249
Trachealis cynanche,   -    -  308
S.                  Typhus,                       176
Scabies,    -   -    -    - 240        "   cerebralis,    -    -  183
Scarlet fever,    -    -    - 198          pneumo, -    -    - 187
Scarlatina, -    -    -    - 198       "   abdominalis,  -    - 190
Scarlatina simplex,    -    - 199
"    anginosa,   -    - 199                    U.
"    maligna,         - 200  Ulcers of the cornea, -    - 582
Schirrus of the eye,   -    - 617      i"  "  "  surface, -    - 488... uterus,    519, 497     " "   throat, &c.    - 488
Scrofula,          - -    -    - 566   "  "  " lungs,  -    - 346
Scrofulous ophthalmia,    568, 592  Urethritis, -    -    -    - 465
C    disease of the me-        Urethra, inflammation of,   - 465
senteric glands,   -    - 569      "   strictures of,  -  452, 470
Secondary syphilis,   -    - 488  Urinary calculi,  -    -        454
Serous exhalent vessels, dis-          "   organs, diseases of, - 432
eases of,    -    -   - 530  Urine, incontinence of, -    - 442
Skin, acute diseases of,   - 198       "  suppression of, -    - 443
"  chronic diseases of,    - 235     "  scalding of the, -    - 466
Sloughing of the cornea,    - 582      "  increased secretion of,  436
Small pox, -    -    -    - 212        "  bloody,   -    -    - 467
Softening of the brain, -    - 380     "  saccharine,          - 440
Specific effects of morbific and       "  coagulable,     -    - 533
remedial agents,  -    -  40  Urticaria,  -    -    -    - 221
Squamous diseases,   -    - 245  Uterus, inflammation of,  513, 519
Spinal marrow, inflammation            "  hemorrhage from,   - 517
of          -    -    - 410        "  scirrhus of,        - 497
Sporadic cholera, -        -  295' prolapsus of,   -    - 498
Strictures of the urethra,    - 470    "  polypi of, -         - 497
St. Anthony's fire,    -    - 227      "  hydatids of,      - - 497
Stomach, acute inflammation            "  congestion of,.  513, 519
of,    -    -    -    - 253
Stomach, chronic inflammation                       V
of,         -    -    - 257  Valves of the heart, diseases
Stomach, neuralgia of, -    - 267       of;    -    -    -    - 360
"   acidity of,       - 259  Varicella. -    -    -          217
Suppression of the menses, 503, 506  Variola,   -    -    -    - 212... "   urine,   - 443  Venereal disease, -                 482
Susceptibilities of parts great-       "    node,    -         - 489
est in disease,    -    -   54  Vital principle, &c., doctrines
Stye, -                       621       respecting, -    -   -   22
Syphilis,   -    -    -    - 482  Vomiting of blood,           - 266
T.                                 W
Tetanus,   -    -    -        410  White swelling, -    -    - 568
Testes, inflammation of,    - 482  Whites,    -    -    -    - 496
"  dropsy of,          - 544
Tetter,    -    -          - 236                   Y
Therapeutics,    -    -    -   36  Yellow fever,   -    -    - 159'The plague, -    -    -    - 235




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