u i\n i\ i A MANUAL OF HOMCEOPATHIC PRACTICE PAET I. PHARMACODYNAMICS. A MANUAL PHARMACODYNAMICS. RICHARD HUGHES, L.B.C.P. ED. (EXAM.), M.B.C.S. ENGL. LONDON: HKXRY TURNER & CO., 77, FLEET STREET, B.C., AND 74, NEW BOND STREET, W. MANCHESTER: 41, PICCADILLY, AND 15, MARKET STREET. 1867. J. E. ALABD, PEINTBE, BARTHOLOMEW CLOSE, E.G. TO HENBY B. MADDEN, ESQ., M.D. MY DEAE DR. MADDEN, I am discharging a duty, no less than indulging a pleasure, in dedicating this volume to you. It was from your conversation and writings that I first learned the reasonableness of Homoeopathy : it was under your guidance that I began to study and practise it. You will recognise in the following pages much that I have leamt directly from you, and much that we have worked out together. Even that in them which I may call mine would not have been without the inspiration first caught from you. So I am but giving you of your own : and am proud to head my pages with the grace and sanction of your name. That you may long enjoy and fruitfully use the health you have travelled so many miles to re-establish, is the earnest prayer of Your aifectionate friend, RICHAED HUGHES. Vlll PREFACE. furnish to students and beginners in Homoeopathy a full digest of the knowledge peculiar to our school of medicine. Leaving the Therapeutical part for the present, I would say a few words upon the manner in which I have treated the subject of Pharmacodynamics. 1. My work in no way professes to be a substi- tute for the ' Materia Medica.' It is rather a guide and companion to it. The pathogeneses of the medicines, given in detail there, are presented here in the way of descriptive outline, of analysis, or (wherever possible) of physiological expression. But reference is always made to the Materia Medica itself as the mine where the treasure, how- ever rough its form, really lies. To indicate the vein where each mineral may be worked, to estimate the value of its yield, to exhibit such of its products as have been obtained and smelted, and especially such as have been applied to use this has been my work. If there are any who cannot or will not work the mine for themselves, that which they learn from what I show them out of it is at any rate better for them than total ignorance. To most of my readers I hope that the specimens I exhibit will excite a thirst for farther research of their own, rather than a less worthy content with the results of the labour of others. 2. My main object has been to set forth the PREFACE. IX sphere of action of each medicine. Putting out of sight those great polychrests which embrace nearly the whole organism within the circle of their influ- ence, every medicine has one or more centres of action. What these centres are we learn, some- times by the study of the pathogenesis, sometimes by the result of clinical experience. When we have learnt them, they become all-important stand-points for the understanding and the remembrance of the medicine. Jhese centres I have endeavoured wherever practicable to reach : and around them to group the several actions and uses of the drugs. There will always be residuary phenomena in such a process : but these I have not failed to note when their importance demanded it. 3. One word about the unusual form of my work, viz., that of letters. I was driven to adopt it by the object I had in view. I write especially for practitioners of the old school, who desire to acquaint themselves with and furnish themselves for our practice. I felt accordingly the need of some mode of communication which should be colloquial rather than didactic. And moreover I wanted to have always before me the mind of our confreres, wedded to old notions, bristling with objections to anything new, and requiring explanations to the fullest degree. By erecting the friend whose wants evoked my book into an X PREFACE. imaginary correspondent, and writing what I had to say in the shape of letters to him, I found the form of composition I required. For all that remains, I leave my pages to speak for themselves. They have employed for many months all the leisure left me by a laborious prac- tice. Since they aim at supplying a general want, I ask for them the indulgent consideration of my colleagues. CONTENTS. LETTER PAGE I. Introductory 1 II. Nomenclature and Pharmaceutics 10 III. The Acids 19 IV. The Acids (continued) 29 V. Aconite 37 VI. Actsea, JSsculus, ^thusa, Agaricus 49 VII. Agnus ca*stus, Allium cepa and sativum, Aloes, Alu- mina, Ambra, Ammonium carbonicum and muri- aticum 59 VIII. Anacardium, Angustura, Antimonium crudum, and Tartaricum 71 IX. Apis, Apocynum, Argentum metallicum and Nitri- cum, Arnica 86 X. Arsenic 105 XI. Artemisia, Asafcetida, Asarum, Asterias, Aururn, Baptisia, Baryta carbonica 123 XII. Belladonna 136 XIII. Berberis, Bismuthum, Borax, Bovista, Bromium, Kali bromidum 153 XIV. Bryonia 160 XV. Cactus grandiflorus, Calcarea acetica, carbonica, muriatica and phosphorica, Calendula, Camphora 176 XVI. Cannabis sativa and indica, Cantharis, Capsicum, Carbo animalis and vegetabilis 190 XVII. Caulophyllum, Causticum, Cedron, Chamomilla, Chelidonium, Chiinaphila 202 XVIII. Cicuta, Cina, Cinchona and Quinine 214 XIX. Cistus, Clematis, Cocculus, Coccus cacti, CofFea, Colchicum, Collinsonia 225 XX. Colocynth, Conium, Copaiba, Corallia, Crocus, Cro- talus . , 241 Ill CONTENTS, LETTEE PAGE XXI. Croton, Cuprum, Curare, Cyclamen, Digitalis 253 XXII. Drosera, Dulcamara, Elaterium, Eupatorium, Eu- phorbium, Euphrasia, Ferruia 269 XXIII. Gelseminum, Glonoine, Graphites, Gratiola, Guia- cum, Gummi guttse, Hamamelis 284 XXIV. Helleborus, Helonias, Hepar sulphuris, Hydrastis, Hyoscyamus, Hy peri cum 298 XXV. Ignatia, Indigo, lodium, Kali hydriodicum 313 XXVI. Ipecacuanha, Iris, Kali bichromicum 335 XXVII. Kali carbonicum, chloricum, nitricum, and per- manganicum, Kalmia, Kreasote, Lachesis 351 XXVIII. Laurocerasus, Ledum, Leptandria, Lobelia, Lyco- podium, Magnesia carbonica and muriatica, Manganum, Menyantbes 366 XXIX. Mercurius 381 XXX. Mezereum, Millefolium, Moscbus, Murex, Naja, Natrum carbonicum and muriaticum, Nuphar, Nux juglans, Nux moscbata 403 XXXI. Nux vomica 414 XXXII. Oleander, Oleum animale, Opium, Origanum, Petroleum 427 XXXIII. Phosphorus 436 XXXIV. Phytolacca, Platina, Plumbum, Podophyllum 450 XXXV. Pulsatilla 462 XXXVI. Ranunculus, Ratanhia, Rheum, Rhododendron, Rhus 471 XXXVII. Rumex, Ruta, Sabadilla, Sabina, Sambucus, Sanguinaria, Sarsaparilla, Scilla 482 XXXVIII. Secale, Selenium, Senega, Sepia, Silicea 492 XXXIX. Spigelia, Spongia, Stannum, Staphysagria, Stra- monium 503 XL. Sulphur 514 XLI. Tabacum, Taraxacum, Tellurium, Terebintbina, Teucrium, Thea 525 XLII. Thuja, Uranium, Urtica, Uva ursi, Valerian, Vera- trura album and viride 534 XLIII. Verbascum, Vinca minor, Viola odorata and tri- color, Xanthoxyllum, Zincum 544 ALPHABETICAL LIST OP THE MATERIA MEDICA HOMGEOPATHICA. N.B. The different sizes of type indicate the relative importance of the medicines : and may afford useful hints as to order of study. PAGE Acidum benzoicum 19 Acidum fluoricura 21 Acidum hydrocyanicum ... 22 Acidum muriaticum 25 ACIDUM NITEICUM 29 Acidum oxalicum 31 ACIDUM PHOSPHORICTTM ... 33 Acidum sulphuricum 35 ACONITUM NAPELLUS 37 Actasa racemosa 49 ^Esculus hippocastanum ... 52 ^Ethusa cynapium 54 Agaricus rauscarius 55 Agnus castus 59 Allium cepa 60 Allium sativum 61 Aloes 62 Alumina 64 Ambra grisea 66 Ammonium carbonicum ... 67 Ammonium muriaticum ... 69 Anacardium 71 Angustura vera 73 Antimonium crudum 74 AKTIMONIUM TARTAEICTJM 76 APIS MELLIFICA 87 Apocynum cannabinum ... 93 Argentum 94 Argentum nitricum 96 ARNICA MONTANA... . 99 PAGE ARSENICUM ALBUM ... 105 Artemisia 123 Asafoetida 124 Asarum 126 Asterias rubens 127 Atropia 151 AtTETTM 128 Saptisia tinctoria 131 BARYTA GARBONICA 134 BELLADONNA 136 Berberis 153 Bismuthuin 154 Borax 155 Bovista 156 Bromium 157 BKYONIAALBA 160 Cactus grandiftorus 176 Calcarea acetica 180 CALCAREA CARBONICA 181 Calcarea muriatica 184 Calcarea phosphorica 184 Calendula 184 CA>MPHORA 185 Cannabis indica 192 Cannabis sativa 190 Cantharis 193 Capsicum 198 Carbo animalis .,..., ,. 199 XIV ALPHABETICAL LIST. PAGE C AEBO VEGETABILIS 200 Caulophyllum 203 Causticum 204 Cedron 206 CHAMOMILLA 207 Chelidonium majus 210 Chimaphila 213 Cicuta virosa 214 Cina 215 CINCHONA 217 Cistus canadensis 225 Clematis 226 Cocculus indicus 227 Coccus cacti 230 Coffea 232 Colchicum 234 Collinsonia 239 Colocynth 241 Conium 244 Copaiba 248 Corallia rubra 249 Crocus 250 Crotalus 251 Croton iiglium 253 CFPBTJM 255 Curare 257 Cyclamen 258 DIGITALIS 259 Digitaline 268 Drosera 269 Dulcamara 271 Elaterium 274 Eupatorium perfoliatum ... 275 Euphorbium 277 Eupkrasia 278 Ferrum 280 Gelseminum 284 Qlonoine 287 Graphites 291 Gratiola..., 292 Guiacum 293 Gummi guttse 293 Hamamelis 294 Helleborus niger 298 PAGE Helonias dioica 300 HEPAB SULPHUBIS 302 Hydrastis 305 HYOSCYAMTTS 309 Hypericum perfoliatum ... 312 IGNATIA AMAEA 313 Indigo .; 316 IODIUM 316 IPECACUANHA 335 Iris versicolor 341 KALI BICHEOMICUM 343 Kali bromidum 158 Kali carbonicum 351 Kali chloricuni 352 Kali hydriodicum 330 Kali nitricum 354 Kali permanganicum 356 Kalmia latifolia 357 Kreasotum 358 LACHESIS 362 Laurocerasus 366 Ledum palustre 367 Leptandria virginica 368 Lobelia inflata 369 LTCOPODIUM 371 Magnesia carbonica 376 Magnesia muriatica 376 Manganum 377 Menyanthes 379 MERCURIUS 381 Mezereum 403 Millefolium 404 Moschus 405 Murex purpurea 406 Naja 407 Natrum carbonicura 409 Natrum muriaticum 409 Nuphar luteum 411 Nuxjuglans 412 Nux moschata 412 NUXVOMICA 414 Oleander 427 Oleum animale ... .. 428 ALPHABETICAL LIST. XV PAGE Oleum j ecoris aselli 333 Opium 428 Origanum 434 Petroleum 434 PHOSPHORUS 436 Phytolacca 450 Platina 455 Plumbum 456 Podophyllum 459 PULSATILLA 462 Quina . 221 Ranunculus 471 Ratanhia 473 Rheum 474 Rhododendron 474 RHTJS TOXICODENDBON ... 476 Rumex crispus 482 Euta 483 Sabadilla 485 Sabina 486 Sambucus 488 Sanguinaria 489 Sarsaparilla 490 Scilla 490 Secale comutum 492 Selenium 494 Senega 495 Sepia 496 PAGE SILICEA 499 Spiff elia 503 SPONGIA 505 Stannum 507 Staphysagria 509 STRAMONIUM 510 Strychnia 425 SULPHUR 514 Tabacum 525 Taraxacum 527 Tellurium 528 Terebinthina 529 Teucrium 533 Thea 533 Thuja occidentalis 534 Uranium nitricum 537 Urtica urens 538 Uva ursi 538 Valeriana 539 Veratrum album 540 Veratrum viride 543 Verbascum thapeus 544 Vinca minor 545 Viola odorata 545 Viola tricolor 546 Xanthoxyllum fraxineum ... 547 ZlNCTTM... .. 548 LETTER I. INTRODUCTORY. MY DEAR You tell me that you have become a convert to Homoeopathy. I need hardly say how gladdened I am by the intelligence. It is always a satis- faction to hear that any of the priests are obedient to the faith. And one's gratification is great indeed, when it is an old frieud and fellow-student who comes forward to give in his adhesion to a truth, which it is the object of one's own life to maintain and put in practice. You now write to me for advice. Your con- victions, you say, have been attained in a great measure by the study of our apologetic writings. They have satisfied you of the reasonableness of our doctrine and of the positive efficacy of our remedies. In the few cases in which you have tried Homoeopathic medicines your experience has been confirmatory of the reports of others. You have obtained curative results, not only most satis- factory as to rapidity and thoroughness, but of a character quite new to you, or, at least, resembling only that of those medicines you have hitherto known as " specifics." You feel certain that in this law of similars a new vein has been struck, 1 2 INTRODUCTORY. pregnant with remedial wealth ; and you ask how you are to furnish yourself so as to work the vein to its utmost. Now, if you have thoroughly mastered the law in question, it will be obvious to you that the first requisite for its application is a knowledge of the pathogenetic influence of drugs, i. e. of the effects they are capable of producing on the healthy body. Some of these effects are already familiar to you they are part of the body of knowledge comprised under the heads of Toxicology and Materia Medica. But you will feel at once that if your acquaintance with pathogenetics were limited to this range, you would be poorly furnished for the application of the law of similars. It is but a small number of drugs whose physiological action is at all well known, and of these only the more violent effects have been noted. A few typical and severe diseases are pictured therein ; but for the " covering" of the vast majority of the morbid conditions which come before us in daily practice, Toxicology and Materia Medica give little, if any, aid. You will see, there- fore, the necessity of becoming acquainted with those more refined and thorough investigations into pathogenesy which, as you know, have been con- ducted by Hahnemann and his followers. These investigations have extended over many years, and their records are scattered throughout our literature. The well-known 'Manual' of Jahr is an attempt to bring together in a condensed form all these " provings/' as we call them all, that is, that were extant at the time of its publication, now many years ago. You must have it, I suppose, for INTRODUCTORY. 3 those medicines the original sources of whose pathogenesy are difficult to get at. But I would recommend you to obtain, wherever practicable, the primary records themselves, which have a life and freshness quite unfelt in the second-hand compila- tions. The greater part of these are readily acces- sible in an English dress. There are the provings contained in the ' Materia Medica Pura ' and the ' Chronic Diseases ' of Hahnemann, and the 'Addi- tions to the Materia Medica' of Stapf, all of which have been translated by Dr. Hempel. Many others, both of home and foreign origin, are con- tained in the volumes of the ' British Journal of Homoeopathy/ From America we have the ' Mate- ria Medica of American Provings/ compiled by Dr. Esrey from the ' Transactions ' of the American Institute ; the ' Homoeopathic Provings ' of Dr. Metcalfe, being? those contained in the appendix to the ' North American Journal of Homoeopathy ;' and the ' New Remedies in Homoeopathic Practice' of Dr. E. M. Hale. Last, in the ' American Ho- moeopathic Review* of 1864-6, Dr. Constantine Hering has been publishing the results of the ex- periments in pathogenesy carried out under his superintendence. By furnishing yourself with these works you will be possessed of the original records of the provings of at least five sixths of our Materia Medica. But I fear that when you come to in- spect your treasures you will be at a loss what to do with them. A few of the provings, such as the Colocynth, Sulphur, and Thuja of the Austrian Society, are everything that can be desired. Each 4 INTRODUCTORY. experimenter records day by day the quantity of the drug taken, and the phenomena objective and subjective which occur in his body in their time, place, and order. But such provings are the ex- ception rather than the rule. Following the un- fortunate example of Hahnemann, those who have undertaken to publish the pathogenetic experiments have done so in such a way as to make them as uninteresting and uninstructive as possible. They have thrown together the whole mass of symptoms observed by the various provers, and have re- arranged these under regional headings, and accord- ing to an anatomico-physiological "schema." The result of unknown doses of the drug, often without note of their time of appearing relative to its in- gestion, and divorced from their natural grouping and connections, these symptoms present to the student a maze for Theseus, a riddle for (Edipus. It is as though the features of some half-a-dozen English landscapes were brought together within one frame, all the trees being put into one panel, all the clouds into another, all the pieces of water into another, and so on ; and that the spectator were then called upon to identify the particular bits of scenery which the original paintings were intended to represent. From such disjecta membra of pathogenesy hints for practice may be and have been drawn : but the attempt to trace in them veri- table pictures of disease is well-nigh hopeless. I have written strongly on this subject, not only because I feel bitterly the injury inflicted upon Homo3opathy by this senseless arrangement, but because I am anxious to anticipate the disappoint- INTRODUCTORY. 5 ment and even disgust you will almost inevitably feel when it comes before you. Do not let it dis- courage you. In spite of all the obstacles this grouping presents, our catalogues of symptoms have led to much successful practice. And there are certain clues in our hands which are of no little assistance to us in attempting to thread the laby- rinth. 1st. We have those very facts of Toxicology and Materia Medica which I have hitherto spoken of as insufficient for our purposes. Insufficient they indeed are, but, nevertheless, in their measure ex- tremely helpful. To know that a poison is narco- tic, narcotico-irritant, or irritant only, is knowledge sufficiently vague ; but it is a clue. It supplies a framework in which the symptoms may be arranged in some order ; it indicates the class of diseases to which the drug corresponds. The revelations of morbid anatomy carry us a step onward they in- dicate the organs and tissues upon which the poison exerts its influence, and in a broad way the cha- racter of that influence. The teachings of our treatises on Materia Medica crown this body of information. By their classifications of drugs as cathartics, diuretics, expectorants, and so on, they help us still further to localise the sphere of the influence of each : and from their summary of the uses of medicines in disease many a hint may be drawn in regard of the same object, 2nd. In addition to the above, we derive great help in our studies of pathogenesy from the usus in morbis. A great mass of clinical experience with Homoeopathic remedies has now been accumulated, 6 INTRODUCTORY. and may be read in the volumes of our journals and in the collections of Riickert and Beauvais (Roth). In a paper on Ipecacuanha in the twenty-third volume of the ' British Journal of Homoeopathy/ p. 35, I have endeavoured to point out the bearing of such clinical experience upon the science of phar- macology. I venture to cite what I have there said. " If it be observed that a certain drug uni- formly exerts a curative influence upon a well- defined type of disease, and if that influence is not to be accounted for by any indirect action, or any physical or chemical properties of the drug, we say that the remedy is ' specific/ T.o a phar- macologist of the old school, ' specific' means incomprehensible ; and his use of the term indicates that his knowledge has at this point terminated in ignorance. But we find him also using the term * specific' to express that special affinity for certain parts and special action upon certain processes of the organism which is manifested by all medicines, however introduced into the system. He might fairly extend this meaning of the term into the province of therapeutics, and, when a remedy acts ' specifically/ infer that the cure depends upon the affinity of the drug for the organ whose struc- ture or function is affected. To such an inference Homoeopathy adds another, viz. that the kind of morbid action present in the disease cured is that which is characteristic of the pathogenetic influence of the medicine. " If, then, we know that a definite morbid condi- tion has been over and over again removed by a given drug, incapable of exerting any mechanical or INTRODUCTORY. 7 chemical influence upon it, we are justified in infer- ring that the drug in question acts by special affi- nity upon the parts involved in the disease, and in a similar manner. Thus, we know that Belladonna causes heat, dryness, and redness of the throat ; and we infer that it acts specifically upon the mucous mem- brane of the fauces, and after the manner known as inflammatory irritation. But if, prior to this knowledge, a number of cases had been put on record in which Belladonna had cured an inflamed throat so characterised, we should have been justified in drawing precisely the same inference as that which now results from our pathogenetic ex- perience." These aids being so indispensable to the study of the Materia Medica Homoeopathica, it may fairly be asked of us by inquirers and converts that we should supply them in some convenient form. The only complete attempt in this direction which I know of is the ' New and Comprehensive System of Materia Medica and Therapeutics' of our indefati- gable colleague, Dr. Hempel. It is a book you ought to have. But if you will read a review of it in the twenty-third volume of the ' British Journal of Homoeopathy/ you will see why I cannot recom- mend it to you as supplying all your wants. I set myself accordingly to embody, for your help, the materials which I have been amassing these six years past in aid of my own study of the Materia Medica. If they prove useful to you, they may perhaps assume a more permanent form for the benefit of others in like case. At any rate, I am sure the task will be advantageous to myself, and 8 INTRODUCTORY. will lead to firmer grip of what I have learnt, and greater precision in applying it. I propose, then, as T have leisure, writing you a series of ' Letters on the Materia Medica.' After defining what it is that we are administering under the common names of the drugs Aconite, Arsenicum, and so on I shall refer you to the authorities for our knowledge of each. Under this head will be mentioned the original provings, where accessible, and any special sources of information which may exist. Then I shall proceed to describe the pathogenetic influence of the drug, illustrating this from our clinical expe- rience with it, wherever such has been obtained. A list of "Allied Medicines" will then be given, with which the drug under study may be profitably compared. Lastly, under the heading and 1, and between 1 and 2. After 3 such intermediate stages are unnecessary, and the further dilution may always be proceeded with upon the centesimal scale. Before leaving the vegetable drugs, I must notice the " concentrated organic medicines" lately intro- duced from America. They purport to consist of all the active ingredients of the drugs, recotnbined in their original proportions, but divested of such inert matters as woody fibre, &c. They are t dis- tinguished by the termination " in," as Atropin, Caulophyllin, Irisin. Potencies are prepared from 16 NOMENCLATURE AND PHARMACEUTICS. them by trituration. So far as my experience goes, I must agree with Dr. E. M. Hale in thinking these preparations inferior to the tinctures pre- pared, as these may nearly always be, from the fresh plant. The mineral substances used in our practice are differently prepared according as they are soluble or not. In the former case the dilutions are made with water, which is (or should be) also the vehicle of the mineral acids. The metals themselves, and their insoluble salts, are prepared by the Hahne- mannic process of trituration. This consists in rubbing up a grain of the substance with nine grains of sugar of milk to form the first trituration, a grain of this with nine grains more of sugar of milk for the 2nd, and so on to the 6th. After the 6th decimal the further dilution is carried on accord- ing to the centesimal scale, and is commonly effected by solution. A grain of the 3rd tritura- tion is dissolved in fifty drops of water, and to this are added fifty drops of alcohol. A drop of this fourth dilution is mixed with ninety-nine drops of alcohol for the fifth potency, and so on. Long ago, however, my friend Dr. Madden advised* that all the potencies of insoluble substances should be pre- pared by trituration ; and the recommendation has recently been carried into effect in Germany. I have not yet tried these preparations, but intend to take an early opportunity of so doing. Struck by the remarkable development of medi- cinal power obtained by this process of trituration, even such inert bodies as the metals becoming ac- * ' British Journal of Homoeopathy,' vol. v, p. 372-3. NOMENCLATURE AND PHARMACEUTICS. 17 lively pathogenetic and curative, Hahnemann was led to employ it in the preparation of several vege- table substances, as Lycopodium and Charcoal, with the result of elevating them to a high rank as medi- cines. The process of trituration is also resorted to in the case of such products as Coral and Sponge, and (as an alternative to maceration in alcohol) of such dry plants or portions of plants as Ipecacuanha and Nux vomica. You may, perhaps, be surprised that I have hitherto said nothing about what has appeared to many the distinctive feature of Homoeopathic phar- maceutics, the globule. I have said nothing about it, because I cannot recommend its use. I look upon its adoption by Hahnemann and his im- mediate followers as a mistake. Not merely from its ridicule-exciting smallness, for the modern pilule removes that reproach ; but from the objectionable nature of the preparation. The globules or pilules are medicated (as you are probably aware) by being immersed for some days in the tincture of the drug they are intended to represent : such tincture being of course in the case of insoluble substances of the fifth potency or higher. To say nothing of the un- certainty of this mode of preparation, the globules and pilules have the fatal defect of coming at second hand. Tinctures and triturations are nearly as convenient of administration ; and have the great advantage of being the original preparations of the drug. In advising you thus to discard the globule and (save in rare instances) the pilule, I am saying nothing about the question of dose, with which this 2 18 NOMENCLATURE AND PHARMACEUTICS. form has been unaccountably mixed up. A globule of tbe 3rd is stronger than a drop of the 6th attenua- tion. The question of dose is one which for the present I must leave open. LETTER III. THE ACIDS. HAVING disposed of introductory matter, we may now begin our studies of the long list of medicines which lies before us. Our alphabetical arrangement gives us, in the first instance, the group of acids. Of these, the Benzoic, Fluoric, Hydrocyanic, Muri- atic, Nitric, Oxalic, Phosphoric, and Sulphuric, are known to possess dynamic over and above their chemical properties. We will take first the Acidum benzoicum. The pure acid in trituration or (better) alcoholic solution is used. Our sole Homoeopathic authority for this medi- cine is the original proving by Dr. Jeanes, of Phila- delphia, published in Esrey's ' Materia Medica of American Provings.' Irritability of the bladder, shifting rheumatoid pains in the joints, and a recurring attack of pulsation of the heart and temporal arteries at about two in the morning, forbidding further sleep (comp. with Nux vomica), are the most prominent symptoms produced by small doses of the drug. Taken in quantity, Benzoic acid causes the urine to I 20 ACIDUM BENZO1CUM. become highly coloured and strongly scented. This seems to depend upon the existence in the urine of hippuric acid, which was formerly supposed to result from the conversion of uric acid, but is now considered to be the Benzoic acid itself in an altered form. How- ever this may be, the highly coloured and strongly scented urine caused by Benzoic acid is stated by Dr. Jeanes to be, when occurring in disease, a character- istic indication for the remedy. He cites cases of condyloma, of rheumatism, and of irritative cough, coming on after suppression of chancre or gonorrhoea ; also of recurring quinsy, of nephritic colic, of ulcera- tion of the mouth, and of rheumatico-gouty arthritis in all of which Benzoic acid, prescribed mainly be- cause of the presence of the characteristic urine, relieved greatly or cured. It has occasionally proved curative in enuresis* My own experience with the medicine is confined to this disease. I have found it very serviceable in old people, when a high- coloured and strong-smelling urine dribbles away, partly from the irritation it causes, and partly from want of power on the part of the bladder to retain it. I see that Benzoic acid is now used in the Leopoldstadt Hospital in Vienna in acute articular rheumatism ; the physicians compare its action to that of Bryonia. I know of no medicine whose general action resembles that of Benzoic acid sufficiently to make a comparison profitable. As to dose, Benzoic acid has usually been given in the potencies from the 3rd upwards. I myself, * See cases in ' North American Journal of Homoeopathy,' vol. iii, p. 334. ACIDUM FLUORICUM. 21 in the cases I have mentioned, have given the 2nd and 3rd decimal. The acid next in order is Acidum fluoricum. More strictly, Hydrofluoric. The primary dilu- tions are made with water. Esrey's ' Materia Medica of American Provings' contains an exhaustive proving of Fluoric acid, conducted by Dr. Hering. In this proving we notice, among other symp- toms, a tendency to determination of blood to the head and to falling off of the hair, much irritation of the faucial and pharyngeal mucous membrane, sharp pains in the left side of the chest and abdo- men, great excitement of the sexual instinct and premature appearance of the catamenia, purple deposit in the urine, pains in the bones generally, numbness and powerlessness of the hands, and itch- ing of the skin. The curative sphere of Fluoric acid closely resembles that of Silicea (which is really Silicic acid). Under its use whitlows have been blighted, fistulse lachrymal and dental have healed, varicose veins have shrunk to half their size, fresh hair has grown on a bald head, and moist palms have regained their healthy dryness. In Laurie's ' Elements of Homoeopathic Practice of Physic' two cases of caries are cited one follow- ing scarlatina, the other resulting from whitlow, in both of which Fluoric acid 30 proved curative. Lately, Dr. Laurie himself has put on record some cases of secondary syphilis of the tongue and throat, 22 ACIDUM HYDROCYANICUM. and of chronic diarrhoea, in which Fluoric acid 6 was of essential service.* Still more recently it has been attempted to establish a relation between the presence of fluorides in drinking water and bronchocele. It is stated that a true and perma- nent goitre was induced in a dog to whom the acid had been steadily administered. f I have myself had little personal experience with this medicine. Silicea is the only really analogous drug. The dilutions from 6 to 30 have been used in the recorded cases of cure by Fluoric Acid ; and as the proving was carried on by means of the 3rd and higher potencies, it would seem best that the same should be chosen for fulfilling the therapeutic indi- cations afforded by the symptoms obtained. Hitherto I have been speaking of substances almost if not quite unknown to you as medicines. I am entering, however, upon more familiar ground, which I take as the third of my group of acids Acidum hydrocyanicum. The Pharmacopoeial acid (containing 2 per cent, of the anhydrous acid) mixed with equal parts of alcohol, or Scheele's acid (4 per cent.) with three parts, will make a preparation equivalent to our 1st centesimal dilution. There exists no regular Homoeopathic proving of Hydrocyanic acid. Some experiments, however, have been made with it by Professor Jorg and his pupils. These, with the records of toxicology, * ' British Journal of Homoeopathy,' vol. xxiv, p. 154. t Ibid., p. 518. ACIDUM HYDROCYANICUM. 23 have been collated, and their bearing on Homoeo- pathic practice analysed, by Dr. Madden and myself in the 20th volume of the ' British Journal of Homoeopathy/ I would refer you to that paper for more details than can here find place. You know Prussic acid as an occasional remedy for hooping-cough, for vomiting, and for gastro- and entero-dynia. You will notice that the cha- racter common to all these affections is the spas- modic ; they are all instances of morbidly excited muscular action. The theory of antipathy being dominant, it is hence concluded that Hydrocyanic acid is a " sedative," and it is classed accordingly. But read over a few cases of poisoning by this sub- stance. You will find that convulsions and spasms, generally of tetanic character, are amongst the most prominent and constant symptoms observed. If, therefore, Hydrocyanic acid be sedative as a remedy, it is certainly excitant as a poison ; i. e. its curative action is Homoeopathic. It seems to excite the whole motor tract of the cranio-spinal axis. An influence of this kind upon the medulla oblongata will explain the cerebral symptoms, which are from small doses dizziness and headache, and from poisonous quantities sudden loss of consciousness with falling. Each and all of these would result from contraction of the arteries of the brain, brought about by excitation of their nerves, which (according to Schiff) are under the influence of the medulla oblongata. The loss of consciousness, with falling, caused by Hydrocyanic acid, with its convulsions and other concomitant symptoms, closely resemble an epileptic paroxysm, to which 24 ACIDUM HYDROCYANICUM. they have been likened by Pereira, Christison, and Taylor. The same excitation of the me- dulla oblongata, aided by that of the upper part of the cord, will account for the disturbance of the respiration, ranging from laboured breathing to complete asphyxia, and for that of the circulation. The sudden death which often results from poison- ing by this acid seems analogous to that caused by " pithing," and this operation has been shown by Dr. Brown- Sequard to kill by stopping the heart's action through the medium of the vagi. The tetanic spasms are, of course, due to an excitation of the whole length of the cord. These physiological properties of Hydrocyanic acid obviously render it Homoeopathic to spasmodic affections of very many kinds. There is a form of vertigo, resembling that experienced by epileptics, in which I have found it very useful. In epilepsy itself I have much confidence in it in recent cases ; but the evanescent character of its action has dis- appointed my hopes of curing the disease when con- firmed. The same remark applies, for good and for ill, to its action in asthma. I have never used it in spasmodic coughs ; but Dr. Marcy states that the 12th dilution often gives much relief to the cough of phthisis. With the same potency he pro- fesses to have cured cardialgia. I have no ex- perience of Hydrocyanic acid in the vomitings and pains of the stomach for which it is recommended in the old practice ; but I have frequently removed by it the distressing feeling known as " sinking at the stomach," when this has been unconnected with the climacteric age. From what I have seen of its ACIDUM MURIATICUM. 25 action in cases of this kind, I am inclined to credit it with a special influence on the solar plexus. Hempel cites several cases of tetanus cured by Hydrocyanic acid : and Dr. George Moore has lately contributed to the ' British Journal of Homoeopathy' a capital case of the traumatic form of this disease, in which a rapid and complete cure was effected by drop doses of Scheele's preparation of the acid.* For its action on the spinal cord Hydrocyanic acid may be compared with Aconite and Strychnia. As an epileptifacient, its only analogues are the Ilmbelliferae, &thusa cynapium, Cicuta virosa, and (Enanthe crocata, I have generally used Hydrocyanic acid in the dilutions from the 3rd to the 6th decimal. The experience of the old school would seem to show that in such affections as hooping'cough, vomiting, and gastrodynia, the 1st dilution may be used with advantage. We have next for our consideration the Acidum muriaticum, or, as modern chemistry styles it, Hydrochloricum. The lower potencies are, of course, prepared with water above the 3rd the use of alcohol seems uninjurious. There is a pathogenesis of Muriatic acid (then called Muriatis acidum) in Ilahneraann's ' Chronic Diseases.' Having referred you thereto, I must leave you to ascertain by analysis of the symptoms (if you can) the physiological action of the drug. * ' British Journal of Homoeopathy,' vol. xxiv, p. 506. 26 ACIDUM MURIATICUM. I am quite unable to do so for you, or, indeed, for myself. Happily, our clinical experience with Muriatic acid is sufficiently extensive to enable us to define pretty closely its sphere of action. Apart from its local uses, Muriatic acid is known to you as a remedy of much value in low fevers. Of old, its action in these cases was ascribed to a power of modifying a supposed putrescence of the fluids : and the medicine was given also in malig- nant scarlatina and putrescent sore throat. Now-a- days, I believe, its use is pretty well confined to true " fever," and it is considered to act by neutralising superabundant alkali (Eichardson), or by supplying deficient acid (Chambers). I am myself disposed to believe that its action in these cases is, after all, dynamic; for it is certain that Muriatic acid, in doses too small to exert any chemical action, has a very high reputation in our school as a remedy for these morbid conditions. Teste ranks it as " the leading remedy in typhus." I myself esteem it very highly, though I think it indicated less often than Arsenic. I would say the same as regards malig- nant scarlatina, although I know no remedy like it for some of the sequelae of this disorder, especially the affections of the ears and nose. In ulcerative angina of a low type Muriatic acid is often the best medicine,* but I can say nothing of it in the * The following case by Dr. Russell illustrates the statement in the text : " The case was that of a lady about sixty years of age, who had been ill for two days. He found the pulse very small and quick, as high as 130. There was great prostration ; the expression of the countenance almost like that of cholera, from the sunken, exhausted look very remarkable, considering the shortness of the illness, and indicating the action of some poison. There was great ACIDUM MURIATICUM. 27 treatment of true diphtheria, save as a local appli- cation. These uses of the acid seem to depend upon an influence exerted, primarily at least, upon the blood. It has also, however, certain local actions. By its elective affinity for the mucous membrane of the mouth it controls aphthous, mercurial, and other forms of ulceration occurring therein. It is one of the few medicines which have a specific action on the tongue ; it has been used successfully for many affections of this organ. And, acting on the skin, it is sometimes of much value in burning itching eruptions, as eczema of the ear. Nitric acid is the only medicine with which, as it seems to me, Muriatic acid can be advantageously compared, though it has some points of contact with Arsenicum, Baptisia, Lachesis, and Rhus. There seems no advantage in raising Muriatic acid above the third potency, and the first is, perhaps, most commonly used. You will have noticed the wide difference of action between these medicines we have been con- sidering. The sphere of Fluoric acid is as undoubt- edly the vegetative functions and less highly organ- ized tissues, as that of Hydrocyanic acid is the nervous system and that of Muriatic acid the blood. If fetor of the breath, and on examining the fauces the whole surface was of a dark red, approaching violet hue, and spotted over with white membranous deposit. He gave a drop of the 1st dilution of Muriatic acid every hour, and next day found great improvement. From the first dose the patient was sensible of benefit, which con- tinued till she got well. The disease had been increasing up to the time of the administration of the medicine, and from that time declined." (' Annals,' vol. i, p. 231.) 28 ACIDUM MURIATICUM. Homoeopathic treatment were the imaginary thing it is represented, these distinctions would never have been established, for all our remedies would act alike. LETTER IV. THE ACIDS (continued). I AM coming now upon one of the most im- portant medicines in the group of acids, namely Acidum nitricum. The preparation of the acid is similar to that of Muriatic acid. Like that acid, moreover, our only authority for its physiological action is the pathogenesis given in Hahnemann's ' Chronic Diseases.' I must confess myself at a loss what to make of the provings con- tained in that remarkable work. Until the day- books of the provers are published, and the quan- tity and frequency of the doses taken are ascertained, I feel the utmost uncertainty as to the reality of the numerous and multifarious symptoms ascribed to the " antipsoric" medicines. With Nitric as with Muriatic acid, I must direct you for the present to clinical experience as the only available means of ascertaining its sphere and mode of action. That Nitric acid has a dynamic over and above its chemical influence you will be ready to admit, knowing as you do its reputation in chronic hepa- titis, in some forms of syphilis, and recently in 30 AC1DUM NITRICUM. hooping-cough. Homoeopathic experience has con- firmed these actions of the drug, while adding many others. Its specific influence seems exerted mainly on the mncous outlets, i. e. the parts at which mucous membrane merges into skin. Thus, it is a prime remedy in affections of the mouth, and only less so in those of the throat, these being of an ulcerative character, syphilitic or otherwise ; it is also curative of mercurial sore mouth and ptyalism. Leaping over the intermediate tract, proving occa- sionally serviceable in chronic dysentery, it concen- trates its influence upon the rectum and anus ; it has cured prolapsus, fistula, and several times fissure. In the respiratory tract it controls the nasal and laryngeal mucous membranes, being curative of the affection of the nose which obtains in malignant scar- latina, of dry and violent laryngeal coughs, and even (so it is said) of syphilitic ozaena andlaryngeal phthisis. Acting on the genito-urinary mucous membrane, it is a valuable remedy against chronic vaginal leucor- rhoea in cachectic subjects. Its choice of these mucous outlets, and the kind of mischief it there meets and controls, would of itself suggest it as a remedy for some syphilitic conditions, even had not experience plainly pointed that way. We use it much as you do, in the soft chancre occurring in weakly or scrofulous subjects, and in the secondary ulcerations of the mucous membranes. We also think very highly of it placing it second only to Thuja in that curious offset or ally of syphilis which Hahnemann distinguished as sycosis, whose local manifestations are condylomata. It seems probable that Nitric acid also, like its congener, ACIDUM OXALICUM. 31 Muriatic acid, affects the blood, and may find an occasional place in the treatment of the toxsemic fevers. It has been spoken of in typhoid fever, scarlatina maligna, and diphtheria. I have no experience of it in hooping-cough, for which I see it is highly recommended by some physicians of the old school. Nor can I define its action in hepatic disease, though there seems little doubt of its exerting a specific influence upon the liver. I have lately treated a case of chronic hepatitis with ascites by drop doses of Nitric acid, 1st dec., with very gratifying results. Nitric acid may be compared with Muriatic and Sulphuric acid, with Mercury, and with Thuja. High dilutions (the 30th) have been used with advantage only in affections of the anus; in other diseases it is usual to prescribe the potencies from the 1st to the 4th dec. For our next acid we have once more the advan- tage of a good pathogenesis. This is Acidum oxalicum. Tt is prepared by trituration or aqueous solution. Oxalic acid is one of the medicines chosen for experiment by the American Institute; an account of the proving is given in Esrey's ' Materia Medica of American Provings.' The toxicological experiments of Drs. Christison and Coindet, which first appeared in the ' Edinburgh Medical and Surgical Journal, vol. xix, are also narrated in considerable detail as a preface to the proving. Oxalic acid is a specific emetic, and irritant of 32 ACIDUM OXALICUM. the gastric mucous membrane. It also inflames the trachea and the pulmonary tissue. But its main action, when absorbed, is on the nervous centres, which it paralyses from below upwards. The loss of power in the lower extremities which is very characteristic is accompanied with numbness and neuralgic pain in the back and legs. As the poi- soning advances up the spinal cord paroxysms of spasmodically suspended respiration and palpitation of the heart manifest its influence. In the small doses used in the proving (1st and 2nd triturations) Oxalic acid produced few marked symptoms much flatulent colic about the navel, excitement of the genito-urinary organs, and sharp shooting pains in the heart and left lung, being all that I can particu- larise. It has been but little used in practice. Dr. Marcy, in the ' New Materia Medica,' speaks favor- ably of it in some chronic inflammations of the mucous membranes, in glossitis, and as moderating hectic and drying up cavities in tubercular phthisis. I am myself giving it with much benefit in a long- standing case of inflammation of the alimentary mucous membrane. It ought to be serviceable in some forms of paraplegia, and to relieve neuralgic pain and disturbed respiration in cases of incurable softening of the cord. Oxalic acid has some points of analogy with Argentum nitricum and Arsenicum. It has been given in the dilutions from 2 to 12. The acid I am now coming upon is a special favorite of mine. This is ACIDUM PHOSPHORICUM. 33 Acidum phosphoricum. The preparation is like that of the other acids. The pathogenesis of Phosphoric acid is in the 'Chronic Diseases.' It impresses one, however, with a much greater sense of reality than most of those contained in this series. Perhaps, as the original proving appeared in the ' Materia Medica Pura/ many of the symptoms were obtained from material doses. We observe in this proving depression of the mental powers ; much disorder of the sight and hearing; whitish-gray diarrhoea; cl pale urine, forming thick whitish flocculi ;" swelling and uneasiness in the testicles and spermatic cord ; violent cough, with expectoration ; tendency to arrest of circulation in the extremities (especially the hands) ; " intense pain in the periosteum of all the bones, as if scraped with a knife/' and fever with profuse sweat. Many valuable applications of the drug have resulted from the study of these symptoms. But its therapeutic sphere has been still more widely extended by its use as an ally of its base, Phosphorus, to which great medicine it bears many striking analogies. The chief sphere of the curative action of Phos- phoric acid is the nervous system, and in this it influences less the functional than the organic dis- orders, when these latter are not very grave and deep. Thus it is of great service in cases of cere- bral weakness dependent upon brain-fag (cump. Nux vomica) or upon sexual excesses (comp. Anacardium). In these patients I have always noticed a very slow pulse. It has cured amblyopia 3 34 ACIDUM PHOSPHORICUM. and deafness, probably resulting from similar causes. It is also valuable for mental weakness remaining after typhoid fever, here also comparing with Aua- cardium.* It is probably through the nervous cen- tres that it affects the male sexual organs, on which its influence is very powerful. The condition of irri- table weakness left in these organs after previous excess, without inflammation, is strikingly benefited by the acid, as is also the general debility and especially the cardiac distress resulting from the same cause. Phosphoric acid affects the blood less than the other mineral acids ; but it has proved very curative in purpura and passive hemorrhages, and is used generally in the Leopoldstadt Hospital in the slighter forms of typhoid fever. In the sphere of the renal organs Phosphoric acid has a remarkable control over those changes in the composition of the urine which arise further back than the kidney itself. Thus, it is the best remedy for phosphatic deposits, when these depend upon excess of phos- phoric acid from waste of nervous tissue, or upon alkalinity of the urine from nervous depression. It cures those derangements of nutrition in children connected with a milky state of the urine ;f and would probably help in the West Indian " chylous urine," whose constitutional symptoms are very characteristic of the drug. Even in true diabetes mellitus Phosphoric acid must be credited with more than one cure.J The acid competes with the * See ' Monthly Homoeopathic Review,' September, 1866. f ' British Journal of Homoeopathy,' vol. vii, p. 391. J Ibid., vol. xxiv, p. 260. Since a lesion of the nervous centre may also cause albuminuria (as in Claude Bernard's experiments), ACIDUM SULPHURICUM. 35 base in the treatment of diseases of the bones ; it has a high reputation on the Continent as a remedy for caries. It is specially valuable in the hectic fever which accompanies these maladies, as in scro- fulous hip-disease. It has been found useful in cholerine : there is a gluey matter on the tongue, the stools are yellowish, and the evacuations painless. Dr. Marcy commends it in thin, acrid leucorrhoea : and has cured with the 1st dilution a chronic puru- lent and fetid discharge from the nostrils. I have omitted to state that Phosphoric acid is a good medi- cine for falling of the hair in convalescence or debility : and has cured an obstinate intermittent characterised by blueness of the hands during the chill, and very profuse sweat subsequently.* Phosphoric acid works side by side with Phos- phorus throughout its action. Besides this, it touches at some points Fluoric acid and Silicea ; China ; Anacardium ; and the mineral acids in general. In the nervous affections, in milky urine, and in cholerine, Phosphoric acid acts well in the potencies from 3 to 12. But as a sexual tonic : in purpura, phosphatic diathesis, diabetes, and caries, it acts best in doses of several drops of the 1st decimal dilution. The last of our group of acids is Acidum sulphuricum. there may be cases of this malady in which Phosphoric acid may be indicated. Two cures by it are on record ( Hempel, vol. ii, p. 46, and ' Monthly Homeopathic Review,' September, 1866). * ' Annals,' vol. i, p. 457. 36 ACIDUM SULPHTJRICUM. The preparation is that of the other mineral acids, and the pathogenesis, of which I cannot say much, is in the ' Chronic Diseases.' Sulphuric acid seems to have, beyond its chemi- cal properties, a more limited dynamic action than any of the mineral acids. If it be as valuable as Pereira states in relieving the itching of many cutaneous eruptions, this is an effect of a specific character : we have no experience with it. It is probably also homoeopathic to the forms of diarrhoea which it undoubtedly (meipso dum Allosoputhico teste) cures ; for its physiological action is to purge rather than to bind. It is recommended in chronic head- aches in cachectic women subject to leucorrhoea, in persistent hiccough, in scarlatina when diarrhoea is troublesome, and in scrofulous suppuration of the joints (?). It has been very little used in Homoeo- pathic practice. Sulphuric acid may be compared with the other mineral acids. The 1st dilution is used in diarrhoea; in other affections the 6th or 12th. LETTER V. ACONITE. THE survey which we have now completed of the acids used in our practice, will have shown you the weakness as well as the strength of Homoeopathy as it at present exists. But in the medicine we have now to study the strength is seen alone, and that at its very fullest. If Homoeopathy had done no- thing for therapeutics but reveal the virtues of Aconitum napellus, it might even die content. The tincture prepared upon the Hahnemannian method from the whole fresh plant has hitherto been used in Homoeopathic practice. I myself however agree with Dr. Hempel in preferring " Fleming's Tincture " obtained from the dried root, from which the 1st decimal dilution may be made in the proportion of two to eight. Aconite is the subject of the first proving in Hahnemann's ' Materia Medica Pura/ It was re- proved in a most thorough manner by the Austrian Provers' Society, and the result published in the first volume of the ' CEst. Zeitsch. f. Horn/ The two provings are collated, with some additional matter, by Dr. Dudgeon in the first (and only) part 38 ACONITUM NAPELLUS. of the r Hahnemann Materia Medica.' There are also monographs upon the drug by Dr. V. Meyer in the 'North Amer. Journ. of Horn./ and by Dr. Carroll Dunham in the 'American Homoeopathic Review' for July and August, 1865. Collections of cases of poisoning have been made by Dr. Hempel in his ' Materia Medica/ and by Drs. Marcy and Peters in the ' New Materia Medica/ Your interest in Aconite has probably been hitherto toxicological only. You have learnt from your Pereira that it causes, both locally and gene- rally, numbness with pricking and tingling going on to complete anaesthesia. And you have used it accordingly to deaden sensibility in parts where that function is morbidly increased. But when you have gone through the cases of poisoning and the groups of pathogenetic effects to which I have referred you, you will have had your notions of the physiological effects of the drug very widely extended. First, you will have observed that the motor functions are very far from being affected similarly with the sensory. Not paralysis, but spasm is excited, and that nearly always of a tonic character. Trismus is a common symptom of Aconite poison- ing : the sufferers frequently complain of constric- tion at the throat, and of local cramps and spasms : and there are several cases on record in which complete opisthotonos existed, and the pseudo- tetanic state was induced as completely as by Strychnia. Secondly, some very striking phenomena are observed in the sphere of the circulation. In acute poisoning the dilated pupils, the pale face, the ACONITUM NAPELLUS. 39 quick and contracted pulse, and the general coldness within and without speak of an excitation of the vaso-motor nerves throughout the body, analogous to that of the musculo-motor centres which results in tetanus. In other words, we have a condition answering to the chill of fever, the cold stage of ague, the collapse of cholera. That this is the true explanation of the symptoms appears from what follows. Whfiii reaction takes place, the condition of febrile heat succeeds that of chill ; as Dr. Wood states, " the circulation, respiration, and general temperature are somewhat increased."* This is seen in such a case of poisoning as No. 10 of Dr. HempeFs series : but it is still more marked in the 'Austrian Provings' (see symptoms 777 to 782 in Dr. Dudgeon's arrangement). One prover was so distressed by the febrile heat induced, that, not knowingwhatdrughe had been trying,he commenced taking Aconite to obtain relief. The fever is accom- panied by signs of arterial congestion of the head and chest. Further evidence, if such were needed, of the action of Aconite upon the vascular nerves is afforded by the effects of its local application. Drop (as Prevostf and myself have done) some of the diluted tincture upon the web of a frog's foot, and you will see under the microscope the primary con- traction and secondary dilatation of the arteries which are just the febrile chill and heat upon a small scale. Thirdly, besides these general effects of Aconite, both poisonings and provings present certain pretty * ' Materia Medica,' vol. ii, p. 142. f ' British Journal of Homoeopathy,' vol. ix, p. 134. 40 ACONITUM NAFELLUS. constant symptoms, showing its power to influence particular organs and tissues. The heart is much affected. In small doses, its action is simply quick- ened, as observed by Schroen and Arnold.* But when, as I myself have ascertained, equal parts of the tincture and water are dropped upon the organ, the pulsations are fewer, but much stronger, so that the heart seems lifted out of its place at each beat. Hence Aconite is primarily excitant of the heart's action. That it is also irritant of its tissue seems probable from the painful palpitation and prsecordial anxiety, alternating with pains in the joints, which one of the Austrian provers experienced from large and repeated doses of the tincture. These pains in the joints, muscles, and fibrous tissues generally, of a tearing and shooting character are very frequent in the subjects of the influence of Aconite. Again, very painful hyperaemia of the eyes has been more than once observed ;f and looks like inflam- matory irritation of the sclerotica. Lastly, in post-mortem examinations, decided evidences of inflammation of the pleura and peritoneum have been found : and the symptoms elicited by some of the provers are at least in harmony therewith (see symptoms 319, and 449 to 463 of Dr. Dud- geon's schema). There are many other pathogenetic effects of this potent poison recorded in its provings, which may direct us to its choice in doubtful cases. But those whose outline I have now drawn will enable you to * Dudgeon, section on " Heart." f See case 7 in ' New Materia Medica,' and cases xv and xvii in the Appendix to Fleming's ' Monograph on Aconite. 5 ACONITUM NAPELLUS. 41 see the rationale of its curative effects, which I shall now endeavour to describe. To enumerate all the morbid conditions in which Aconite has proved useful would be tedious and hardly profitable. Dr. Dudgeon has given numerous references to its therapeutic literature at the end of his article in the ' Hahnemann Materia Medica.' I think I shall help you more effectually if I suggest those general principles which seem to govern its whole remedial action. The remarkable action of Aconite upon the circulation at once gives it a high place among the remedies for the condition we know as fever. Ex- perience has confirmed this indication : and has shown that in its own sphere it is quite unrivalled as an "antiphlogistic." But it is of great impor- tance to define this sphere of its action, lest an in- discriminate use should cause disappointment. Thus, Aconite has no influence upon the blood itself; and has hence little control over such fevers as depend upon a poisoned state of that fluid. Its use in gastric, typhoid, typhus, and yellow fevers is mere waste of precious time : and even in scarlatina, variola, and measles it will not lower the circulation until the eruption comes out. If, indeed, after this the fever keep up it may be most useful. Nor will it avail to prevent the return of the paroxysms of hectic and intermittent fevers : though in the latter it may relieve distress when administered during the chill and heat. Again, Aconite will do little for a fever which is symptomatic of an acute local inflam- mation. Read Tessier's cases of pneumonia, and 42 ACONITUM NAPELLUS. observe how the pulse defied Aconite, but went down rapidly when Bryonia or Phosphorus touched the local mischief. I have frequently verified this rule, which is a very important one, and often un- perceived. It is well expounded by Dr. Carroll Durham, in the article to which I have referred : and shown by him to accord perfectly with the symptomatic indications for the medicine originally laid down by Hahnemann himself. It follows also from the physiological effects, which show general fever, but without (save in rare instances) local inflammation. When we say, after Hahnemann, that Aconite quickly cures " pure inflammatory fever," we mean before such fever has so localised itself as to develop organic change. Let the morbid impression known as "a chill " be made upon the vascular nerves : let them first contract to produce the cold stage, and then dilate for the hot stage of simple fever; and we have the every- day occurrence for which Aconite is the specific remedy. Whether the chill or the heat be present, the medicine is no less indicated. Let the storm of arterial excitement be ever so high, a dose or two will quiet its fury. "In as short a time as four hours after the administration of Aconite in the morbid states in question, all danger to life is past, and the excited circulation returns from hour to hour to its more tranquil course." So truly wrote Hahnemann, in pointing out to us this most im- portant use of our medicine. Indeed it may be laid down that unless a fever (not being rheumatic) has greatly abated within twenty- four hours of com- mencing Aconite, it is one for which the remedy is ACONITUM NAPELLUS. 43 uusuited. But it should not be supposed that the time for administering Aconite has gone by because individual parts have begun to show signals of distress. The provings have shown us that the Aconite fever is not without symptoms of arterial congestion in more than one part of the body. And so it will often happen that a commencing coryza or angina, and even a pneumonia, may disappear under Aconite with the fever for which the medicine was given. In some inflammations, even, Aconite may alone effect a cure, as being itself a specific irritant of the part affected. This is especially the case in the rheumatic inflammations : but even non-rheumatic pleurisy, in its plastic form, is often under the control of Aconite. It is only when in a part to which Aconite is not specifically irritant true inflammatory changes have actually begun, that it ceases to exert remedial influence : and a medicine Homoeopathic to the local mischief must take its place. It is a very general custom under these circumstances to continue the Aconite in alternation with the local remedy. I myself do this sometimes : but it is inaccurate practice. It is only justified by a want of certainty in the mind of the prescriber as to the exact point to which the morbid process has advanced : and such uncertainty is a fault, and should be remedied.* * You may have noticed how exactly all this corresponds with the effects of bloodletting, as described by the physicians of the last generation. Fleming, in his ' Treatise on Aconite,' frequently remarks upon the great similarity between its effects and those of venesection : and two patients, to whom thirty drops of his strong tincture had been given, stated that they felt as if dying from excessive loss of blood. The lancet has been abandoned, in wise 44 ACONITUM NAPELLUS. If you have got these thoughts about Aconite clearly before your mind, you will at once see a large class of acute febrile affections in which its use must be most advantageous. In active haemorrhage, especially haemoptysis ; in acute congestions of almost any part ; in recent febrile dropsy ; in acute heemorrhoidal attacks; and in erysipelas, Aconite will always commence and often complete a cure. Its power of rectifying the disordered balance of the circulation is also shown in many morbid conditions not strictly febrile. In apoplexy and in puerperal convulsions, where there is much arterial excitement, Aconite will do everything for which the lancet used to be thought indispensable. In suppression of the menses from a chill, and in the circulatory disturb- ance which often attends the commencement of menstrual life, it is the best medicine : though, strangely enough, it has little or no influence over the similar disturbances, known as flushings, which occur at the menopausic age. Nor is it less valuable when the circulatory disorder, short of inflammation, is local : as when neuralgia or stiff-neck has resulted from a draught. Lastly, in the collapse of Asiatic cholera, where the chill is so deadly that were it not for the " consecutive fever " its true nature would be hardly recognisable, Aconite will still assert its power. I venture to predict that it will some day abhorrence of the spoliation of vital fluid resulting from its use. But in the utter absence of any efficient substitute, it is almost certain that bleeding will one day regain its place in old-school therapeutics : and there are not wanting even already indications of its return to power. In Aconite, however, we possess a remedy which has all the energy without the inconveniences of venesec- tion : and by it the place of the lancet is irrevocably taken. ACON1TUM NAPELLUS. 45 be recognised as superior even to Arsenic in those terrible cases where vomiting and purging are well- nigh absent, and death seems imminent from arrest of the circulation. Another large class of curative actions its power over spasmodic affections belongs to Aconite in virtue of its influence on the musculo-motor centres. In the spasm of the glottis known. as laryngismus stridulus its curative powers are very marked. In hooping-cough it greatly aids Ipecacuanha in the treatment of the early stage, in which also there is generally a tendency to febrile excitement. In the " neuro-phlogosis " we call croup it seems indis- pensable in alternation with Iodine or Spongia : and probably acts by modifying the tendency to spasm so characteristic of this disease. In spas- modic asthma it often gives great relief during the paroxysm. In simple trismus, in spasmodic gastro- dynia and colic, and many other local cramps and spasms, especially when excited by a chill, Aconite should be thought of. But above all, it bids fail- to be a valuable remedy for true tetanus. There are seven cases of the traumatic form of the disease now on record in which Aconite was the main remedy : and in six recovery was the result. It would be still more suitable, however, to the idiopathic form of the disease, from exposure to cold and wet. A survey of the more localised effects of Aconite its action upon the heart, the joints and muscles, the sclerotica, and the serous membranes suggests at once its close analogy with the rheu- matic poison. In acute rheumatism it is our main remedy. The fever is one element in the Homoso- 46 ACONITUM NAPELLUS. pathic relation between the disease and the drug; but, being of the toxsemic type, it must not be ex- pected to disappear under the Aconite in a few hours. Nevertheless, when occurring in persons of fairly good constitution, and not presenting asthenic symptoms, acute rheumatism will yield to Aconite perhaps more rapidly than to any other drug or mode of treatment. Our experience quite co- incides with that of your own Fleming, who states that under its use the average time required for cure is from five to six days; that the drug seems to protect the patient from cardiac complications ; that the convalescence is very short; and that much less stiffness of the joints is left than under the or- dinary treatment. Tt is obvious that the superven- tion of any of the common complications would not render Aconite less truly indicated in acute rheuma- tism. Sometimes it may be that it is aided or even superseded in such cases by medicines acting more powerfully upon the tissues affected, as Bryonia in pleurisy, Colchicum in pericarditis, Arsenicum or Spigelia in endocarditis, and so on. In acute local effects of the rheumatic poison not occurring during rheumatic fever, Aconite is often most effec- tual : such are lumbago (comp. with Bryonia, Khus, and Actsea racemosa), sclerotitis (with Spigelia), pleurodynia (with Ranunculus btilbosus), and sciatica and the other rheumatic neuralgias. Nor is it in rheumatic affections only of the parts which it specifically influences that Aconite proves effec- tual. It is very useful in all diseases of the heart characterised by increased action, especially where the left side is chiefly involved (comp. Cactus). Its ACOXITUM XAPELLUS. 47 continued use gives much relief to the distress occa- sioned by cardiac hypertrophy. In spasm of the heart, I have seen almost instantaneous relief follow its administration. In angina pectoris, it is the best palliative at the time of attack. It is, I think, inferior to Moschus in pure nervous palpitation. Of its action in pleurisy I have already spoken : and the same remarks will apply to peritonitis. I have now, I think, put you in possession of the main principles of the action of Aconite. As you use it in your daily practice, its applications will be ever multiplying, and its virtues will be to you a continual source of delight and thankfulness. When I come to think of allied medicines, it seems to me that Aconite is perfectly unique as to its action in the sphere of the circulation. The influence of Arsenic, Quinine, and Veratrum album over the vaso-motor nerves presents points of con- trast rather than of comparison. And the action of Aconite is quite different from that of the so-called " arterial sedatives," as Veratrum viride and Gel- seminum, which in large doses knock down fever by prostrating the heart's energy. In the musculo- motor sphere, Aconite may be compared with Strychnia (and therefore of course with Nux vomica and Ignatia), with Cicuta, and with Hydrocyanic acid. Its relation to rheumatism classes it with Bryonia, Colchicum, Acttsa race- mosa, and Spiyelia : and in its influence upon the heart, it resembles somewhat Cactus grandiflorus, Naja, and once again Spigelia. And now as to dose. I cannot deny that Hahnemann's immediate successors seem to have 48 ACONITUM NAPELLUS. , found success from the plan recommended (more or less theoretically) by him, of administering in fever a single dose of a high dilution of Aconite (18th to 30th), and allowing it to act. But it is no less certain that the Homoeopathic practice of the present day in all countries is to give frequently re- peated doses of a low dilution until the fever departs in perspiration. I have myself never adopted any other practice than this : so that I have no other to recommend to you. The dilutions I use are the 1st, 3rd, and 6th of the decimal scale. The first in high fever, in acute rheumatism and rheumatic or other inflammations, in cholera, croup, laryngismus stri- dulus, cardiac spasm or angina, and tetanus. The 3rd in less violent febrile conditions, in hooping- cough and asthma ; and when the symptoms requir- ing the drug occur in young children. The 6th in the febrile chill, in sub-acute circulatory disturbance connected with menstruation, in chronic heart disease, and generally where the medicine has to be taken continuously for some time. LETTER VI. ACT^EA, ^SCULUS, .ETHUSA, AND AGARIC US. WE have devoted much, though I think not too much space to Aconite. We must now pass more rapidly along a list of less important medicines, be- ginning with Actsea racemosa, or, as it is now more frequently called, Cimicifuga racemosa. A tincture is prepared from the dried root by maceration. The " concentrated" preparation, Macrotin, seems to contain most if not all of the virtues of the plant : it is triturated or dissolved in alcohol. Our knowledge concerning Actsea, which has been fairly proved, has been gathered together by Dr. Hale in his ' New Remedies/ Dr. Hempel, in the article on the drug in his 'Materia Medica/ adds an account of some experiments made by a pupil of his. The influence of Actsea is rather extensive, but not very intense. In the sphere of the nervous system it causes irritability and restlessness, which as manifested by the brain closely resemble deli- rium tremens, and by the spinal cord have led to its 4 50 ACT^EA BACEMOSA. successful use in chorea, especially when of rheu- matic or uterine origin. It uniformly causes, and has often cured, headaches accompanied with severe aching pains in the eyeballs. The sense of " faint- ness in the epigastrium " so generally provoked by it is one of the many symptoms which have led to its use in menopausia : I find this symptom a pretty unfailing indication for the medicine. Again, the sufferings referred by the provers to the back have suggested the trial of Actsea in " spinal irri- tation ;" and with reported good results. You will have noticed already the close relation of all these nervous conditions chorea, headaches, " sinking at the stomach/' and spinal irritation to the functions of the uterus. This organ, indeed, seems the principal centre of the sphere of the operations of Actsea. Itself is influenced by the drug in various ways. In default of female provers, we know little of its physiological action upon the ovario-uterine system, save that it is a specific abortifacient and ecbolic ; producing abortion with- out irritation (as by Sabina), and exciting in labour less unremitting contractions than those of Ergot. But its therapeutic virtues in this region are well established. It gives great relief to dysmenorrhoea and after-pains, especially in nervous and rheumatic subjects. In similar patients, it checks the tendency to abortion, and, administered for some weeks before parturition, facilitates that process. In the " irritable uterus," at least when occurring at the change of life, Actsea is very valuable. Moreover, it effectually meets many of the sympathetic affections resulting from this and other morbid conditions of ACT^A RACEMOSA. 51 the uterus, as uterine epilepsy and hysteria. It cures puerperal melancholia; and the restless and unhappy state of mind which is often associated with uterine disturbance. It dissipates the infra- mammary pain in unmarried females which Simp- son tells us is to the uterus what pain in the shoulder is to the liver : also pains in the mammse and other parts sympathetic with the uterus. It is above all useful in the sufferings of menopausia; relieving the sinking at the stomach, the pain at the vertex, and the irritability of disposition better than any other medicine. Actaea has one other great sphere of action also pointed to by its pathogenetic effects : viz. the whole range of rheumatic affections. It controls only the milder cases of rheumatic fever, being far less potent here than Aconite. But in the acute local rheumatisms, as pleurodynia, lumbago, and torticollis, it is very effectual. The experiments of Dr. HempeFs pupil, moreover, make it evident that Actsea affects the heart very powerfully, and in a manner closely resembling that of the rheumatic poison. Dr. Hale cured with it a case which may be described as chronic angina pectoris. The influence of Actsea over pulmonary affections does not fall within either of these categories. It is said to cure pseudo-, and even real non-hereditary phthisis. We need more information upon this point : I have no experience to offer regarding it. The more closely one studies a medicine, the less easy does it become to select medicines truly " allied/' I can only suggest a comparison with Arsenicum, Hyoscyamus, and Ignatia as regards 52 ^ESCULUS HIPPOCASTANUM. tlie effects of Actsea racemosa upon the nervous system ; with Caulophyllum and Secale cornutum in its uterine relations ; and with Aconite, Bryonia, and Colchicum in its influence upon rheumatic disorders. Actsea is used by Homoeopathic physicians mainly in the 2nd and 3rd decimal dilutions of the tinc- ture, or triturations of Macrotin. But as in most of our uses of it we are on common ground with our Alloeopathic brethren, we shall probably gain in many cases by using more material doses. Another minor medicine which has been very fairly proved is the horse-chestnut, JEsculus hippocastanum. A tincture is prepared by macerating the nut, and is certainly efficacious. Pharmaceutically, however, it would seem better to make triturations : which indeed were mainly used in the provings. Dr. Hale's article, in the second edition of his ' New Remedies/ gives a detailed account of all the provings of j93sculus, and collects the many reports of its clinical use which have appeared in our journals. ^Esculus has produced many symptoms in its various provers ; but no part of the body is so strongly affected as the rectum and anus. There is no form of distress belonging to this region which does not find its reflection in the pathogenesis of ^Esculus : and in one prover, not previously sub- ject to piles, these morbid growths were produced. Correspondingly, ^Esculus is acquiring a high repu- jESCULUS HIPPOCASTANUM. 53 tation amongst us as an anti-hsemorrhoidal medicine. In putting on record in the ' Brit. Journ. of Horn.' (vol. xxiii, p. 485) some cases illustrative of its efficacy, I made the following remarks as to the precise form of the disease to which it is specific. " When the piles are only secondary to existing portal- or other intra-abdominal congestion, ^Esculus will probably be inferior to Nux and Sulphur. When they are associated with symptoms of varicosis else- where, and bleed much, Hamamelis will be a better remedy. But when the only connected symptom or appreciable cause is constipation, and there is much pain but little bleeding, ^Esculus seems pretty likely to effect a cure." I have also cured with this medicine a case of severe pain at the anus after stool, resembling that of fissure. (See ' Brit. Journ. of Horn./ vol. xxiv, p. 165. The case is not in Dr. Hale's article.) It must certainly be ranked among the remedies for constipation also. The action of J5sculus in the sphere of the rectum and anus may be compared with that of Acidum nitricum, Aloes, Collinsonia, Ignatia, Nux vomica, and Sulphur. JEsculus seems the better for dilution. I have always used the 3rd potency for acute, and the 2nd for chronic cases. Dr. Hale says "We find it to act well in almost any potency." In our next medicine, we come again within the range of Toxicology. The " garden-hemlock/' " fool's parsley," or 54 ^THUSA ,CYNAPICM. -flDthusa cynapium, has been used as a medicine for the first time by Homoeopathic physicians. The tincture is prepared from the whole fresh plant. A schema, embodying the two provings by Hartlaub and Trinks and by Petroz respectively, is contained in Dr. Roth's ' Materia Medica/ and translated in MetcalPs ' American Provings/ Some good cases of poisoning are related by Dr. Hempel in his article on the drug. .ZEthusa is one of the " narcotico-acrids" of Toxicology.* The nervous symptoms induced in cases of poisoning are somewhat epileptiform in character, or the lower extremities become numb * The following case of poisoning by Jilthusa is suggestive of wider and more marked effects than it has yet been credited with. It is translated from ' Frank's Magazine' in the ' New Materia Medica :' " A scrofulous girl, set. 12, partook of some of the fresh herb. Towards evening she complained of general malaise and anorexia, which continued during the whole of the next day. Towards noon of the second day, she was taken with violent headache, frequent vomiting of greenish substances, vertigo, dry heat, confusion of and inability to raise the head, or keep an erect posture. Pulse full and quick, face periodically cedematous, and mottled with red spots. Her treatment consisted of the frequent application of cold water to the head and face, and injections (?) of dilute Acetic acid, Lemonade, Aqua oxymuriatis, with Syr. cinnainoini. On the third day, how- ever, there was no change for the better. She then had leeches applied for the relief of violent stitches in the left side, but without avail. On the fourth day, she also had stitches in the chest, dys- pnoea, and great prostration of the whole system. On the fifth day, after having had a few stools she began to improve. During the whole attack there was a constant dry heat of the skin, but attended with a total aversion to all kinds of drink." AGARICUS MUSCARIUS. 55 and weak : there is nothing very distinctive about them in the provings. We have no means of knowing whether the irritation of the stomach and bowels set up by ^Ethusa is specific or not : but this quality must obviously be assigned to the severe cedematous inflammation of the eyes which occurred in one of Dr. Hempel's cases. It is mainly in affections of these organs that .^Ethusa has been used as a medicine. From Dr. Petroz's experience, it would seem most useful in subacute inflammations of the ocular and palpebral conjunc- tiva, associated with swelling of the glands and cutaneous eruptions, in a word, in mild cases of strumous ophthalmia. It is also recommended for vomiting of milk by infants ; and deserves attention in the convulsive and paralytic affections of this period of life. As a poison, ^Ethusa ranks with Cicuta virosa and (Enanthe crocata. both Umbelliferae. Its remedial virtues, such as they are, seem to justify Teste in classing it as an analogue of Sulphur. Artemisia also resembles it closely. I can say nothing about dose, having no ex- perience of the medicine myself, and not knowing in what dilutions it has been found curative by others. The last medicine I shall mention in my present letter is the poisonous mushroom known as Amanita, Fly-agaric, or Agaricus muscarius. A tincture is made of the fresh, or triturations of the dry fungus. 56 AGARICUS MUSCARIUS. The Homoeopathic literature of Agaricus is rather extensive. A pathogenesis of the drug commences the 'Chronic Diseases/ It has been re-proved by the Austrian Society, in its usual exhaustive manner, under the auspices of Professor Zlatarowich : the results are given by Dr. Hempel in the second edi- tion of his ' Materia Medica/ The ' New Materia Medica' contains a good account of the toxicological effects of the fungus : and these are again summed up in a study of Agaricus by Dr. Roth in the eighteenth volume of the ' Brit. Journ. of Homoeo- pathy.' Agaricus appears to exert its chief influence upon the nervous centres. Upon the brain it acts as an intoxicating agent, like Alcohol, Opium, and Has- chisch : it is used for this purpose by the Kam- schatkans. The exaggeration with disorder of function ending in suspension, which intoxication implies in the cerebral centres, are also manifested in the other divisions of the nervous system. The sensory nerves lose their elasticity and power of re- sistance : when even feeble pressure is applied to any spot, it pains still a long while after. But the motor centres suffer most severely. Very marked chorea-like twitchings are produced by it ; and in several of the provers were developed symptoms of a profound affection of the spinal cord. Thus, Baumgartner experienced from small doses an ex- traordinary heaviness and languor in the lower ex- tremities : from larger quantities, pain in the first and second lumbar vertebrae, with sense of coldness in the glutei muscles and formication in the feet ; then the coolness spread down the legs, accompanied AGARICvTg MUSCAIUUS. 57 with numbness and twitches, and the urine began to dribble away ; the paralysis extended to the sphincter ani, and lasted some time. Other provers experienced similar symptoms : in one there was pain all along the spine, which in several places was tender to touch. Besides these important actions, Agaricus appears to poison the blood, which in post- mortem examinations is everywhere fluid, the veins of the brain, lungs, and liver being gorged with it : and the bodies are very livid. During life, too, there are many symptoms of septic change in the subjects of its poisonous influence : the face is blue, the body swells, the breath, flatus, and stools are fetid. There are many other characteristic symp- toms induced by Agaricus, which as yet defy classi- fication. Thus the mucous membranes are found coated with yellow mucus ; on the skin a lichenous eruption (lichen pilaris urticatus) has been developed, with crawling, stinging, and burning ; the liver is found greatly enlarged on autopsy ; pains as though innumerable splinters were in them are felt in the muscles, especially in the deltoid, where a small abscess even developed itself. Neuralgic pains also are experienced, as though sharp ice touched the parts, or cold needles ran through the nerves (comp. with the Arsenic neuralgia, in which the imaginary needles are red hot). The use of Agaricus has by no means been com- mensurate with its physiological importance. It has cured chorea : to the idiopathic form of which it is eminently Homoeopathic. It has proved effec- tive in Dr. Drysdale's hands in two cases of ataxic 58 AGARICUS MUSCARIUS. typhus, with much delirium and restlessness.* It has cured a recurring congestive headache ; and a cardialgia where " daily, about three hours after a meal, there was a burning at the stomach, changing into a dull pressure, like a foreign body, with nausea/' But it should find a place in the treat- ment of many important affections : as delirium tremens, and the nervous tremors and other affec- tions of drunkards ; venous congestions of the brain ; " nervousness" in general, where physical rather than psychical ; paraplegia from congestion of the lumbar portion of the cord ; congestive en- largement of the liver; and many unclassified ner- vous affections. The medicines most allied to Agaricus seem to be Cannabis indica, Hyoscyamus, Ignatia, Opium, and Stramonium. The lower dilutions, and even the mother-tinc- ture, appear to give the most suitable dose. * ' British Journal of Homoeopathy,' vol. xxi, p. 401. LETTER VII. AGNUS CASTUS, ALL1UM CEPA AND SAT1VUM, ALOES, ALUMINA, AMBRA, AMMONIUM CABBONICUM AND MURIAT1CUM. I HAVE now to introduce to you a new acquaint- ance in the Agnus castus, from whose berries we make a tincture in the usual way. The pathogenesis of Agnus castus is in Stapf's ' Additional Provings :' and it is prefaced by a sum- mary of all that is known concerning the drug. Dr. Roth's recommendations of Agnus, cited in the ' New Materia Medica/ need confirmation. The name of this plant hints at its special action : and its history points the same way. It was used by Athenian women during religious solemnities, and by mediaeval monks, to repress carnal desire. Its provings show that it really has this property, depressing sexual instinct and energy without pre- vious excitation. It is even reported to have caused in one case permanent extinction of virility. Its therapeutic use has accordingly been directed against atonic conditions of the sexual organs. In the hands of Drs. Stapf and Marcy it has cured simple 60 ALLIUM CEPA. impotence in males : and old Dioscorides states that it promotes menstruation and the secretion of milk. Its elective affinity for the sexual organs seems even to render it effectual against their local dis- eases : for it is said to have been occasionally cura- tive of gonorrhoea, gleet, induration of the testes, and leucorrhoea. Baryta carbonica and muriatica, Camphora, Conium > Nuphar lutea, Phosphorus and Phosphoric acid are the medicines which in the sexual sphere invite comparison with Agnus castus. Drs. Marcy and Stapf both report the 6th dilution as that with which their success was ob- tained. You may be amused when as my next medicine I mention the common onion. You will find, how- ever, if you read Dr. Bering's preface to its proving, that this vegetable was highly esteemed as a remedy by the ancients, and was credited with considerable pathogenetic power. We prepare the Allium cepa by making a tincture in the usual way from the juice of the long red onion, freshly gathered. The pathogenesis of Allium cepa is translated fromDr. Bering's "Amerikanische Arzneiprufungen" in the sixth volume of the ' American Homoeopathic Review/ With the discontinuance of the journal in ques- tion the record of this proving comes to an un- timely end, before even the all-important catarrhal symptoms have been chronicled. Enough, how- ALLIUM SAT1VUM. 61 ever, has been said to show that the well-known irritation of the eyes and nose produced by the ema- nations from the onion are specific effects, as they also result from the internal use of the tincture. It is hence recommended for fluent coryza, which it seemed to have occasionally cured. "Whether it is needed to occupy a place in the treatment of this malady which Euphrasia, Arsenicum, Mercurius, or Kali iodidum do not fill, experience alone can decide. I have only tried it twice ; but neither time success- fully. In these medicines I have named the analogues of Allium cepa in its relation to the conjunctival and nasal mucous membrane. Dr. Hering thinks it occupies a middle place between Aconite and Ipe- cacuanha. The higher dilutions seem most in favour. The transition from onions to garlic is as natural as it is alphabetical. As Allium sativum, we use a tincture prepared by maceration from the cloves. A pathogenesis of garlic, with clinical remarks, was presented by the late Dr. Petroz to the Societe Gallicane in 1852, and published in the third volume of its journal. It is translated, with additional symptoms and therapeutic notes, by Teste in his ' Materia Medica.' Eructations with salivation ; profuse whitish urine, which becomes cloudy on the addition of nitric acid ; much cough, with glutinous mucus and 62 ALOES. pains beneath the ribs ; swelling and tenderness of the mammae ; and severe pain in the conjoined psoas and iliacus muscles when put in action seem the most characteristic symptoms of Allium sativum. It has cured chronic cough, with profuse mucous expectoration : and morbid sensibility to the influence of cold air. Petroz wrote of it " Allium sativum has been of remarkable service in cases where the herpetic diathesis has manifested itself in the respiratory or digestive mucous membranes." He considered a pale red appearance of the tongue, with effaced papillae, pathognomonic of this affection. The old authors consider garlic an excellent remedy for "phlegm." I do not perceive any medicine in my list which bears a real resemblance to Allium sativum. The 6th dilution was most probably that used by Petroz and Teste. My next medicine is one familiar to you as a purgative, though new as a specific remedy. I speak of Aloes. Of the best Socotrine Aloes we make triturations, or (which is less certain) an alcoholic tincture. A copious pathogenesis of Aloes is translated from Dr. Bering's " Amerikanische Arzneiprufungen " in the ' American Homoeopathic Review/ vols. iv vi. Although, as I say, you have hardly thought of Aloes as a specific remedy, yet you know a good deal about its specific action. You know that it is no mere aperient, but has peculiar properties. That ALOES. 63 it purges however introduced into the system ; that it affects the large intestine only, especially the rectum ; that here also it excites the action of the muscular coat rather than the secretions of the mucous membrane, being thus (as Dr. Druitt calls it) " eccoprotic;" that it not unfrequently irritates the rectum and anus, causing heat, tenesmus, and even hemorrhoids ; and that the determination of blood it induces towards the lower bowel extends itself also to the other pelvic viscera, so that the bladder becomes irritated, and menstruation excited, these are the teachings of every work on Materia Medica. Our provings confirm them in every particular. They add evidence that the sexual instinct also is excited : that the whole abdomen shares though to a less degree in the congestion of the pelvis, becoming distended and tender; that there is (as Wedekiud long ago taught) a decided action on the liver, shown mainly by dull pain there ; and that, probably in sympathy with these affections, a heavy headache is caused by the drug. The use of Aloes in the Homoeopathic school has hitherto been pretty well confined to dysentery. It is especially indicated where the rectum is much affected, where the tenesmus is severe,* and where there is faintness after each stool. It should be useful in some cases of piles, where the characteristic symptoms exist; also in pelvic congestions in general. Dr. P. P. Wells recommends it for " a * " Aloes 3rd, a single pellet, once cured for me almost instanta- neously a tenesmus which had endured for a week or ten days after recovery from dysentery." (Dr. Holcombe, in 'United States Medical and Surgical Journal,' vol. i, p. 228.) 64 ALUMINA. peculiar heavy, dull, pressing pain in the forehead, of no great severity, but which indisposes to or even incapacitates for all exertion, especially for intel- lectual labour." Also for a sense of insecurity in the bowels, as if diarrhoea might occur at any minute, which is especially prevalent during an epidemic of Asiatic cholera. Dr. Peters suggests Aloes as the specific remedy for the " hsemorrhoidal congestions " of various parts described by Schb'nlein, if these be anything more than pathological abstractions. Aloes is said to have cured falling of the hair. Teste promulgates some curious experience on this subject. " Aloes, in the 6th dilution, produces and cures fall- ing of the hair in adults. Upon one of the persons who lent himself to my experimentation, this pheno- menon was so marked, that a lock of white hair which this person had on the top of his head, in consequence of a blow received on this part twenty years before, completely recovered its black hue, like the rest of his hair. But, in compensation, the temples were garnished with white hair, which, how- ever, disappeared the following month." ^Esculus, Collinsonia, Nux vomica, and Sulphur compare with Aloes. In dysentery, the potencies from the 1st to the 3rd have been used. Teste, as he mentions, gives the 6th ; and Dr. Wells prefers the 200th. My next medicine is as strange as Aloes is familiar ; it is Alumina, by which we mean the genuine Oxide of Aluminium : not Alum. It is prepared by trituration. ALUMINA. 65 The original proving of Alumina is in Hahne- niann's 'Chronic Diseases/ You may occasionally find an exceptional case of disease pictured in this extensive pathogenesis : but I think you will learn more of the drug's sphere of action by reading the clinical remarks of Teste and of Peters and Marcy in their articles upon it. Alumina seems to affect chiefly the sexual system and the mucous membranes. Teste says "I have often derived the greatest advantages from the use of this drug in the case of aged females, against diseases that had been apparently seated in the sexual system, but whose primary symptoms had disappeared with the complete cessation of the menstrual periods/' It has cured chronic gonorrhoea and leucorrhosa, chronic post-gonorrhoeal induration of the testicles, and raised itching spots in the vulva and vagina. In the mucous membranes, the cha- racteristic feature indicating Alumina seems to be dryness with more or less irritation. Thus it has proved curative in morbid sensitiveness of the nasal mucous membrane to cold ; in chronic pharyngitis where the membrane looks dry, glazed, and red ; in dry hacking coughs from pharyngeal or laryngeal irritation ; in dyspepsia from deficiency of gastric juice; andin constipation fromlack of intestinal secre- tion. It has also cured a frequent desire to urinate during the night, occurring in an old paralytic. All the affections to which Alumina is suitable are of a chronic character, and occur in old people, or in dry and thin subjects. I have no experience of the drug myself: it is very rarely used. Its analogues are Baryta, Conium, and Plumbum. 5 66 AMBRA GRISEA. What curative virtues Alumina has are probably obtainable from the 30th dilution or thereabouts. I shall not trouble you with a discussion as to the exact nature of Ambergris Ambra grisea. Suffice it to say that the substance, as met with in commerce, is triturated for Homoeopathic uses. The proving of Ambra is in Hahnemann's ' Materia Medica Pura/ Dr. Marcy, in the ' New Materia Medica/ contributes some therapeutic in- formation concerning the drug. Ambergris is one of those strongly scented sub- stances, like Musk, Castor, and Valerian, which disturb sharply but superficially the functions of the nervous system. The symptoms of its pathogenesis all answer to this description. " Choking and vomiting can hardly be avoided when hawking up phlegm fromthe fauces;" frequent tenesmus, whatever be the character of the stool ; frequent micturition of pale and copious urine; some sexual excitement (it was esteemed of old as an aphrodisiac) are symp- toms of this kind. Ambra is obviously what the therapeutists of the old school call " a nervine :" it finds its place in the treatment of nervous and hysterical affections. Depression with anxiety, sleeplessness, diminished sight and hearing from mental trouble, spasmodic choking and convulsive cough iii hysterical subjects, are some maladies of this kind which Ambra is reported to have cured. It is little used. As I have already suggested, Ambra is closely AMMONIUM CARBONICUM. 67 allied with such medicines as Asafcetida, Castoreum, Moschus, and Valerian. Hahnemann recommends the 3rd ; but Dr. Marcy seems to have been successful with the 12th and 30th. I shall conclude this letter by giving you some account of the Homoeopathic uses of Ammonia and its salts. The specific properties of these substances are few compared with those of a chemical nature : hence they play a far less important part in Ho- moeopathic therapeutics than in those of the old school. Nevertheless, they exert some dynamic action, of which we must take cognisance. The Acetate of Ammonia (Ammonium aceticum) has not been proved : but I would suggest that its remarkable power of relieving dysmenorrhoea (see ' New Materia Medica/ p. 254) is of a specific cha- racter. The plain solution of Ammonia (Liquor ammonise, Ammonium causticum) is rarely used but in veterinary practice. Mr. Moore seems to esteem it highly in acute bronchial and pulmonary affections of a severe type occurring in animals. But there are two salts of Ammonia which have been proved, and of which we have some slight clinical know- ledge. The first is the Carbonate, or (as it is in- correctly called) Ammonium carbonicum, of which we make triturations or watery dilutions. There is a pathogenesis of this substance in Hahnemann's ' Chronic Diseases :' a short proving by Professor Martin of Jena in the ' Brit. Jour. 68 AMMONIUM CARBONICUM. of Horn./ vol. xviii, p. 207 ; and a full account of its clinical uses in the ' New Materia Medical That Ammonia liquefies the blood, causing haemorrhages and exhaustion, you know well : but the action seems too purely chemical to allow of the inference that it is Homoeopathic to scurvy and other spausemic disorders. You know it also as a " stimulant :" and I hope you will not cease to use it to produce this effect in cases where the respiration needs assistance. Especially where dyspnoea results from the retrocession of an eruption, as in measles, or from impending death from phthisis pulmonalis, Ammonium carbonicum in the 1st or 2nd dec. dilu- tion will generally relieve. I do not know whether also, in common with many of your brethren, you regard the Carbonate of Ammonia as a true specific in scarlatina. If so, its virtues must be dynamic, as its chemical action would favour rather than oppose the scarlatinal condition of the blood. Homoeopathic physicians have not unfrequently used it with advantage in this disease, especially when the throat symptoms are prominent. la Homoeopathic practice, it has cured (3rd trit.) epis- taxis, the flushes of menopausia, and some chronic coughs with bronchial irritation and tendency to asthma. It is also very useful in incessant cough excited by a sensation as of down in the larynx. Acidum muriaticum curiously enough has strong analogies with Carbonate of Ammonia : and I know of no other medicine of which the same can be said. The lowest dilutions have generally been em- ployed. AMMONIUM MURIATICUM. 69 The other salt of Ammonia which takes rank in the Homoeopathic Materia Medica is the Hydro- chlorate, Sal ammoniac, or Ammonium muriaticum. A trituration of the crystals is used in our practice. Ammonium muriaticum has a pathogenesis in the ' Chronic Diseases/ Some interesting experiments with it by one Gumpert are translated from ' Frank's Magazine' in the ' New Materia Medica/ From these experiments it would appear that Sal ammoniac has the property in large and long- continued doses of causing a morbid increase in the secretions of all the mucous membranes in the body, a " status pituitosus," as the Germans call it. This is accompanied with chilliness ; lassitude, sluggish- ness, and prostration ; loss of appetite ; and profuse sweating and urination. Later on, a true inter- mittent fever was induced, having the curious character of recurrence every seventh day. From other experiments it would appear that Ammonium muriaticum diminishes the plasticity of the blood, and specifically inflames the stomach and stimulates the spinal cord. The only case of cure by this drug when potentised that I know of is one of spas- modic cough, recurring daily at about 6 p.m. The 30th dilution was used. But many of the uses of Ammonium muriaticum, though in large doses, are certainly dynamic. It exerts great power over the chronic catarrhs (mucous flux of Chambers) which its pathogenetic effects so much resemble. It often acts in an almost magical manner, as you are doubtless aware, in relieving inflammatory face-ache. 70 AMMONIUM MURIATICUM. And if the German physicians are not mistaken, it exerts an influence upon the liver which is doubt- less of a specific character. It may be worth noting, moreover, that it seems to give much pal- liative relief in stricture of the oesophagus and scirrhus of the stomach. It should be useful in those seven-day agues which are sometimes left after the suppression of quotidians by Quinine. In its action on the mucous membranes, Ammo- nium muriaticum closely resembles Antimonium crudum and Pulsatilla. As I have said, we know the drug at present as a remedy only in material doses. LETTER VIII. ANACARDIUM, ANGUSTURA, ANTIMONIUM CRUDUM AND TARTARICUM. THE drug I am now to introduce to you is one of the many of high repute of yore which had fallen into disuse, but which the Hahnemannian method has restored to its due place in medicine. It is the Malacca bean, cashew nut, or Anacardium orientale. A tincture may be prepared from the whole seed ; or the oily dark substance which separates the husk from the kernel, and in which the active virtues of Anacardium seem to reside, may be triturated with sugar of milk. The proving of Anacardium is in the ' Chronic Diseases/ Some very interesting facts relative to its action on the skin are contained in the ' New Materia Medica' of Drs. Marcy and Peters. The ancient reputation of Anacardium was as a remedy for weakness of the mind, memory, and senses : a preparation of it was known as the " con- fectio sapientium." Noack and Trinks mention that Caspar Hoffmann called it rather "confectio stul- torum," because many had lost their memory and become mad on account of using it too often and inconsiderately. They therefore fairly claim its 72 ANACARDITTM ORIENTALE. remedial powers for Homoeopathy. Our provings and therapeutic records confirm these observations of the old physicians. Anacardium appears from its pathogenesis in the ' Chronic Diseases' to depress the cerebral centres and the organs of special sense : and it has frequently proved curative in weakness of the brain caused by onauism or remaining after acute diseases. It is an important remedy in dementia, and in too rapid loss of memory and mental vigour in old persons ; also in amblyopia and nervous deafness. It has removed an hallucina- tion of a dyspeptic which took the form of a belief that a demon was pursuing him. It has also cured paralysis of the tongue. Later researches have shown that Anacardium has a remarkable influence upon the skin. In its slightest degree of action it causes the appearance of wheals like those of urticaria tuberosa, with itching, burning, and swell- ing, terminating in desquamation. When operating more intensely it developes eczematous vesicles, and even bulla3. I am not aware that it has been used as yet as a cutaneous remedy ; but it deserves atten- tion in some forms of nettle-rash, eczema, and pemphigus, and even in vesicular erysipelas. It would probably help in cases of nervous disorder induced by repelled cutaneous eruptions. In the cerebral sphere, Anacardium resembles Phosphoric acid and Zinc ; in its action on the skin, Cantharis, Apis, and Rhus. Anacardium seems generally to have been used in the 1st and 2nd dilutions. In some Homoeopathic treatises on Materia ANGUSTURA VERA. 73 Medica, a section on the Angustura spuria is intro- duced in this place. I have decided to omit it altogether, from the extreme uncertainty of its nature. If, as Christison and Pereira believe, it is the Strychnos Nux vomica itself, we have it already under another name. If it be an allied species, there is nothing in the symptoms of poisoning by it to distinguish it from Nux vomica. So I pass at once to the bark of the Galipea officinalis, the Angustura vera, or Cusparia. It is prepared in tincture. A proving of Angustura vera is contained in the ( Materia Medica Pura.' It presents nothing charac- teristic. Were it not that Angustura is one of Hahne- mann's medicines, I should not have burdened your memory by inserting it here. You know that it is used in its native marshes as a substitute for Cin- chona in the treatment of remittent and intermit- tent fevers. Homoeopathy has nothing to add to this, save one case of prosopalgia cured with it by Dr. Marcy. That he used the 1st dilution is all I can say about the dose : and I cannot choose analo- gous medicines to one itself so little understood. You must have become pretty well tired of minor medicines : for we have not come upon a polychrest since we left Aconite. Nevertheless I cannot think the space I have devoted to these medicines other- wise than well bestowed. You have learned the remedial action of Actsea racemosa in uterine and rheumatic affections, of ^Esculus in haemorrhoids, of 74 ANTIMONIUM CRTJDUM. Agaricus in hypermobility of the nervous system, of Agnus castus in sexual atony, of Aloes in rectal irritation and pelvic congestion, of Alumina in chronic unhealthy conditions of raucous membrane, of Ambra in hysteria, of Ammonium muriaticum in gastric flux, and of Anacardium in cerebral weak- ness. The very limitation of their action makes it easier to grasp and remember. It is well that you should do so : for we are just coming upon a succes- sion of important medicines which will require all your attention to apprehend. The first of these, Antimony, I will endeavour to Homosopathise for you in my present letter. Two salts of Antimony take rank in our Materia Medica, the black sulphuret, Antimonium crudum, now, I believe, recognised by chemists as a ter- sulphide ; and the potassio-tartrate, the well-known tartarised Antimony or Tartar emetic (Antimonium tartaricum). I will speak first of the Antimonium crudum, which, for our purposes, is prepared by trituration. The proving of Antimonium crudum is in the ' Chronic Diseases/ There is an excellent article upon it by Dr. Hempel in his ' Materia Medica/ To Dr. HempePs remarks I own myself indebted for all the knowledge I possess of the sphere of action of this medicine. He points out its essen- tial relation to a state of depressed vitality of the mucous membranes and the skin. The action hardly goes on to inflammation. The mucous mem- branes are loaded with mucus, giving rise to slow digestion with fermentation of the food, nausea, ANTIMONIUM CRUDUM. 75 arid occasional vomiting ; alternate constipation and diarrhoea, with mucous discharge from the anus ; much hawking and expectoration of phlegm ; and irritability of the bladder, with mucous sediment. The secretions and the flatulence are of a foul odour ; and there is drowsiness, and loss of flesh and strength. This is the " mucous flux" I have already spoken of while upon Ammonium muriaticum : but here there is no tendency to fever. The condition of mucous membrane described finds its parallel in the cutaneous disorder caused by Antimonium crudum. Parts readily become sore ; chilblains appear on the feet ; and tuberculous and pustular eruptions are developed. When these gastric and cutaneous affections are met with in practice, Anti- monium crudum will prove an excellent remedy. The coating of the tongue indicating it I have always seen as a milky-white, very different from the no less thick coats of Pulsatilla and Kali bichromicum. It is indicated in that " diseased condition of the intestinal lining in children which favours the development of worms" (Hempel). Among skin affections, it has cured nettle-rash when dependent on gastric disorder ; the sore eyelids, ears, and nose of scrofulous children ; and even eczema impetiginoides.* It is worthy of trial (as suggested by Dr. Hempel) in the tuberculse, mol- luscum, acne, and mentagra. The analogues of Antimonium crudum are Ammonium muriaticum, Kali bichromicum, Petro- leum (?), and Pulsatilla. * See a good case in the ' British Journal of Homoeopathy,' vol. xxiv, p. 312. 76 ANTIMONIUM TARTARICUM. The 6th and 12th dilutions appear the most suitable. The other salt of Antimony which we use is common to both old medicine and new. The cor- respondences and divergences of its application in the two schools respectively are very instructive. I shall detain you some time in the study of Antimonium tartaricum, or Tartar emetic. We prepare it by trituration, or (after the pattern of Autimonial wine) by solution in diluted alcohol. Strangely enough, though Tartar emetic is so freely used among us, it has never been " proved." We have obtained our knowledge of its physiological action mainly from the records of the effect of large doses contained in the ordinary treatises on Materia Medica. The largest collection of such facts with which I am acquainted is that of the ' New Materia Medica.' The action of Tartar emetic on the skin has been specially studied by M. Imbert-Gourbeyre, whose article on the subject you will find translated in vol. xix of the 'Brit. Journ. of Horn/ In the number of that same Journal for April, 1867, is a study of the medicine by Dr. Madden and myself, in which an attempt is made to reduce the materials above enumerated to order, and to give the phe- nomena of antimonial action their physiological expression. I refer you to that study for an ampli- fication of the remarks I propose to make here. Let me begin by citing what we there say con- cerning the nausea and vomiting so characteristic of ANTIMONITJM TARTARICUM. 77 our drug. " The emetic influence of tartarised Antimony appears to be purely neurotic in its modus operandi. The numerous muscular move- ments, whose harmonious play produces the com- plex act called vomiting, are under the control of the nervous centres at the base of the brain and in the medulla oblongata, and are especially effected through the medium of the pneumogastric nerves. That Tartar emetic acts directly on these centres and through these nerves is shown positively by the fact that it causes vomiting when injected into the veins or rectum, or rubbed into the skin, as well as when introduced into the stomach, and in the latter mode of administration is emetic in doses too small to irritate the mucous membrane ; negatively, by the experiment of dividing the vagi on both sides, when neither Antimony nor any other emetic will act." We then go on to speak of the remarkable effects on the circulation and respiration produced by large doses of Tartar emetic, totally independent of and unlike nausea : and show that they are accounted for by the same action on the pneumo- gastric centres upon which depends the antimonial vomiting. I do not wish to dwell here upon these phenomena, which are familiar to you, and which have a physiological rather than a practical inter- est. You will rarely meet with cases of nausea or vomiting to which Tartar emetic is more suitable than other medicines : although the presence of these symptoms in acute affections to which it is other- wise related must always be an additional indication for its use. You will observe that the vomiting to 78 ANTIMONIUM TARTARICUM. which it is Homoeopathic is nervous and sym- pathetic rather than gastric. Nor do we ever need the " contra-stimulant" action of Tartar emetic with which Rasori has familiarised us. Its most im- portant sphere of action for Homosopathists lies in the mucous membranes and the skin (herein resembling Antimonium crudum, but acting much more sharply), and in the lungs. 1. There are two forms of morbid action set up by Tartar emetic in the mucous membranes. The first is that peculiar kind of inflammation we call catarrhal. In the second we have on the mucous membranes the same pustular eruption on an ery- thematous base with which you are well acquainted as the specific effect of the drug upon the cutaneous tissues. Thus, in the alimentary canal a catarrhal gastritis and enteritis are set up ; it is found after death lined with a whitish yellow viscid secretion. In two cases of poisoning observed by Dr. Wood, the matters vomited and purged were white and liquid, without a trace of bile, resembling opaque rice- water. Post-mortem appearances show the stomach and small intestines to be most affected ; the glands of the latter, especially those of the ileum, have not uncommonly been found enlarged. On the other hand, the pustular eruption characteristic of Antimony has been seen in the jejunum, the stomach, and the lower third of the oesophagus : but is most severe and constant about the mouth and throat. In this latter region it begins with a feeling of tension, and other disagreeable sensa- tions, and a metallic taste ; patches of erythematous ANTIMONIUM TARTARICUM. 79 inflammation then appear, upon which come aphthse, vesicles soon going on to pustules, and even false membranes. Upon the respiratory mucous mem- brane the influence of Tartar emetic is almost purely of the catarrhal character, though pustules are said to have been seen in the larynx. The nares escape untouched; but the inflammation, beginning in the larynx, becomes intense in the trachea and bronchi. The production of this in- flammation under the influence of Tartar emetic has been established not only by post-mortem ap- pearances in animals, but by the symptoms of the living, as in the experiments of Dr. Molin, to which I shall hereafter advert. And now what about the lungs ? Does the irritant influence of Tartar emetic upon the respira- tory mucous membrane extend to the pulmonary tissue itself? You know probably that Magendie affirmed this, as the result of his experiments upon animals. Lepelletier also, as quoted by Christison, testifies independently to the same fact, and naively expresses his surprise that the drug is not per- nicious instead of useful in pneumonia. On the other hand, you have doubtless read that counter- experiments have been performed by Rayer in France and Campbell in England in which no pneumonia was set up by Tartar emetic. Let me then recommend you, in this conflict of authorities, to read the account of Dr. Molin's experiments which in our study of Tartar emetic we have cited. They can hardly fail, I think, to carry conviction to your mind on this question. He accounts most satisfactorily for the discrepancy existing between 80 ANTIMONIUM TARTARICUM. Magendie and Rayer, by showing that the latter ex- perimented with such large doses that the animals died before the inflammation had time to be pro- duced ; whereas the former, by using smaller doses, enabled the poison to produce its specific effects on the lungs. When you have satisfied your mind from these experiments on the general question, I beg you to notice the special points about them. Observe that the pneumonia induced never goes beyond the second stage (i. e. that of red hepatiza- tion) ; that it is always accompanied by bronchitis ; and that the inflammation of the bronchial tubes is observed in cases where the animals die before the pneumonia has time to be developed. You will already have drawn the obvious moral of these facts. The well-known curative action of Tartar emetic in bronchitis and pneumonia is after all an instance of the law of similars. You have hitherto in all probability acquiesced in the common belief that it acts in these cases by its general anti- phlogistic power, in virtue of its depressing influence upon the circulation, and liquefacient action on the blood. But were this its only or even chief modus operandi, it ought to be beneficial alike in all in- flammations, wherever occurring. That it is not so, your own therapeutists freely admit. In inflamma- tions of the respiratory mucous membrane, it is in- valuable; when other parts, as the serous mem- branes, are affected, it does little or nothing. Even from this alone it would appear that the drug has some specific relation to this part of the organism : and we have already seen it acting as a specific irritant of the trachea, the bronchi, and the lungs. ANTIMONIUM TARTAR1CUM. 81 We conclude, therefore, that Tartar emetic must be a true Homoeopathic remedy against certain kinds of tracheal, bronchial, and pulmonary inflammation. The experience of our school has verified its value in catarrhal (not membranous) croup : in the second stage of bronchitis in infants and aged per- sons, when the mucus is profuse and the expulsive power feeble : and in the second stage of the pneu- monia of the same subjects, where there is little pain but much dyspnoea. It is obviously broncho- pneumonia (comp. Phosphorus) rather than pleuro- pneumonia (Bryonia) to which Tartar emetic is ho- moeopathic.* The drug has also several times proved curative, in the hands of Drs. Wurmb and Caspar of Vienna, of acute oedema of the lungs. I have myself seen this condition, occurring in the course of general dropsy, subside entirely under the use of Tartar emetic. It is also very useful in chronic coughs, where the expectoration is profuse and easy, and of a mucous nature. We have little experience of Tartar emetic in af- fections of the alimentary canal. It should be ser- viceable in aphthous, pustular, and other eruptive diseases of the mucous membrane ; perhaps in the aphthous mouth and throat of those dying from ex- hausting diseases, as phthisis. I intend trying it next summer in cholera infantum, to which it seems strikingly homoeopathic, and for which we sadly want a perfect remedy. 2. I have yet to speak of the action of Tartar * You will find the place of Tartar emetic in pneumonia very fully discussed by Dr. Cl. Miiller, in Laurie's ' Horn. Practice of Physic/ p. 282. 6 82 ANTIMONIUM TARTARICUltf. emetic upon tlie skin. You know well the peculiar pustular inflammation which is excited by the local application of the drug. If your memory needs refreshing as to its characters, you will find them described at length in our article. But it may be a new idea to you, that this effect of Tartar emetic belongs to it, not as a mere local irritant, but as a dynamic agent. Nothing, however, can be more clearly demonstrated than is this thesis by Dr. Imbert-Gourbeyre, in the paper I have already referred to. He first quotes nineteen observations to show, that when Tartar emetic is used locally, pustular eruptions are apt to occur on other parts of the body, especially about the scrotum and labia, and the anus : and this without the possibility of the mechanical transference of the ointment. He then cites five instances in which eruptions, closely resembling those produced by Tartar emetic oint- ment (and those also which characterise variola), have appeared during the internal administration of the drug.* Lastly, he adduces evidence to prove that the local effect of the drug is not pro- duced till after a day or two, and sometimes does not appear at all at the spot of application, but on some other part of the body. Coupling these facts with the peculiar and specific character of the erup- tion, and with the frequent occurrence of similar pustules on the internal mucous surfaces under the use of the drug, he comes to the fair conclusion that Antimony is a specific and dynamic " exanthe- * Two additional cases of this kind are cited in the ' New Materia Medica' (see our article). ANTIMONIUM TARTARICUM. 83 matogenic/' its characteristic eruption being pus- tular. The precise form of cutaneous eruption to which Tartar emetic corresponds is ecthyma. " The pus- tules/' says Erasmus Wilson, " following the irri- tation of tartarized antimony are ecthymatous." A case of this disease cured by Tartar emetic is given in the ' New Materia Medica/ It is less suitable or serviceable in impetigo,, save in one form of the disease, the impetigo erysipelatodes. Here I have found it as curative as it is homoeopathic. But the deepest interest of Tartar emetic in this sphere lies in its relation to variola. Not only does it cause a specific pustular eruption closely resembling that of smallpox, but it has also the vomiting, the pus- tules of mouth and throat, the viscid mucus clog- ging the air-passages, and the hypinosis of the blood which no less characterise the disease. Still further, the inoculation of the lymph of Tartar emetic pustules appears to effect results analogous to those of vaccination. The pustules produced are precisely similar in appearance to those of cow-pock ; they in their turn can excite fresh pustules by inoculation; and they are said (though this re- quires confirmation) to confer the same protection from smallpox. Correspondingly with this close homceopathicity, the power of Tartar emetic as a remedy for variola is very great. Testimonies to its value are collected in the ' New Materia Medica :' it is said to be especially useful in cases where the respiratory mucous membrane is much affected. I myself have invariably used Tartar emetic (in the 1st trit.) as the medicine for smallpox, and 84 ANTIMONIUM TARTARICUM. have rarely had occasion to substitute any other. I cannot say that it cuts short the disease ; it is doubtful if any medicine can. But it seems to me to conduct the cases through in a very satisfactory manner, decidedly mitigating all the incidental troubles, and leaving very little pitting behind. I have now described the three great spheres of the action of Tartar emetic, the pneumogastric nerve, the respiratory mucous membrane, and the skin. There are other forms of disease in which it is occasionally useful, notably delirium tremens. For these collateral phenomena I must refer you to the admirable collection of the ' New Materia Medica/ to which I have so often referred. Ipecacuanha is the medicine most closely allied to Tartar emetic. Then we have, as acting like it on the pneumogastric, Digitalis, Lobelia, Tabacum, and Veratrum viride ,- on the respiratory organs, Phosphorus ; on the skin, Antimonium crudum and Clematis. The success of old-school practice with Tartar emetic in croup, bronchitis, and pneumonia shows that these diseases do not need very infinitesimal doses of the drug. In these, and in variola, I have generally used the 2nd, rarely the 3rd decimal potency. Higher dilutions (12 15) seem to answer well in oedema pulmonum. I said at the outset that the correspondences and divergences of the application of Tartar emetic in the two schools respectively are very instructive. These have now appeared. You know the drug as an emetic, a depressant of the circulation, and a ANTIMONIUM TARTARICUM. 85 specific remedy in acute pulmonary affections. We directly oppose the first of these three uses : the second we reject utterly : the third we claim for Homoeopathy, define its range,, proportion its quan- tities, and add to the diseases it includes others bearing to the pathogenetic effects of the drug the same relation of similitude. LETTER IX. APIS, APOCYNUM, ARGENTUM METALLICUM AND NITRICUM, ARNICA. THE medicine I am now about to introduce to you under the name of Apis mellifica differs iu important respects from the substances you have been accustomed to regard as drugs. I shall have to ask you to believe that the symptoms which you know to result from the sting of a bee are also produced when the virus of the insect, in a diluted form, is taken into the stomach. Moreover, in noting indications for the remedial use of the virus, I shall depend much upon the phenomena of bee- stinging : and shall take it for granted that similar phenomena occurring in disease are Homoeopathically curable by the internal administration of the poison. I am bound to consider the difficulties which such assumptions must inevitably raise in your mind. There is nothing a priori improbable in the statement that the virus of a bee, when taken into the stomach, should produce symptoms similar in kind to those of a bee-sting. In each case the poison is introduced into the blood, and therefrom produces its effects. The difference of the point of entrance should cause no variation in the results, any more than it does in the case of other specifically APIS MELL1PICA. 87 acting poisons. But you are probably thinking 'of Fontana's experiments, and of the well-known inuocuousness of serpent-poisons when introduced into the stomach or sucked from a bite. Of this there is no question : and we admit that here the secretions of the alimentary canal decompose or otherwise neutralize the virus. But on the other hand, it no less appears that the same serpent-poison, when taken in a diluted form, does cause decided disturbance, and that of a kind similar to the effects of the reptile's bite. Read the admirable provings of the cobra poison (Naja tripudians) by Dr. Russell in vols. xi and xii of the ' British Journal of Homreopathy.' These positives are surely as good as Fontana's negatives. And if we assume, to explain his observations, that the digestive secretions destroy the virus; we are no less compelled by the other experiments to suppose that dilution enables it to escape that destruction. What is true of the virus of serpents must be true also of that of bees. Hence the question is one merely of fact. And if the effects of bee-stings, and of bee-virus taken internally be the same in kind, however different in degree, it follows that they must all be classed together as pathogenetic symptoms of the substance : and may one and all furnish indications for its thera- peutic use. With this preface, we will proceed at once to the consideration of Apis mellifica, the poison of the honey bee. It is prepared for use 88 APIS MELLIFICA. in 'more than one way. A trituration of the whole bees, dried ; or a tincture prepared by macerating their hinder parts, after killing them while in a state of excitement, have been used, and seem to contain the virtues of the medicine. But a better prepara- tion would be a solution of the virus itself dissolved in alcohol. It can be obtained, as Dr. Hering suggests, by seizing the bee by its wings and causing it to eject its poison upon a piece of sugar, or by grasping the sting of a stupefied bee with a small pair of nippers, and gradually drawing out the sting and poison-bags together. The original proving of Apis is in Dr. Hering's 'Amerikanische Arzneiprufungen/ A summary of the symptoms is given in the ' Brit. Journ. of Horn./ vol. xi, p. 392; in Metcalf's 'Homoeopathic Provings/ and in the 'American HomoBopathic Review* for July 1865. Numerous clinical cases are appended to the two former ; and are contained also in the ' New Materia Medica/ and in an article by Dr. Yeldham in the ' Brit. Journ, of Horn./ vol. xii, p. 394. Let us consider the local effects of a bee-sting. The part rapidly swells up, becomes more or less hot and red, with a tense pain, and often considerable burning, tingling, and itching. This is the simplest and most characteristic form of the pathogenetic influence of Apis. It is an acute oedema, the cellular tissue being more affected than the skin. Whenever a similar condition occurs idiopathically, whether on cutaneous or mucous surfaces, Apis is Homoeo- pathically indicated. Acute cedema occurring on the skin is a form of erysipelas : and in this disease Apis is a prime remedy. It stands between Bella- APIS MELLIFICA. 89 donna and Rhus, not controlling intense cutaneous inflammation like the former, or the tendency to form vesicles like the latter; but acting most efficiently in its own sphere. Then there is a species of sore-throat in which Apis is specific. There is no very great redness or pain (Belladonna), nor is the parenchyma of the tonsils inflamed (Baryta carhonica) ; but there is general oedema of the sub- mucous cellular tissue covering the tonsils, uvula, soft palate, and even the posterior portion of the hard palate. When you look at the throat it seems as if a bee had flown in and stung the patient there. If you will study the numerous cases of angina cured by Apis which have been recorded in our journals (as in Dr. Yeldham's paper) you will find this to have been their character. Such a sore- throat is not uncommonly an extension of erysipelas, as Dr. Todd describes it in his ' Clinical Lectures/ It is often, also, the beginning of oedema glottidis : in which Apis should be the great remedy. Other forms of acute oedema are inflammations of the tongue and of the labia : in both of which Apis has been actually found curative. Indeed, if you bear in mind this pathological condition as the main indication for the medicine, you will rarely go wrong in using it. We have still remaining the burning, itching, and tingling of our bee-sting, features by no means common in idiopathic oedema. They rather point to cutaneous hypersesthesia and eruptions : into which indeed in the provers they are seen developed. The exanthem induced generally resembles urticaria; in which disorder Apis is our great remedy. It has 90 APIS MELLIFICA. also cured cases of lichen, and of erythema nodosum : and is generally indicated in skin affections not going on to destruction of tissue, but accompanied with excessive itching, especially of a burning and stinging character. Urticaria, like erysipelas, may manifest itself internally. Here also we have acute oedema, but without the tendency to suppuration belonging to the erysipelatous form. The distressing and some- times even dangerous symptoms arising from this cause have several times been successfully encountered by Apis.* In acute oedema, erysipelatous and urticarious, we have the pathological condition most character- istic of Apis : and upon this I am desirous of fixing your attention. But both provings and therapeutic records credit the medicine with a range far wider than this, as will appear from what follows. 1. The mucous membranes are not influenced in their general extent by Apis : but at certain spots it manifests great power. It inflames the conjunc- tiva : and has frequently proved curative in catarrhal and scrofulous ophthalmia. It is where the cornea is much involved that its most striking curative results are seen. It causes hoarseness and dry cough : and is often useful in subacute and chronic laryngo-tracheal irritation, of a mild type (comp. Rumex crispus and Carbo vegetabilis). It irritates the stomach, and somewhat the bowels ; it is one of the best remedies for diarrhoea recurring every morning, the motions greenish-yellow and * See Erasmus Wilson on ' Diseases of the Skin/ article " Urti- caria," and cases 14, 16, 28 in Dr. Metcalf's paper. APIS MELLIFICA. 91 painless (comp. again with Ruraex crispus). It is very decidedly irritant to the kidneys and neck of the bladder (as Cantharis). Dr. Marcy recom- mends it in incipient Bright's disease, in inflam- mation of the neck of the bladder, and in " irritable bladder." 2. Apis acts rather powerfully in the ovario- uterine sphere. Few medicines cause so many ovarian symptoms : and it has not uncommonly provoked miscarriage when given to pregnant women. It has proved curative in amenorrhcea, dysmenorrhcea, and menorrhagia when resulting from acute congestion of the ovaries : and even in chronic affections of the latter organs. I know of no certain evidence, however, to sustain the vague notion which seems to obtain of its power of curing ovarian dropsy. 3. I come now to the important question, what power has Apis over dropsy, general and local ? It is credited with almost unbounded curative virtues in this disease : but I think discrimination is needed. Its action on the kidneys is sufficient to make it a most useful remedy in acute febrile dropsy from a chill, in post-scarlatinal dropsy, in that of incipient Bright's disease, and in that which sometimes appears in the later months of pregnancy and lays the foundation of future puerperal con- vulsions. In all these forms of dropsy Apis has been used successfully : its curative action being generally announced by a great increase in the secretion of urine. By the same influence on the kidneys, as I suppose, it will sometimes remove for a time the oedema of the lower extremities 92 APIS MELLIFICA. symptomatic of disease of the thoracic organs : but this action is uncertain, and at best pallia- tive and temporary. Then there are the serous dropsies, ascites, hydrothorax, hydrocephalus. These may be mechanical, from obstruction of the circulation ; as when ascites results from cirrhosis of the liver. In such cases, I cannot con- ceive of Apis dispersing the effusion ; nor do I see sufficient evidence that it has ever done so. It is otherwise when the dropsy is the unabsorbed effusion remaining after serous inflammations. There seems little doubt but that Apis acts specifi- cally upon the serous membranes. I do not know that it has ever been used in their acute inflamma- tions : but in ascites and hydrothorax remaining behind after peritonitis and pleurisy it has over and over again proved curative, and there is some reason to suppose that it has removed the effusion in cere- bral meningitis (probably non-tubercular). In conclusion, I would mention that Apis has considerable repute in America as a remedy for ague; and that Dr. Nankivell has lately recom- mended it in scarlatina. He was led to use it in this disease by noticing in a patient affected by it that a patch of skin of the arm remained white amidst the surrounding redness ; and being in- formed that this spot had been a short time pre- viously the seat of the inflammation resulting from the sting of a bee. I have indicated many of the medicines which in particular spheres of action correspond with that of Apis. Thus, Cantharis and Terebinthina in the urinary organs, Sabina in the ovario-uterine system, APOCYNUM CANNABINUM. 93 Rumex in the morning diarrhoea and laryngeal symptoms, and Euphrasia in the action on the con- junctiva closely resemble the present medicine. For the cutaneous symptoms, Anacardium, Belladonna, Croton, Rhus, and Urtica may be compared ; and for the affections of the serous membranes, Apocy- num, Mercurius corrosivus, and Bryonia. As a whole, the action of Apis more nearly resembles that of Arsenic than of any other drug. The 3rd dec. dilution is that which I always employ in acute oedema. In dropsies, Dr. Marcy prefers the lower dilutions, from the 3rd downwards ; in cutaneous affections, from the 3rd upwards ; in irritation of the bladder he says we ought never to go lower than the 6th. The most striking cures of chronic ophthalmia have been made with the 30th : and this and even higher dilutions are preferred in the treatment of intermittents. I have next to bring before you the Apocynum cannabinum, called in America " Indian Hemp." It must not be confounded, however, with Cannabis Indica. The article in Dr. Hale's 'New Remedies' contains all that is known concerning this drug. And "all that is known" is just this, that Apo- cynum has virtues of a remarkable kind in the treatment of all kinds of dropsy. Anasarca, hydro- cephalus, hydrothorax, and especially ascites, of all kinds and from all causes, are among the diseases cured by it in the cases collected by Dr. Hale. I am quite unable at present to distinguish the 94 ARGENTUM METALL1CUM. precise form of action of Apocynum in this sphere : and still less to suggest its rationale. It seems nearly always to require to be given in largish doses, yet it is not a diuretic : for when proved by Drs. Peters and Marcy, it diminished in both the urinary secretion. I have tried it fairly myself in two otherwise unreachable cases : acute hydrocephalus, and ascites from hepatic cirrhosis. In neither case was any effect produced. Nevertheless, one cannot read Dr. Hale's cases without feeling assured that Apocynum has a true place as a specific remedy for some forms of dropsy. You will probably feel, with myself, that it should be held in readiness for cases which our ordinary remedies fail to relieve. Apocynum has also cured menorrhagia, to which it seems homoeopathic ; and I have removed with it in a case of dyspepsia the sensation of sinking at the stomach, which it caused verymarkedly in Dr. Marcy. Apis and Helleborm are the only medicines analogous to Apocynum. No effect seems to be obtainable in dropsy from the usual dilutions. The mother-tincture, in doses of from one to five drops, has sometimes proved effectual : but more frequently it has been neces- sary to resort to a decoction of the fresh root. I would suggest triturations of the dried root. To obtain the specific effects of Silver, we use in our practice two preparations, Argentum metallicum and Argentum nitricum. Argentum metallicum is prepared by triturating with sugar of milk the ARGENTUM METALLICUM. 95 finest silver foil. It probably becomes an oxide in the process. Metallic silver was proved by Hahnemann, and subsequently by Dr. Huber of Vienna. The pa- thogenesis obtained by the former is in the ' Materia Medica Pura :' Huberts experiments I know only through the medium of Hempel. Teste's article should be read. The said Huber sums up his proving by suggest- ing that Argentum acts specifically upon the articu- lations and their component elements, bones, car- tilages, ligaments, &c. It seems to correspond to arthralgia rather than arthritis. I know of no clinical experience with it in this direction. It seems also to irritate the genito-urinary organs : it is homoeopathic to diuresis, and has cured chronic gonorrhoea and atonic spermatorrhoea from onanism, and greatly relieved for a time the symptoms of cancer of the uterus. It is also recommended for chronic laryngitis in public speakers. I see that your own Pereira recommends it in painful affections of the stomach and bowels, with increased secretion ; in similar conditions of the uterus ; and occasionally in epilepsy and syphilis. It is probably destined to take a higher place than that which it now enjoys. Aurum, Platinum, and Selenium are analogous of Argeutuin : less so Zincum. I know of no clinical experience by which to fix the dose : but the potencies from the 3rd to the 6th would probably answer every purpose. 96 ARGENTUM NITRICUM. Argentum nitricum is prepared in aqueous solution, and preserved with the usual precautions. It is sometimes triturated : but the preparation must be uncertain. An exhaustive proving of Nitrate of silver has been made under the direction of Dr. J. O. Miiller, of Vienna : and may be found in Stapf's ' Additions to the Materia Medica/ Some physiological ex- periments by Krahmer, and clinical experience by Kopp are related in Dr. HempePs article on the drug. I suppose I may sum up your old-school know- ledge of the internal action of Nitrate of silver in the following quotations from Pereira. " If the dose be too large, it occasions gastrodynia, some- times nausea and vomiting, and occasionally purging." " In chronic affections of the stomach (especially morbid sensibility of the gastric and intestinal nerves) it has been favorably spoken of by Auten- reith, Dr. Jas. Johnson, and Kneff. It has been employed to allay chronic vomiting connected with disordered innervation, as well as with disease of the stomach (scirrhus and cancer), and to relieve gastro- dynia." Again he writes " It exercises a specific influence over the nervous system ; at least I infer this, partly from the convulsions observed by Orfila when it was injected into the veins of animals, and partly from its occasional curative powers in affec- tions of this system, as epilepsy and chorea/ 5 To this knowledge (singularly Homoeopathic in its appearance) Dr. Muller's admirable proving has added considerably. It has shown that the specific ARGENTUM NITRICUM. 97 action on the nervous system which Pereira recog- nises is indeed very extensive. On the cerebro- spinal centres Argentum nitricum acts as a depress- ant. It causes headache deep in the substance of the brain, with low spirits ; want of mental power ; restless, dreamful sleep ; weakness of the spine, with pain at the small of the back ; weakness even to paralysis of the legs ; vertigo; blindness. There is also a very characteristic infra-orbital neuralgia. Dr. Mu'ller considers that it specially affects the ganglionic centres of the chest and abdomen ; and to this action refers the spasms of the stomach, gullet, and intestines ; the cardialgia with heartburn and water-brash ; the bulimia or anorexia ; the con- stipation; the irregularity and palpitation of the heart ; and the dyspnoea, observed in its provers. Next, the Nitrate is shown to affect the mucous membranes. Locally, it may of course inflame the whole digestive canal : but it specifically irritates the mouth, throat, cardia, and duodenum. The throat looks dark red, and feels dry, and as if a splinter or ulcer were there ; the tongue is sore, and the papillae elevated. The conjunctiva is much inflamed, even to chemosis ; there is also fluent coryza, and titillation of the larynx. From this last cause, and from the irritation of the throat, a dry spasmodic cough is set up. Urethritis is in- duced; and flat pseudo-chancres have appeared on the glans penis. The skin follows here, as elsewhere, the mucous membrane : there is prurigo, followed by a small rash. Even the glands are influenced by this powerful drug. Its long-continued use is said to have caused disease of the liver and dropsy : 7 98 AROENTUM NITRICUM. diuresis is induced ; the right testis has become enlarged and hard, the sexual desire suppressed, and the penis shrivelled ; the axillary glands have been affected with tension and swelling. From this extensive range of pathogenetic influ- ence, one would infer the possession by Nitrate of silver of a corresponding therapeutic efficacy. I am sorry to say, however, that my use of it hitherto has been a series of disappointments. There are only two disorders in which I have found it of service. The first is ophthalmia neonatorum, where it is a true specific, and cures rapidly, without the need of any external application. We owe the suggestion of this remedial use of the drug to Dr. Dudgeon. The second is commencing paraplegia, from debili- tating causes. Recent French experience makes it probable that Argentum nitricum will take the highest place in the treatment of this affection, when arising from tabes dorsalis or any other form of spinal exhaustion. A word before we close upon the local application of Nitrate of silver. You are probably accustomed to use it in this manner ; and would be loth to lose the advantages of the practice. I too should be loth to urge its discontinuance. There is a rough Homceopathicity about most of it, which is grati- fying enough : you are subduing inflammation of skin and mucous membrane with a substance which certainly inflames them when applied in health. But however this may be, Homoeopathy is affirma- tive, not negative. She forbids nothing, not even bleeding and blistering : she ousts them merely by curing without their aid. So by all means if ARNICA MONTANA. 99 you have an ulcer or a local inflammation which you cannot cure by specific remedies, apply your lunar caustic. But try the specific treatment first. I venture to predict that as that becomes perfected, the local treatment will cease to be re- quired : and the porte-caustique will take its place with the phlebotomy lancet among the disused in- struments of torture. Argentum nitricum has obvious points of analogy with Arsenic and Mercury ; with Phosphorus ; and with Hydrocyanic acid. I always employ the 3rd potency. In my fruit- less trials of the drug, I used all dilutions, from the 1st to the 30th. Arnica montana is another of the precious gifts made by Homoeo- pathy to therapeutic art. A tincture is prepared from the entire fresh plant, or from the root, recent or dried. The original proving of Arnica is in the ' Materia Medica Pura/ An account of Jorg's experiments with it is given by Dr. Hempel ; and Testers article on the drug is worth reading. I have said that Arnica is a precious gift made by Homoeopathy to therapeutic art. In thus speaking I am making no allusion to its external application. This was a common practice in Ger- many before Hahnemann was born ; and although as a matter of fact it was introduced into England by Homosopathists, our system cannot take credit for it, any more than it can for the use of Calendula as a vulnerary. I say this the more earnestly, 100 ARNICA MONTANA. because some experiments have lately been made by Dr. Garrod, which go to disprove the action of Arnica in dispersing sanguineous effusions. Whether his results are confirmed or, by further experience, rejected, it matters not to Homoeo- pathy. It is the internal use of Arnica concerning which the law of similars gives the fullest and almost indeed the only information. Our experience, pathogenetic and therapeutic, has thoroughly established the ancient reputation of Arnica as an internal remedy against the effects of falls, blows, strains, and other mechanical injuries; whence its common names Fallkraut and Panacea lapsorum. I would say that it is to an injury what Aconite is to a chill : it will infallibly neutralise the ill affects if given before organic mischief has been set up. With Arnica as with Aconite, how- ever, we must not be too ready to assume that the time for giving it has gone by. I have seen suf- ferers from injuries as from railway accidents of very distant date immensely benefited by Arnica.* Indeed, I can hardly conceive of a case where mechanical violence was the primum mobile, and where Arnica would be of no advantage whatever. But even here we must discriminate. Thus I have no reason to suppose that Arnica influences directly the nervous centres, or would be curative of the consequences of concussion of the brain or spinal cord. Hahnemann seems to me right in * I may refer you for some illustrations of the good effects of Arnica in remote results of mechanical injury to a paper by Mr. Nankivell in vol. xxiii of the 'British Journal of Homroopathy,' p. 177, " On the Thoracic Affections of the Cornish Miners." ARNICA MONTANA. 101 limiting its effects to " the pernicious consequences which often attend falls, contusions, blows, thrusts, straining, twisting or tearing the solid parts of our organism." I may be wrong in this : and there can be no objection to giving Arnica in such cases, unless some other medicine is better indicated. But you should watch whether your case differs in its progress from the course of spontaneous recovery. Again, we have many morbid conditions to which the term "traumatic" is prefixed, as tetanus, cer- tain inflammations, surgical fever, &c. You would be using Arnica very ill if you relied upon it in such disorders as these. They cannot be classified among the consequences of mechanical violence; and are in themselves quite out of the sphere of action of the plant. The parts specially involved in mechanical injuries are the muscles ; and upon these Arnica specially acts. It is above all things a myotic. It thus becomes the main remedy for those nu- merous affections which Dr. Inman has so well described under the term myalgia. Over-exertion of healthy muscles, or the normal use of weak muscles will bring on these .pains : and Arnica will almost infallibly relieve them. As their occurrence is very common, it is a medicine in daily use. I need only specify two of them. One is the form of pleurodynia known as spurious pleurisy. This may readily be induced by over-exertion, as in the fol- lowing case reported by Dr. Inman. "A party of gentlemen on a severe pedestrian excursion were all tired on the first day, and that was all ; on the second day some began to have frequent stitches in 102 ARNICA MONTANA. the side, could not sleep on the side, but only on the back ; on the third day the pains in the side were terribly increased, with so much tenderness that they could not bear the weight of the clothes." In this not uncommon form of pleurodynia Arnica gives rapid relief. It must be distinguished from the muscular rheumatism so called, which yields much more satisfactorily to Bryonia or Actsea race- mosa. Another myalgia which I would specify is one of the forms of pain after food. The pain comes on immediately, even during the act of swal- lowing ; the patients are weak, and of lax fibre ; and they often have or have had myalgise else- where. Here too Arnica is an admirable medi- cine.* With Arnica, as with other medicines, my main endeavour has been to indicate to you the prin- cipal and most characteristic sphere of its operations. But there are, as with other medicines, so with Arnica, certain residuary phenomena which do not come under the primary law of its working. These also I must, however briefly, indicate. 1. There is the well-known eruption of Arnica, which in some susceptible persons results from its external application. I have even known it follow the internal use of the 1st dilution. It consists of * I had written this article before the appearance of Dr. Madden's paper on " Myalgia " in the ' British Journal of Homoeopathy/ and of Dr. Bayes' remarks on " Arnica," in the ' Monthly Homoeopathic Review.' The experience of both these excellent physicians is quite in accordance with the statements here made. They concur, more- over, in stating that the my otic action of Arnica reaches even the heart, so that it is frequently curative of the hypertrophy and dila- tation of this organ brought on by violent exercise, as rowing. ARNICA MONTANA. 103 a. number of very fine vesicles on an erythematous base, with much heat and itching. I am not, however, aware of Arnica having been used in cutaneous disorders, except for boils. Hahnemann recommends it (apparently from theory only) for the diathesis which leads to the formation" of boils : and Teste has cured with it an angina which seemed to result from their retrocession. For myself, I find no need of any other medicine for boils beside Bella- donna and Sulphur. 2. Arnica " determines to the surface," and tends to produce haemorrhages. For their idiopathic occurrence it is often a useful remedy ; especially, as one would suppose, when resulting from mechani- cal violence, as in epistaxis from a blow, and hae- moptysis from violent coughing. 3. Partly from its relations to haemorrhage, and partly from its influence on muscular fibre, Arnica finds a place in the treatment of dysentery. It gives marked relief to the tormina. 4. Arnica may occasionally be given with advan- tage in dry, spasmodic coughs ; and in gastric head- aches. It is said to have caused the reabsorption of cerebral effusion. In its antidotal power against mechanical vio- lence, Arnica stands quite alone. In its action on the muscles Bryonia and Act&a racemosa resemble it somewhat : as a cutaneous irritant, it is allied to Rhus and Croton. Arnica is one of those singular medicines which, though by no means actively poisonous, manifests its full remedial powers only in very infinitesimal doses. I used to care very little for the remedy 104 ARNICA MONTANA. when I gave it from the 1st dil. to the mother- tinc- ture ; but since I have used the dilutions from 2 to 12 I have obtained from it the most unfailing and satisfactory results. Our general experience with Arnica seems to have been gained from about the 3rd potency. LETTER X. ARSENIC. WE have now to gird up our loins, and summon all our strength, that we may master the greatest of medicines, because the greatest of poisons, Arsenicum. By this name, a Homoeopathist means Arsenious acid, the Arsenicum album of the old nomenclature. This salt is triturated up to the 3rd dec. potency, and then prepared by solution. Our sources of information concerning Arsenic are very numerous. Hahnemann published a proving of it in the ' Materia Medica Pura;' and subsequently another in the ' Chronic Diseases/ I would recom- mend you to study these pathogeneses in Dr. Black's able article in the ' Hahnemann Materia Medica/ Part I, where unreliable symptoms are omitted, new ones added from later cases of poisoning, and many clinical notes appended. It is prefaced, moreover, by seventeen cases of poisoning, some of which are not met with in other compendiums. There is a " Study" of Arsenic by the late Dr. Wurmb trans- lated in the 3rd and 4th vols. of the ' Brit. Journ. of Homoeopathy/ M. Imbert-Gourbeyre, who has been working at Arsenic for many years, has 106 ARSENICUM. published papers on "Arsenical Eruptions " ( l North Amer. Journ. of Homoeopathy/ vol. vii, p. 512), on "Arsenical Epistaxis" (' Brit. Journ. of Horn./ vol. xxii, p. 519), on "The Action of Arsenic upon the External Genitals " (ibid., vol. xxiii, p. 77), and on " The Febrigenic Properties of Arsenic " (ibid., vol. xxiv, p. 72). If to these you will add the articles on this substance in your Christison and Pereira, and in our Hempel and Teste : and will also wade through the copious but undigested material which is heaped around it in the ' New Materia Medica/ you will have before you most of the facts on which my remarks now following are based. I shall make reference to other information regarding Arsenic as we proceed. It would be an affront to your knowledge were I to detail in any elaborate manner the phenomena of poisoning by Arsenic. We will, however, pass them rapidly in review, that we may inquire into their physiological expression, and ascertain their precise pathological similes. I. There are certain actions of Arsenic which we must (provisionally at least) call general, as we are as yet unable to localise them. Thus, there are cases of Arsenical poisoning in which the sufferer dies simply prostrated, without special symptoms or discoverable lesion. The same profound adynamia is seen to characterise the influence of the drug in the provers. It must be reckoned as a part of its general action. Again, a tendency to exacerbations and remissions, and sometimes even to intermissions, is noticed in the symptoms produced by Arsenic : ARSENICUM. 107 and not uncommonly in these instances there is well-marked periodicity of return. II. A certain number of the symptoms of Arseni- cal poisoning seem referable to a direct action upon the nervous tissue. This action is not one of pure depression, like that of Curare ; still less of pure excitation, like that of Strychnia. It is a curious mixture of depression with irritation ; the paralysis is accompanied by cramps, and the anaesthesia with neuralgia. These last-named phenomena are seen only in chronic poisoning : they are worth consider- ing, and comparing with the effects of Lead, Copper, Mercury, and Zinc. You will observe that both paralysis and anaesthesia mount periphero-centrad, and are hence often partial ; and that they some- times affect one side only.* The mental and moral symptoms, moreover, which characterise the suffer- ings from Arsenic are so uniform, that I cannot but refer them to a direct action upon the ideational and emotional centres. There too there is the mingling of irritation and depression ; there is melancholy, but also restlessness, irritability, anxiety, and anguish. I would add, without at present at- tempting explanation, that Arsenic has occasionally caused epileptiform and choreiform convulsions. There is yet remaining another division of the nervous system, whose importance we are just learning to recognise the sympathetic or ganglionic. * In a case of hemiplegia produced by Arsenic, where there was also aphonia, the laryngoscope detected paralysis of the vocal cord of the affected side. In the Arsenical anaesthesia there is sometimes manifested an acute sensibility to cold : by which also the neuralgia is aggravated. 108 ARSENICUM. Arsenic powerfully affects the vaso-motor nerves, and somewhat similarly to Aconite. Hahnemann long ago remarked this, and expressed it thus in the language of his time. " This much I have myself ascertained, that Arsenic is well capable of producing that spasm in the blood-vessels and that commotion in the stomach called the febrile rigor. If it be used in a strong dose the fifth or sixth of a grain for an adult this rigor is very observable." The febrile reaction, when it takes place, sometimes assumes a typhoid type. More commonly chill, heat, and sweat recur periodically, in somewhat irregular rotation. III. You will be more prepared to admit that Arsenic is an haematic than that it is a neurotic. The researches of Schmidt and Sturzwage appear to have established this action : and Dr. Harley's experiments have led him to the same conclusion. In small doses, frequently repeated, the only result of this influence of the drug is a diminution of the metamorphosis of the tissues, leading to obesity. This the experimenters referred to suppose to account for the peculiar effects of Arsenic eating upon the Styrian peasants and the Vienna horses. The poison acts directly on the red corpuscles, diminish- ing their power of taking up the oxygen supplied to them in the lungs ; and the carbonaceous compounds thus unconsumed deposit themselves in the form of fat. If this direct action on the corpuscles be granted, many of the phenomena of Arsenical poisoning become explicable. No wonder that the blood is black and non-coagulable, resembling that of malignant fever and cholera ; that petechial effu- ARSEMCUM. 109 sion frequently occurs; and that chronic poisoning takes the form of a profound cachexia. IV. I cannot but think that Arsenic acts directly upon muscular tissue also. Hahnemann (who while yet an old-school practitioner wrote an exhaustive treatise on Arsenical poisoning) calls special attention to the myotic influence of the poison. "The constricting power of Arsenic" he writes " shows itself after death by many phenomena. We usually find after poisoning by Arsenic the cardiac and pyloric orifices of the stomach in such a state of contraction, that not the least quantity of air can be passed through them. The pharynx is also contracted, the breast (Qy ? diaphragm) con- stricted, the muscles of the abdomen strongly con- tracted ; almost all the sphincter muscles, especially those of the anus and bladder, are closed ; the mouth of the ducture communis choledochus in the duodenum appears to be often so much narrowed, that no bile can be passed through it. Also some have found the stomach, after Arsenic has been taken, strongly contracted on itself. There appears likewise to be produced in the limbs a visible contraction or spasm of the muscular fibres." To such a myotic influence I would refer the cramps so characteristic of Arsenic poisoning. They can hardly be produced through the motor nerves, as these are more or less paralysed. We have a parallel instance of the opposite kind in Plumbum and Digitalis, which paralyse the muscles directly, and not through the medium of the nervous system. A lesser but more diffused degree of the same muscular irritation, combined with the neurotic effects of the poison, 110 ARSENICUM. seems the cause of the chorea-like restlessness, trembling, and twitching so frequently observed. To the same action also I would refer the cardiac symptoms, prsecordial pain and anxiety, violent palpitations, quick and irregular pulse, &c. V. The most important action of Arsenic, how- ever, is its power of setting up inflammatory irrita- tion of the tissues. Hardly any part of the body escapes this influence of the poison : but we know its effects mainly in the mucous and serous mem- branes, and the skin. a. Arsenic is a specific irritant to mucous mem- brane, wherever found. The " burning pains " so common in its pathogenesis are regarded by Dr. Wurmb as dependent upon this action. The cha- racter of the inflammations here produced is not (as with Tartar emetic) muco-purulent, but the membrane is dry, or exudes a thin, ichorous dis- charge : and the further progress of the disease is towards ulceration rather than suppuration. The alimentary canal is affected throughout, but more especially in the mouth, throat, stomach, duodenum, and rectum. The inflammation is severe, and causes vomiting, diarrhoea, and dysentery, aphthae in the mouth, ulceration of the stomach and intes- tine, and even gangrene at the anus. In one case, there was found enlargement of Peyer's glands at the lower part of the jejunum, with tendency to ulceration. On the respiratory tract the influence of Arsenic is less potent, save on the upper portion. Tight frontal headache from irritation of the lining membrane of the ethmoid cells and frontal sinus; and coryza, with profuse ichorous discharge, are ARSEN1CUM. Ill commonly produced. The Arsenical conjuncti- vitis, moreover, which is as well known as the Mercurial stomatitis, belongs to this category. The irritation diminishes as it descends, but takes a fresh start in the lungs. The genito-urinary mucous membrane is inflamed throughout : in the penis, scrotum, and vulva (as in the anus) gangrene not infrequently takes place. The renal structure shares in the general irrita- tion. In acute poisoning the secretion of urine is nearly always diminished or suppressed : if any urine is obtained, it is found to contain albumen. The chronic effects of Arsenic upon the kidneys have been ascertained by Dr. Quaglio. He slowly poisoned four cats by the Arsenite of potash; and in the description he gives of the post-mortem ap- pearances of the kidneys you will recognise plainly the essentials of the most common form of Bright's disease, the "chronic non-desquamative nephritis" of Dr. George Johnson, the large white kidney, with scanty urine, albuminuria and dropsy. b. Arsenic affects the serous no less powerfully than the mucous membranes. The inflammations here caused by it are of a subacute character, with speedy and copious serous (less often purulent) effu- sion. The pleura are most frequently affected ; then the pericardium : less often the peritoneum and arachnoid. I must refer you to the authorities mentioned at the beginning for instances of these effects of Arsenic. c. The powerful irritant action of Arsenic upon the mucous membranes makes it almost certain that it must exercise a similar influence upon their 112 ARSENICUM. external continatiou, the skin. Should it do so, however, it convicts of unconscious Homoeopathy the almost universal use of this drug in the treat- ment of cutaneous diseases. I must accordingly cite old-school authority for the fact. Mr. Hun-t (than whom no better man could be named) bears witness to a pityriasis being almost always, and a lichen occasionally induced by the continued use of Arsenic. Dr. Inman writes " Arsenic, when taken in excess, produces a sort of chronic inflammation of the skin, accompanied with oedema, harshness, and dryuess, and followed by desquamation of the cuticle and shedding of the hair, and sometimes of the nails."* Lastly, M. Imbert-Gourbeyre, Pro- fessor of Materia Medica at the School of Clermont Ferrand, has collected a vast number of cases in which Arsenic has produced eruptions on the skin. Every form of cutaneous irritation is shown by him to have been caused by it, from simple erythema to malignant erysipelas, pustular inflammation, and gangrene. The vesicular and squamous forms, however, are the most common. Pardon me if, after all, I have fallen into too didactic a tone in describing the pathogenetic effects of Arsenic. It was necessary to set these forth in a somewhat systematic way, that you might have before you the basis on which the application of the law of similars has enabled us to raise so imposing a superstructure. I shall now pass in review the curative powers of * ' New Theory and Practice of Medicine,' p. 269. AIISENICUM. 113 Arsenic, tracing as I proceed their relation to its pathogenetic effects. I. The action of Arsenic on the cerebro-spinal centres would lead us to use it in some cases of general paralysis and of melancholia. Less intelli- gible, but unquestionable, is its power over chorea, and occasionally over epilepsy (especially when the paroxysms recur periodically). I can only say that its use in these affections is Homoeopathic, because it has caused them in the healthy. But the capital instance of the pure neurotic influence of Arsenic is its curative power in neuralgia. It is one of the very few medicines which causes genuine neu- ralgia : and it far excels all others in the treatment of the idiopathic disorder. The Arsenical neuralgia is pure, i. e. neither inflammatory, toxsemic, nor reflex. The pain is burning and agonising, accom- panied with great restlessness and anguish ; it is often intermittent, with tendency to periodic return ; is generally made worse (even though at first re- lieved) by the application of cold ; is worse at rest, and diminished during exercise ; and usually affects (at least in the first instance) the left side. Such a neuralgia you often meet with as a consequence of malaria or influenza, still more frequently as a symptom of pure debility. If you will read the cases published by Dr. Quin in the fourth volume, and by myself in the twenty-second volume of the ' British Journal of Homoeopathy/ you will see evi- dence that Arsenic exerts a magical influence over pure neuralgise, whenever occurring. II. The action of Arsenic on the vaso-motor nerves, coupled with the tendency to intermittency 8 114 ARSENICUM. and periodicity observable in its symptoms, at once suggests Arsenic as a remedy for ague. Indeed, Hahuemann,* Bonding and ClarusJ have each observed an instance of true intermittent fever re- sulting from its use. You of the old school I believe place it only second to Quinine ; but use it only as an alternative remedy to that drug. We rather endeavour to discriminate. Giving Quinine in recent, typical, and uncomplicated cases, we should prefer Arsenic in the severer and more malignant forms of the disease; in the tertian and quartan types ; and in long-standing cases, where the phenomena of the paroxysms have lost their integrity and rhythm. Dr. Wurmb who made Arsenic the prime remedy for intermittents at the Leopoldstadt Hospital in Vienna thus epitomises the special indications for its preference. " One stage absent ; heat burning ; rapid prostration ; torpid weakness ; dropsical swellings ; cachexia ; abuse of Quinine." As the last phrase suggests, Arsenic is a capital antidote to the ill-effects of Quinine, when (as so often happens) it has been abused in chronic cases of ague. III. In the twenty-fourth volume of the ' British Journal of Homoeopathy' (p. 485) I have endea- voured to prove the essential resemblance between ague and Asiatic cholera. The common ground which these two diseases occupy, viz. the in- tense excitation of the vaso-motor nerves, causing temporary arrest of the circulation is just the * ' Lesser Writings,' translated by Dudgeon, p. 336. f ' Traite des Fievres Intermittentes.' British Journal of Homoeopathy,' vol. xi, p. 334. ARSENICUM. 115 sphere of the action of Arsenic. Add thereto the general prostration, the cramps, and the suppression of urine induced by the drug, and you have the really alarming features of the collapse of cholera, compared with which the vomiting and purging are quite secondary matters. Were the latter as was at first supposed the essential elements of cholera, Arsenic would not be homoeopathic to the disease, nor curative of it ; as these symptoms in Arsenical poisoning depend upon the gastro-enteritis set up, which is entirely absent in cholera. It was pro- bably for this reason that Hahnemann, on first hearing an account of the disease when it invaded Europe in 1830, in naming the drugs most likely from their homoeopathicity to be its antidotes (Camphor, Veratrum, Cuprum) omitted Arsenic. Further knowledge of the disease has shown that the vomiting and purging are not necessary elements of cholera, and that in some of the worst cases they are altogether absent. Arsenic has accordingly been added to the three Hahnemannian medicines. Being perfectly homoeopathic to the general con- dition set up by the cholera poison, and vieing with it in energy, it has become our sheet-anchor in the most desperate cases. In the epidemic of 1849, Dr. Russell at Edinburgh, and Dr. Drysdale at Liverpool concur in assigning to Arsenic the chief place in the treatment of cholera, when the time for curing with Camphor has gone by. I would sug- gest that in this rapidly destructive disease, the medicine should be used in the more soluble form of the Liquor Potassse Arsenitis, and given in appreciable doses. 116 ARSENICUM. IV. Another epidemic disease, characterised by vaso-motor disturbance, prostration, and local dis- charge, is influenza. To the typical form of this malady Arsenic precisely corresponds, being homo3opathic here to the local affection also. In my hands it has always proved rapidly curative of the disorder, unquestionably cutting short its pro- gress. The only symptom it does not cover are the pains in the bones : and these, when excessive, require a few doses of Eupatorium perfoliatum. V. If Arsenic be homoeopathic to the collapse or chill of cholera, it is no less so to the " consecutive fever." And when to this we add its poisonous influence upon the blood, we can hardly fail to re- cognise in it a probable remedy for the true toxsemic fevers, and for typhoid conditions in general. So close is the correspondence, indeed, that cases of poisoning by Arsenic have more than once been compared to, and once even mistaken for an attack of typhoid fever. Let me urge you to get this thought well into your mind, that what Aconite is to simple fever, that Arsenic is to the malignant and typhoid forms. Whenever the well-known " typhoid" symptoms occur especially the dry tongue and the involuntary diarrhoea whether in continued fevers, in the exanthemata, as sympto- matic of local gangrene, or as results of poisoning, always put in your Arsenic, and use it freely and persistently. I have seen many an apparently des- perate case cured by it. VI. The frequency of petechial effusion in Ar- senical poisoning, while forming one element of its homoeopathicity to typhus, suggests it also as a ARSENICUM. 117 remedy for purpura hseraorrhagica. But before leaving the haematic action of Arsenic, I must dwell upon its antidotal power against one of the worst of the dyscrasise, cancer. Homoeopathic experience quite coincides with that of your own Walshe and Hunt, in ascribing to Arsenic a real specific influ- ence over this fatal disease. In epithelial cancer of the lip and face, and in cancer of the tongue, it has even proved curative ; its local being conjoined with its internal use. It is only less efficacious in cancer of the stomach ; and has some power over the dis- ease when affecting the breast and uterus. In the last-named locality, it is said to act best in the form of the Iodide. VII. The myotic influence of Arsenic with possibly some elective affinity for the organ makes it a most valuable medicine in cardiac diseases. Of pericarditis I shall speak under the head of its action on serous membranes. In endocarditis it should be the prime remedy : though I know of no recorded cases of its use. But in chronic organic disease of the heart especially dilatation and val- vular mischief the testimony to its value is loud and unanimous. It relieves pain, palpitation, and dyspnoea ; and above all, has a very marked influ- ence over the anasarca in which these cases usually end. It is also of considerable efficacy in keeping at bay the paroxysms of angina pectoris. Hitherto we have been dwelling in the sphere of the neurotic, haematic, and myotic action of Arsenic. Neuralgia, ague, cholera, influenza, typhoid con- ditions, cancerous growths, and cardiac diseases, crown it with a goodly wreath of therapeutic triumph. 118 ARSENICUM. But we have yet to follow it through the tissues it irritates, noting as we go what it has done to modify their inflammations when otherwise induced. 1. There are few inflammatory diseases of the alimentary canal in which Arsenic is not of great service ; though in some it is eclipsed in value by other remedies. Thus, in the mouth and throat, Mercury, the mineral acids, Chlorate of potash, and Belladonna, supersede it on ordinary occasions. But in " cancrum oris," in aphthse occurring in the course of exhausting diseases, and generally in malignant inflammations and phagedsenic ulcerations of these parts, Arsenic is indispensable. It appears to have no influence over true diphtheria. In gas- tritis, acute and chronic, it is the chief remedy. I have often cured with it pain after food, vomiting, and other dyspeptic symptoms dependent on chronic inflammation of the stomach and duodenum. It deserves a trial in ulcer of the stomach : though here it may be excelled by Kali bichromicum. Arsenic would generally yield to Mercurius corro- sivus in dysentery : but is very useful when the rectum is most affected, or when there is great prostration. As the purging caused by it depends upon intestinal inflammation, it is not homoeopathic _to simple " functional" diarrhoea, however severe. But in the various forms of chronic diarrhoea, where there is generally inflammation, ulceration, or some other kind of disorganisation, Arsenic is a glorious remedy. 2. Arsenic holds an important place in the treat- ment of the disorders of the upper portion of the respiratory mucous membrane. Of its action in ARSENICUM. 119 influenza I have already spoken : it is no less valu- able in coryzas approaching this type. It is also about the best medicine we have (which is after all not saying much) for hay-fever and -asthma. The conjunctiva being an offset of this mucous tract. Arsenic is a remedy for several kinds of ophthalmia. In chronic conjunctivitis I place great reliance upon it ; and in strumous ophthalmia my experience co- incides with that of many others, that it will often cure obstinate cases where every other medicine has failed. In affections of the larynx and trachea Arsenic is seldom if ever required. In bronchitis and pneumonia it is indicated only when the in- flammations occur in aged people, are of a low type, and are accompanied with much suffocation (capillary bronchitis, pneumonia notha). Even here I greatly prefer Tartar emetic. Arsenic has much reputation in our school in the treatment of asthma. I must confess, however, that I myself prefer other remedies. Dr. Wurmb gives the fol- lowing special indications for its choice. " When the paroxysms of suffocation come on especially towards evening or at night, or are brought on by walking, going up hill, deep inspiration, coughing, or anger; and are accompanied by great feelings of weakness, fretfulness and anxiety, rawness in the pit of the stomach and chest, and dry hacking cough/' 3. In inflammations of the urinary tract, and in acute renal affections, Arsenic is more than rivalled by other medicines, notably Terebinthina and Cantharis. But in chronic Bright's disease it is probably the very best medicine, and has effected some brilliant 120 ARSENICUM. cures, as the references will show.* It is probably the large white kidney only to which it is curative, as it is to this form only that it is homoeopathic. In affections of the generative organs its use is known at present only in chronic raenorrhagia (for which it is extolled by your own Locock and Hunt), and where the soft chancre runs into phagedsena. It will probably be found curative in noma pudendi, in cancer scroti, and other malignant and gangrenous affections of the external genitals. Dr. Black sug- gests the use of Arsenic in chronic uterine disease : a thin, corrosive, burning leucorrhoea would indicate it in such cases. 4. In inflammations of the serous membranes Arsenic is called for whenever very copious serous effusion is present. No remedy equals it here. It has most influence on the pleura, least on the peri- toneum. In chronic serous dropsies the persevering use of Arsenicum is sometimes attended with good results. f In idiopathic cases it is probably inferior to Apis, perhaps also to Apocynum ; in ascites from disease of the liver, it can do little ; but in dropsy secondary to cardiac or renal disease its powerful action upon the organs primarily affected makes it a most valuable medicine. 5. I need hardly tell you that Arsenic has a curative range in cutaneous diseases not less extensive than its pathogenetic influence in the same sphere. * See ' Lancet,' January 18, 1862 : Black, p. 17, note l : and ' British Journal of Homoeopathy,' vol. xii, p. 485 ; vol. xiii, p. 566 ; vol. xiv, p. 20; vol. xvi, p. 219; vol. xvii, p. 545, 573. t See some capital cases by Dr. Yeldham in vols. iii and iv of the ' Annals.' ARSENICUM. 121 I suppose that Mr. Hunt fairly expresses your own experience and that of old-school practitioners generally. If you will read through a review of his book which I wrote in the ' Brit. Journ. of Homoeo- pathy/ vol. xxi, p. 660, you will see the Homoeo- pathicity of his treatment argued out. It extends even to dose, when he gives (as in one case) the 4oth of a grain only at a time. We have many other remedies for skin diseases besides Arsenic, and hence do not use it so indiscriminately as in the old school. But in chronic cases of urticaria, eczema, pemphigus, rupia simplex, lichen, prurigo, pityriasis, psoriasis and lepra we esteem it as highly as you do, and use it as the leading remedy. And so we come to the end of the therapeutic virtues of Arsenic, having added to its conquests formerly enumerated (among other diseases) cancrum oris, gastritis, diarrhoea chronica, ophthalmia chronica and scrofulosa, asthma, Bright's disease, menor- rhagia chrouica, serous effusions and dropsies, and chronic diseases of the skin. Truly a goodly list ; and it might be yet extended. For myself I can say this, that were I reduced to two medicines only out of the whole Pharmacopoeia, the two I should choose would be Aconite and Arsenic. The action of Arsenic is so extensive, that it has points of analogy with nearly every medicine in the ' Materia Medica/ Those which resemble it most closely are Mercurius corrosivus, Kali bichromicum, and Iodine. Like all polychrests, Arsenic must be given in various dilutions to obtain its full efficacv. In 122 ARSENICUM. cholera, typhoid conditions, cancer, chronic menor- rhagia, and cutaneous diseases you may use the 1st trituration of Arsenious acid, or (which I prefer), the Liquor Potasses Arsenitis, which contains gr. j of Arsenious acid in TT^CXX. The 3rd dec. trituration is a very useful potency for chronic diarrhoea, and for chronic inflammation of those tissues to which Arsenic is irritant. The 6th dilution answers admirably for influenza, coryza, acute serous effusion, and other acute inflammations to which the drug is homoeopathic. The potencies from the 6th upward have proved most serviceable in neuralgia, in chronic intermittents, and in asthma. LETTER XI. ARTEMISIA, ASAFffiTIDA, ASARUM, ASTERIAS, AURUM, BAPTISIA, BARYTA CARBON1CA AND MURIATICA. THE alphabetical arrangement we. are following brings us now to a series of minor medicines, each of these, nevertheless, having its. own place in the treatment of disease, which place cannot be filled by any other without loss. The first in order is the common Mug-wort, the Artemisia vulgaris. A tincture or (better) trituration&r may be made from the inner part of the root. There is no proving, .of Artemisia extant. Our knowledge concerning it (mainly contributed by Dr. Burdach) is set down in .Hempel and in the 'New Materia Medica/:z/6 voce. From the facts there narrated, it would appear that Artemisia exerts a decided influence over the nervous system, enabling it to modify such disorders as epilepsy, chorea, somnambulism, &c. It has quite a reputation among the common people as an anti- epileptic. The eases in. which it is of- -most value, according to Burdach, are those in- which the paroxysms recur, several times daily. I have lately nearly cured a long- standing case in which the petit 124 ASAFtETIDA. mal occurred five or six times daily with Artemisia, after the failure of the more usual remedies. The curative effect is generally accompanied by profuse and foetid perspirations. Burdach considers it also quite a specific for the epileptiform convulsions of children, as from dentition. Artemisia closely resembles JEthusa, and hence also Cicuta and (Enanthe crocata. It has hitherto been prescribed only in material doses. In the case I have referred to I gave the 1st dec. trit. of the dried root. The next drug in order is the familiar Asafoetida, for so, and not " Assafoetida," it is correctly spelt. I need hardly tell you that the drug known by this name is the dried juice of the root of the Indian plant which yields it. From the Asafoetida of com- merce we prepare a tincture in the usual manner. Asafoetida has been proved only by Professor Jorg and his pupils. An account of their experi- ments is given in Hempel. Pereira thus sums up Jo'rg's results. " Doses of Asafostida, not exceeding a scruple, caused uneasi- ness and pain in the stomach, increased secretion of the gastro-intestinal mucous membrane, and alvine evacuations. The pulse was increased in frequency, the animal heat augmented, the respiration quick- ened, and the secretions from the bronchial mem- brane and skin promoted. A very constant effect was headache and giddiness. The urino-genital apparatus appeared to be specifically affected, for in ASAFCETIDA. 125 the males there was an increase of the venereal feelings, with irritation about the glans penis, while in the females the catamenial discharge appeared before its time, and uterine pain was experienced." Our main use of Asafostida is that with which you are well acquainted, viz. as a remedy for hys- terical troubles. A symptom repeatedly observed by two of the provers strikingly resembles the glo- bus hystericus ; and hysterical cough, tympanitis, and asthma come within its range of influence. I confess that I myself rarely use it, preferring the more agreeable Moschus, whose action seems so precisely similar. Quite another, and a very inex- plicable action of Asafostida, is its influence upon diseases of bone. Dr. Holcombe writes, " I have twice verified the value of this remedy in scrofulous caries of the bones. I used the 12th dilution. It is singular that a remedy, whose principal applications are to the most fugitive and sympathetic distur- bances of the nervous system, should extend its curative power to the most deep-seated and chronic organic lesions." It is also highly commended in acute necrosis. I give you these facts as they stand. For myself, I have given Asafoetida very persistently in several cases of chronic caries, without being able to discern the slightest result from its use. The relations of Asafostida as a nervine are with Ambra, Castoreum, Moschus, and Valerian. Its influence upon bone (if a fact) ranks it with the metals and metalloids Aurum, Mercurius, Phos- phorus, and Silicea. In hysteric disorders, the dose should probably 126 ASARUM EUROPIUM. be from the 2nd downwards. In diseases of bone, Asafoetida has gained its repute in the dilutions from 12 to 30. I am entering a region unknown to you when I proceed to speak of Asarum Europseum, or Asarabacca. We prepare a tincture from the dried root. Asarum was proved under Hahnemann's super- intendence, and the pathogenesis is in the ' Materia Medica Pura.' There is a good article upon it (the last published, I am sorry to say) in the ' New Materia Medica/ That Asarum is a local irritant, of the Elaterium and Veratrum type, to the mucous membranes generally, acting as errhine, emetic, and purgative, is pretty well known : but the fact has little bear- ing on practice. In Hahnemann's provings we are most struck by, as general symptoms, excessive sensibility and general chilliness without thirst ; in particular regions, depression of the cerebral func- tions with heavy headache ; weak sight and twitch- ing of the eyelids ; still more striking dulness of hearing, as though a pellicle were stretched over the meatus auditorius; passing of much mucus from the bowels ; marked stitching in the lungs ; a great deal of myalgia in the back and lower extremities. Asarum has hardly ever been used in disease : the above symptoms may occasionally help you to its phenomenal application. It has a great reputation ASTERIAS RUBENS. 127 in Russia as a remedy for the effects of excessive drinking. I can say nothing as to the analogous medicines or the dose of Asarum. Still more novel is the next medicine I have to introduce to you. It is made from the star-fish, Asterias rubens, by bruising (as I suppose) the dried fish in a mortar and triturating with milk-sugar. Our sole knowledge concerning Asterias is de- rived from the proving and clinical cases furnished by the late Dr. Petroz. They may be found in his collected writings or translated in Metcalfs ' American Provings/ Dr. Petroz makes the following remark. " Experi- mentation on the healthy gives readily, and often in profusion, symptoms indicating disturbance of function ; but it never goes on to alteration of tissue, rarely even to the earliest indications thereof. We must therefore have recourse to clinical experience. Its teaching is sure, when time has confirmed it." To no medicine does this statement apply better than to Asterias rubens. The skin symp- toms alone are well-marked : and these have led to its employment in chronic ulceration, even when of a cancerous nature, with success. Its action seems limited to the left side of the body. It has also cured a case of cerebral congestion with obsti- nate constipation in an old officer.* Asterias had a reputation among the ancients in epilepsy : and * I have myself found it of great use in a similar case. 128 AURUM. Petroz cites two cases in which much benefit re- sulted from its use in infinitesimal doses. I have little personal experience with this remedy. Teste classes Asterias (with Petroz' assent) in his group headed by Sulphur, and including Bovista, Mthusa, and Cicuta. The higher dilutions (12 to 24) were employed in all cases on record of relief or cure by As- terias. We now come to a medicine which Homoeopathy has done much to rescue from unmerited neglect, and to restore to a high place in therapeutics. I speak of gold. There is so little difference between the action of the metal and its salts that I shall speak of them generally as Aurum. We prepare the metal by triturating the finest gold-leaf with milk-sugar. The terchloride (Aurum muriaticum) is dissolved in water or alcohol to make the dilutions. Metallic gold and its muriate were proved by Hahnemann : their pathogeneses were published first in the ' Materia Medica Pura/ and then in the ' Chronic Diseases/ It seems that pulverised gold was in repute among the Arabian physicians for several forms of disease, notably melancholia, palpitation, and dys- pnoea. Abandoned by modern physicians from theoretical objections, based on its supposed insolu- bility, its use was revived by Hahnemanu. His process of trituration developed its medicinal powers, AURUM. 129 and his method of experimentation revealed their range and character. Now, as you probably know, a " Pulvis auri" finds a place in some foreign Pharmacopoeias ; and the introduction of the ter- chloride gives us an agent bearing the same relation to the metal as Corrosive sublimate bears to Mer- cury. Hahnemann's provings make it evident that three at least of the ancient uses of gold were instances of the operation of the law of similars. No medi- cine causes such marked depression, anguish, loath- ing of life, and impulse towards self-destruction : and for melancholia, especially with this suicidal tendency, Aurum in minute doses (1st trit.) has proved an effectual remedy. Again, the symptoms of dyspnoea are very prominent : so that we understand why Avicenna commends it as " extremely useful in difficulty of breathing." I cannot, however, tell you what is the precise kind of dyspnoea of which Aurum is curative : from the proving it would seem to be spasmodic asthma. Thirdly, Gold was known of old as a remedy for the bad effects of mineral poisons, especially of Arsenic and Mercury. Observe then the exostoses, the ulceration and swelling of the nose of the provings: and read the account in Pereira of the salivation and erethistic fever induced by the ter-chloride, and you will see that Aurum antidotes Mercury by virtue of the similarity in their effects. Hahnemann mentions a case of mercurial caries of the nasal and palatine bones cured by the 2nd trituration of Aurum. The proving also shows us the following as effects of Aurum. Determination of blood to the brain, 9 130 All RUM. with turmoil and roaring in the head (compare with Glonoine) ; hemi-opia, so that only the lower half of objects is visible (contrast with Muriatic acid, which cuts off a lateral half by a perpendicular line) ; crusts in the nostrils (especially from Aurum muriaticum) ; very marked sexual excitement ; swelling and tenderness of the right testicle ; and palpitation of the heart. You will probably find these symptoms good indications for the use of Aurum in your practice. Hitherto, its main employment has been (besides the melancholia and hydrargyrosis of which I have already spoken) in tertiary syphilis, and in sarcocele of long-standing. It is an admirable medicine for those constitutions broken down by the combined influence of syphilis and Mercury, which sometimes come before us for treatment.* I once gave to a poor fellow thus afflicted the 1st trituration of gold : he came back to me in a week's time, looking quite another man, and exclaimed, " Surely you have given me the elixir of life." The syphilitic form of sarcocele would of course be that for which it is best suited : but I have seen it act well in the simple disease. It is recommended in ozcena, and should be the best remedy for exostosis. At the Leopoldstadt Hospital at Vienna, Aurum muriaticum, 15th dec., is the favorite remedy for periostitis; and, in the 6th dec. dilution, cured one severe case of albuminuria with general and local dropsy .f In vol. viii of the ' North American Journal of Homoeopathy ' you * Dr. Chapman has narrated a good case of this kind in the ' British Journal of Homoeopathy,' vol. vii, p. 396. t See ' British Journal of Homoeopathy,' vol. xvi, p. 314, 198. BAPTISIA TINCTORTA. 131 may read some cases showing its power over chroiiic ophthalmia. Altogether, Gold is a very important medicine : and its use will probably become more and more extensive. After Mercury, the most striking analogue of Aurum is Platina, which is to the female sex much what Gold is to the male. In its action on the testicles it is associated with Pulsatilla, Clematis, and Spongia. I find that I have mentioned the potencies in which Aurum has proved efficacious : you will see that they have generally been the lower ones. One of the most valuable among the contributions which America has recently made to our Materia Medica is the Baptisia tinctoria or wild Indigo. We make a tincture of the root. Fragmentary provings of Baptisia may be found in the ' North American Journal of Homoeopathy/ vols. v and vii. These, with further pathogenetic and clinical facts, are collated by Dr. Hale in his article on the drug in the " New Remedies. " I can hardly say whether the provings of Baptisia would have led us a priori to its use in gastric fever. But, knowing its high reputation as a remedy for this disease, we see in its pathogenetic effects much resemblance thereto. The weak and tremulous feeling ; the quick (90), full, and soft pulse ; the internal and external heat, with thirst ; the headache and tendency to delirium ; the tongue yellowish-brown in the centre and red at the edges ; 132 BAPTISIA TINCTORIA. the constipation alternating with diarrhoea, all contribute to make up the morbid picture. As regards its curative virtues I will repeat here some remarks which I made in vol. xxiii of the ' Brit. Journ. of Homoeopathy.' " The special interest of this remedy lies in its power over certain kinds of fever. The authorities quoted by Dr. Hale consider it the great specific for all idiopathic fevers of whatever kind. We cannot but agree with him when he says, ' It is doubtful if Baptisia is indicated in all fevers. It is one of the misfortunes of all schools of medicine, that when a new remedy comes up, it is seized upon by certain enthusiastic members of the profession ; and they, losing sight of its specific indications, proceed to laud it in the most extravagant terms, as a panacea in all diseases/ tf In a former No. of this Journal (that for July, 1863), I have endeavoured to indicate the special form of fever to which the pathogenesy of Baptisia, aided by clinical experience, points as its sphere of influence. It is the first stage of the ordinary endemic fever of this country, known popularly as ' gastric/ and medically as ' typhoid' or ' enteric/ In the first stage of this disease the patient has a hot dry skin and a quick full pulse ; the tongue is thickly covered with a f whitey-brown' fur ; the head aches, and there is at least nocturnal delirium ; the appetite is absent, and thirst great ; the urine is high-coloured, and the bowels generally consti- pated. Unless the disease is checked in this stage, the true typhoid symptoms supervene, which I need not here describe. BAPTISIA TIXCTORIA. 133 " Now there is nothing improbable in the supposi- tion that if we could find a remedy perfectly homoeo- pathic to the first stage of this malady, we might cure it there and then before the typhoid symptoms supervened. None of our ordinary remedies seem applicable. Aconite is powerless against such fevers; it never reduces the pulse one beat, or relieves the skin by a drop of moisture. Arsenic is suitable only to the later stage of the disorder. Bryonia is the remedy generally administered ; but, though better than nothing, it is difficult to see anything curative in its action. On the other hand, the pathogenesis of Baptisia, brief as it is, exhibits it as properly homoeopathic to the condition I have described. And the result of my own experience in its use has been, that in the great majority of cases it cuts short the fever in this its first stage, freeing the patient from all the dangers of the second. I have never yet been disappointed in it : and its curative action is often exceedingly rapid. " I have little to add to the above remarks. My own confidence in the power of the drug is un- abated : and testimonies to its value continue to accumulate. I refer you to cases by Mr. Harmar Smith* and Dr. Bayes ;f and to accounts of epidemics in England, J America, and Australia, || by Mr. Freeman, Dr. Hale, and Dr. Madden * ' British Journal of Homoeopathy,' vol. xxiii, p. 400. f ' Monthly Homoeopathic Review,' October, 1866. J Ibid., May, 1866. ' British Journal of Homoeopathy,' vol. xxiv, p. 6G4. || Ibid., vol. xxiv, p. 302. 134 BARYTA CARBONICA. respectively. The facts adduced by the last- named physician relative to the power of Baptisia to shorten the duration of the " colonial fever " observed by him at Melbourne are very striking. Baptisia is also occasionally used with advantage in ulcerative conditions of the mucous membrane attended by tendency to putrescence. Baptisia is a very unique drug. I can hardly liken it to any other, unless it be Gelseminum. Material doses have always been given. In fever, I give a drop or two of the 1st dec. dilution every two hours. Of the salts of Barium we use two in our practice, the Carbonate of Baryta (Baryta carbonica), and the Chloride of Barium (Baryta muriatica). The latter has not been proved : we use it much as do the old school practitioners of the continent, in strumous enlargements of the glands. A much more important medicine is the Baryta carbonica. It is of course potentized by trituration. The proving is in the ' Chronic Diseases/ Among the numerous symptoms contained in this pathogeuesis two groups only have led to practical results. These are, the symptoms of inflammation of the throat and of depression of the sexual functions. Clinical experience has inter- preted the former of these to mean an acute affection of the parenchyma of the tonsils. I know not who first recommended Baryta carbonica in true quinsy (tonsillitis) ; but it is one of the BARYTA CARBONICA. 135 prettiest bits of practice I know. I have never failed to check by its means the progress of the disease, when taken in time : so that the engorgement subsides without going on to suppuration. As regards the sexual functions, my friend Dr. Madden has communicated to me several cases in which impotence has been removed by this drug. Baryta is considered very suitable for affections of aged people, especially old men (Conium takes its place for old women). Baryta, too, has hardly any really analogous medicine. As a sexual depressant, however, it ranks with Agnus castus, Camphor, Conium, Lyco- podium, Naja, Plumbum, Selenium, and Zincum. The higher dilutions are probably the best. In quinsy I always use the 6th : in impotence Dr. Madden gave the 12th. LETTER XII. BELLADONNA. AGAIN we come upon one of our great medicines, our " polychrests." I shall devote this letter to a consideration of the Atropa Belladonna. We prepare a tincture from the fresh plant in the usual manner. The original proving of Belladonna is in the ' Materia Medica Pura/ prefaced by some of Hahne- mann's characteristic remarks. There is another proving by some Vienna physicians (alloeopathic), of which an account is given in vol. vi of the ' British Journal of Homoeopathy/ In vol. xx of the same Journal I have published a number of cases of poisoning by the plant, with commentaries. Lastly, the therapeutic virtues of Belladonna are detailed at much length in Hartmann's ' Practical Observations on some of the chief Homoeopathic Remedies/' 2nd series, trausl. by Dr. Okie. You doubtless consider Belladonna to be in the main a neurotic poison and medicine. That it does influence nervous function directly and extensively, I fully grant : but I submit that the great body of its action is not to be thus explained. Let us see how it affects the nerves, sensory, BELLADONNA. ( 137 motor, and sympathetic. Locally applied, it is a depressant to the two former, causing anaesthesia and paralysis : but, with a not uncommon antago- nism, excites the latter, causing contraction instead of dilatation (as with Opium) of the minute arteries. Similar effects might be expected from its internal administration : but as a fact they are very rarely seen, except in those parts of the body for which Belladonna has an elective affinity. Thus, anaesthesia is produced hardly anywhere but in the eye, where a true amaurosis is set up. Paralysis is seen only in the sphincters, incontinence of urine and in- voluntary defsecation resulting from full doses of Atropine. And the characteristic dilatation of the pupil, with open, brilliant, staring eyes, is the sole witness to excitation of the sympathetic system. You will notice how different all this is from the generally diffused action of Aconite. But you will also, I think, agree with me that such an influence as this in no way accounts for the remarkable disturbance of the cerebral functions so characteristic of Belladonna poisoning : still less for the red face, the dry throat, the scarlet skin, and the urinary irritation which rarely fail to appear. Everything here points to excitement rather than depression of the nervous centres, and to dilatation rather than contrac- tion of the blood-vessels. We must inquire whether Belladonna does not possess properties of another kind which may account for these phenomena. Now although writers on Materia Medica treat of Belladonna as a pure narcotic, a toxicologist like Christison does not hesitate to class it among the narcotico-acrids, adducing several instances in which 138 BELLADONNA. inflammatory irritation as of the throat and bladder resulted from its use. We have only to suppose that it exerts this influence upon the cerebro-spinal centres also ; that it irritates nervous tissue as well as affects nervous function, and the whole difficulty disappears. According as one or other action pre- dominates in any part of the body, so the symptoms will be those of excitement and vascular fulness, or of depression and arterial contraction. Upon such principles we will now pass in review the action of Belladonna, pathogenetic and thera- peutic, in the chief spheres of its operation. These are the intra-cranial nervous centres, the eye, the throat, the bladder, and the skin. I. The whole encephalic mass seems irritated by Belladonna; and each of the nervous centres of which it is made up manifests this in its own peculiar way. In all we have excitement with perversion of function, followed by or accompanied with more or less hypersemia of an active character. Upon the cerebrum the earliest effects are insomnia, delirium, and even mania. These symptoms are generally accompanied with or followed by the signs of active determination of blood, flushing of the face, headache, intolerance of light and sound, &c. When the poisonous influence is severe or prolonged, this stage of excitement is often succeeded by one of sopor and exhaustion, as it is in idiopathic inflammations of the brain. A similar derangement of the motor centres, the corpora striata and perhaps the cerebellum, appears in the disorder of standing and walking observed in many cases of Belladonna poisoning. This does not appear to be a true BELLADONNA. 139 paraplegia : it resembles rather that want of control of the lower limbs which is induced by alcohol. Other evidences of excited but perverted muscular action are seen in the twitchings, jactitations, and chorea-like movements which occur in various parts of the body. As for the sensory ganglia, we have as yet no evidence of the action of Belladonna upon the optic thalami or the olfactory lobes. Upon the centres of vision and hearing its influence is very decided. Auditory illusions, as roaring in thejears, occasionally though not frequently occur : and visual hallucinations are exceedingly common. Lusanna says, "Various phantasms are observed, gigantic forms, and appearances sometimes laughable, some- times terrifying ; also quick rotation and duplication of objects." The excited and perverted functions of the medulla oblongata are seen in the abnormal actions of the parts supplied by the nerves pneumo- gastric, hypoglossal, &c. which originate in it. Such are spasms of the larynx and pharynx, difficult articulation and deglutition, spasmodic cough, and stridulous respiration. Post-mortem examination almost invariably discloses considerable cerebral congestion, involving also the cerebellum and medulla oblongata. The physiological actions I have now enumerated at once lead us to a wide range of therapeutic influence on the part of Belladonna. In all active hypersemise and perversions of function of any of the encephalic centres, Belladonna is the first medicine to be thought of. In delirium and mania the choice nearly always lies between it and Hyoscyamus or Stramonium. When we come to the study of 140 BELLADONNA. these medicines, we shall find that Stramonium is best suited to very acute maniacal delirium ; and Hyoscyamus to cerebral disturbance unconnected with hypersemia, or resulting from toxaemia, as in low fevers. Sometimes, however, the cerebral complication of fever is sufficiently active to require Belladonna. In delirium tremens the presence or absence of hyperaemia of the brain determines the choice between Belladonna and Hyoscyamus. If the distinction between delirium ebriosorum (mania a potu] and true delirium tremens be valid, it is to the former that Belladonna is best suited. Belladonna rarely fails to relieve the ordinary nervo-congestive headache : but is of no value in that which depends on gastric derangement. It yields to Nux vomica as a remedy for apoplexy, and for the chronic cerebral congestion of apoplectic subjects : in these cases there is no tendency to perversion of function. It is the all-important remedy (generally in conjunc- tion with Aconite) in the first stages of phrenitis and acute hydrocephalus ; but obviously becomes inapplicable when collapse or effusion has set in. In puerperal convulsions, when a hyperaemic state of the brain is present, it is our best remedy. Alto- gether, Belladonna stands facile princeps among our brain-medicines; and daily affords us unbounded satisfaction. I pass by the action of Belladonna on the motor and sensory ganglia with two remarks. 1st. Chorea has been described as " an insanity of the muscles," and is to the motor centres what delirium is to the cerebrum. Belladonna, thus essentially homo3opathic to it, may find (as it has found) a BELLADONNA. 141 place in its treatment. 2nd. The curative action of Belladonna with regard to visual hallucinations is most frequently called into play when these arise as a part of the delirium of drunkards or fever patients. It should be thought of, however, in any subjective derangement of vision chromatopsia, diplopia, &c. of intra-cranial origin. But next to the cerebrum, the medulla oblongata is the great sphere of the therapeutic operation of Belladonna, since upon irritation of this centre so many important diseases depend. You are probably acquainted with the recent researches (inaugurated by Schroeder Van der Kolk) on the nature of epilepsy, which point to irritation of the medulla oblongata as the starting-point of the paroxysms. Hence, probably, the great value of Belladonna in the treatment of this disease, which both old and new schools attest. It is the favorite remedy alike at the London Homoeopathic Hospital and at the Hospital for the Paralysed and Epileptic. Infantile convulsions also, when active and epilepti- form, probably start from the medulla oblongata, and find in Belladonna their best medicine. If the irritation fall upon the laryngeal nerves, we may have laryngismus or spasmodic cough. Belladonna should do (I believe it has done) good service in preventing the recurrence of laryngismus stridulus in florid and excitable children. In hooping-cough it frequently becomes useful : especially in the second stage, when the laryngismus is severe, the determination of blood to the head very great, and convulsions are supervening. Again, the poison of hydrophobia falls most upon the medulla oblongata 142 BELLADONNA. and its issuing nerves : and if this disease ever has been cured or prevented, the credit is due to Bella- donna. Since irritation of the medulla oblongata may through the vagi cause true asthma, Belladonna may occasionally be serviceable in this disease. There is a case by Mr. Nankivell in the ' Monthly Horn. Review' which well illustrates the form of the disease to which it is suitable. If you have followed me in this sketch of the main sphere of the operation of Belladonna, you will concur with Teste when he lays down that " the subjects to whose diseases it corresponds most exactly are those whose cerebral functions are most liable to become irritated ; or whose brains, and consequently heads, have the greatest development, i. e. children." You will also appreciate Pereira's naive remark, " In the first degree of its operation, Belladonna diminishes sensibility and irritability. This effect (called by some sedative) is scarcely obvious in the healthy organism, but is well seen in morbid states, when these proper ties are preternaturally increased." II. We come now to the action of Belladonna upon the eye, which presents a most complicated problem. The conjunctiva exhibits the tissue- irritation of the drug : it is generally injected, and in two of the cases of poisoning I have collected actual inflammation was set up. Then comes the dilated pupil so characteristic of Belladonna. On what does this phenomenon depend ? I was always greatly interested in the question, and wrote upon it before I knew anything of Homoeopathy. My most matured views on the subject you may BELLADONNA. 143 read in a paper entitled " Observations on the Pupil, as affected by Disease and Drugs," in vol. xxii of the ' Brit. Journ. of Horn/ I still adhere to the opinion there expressed and reasoned out, that the dilated pupil of Belladonna results from excitation by it of the cervical sympathetic. I know that the general tide of opinion is now setting in the direction of supposing the phenomenon to depend upon paralysis of the circular fibres of the iris. If this be so, it would correspond with the action of the poison on the other sphincters : and would be an instance of its depression of the cerebro-spinal nerves rather than of its excitation of the sympa- thetic. The presbyopia of Belladonna poisoning is undoubtedly the result of the dilatation of the pupil. Not so, however, the impairment of vision going on to complete amaurosis which is so often observed. The two phenomena are not always co-existent ; and the one may decline while the other continues in force. I believe the amaurosis to depend upon an exertion of the anaesthetic influence of the drug upon the retina, which obtains also in the ophthalmic branch of the fifth nerve. In Belladonna poisoning there is insensibility to the stimuli which ordinarily give rise to the act of winking. And as reflex winking may be excited through the medium of either the fifth or the optic nerve, it follows that when it is entirely absent both these must be paralysed. It is most interesting to notice that the phantasms and visual hallucinations, which result from the irritation exerted by Belladonna upon the tubercula quadrigemina the intra-cranial centres of vision are present when, by the anesthetic in- 144 BELLADONNA. fluence of the drug upon the retina, all real objects are invisible. These actions of Belladonna, and the special affinity for the eye which they exhibit, render it an important medicine in maladies affecting this organ. In severe cases of catarrhal ophthalmia, and in the inflammatory aggravations of the strumous form, it is very useful. How frequently its power of dilating the pupil may be turned to advantage you know better than I can tell you. Homoeopathy does not exclude pieces of practice such as this : and now that you do it with the hundred-thousandth of a grain of Atropine, you will feel yourself still in the region of infinitesimals. Do not, on the other hand, make a dilated pupil an indication for the Homoeo- pathic use of Belladonna, at least in cerebral affec- tions. Let me cite what I have said upon this point in the article already referred to. " It is generally taken for granted, that the di- lated pupil of Belladonna poisoning is but a part of the general influence of the drug upon the brain. But this is exceedingly improbable. No fact is better ascertained about Belladonna than that it is an irritant to the intra-cranial nervous centres, ex- citing and deranging their functions, and causing them to attract a larger supply of blood than is natural. In a word, it sets up the first stage of inflammation of the brain. Now this condition of the brain, when occurring idiopathically, is always accompanied by'a contracted pupil; and it is not until the stage of exhaustion or effusion sets in that the pupils dilate. If, then, the dilated pupil of Bella- donna were a symptom of the state of the braiu BELLADONNA. 145 induced by it, that state should be precisely the opposite of what it really is. We conclude, there- fore, that the influence of Belladonna upon the pupil is wholly independent of its action upon the brain." I go on to support this view by a case of com- pound poisoning by Opium and Belladonna. In this case " the cerebral influence of Belladonna was entirely neutralized by the superior power of the Opium : while the dilatation of the pupil was as marked as ever, and this in spite of the tendency of Opium to cause its contraction. If, now, the dilated pupil of Belladonna were sympto- matic of the condition of the brain induced by the drug, we should have in this instance a contradiction of the axiomatic law ' causa sublata tollitur effectus/ (e An important practical conclusion follows, viz., that a dilated pupil is no indication for the exhibi- tion of Belladonna in cerebral disorder. Here, as elsewhere, true physiology and pathology are indis- pensable addenda to symptomatic indications as our guide to the choice of the remedy. Were we to follow, upon the rule ' similia similibus/ the invaria- ble symptom of the dilated pupil as an indication for Belladonna, we should be giving it in those very cerebral conditions to which it is not homoeopathic, and upon which it can exercise no curative influence. And, on the other hand, when Dr. Graves recom- mended the administration of Belladonna in the head affections of fever, when the pupils were con- tracted, although he thought himself acting upon the old principle of antipathy, his remedy was really homoeopathic to the disease." 10 146 BELLADONNA. I have only to say farther as regards the eye that Belladonna ought to find a place in the treatment of amaurosis, though I am not aware of any records of its use. III. Dryness of the throat is an almost con- stant symptom of overdoses of Belladonna. It is to this drug what salivation is to Mercury, and conjunctivitis to Arsenic. In two of the cases in my collection it is said to have been hot as well as dry ; but in neither does any visual examination appear to have been made to ascertain the physical condition of the parts. From other sources, however, which I have cited in the same paper we derive farther information on this head. In one case the patient complained of " sore-throat." In another it is said " he felt great soreness in the throat, which looked very red about the tonsils and palate. The soreness extended to the ears." In another " the mucous membrane, from the posterior third of the palate as far down as could be seen, was of a deep crimson colour, and the tonsils were much enlarged/' Lastly, Christison speaks of " redness of the throat" in one instance, and of " aphthous in- flammation" of this part in two others. I think that from these facts it is evident, that the dry mouth and throat of Belladonna do not result from an anaemic condition of these parts, as from sympa- thetic excitation ; but result from the arrest of secretion which accompanies congestion and in- flammation. Belladonna is hence tissue-irritant to this portion of the alimentary mucous mem- brane. Correspondingly, for ordinary acute sore-throat BELLADONNA. 147 Belladonna is as complete a specific as medicine can present. It is specially indicated where there are much heat and pain on swallowing, bright redness of the affected parts, flushed face, and headache. When the sub-mucous infiltration is great, Bella- donna yields in value to Apis ; when the parenchyma of the tonsils is specially affected, Baryta carbonica is a better medicine. But do not be led away to other remedies (as Mercurius) because ulcers form, or diphtheritic patches appear. In both these forms of sore-throat, if you cut away the inflamed basis with your Belladonna, the ulcers or patches will soon follow. It is only when the angina is ulcerative from the commencement, with little red- ness, or when true constitutional diphtheria appears, that Belladonna ceases to be efficacious. IV. Belladonna has a decided affinity for the bladder. Its paralytic influence over the sphincter I have already noted. In smaller doses, it causes frequent, difficult, and scanty micturition of nearly colourless urine. That these phenomena, like those of the throat, depend upon an irritation of the urinary mucous membrane, appears when we inves- tigate the ultimate effects of the drug in this sphere. Christison quotes one case from Wibmer, in which the patient had " violent strangury towards the close ;" and another from M. Jolly, where there was " vio- lent strangury with suppression of urine and bloody micturition." There are two affections of the bladder in which Belladonna is extremely useful. The one is noc- turnal enuresis, as it occurs in delicate and sensi- tive children, without any irritating quality in the 148 BELLADONNA. urine. It has also been found useful where in- voluntary defsecation reveals a similar state of the rectal sphincter. The other is an irritable state of the urinary apparatus, short of actual inflammation. When true inflammation occurs, Belladonna yields to Cantharis, Cannabis, &c. V. Heat, dryness, and redness of the skin are very constant symptoms of Belladonna poisoning. That here again we have a tissue-irritation appears from the more advanced effects of the drug. In one of my cases the symptoms closely resembled those of erysipelas of the face. Far more com- monly, however, a scarlatinoid eruption, very like that of the idiopathic disease, is observed. In one case, the local application of Belladonna, twenty drops of the mother-tincture to four ounces of water, caused intense redness, with fine vesicular eruption, exactly co-extensive with the lint with which it was applied.* The curative power of Belladonna in inflammatory affections of the skin is very marked. In erythema, especially from insolation, it readily effects a cure. In the ordinary non-vesicular erysipelas, its use is one of the most triumphant things in Homoeopathy. Listou has recorded his testimony to its great value : and he could speak comparatively better than most men. A moderate amount of swelling does not contra-indicate it : but if this symptom be exces- sive, Apis becomes preferable. When vesicles form, it is usual to change to Rhus : and I have seen such capital results from this medicine that I cannot but approve the practice. Boils and car- * ' Annals,' vol. iv, p. 83. BELLADONNA. 149 buncles, which bear so close a relation to erysipelas, may generally be helped the former often blighted by Belladonna. Again, Belladonna so obviously covers the symptoms of ordinary scarlatina the rash, the angina, and the delirium that it has become our leading medicine for the disease. That it shortens its duration, I cannot say : that it does not diminish the fever, I can testify, finding that cases never do so well without Aconite. Nor will it touch the renal affection, or (as far as I know) any other of the sequelse of scarlatina : and it is confessedly inadequate to eope with the more ma- lignant forms of the disease. What then, you will ask, does Belladonna do for us in scarlatina? I can. only say, that I suppose it moderates the angina and delirium, and helps the case to a successful issue. It is somewhat a matter of faith, resting on analogy : but the probability is sufficient to make me use it in every instance. A more valuable pro- perty of the drug would be that claimed for it by Hahnemann, that it acts as a prophylactic against the scarlatinal contagion. Much controversy has raged upon this subject, and very different results have been obtained by different experimenters. You will find a good summary of the facts of the case in Dr. Dudgeon's ' Lectures on Homoeopathy.' On the whole, the balance is in favour of its pro- phylactic virtues : and we do well to administer it for this purpose whenever scarlatina breaks out in a household. I have said nothing about the relation of Bella- donna to the uterus and its disorders. It is a good deal used as a uterine remedy : and there are a few 150 BELLADONNA. symptoms in Hahnemann's proving which suggest its action in this region, especially increased and pre- mature menstruation, and a feeling of pressing down- wards, as if all the contents of the abdomen would issue from the genitals. I have myself removed this symptom by a high dilution of Belladonna. But I cannot help thinking that if Belladonna had an affinity for the uterus like that it manifests for the brain, the eye, the throat, the bladder, and the skin, we should have seen some evidence of it in the cases of poisoning I have collected, of whose subjects several were women. However, do not be deterred from using it by my scepticism. You will see that Hempel recommends it to correct foul states of the uterine discharges, in puerperal fever, and in chronic uterine congestion. Mr. Leadam speaks highly of its power to relax rigidity of the os occurring during labour. This is all I have to say about Belladonna. We are fully justified in placing it with Aconite and Arsenic in the very first rank of our remedies. There are only two medicines which I can call truly analogous to Belladonna; and these are Hyoscyamus and Stramonium. If, as is now be- lieved, the three contain a common active principle, their similarity of action is explained. At the same time, their well-recognised diversities afford another instance of the fallacy of supposing that in these "active principles" resides the whole virtue of a plant. With Belladonna, like Arsenic, we must avail ourselves of the whole scale of potencies. In cerebral affections, the higher dilutions (12 to 30) are best when perversion of function, the lower ATROPIA. 151 (3 to 1) when hypersemia predominates. In recurring convulsive affections (except infantile eclampsia), in strumous ophthalmia, in acutely inflamed throats, in irritable bladder, and in erysipelas I use the 1st and 2nd dec. dilutions : in enuresis, and in recent head- ache or neuralgia, the 6th and 12th. As a prophy- lactic, I think Belladonna should be given in doses of from half a drop to two drops of the mother- tincture twice daily. I must tell you, however, that Hahnemann used the dilutions for this purpose : and that Dr. Bayes has recently advised the 12th as most suitable. Before leaving Belladonna, I must say something of its chief alkaloid, Atropia. Our information concerning its therapeutical virtues is contained in an article by Dr. Caspar of Vienna, which you will find translated in vol. vi of the ' North Amer. Journ. of Horn./ p. 457. Dr. Caspar gives therein the results of the treat- ment of above a hundred cases, in which, having given Belladonna without effect, although well indicated, he substituted Atropine : and afterwards, as his knowledge of the drug grew, gave Atropia in the first instance, followed, if ineffectual, by Bella- donna. His main conclusion is, that Atropia occupies the purely neurotic sphere of Belladonna, having no place in its tissue irritations and vascular excitements. He has cured with Atropia idiopathic and post-febrile headaches, hallucinations, epilepsy (in three cases), irritable throat and larynx, hooping- cough in the convulsive stage, and asthma. He 152 ATROPIA. thinks that it has little or no action below the diaphragm. But Dr. Kafka, of Prague, having made a proving of Sulphate of Atropia upon himself, and experienced marked gastric symptoms, was led to give it in chronic affections of the stomach characterised by much pain and vomiting, and with very satisfactory results. You will find his remarks in the ' British Journal/ vol. xv, p. 238. Of late, Atropia has gained much repute in the treatment of epidemic cerebro-spinal meningitis. The 4th dec. trit. has generally been employed. LETTER XIII. BERBERIS, BISMUTHUM, BORAX, BOVISTA, BROMIUM, AND KALI BROMIDUM. I shall begin this letter by a sketch of the action of the Barberry, Berberis vulgaris. We make a tincture from the delicate rootlets and the bark of the larger roots, at least so says Hempel. Berberis was proved in Germany, under the superintendence of Dr. Hesse. For the pathogenesis I must refer you to Jahr's 'Manual/ There are some notices of cures effected by it in an article by Dr. Hering in the 'American Homoeopathic Review' for August, 1865. From these sources it would appear that Berberis has an irritant influence of a not very intense kind upon most of the mucous membranes. It has been used successfully in some sub-acute urinary irrita- tions, in which it is said to be indicated by a burn- ing along the mucous tract, and by pains in the hips (comp. Cannabis sat.) It is reported to have twice effected a cure of fistula ani, complicated with chest symptoms (comp. Calcarea phosphorica). 154 BISMUTHUM. The two medicines named for comparison are the only ones I know which at all resemble Berberis. Those who have used it have done so in the higher dilutions (6 18). The next medicine is one well-known to you, viz. Bismuthum. So Hahnemann called his preparation, supposing it to be an oxide. But I think that if you read his directions for its preparation, you will agree with me that the resulting salt is identical with that which the London Pharmacopoeia styles Nitrate of Bismuth. By Bismuth, therefore, is meant that preparation of the metal which is used in ordinary practice. We prepare it by trituration. The proving of Bismuth is in the ' Materia Medica Pura/ Some additional physiological effects are related in Hempel's article. Pereira's account of Bismuth is, as usual, un- consciously founded upon the law of similars. " In large doses," he says, " it disorders the digestive organs, causing pain, vomiting, and purging." And its chief uses are, according to him, the relieving painful affections of the stomacb, allaying nausea and vomiting, and checking pyrosis and the diarrhoea of phthisis. I have little to add to this,* except to call your attention to the remarkable action of Bismuth upon the heart, especially the endocardium. " Violent beating of the heart " appears iu the * Dr. Chapman has mentioned some cases in which Bismuth has acted well in the 3rd trituration against dyspepsia. (' Brit. Journ. of Horn.,' vol. vii, p. 504.) BORAX. 155 pathogenesis : and in the post-mortem examination of the only case of poisoning on record, the inner surface of both ventricles of the heart was very red. Bismuth deserves a trial in endocarditis. Teste states that he has used it with brilliant success in phlegmasia alba dolens. Bismuth is one of the analogues of Arsenic ; indeed Arsenic is so frequently present in the specimens of Bismuth we obtain from the shops, that some have ascribed its action to the presence of the more powerful poison. It resembles also Argentum, Hydrocyanic acid, and Zinc. Hahnemann recommends the 2nd trituration to be used for medicinal purposes. Another familiar drug is the Biborate of Soda, Borax. It is prepared by trituration. There is a proving of Borax in the ' Chronic Diseases/ of the real value of which I can say nothing. I need not recount to you the external uses of Borax : they are common to both schools. But there is something in its power over aphthse which looks specific, especially considering the essential nature of the aphthous process. So far as Hahne- mann's proving goes, it would appear that Borax can cause as well cure aphthse in the mouth. But the best evidence of its specific power over this complaint is the fact, which you may verify for yourself, that it will cure aphthse nearly if not quite as rapidly when given internally, say in the 1st trituration. 156 BOVISTA. Besides this, Borax has long been credited with a special influence upon the uterus : and is said to have removed sterility, when connected with a chronic acrid leucorrhoea. In its relation to aphthae, Borax compares with Mercurius and the mineral acids : in its influence on the womb, with Conium. Borax is used in the lowest potencies against thrush, as a uterine remedy in the higher. My next medicine is probably known to you by its poisonous effects only. It is the " puff-ball/' Lycoperdon Bovista. It is prepared by trituration. For information concerning Bovista I can only refer you to some remarks by Petroz on the drug in his ' Collected Writings/ and to the article in Teste. Bovista is said to be indicated, and to have proved curative in head affections characterised by a sensa- tion as if the head were enormously increased in size; also in leucorrhoea when the same symptom was complained of. Its poisonous effects resemble asphyxia, which is a fact worth remembering. Dr. Madden tells me that he has more than once cured with Bovista 3rd dec. an itching of the skin coming on after washing. Bovista is classed by Teste with Sulphur, ^thusa, and Asterias. The 12th dilution was used by Petroz and Teste. I have now to speak of the well-known BROMIUM. 157 Bromium. Dilutions may be prepared with alcohol : but as Bromic acid soon forms in such a solution, it is better to keep the Bromine pure, and dilute it with distilled water when required for use. There is a proving of Bromine by Dr. Hering, for which I must refer you to Jahr's ' Manual/ HempeFs article should be consulted. Both the physiological and the therapeutical actions of Bromine show that its influence is nearly if not quite limited to the respiratory organs. It has frequently proved curative in severe cases of membranous croup, as will be seen in the authorities cited below.* The last of these cases is put on record by Dr. Meyhoffer of Nice, who in a very able way discusses the precise place of Bromine in the therapeutics of this disease. He decides that it is in extension of diphtheria to the air-passages that Bromine is indicated, while Iodine or Spongia is better suited to the more local and sporadic " croup." His own case is certainly of the kind first named : and so are others that I have read. But I confess that I have hitherto been utterly disappointed in Bromine, as in all other medicines, for true croupal diphtheria. In the absence of any other more promising remedy, I should probably try it again in the next case I might see : but I should have little hope of a favourable result. Bromine deserves to be used more than it is in bronchial and pulmonary * ' North Amer. Journ. of Horn.,' vol. x, p. 296. ' Philadelphia Journ. of Horn.,' vol. i, p. 529 ; vol. ii, p. 74, 565. ' Brit. Journ of Horn.,' vol. xxiv, p. 625. 158 KALI BROMIDUM. affections. It caused in one prover " difficult and painful inspirations, violent stitches in the lungs, and cough on attempting to draw a long breath." It also appeared to excite the development of a crop of boils. The chief analogue of Bromine is Iodine. The action of the Bromides of course resembles that of Bromine itself: but is sufficiently distinct to warrant separate notice. Bromine does not bear dilution well. I should never give it higher than the 3rd decimal potency. I will discuss the Bromide of potassium in this place, as having a closer affinity to its Bromine than to its Potassium. Kali bromidum is prepared by trituration or aqueous solution. There is a short pathogenesis of it in ' Jahr's Manual/ taken from Noack and Trinks : but the best account of its physiological effects is an article by Dr. E. M. Hale in the thirteenth volume of the 1 North Amer. Journ. of Horn./ p. 205. So far as Bromide of Potassium affects the air- passages, it resembles Bromine, while inferior in activity. But it manifests an altogether peculiar influence of its own upon the nervous centres. In the brain it causes dull giddy headache, diminished sight and hearing, impaired mental power, drowsi- ness, and stupor. Passing down the spinal cord, it develops ansesthesia of the whole surface, and loss of power of the lower extremities. Its de- pressing neurotic influence is especially seen in the KALI BROMIDUM. 159 throat and its neighbourhood on the one hand, and in the generative organs on the other. In the former the insensibility is so perfect that " the finger can be carried to the base of the tongue, touch the amygdalae or posterior nares, and even tickle the uvula without inducing any effort at vomiting or deglutition whatever/' You are aware that this property of the drug has been turned to good pur- pose for facilitating the use of the laryngoscope. Not less powerfully does the Bromide lower the sensibility and activity of the generative organs. I agree with Dr. Hale that this effect coincides with the temporary loss of power brought about in the lower extremities, and that both are due to a de- pressing influence of the drug on the lower part of the spinal cord. Our clinical use of Bromide of potassium has hitherto been very limited. It has been used by some instead of Bromine in croup and laryngeal diphtheria, but not, I think, with advantage. Your application of it to check epileptic fits, where the irritation starts from the generative organs, is a very pretty one, and I should not hesitate to adopt it were I at a nonplus : but it is not Homoeopathy. We shall probably find the drug useful in some cases of conjoined sexual atony and cerebral de- pression. Phosphorus is the only medicine which essentially resembles Kali bromidum. This is a very short letter : but I must begin another, that I may devote it to one of Hahnemann's great gifts to therapeutics, Bryonia. LETTER XIV. BRYONIA. I shall devote, as I said, this whole letter to another of our polychrests, Bryonia. A tincture of the root of the Bryonia alba is the proper Homoeopathic preparation. Bryonia is one of the medicines whose provings are contained in the ' Materia Medica Pura.' It has been re-proved by the Austrian Society : but their experiments have not been thought worthy of translation. You will find them, if you read Ger- man, in the third volume of the ' Oesterreichische Zeitschrift fur Homoeopathic/ The experiments on animals, which are very interesting, have been translated by my friend Dr. Hutchinson in the ' Brit. Journ. of Horn.' for Jan. 1867. There is a study of Bryonia in HirschePs Pharmaco-dynamics, translated by Dr. Hayle : and another by Dr. Carroll Dunham in the ' American Homoeopathic Review/ vol. vi. As Bryonia is quite a new medicine to you, 1 must detail its pathogeuetic effects with some mi- nuteness. The action of Bryonia is that of a pure tissue- BRYOXIA. 161 irritant, with possibly some direct influence on the blood. It has no neurotic or myotic power : and my only reasons for calling it haematic are 1st, that in some animals poisoned by M. Curie the heart was full of decolorised clots, which must have been formed during life, and were pretty certainly the cause of death ; and 2nd, that Bryonia has high repute for some fevers (as typhus and rheumatism) which have their primary seat in the blood. As an irri- tant, it affects the serous membranes and their con- tained viscera, the mucous membranes, and the muscles. I. No poison (not even Aconite or Arsenic) affects the serous membranes so certainly and power- fully as Bryonia. If you will read the autopsies of the animals poisoned at Vienna, this fact will abundantly appear. In the first the pleura were injected and full of serum, and the peritoneum and arachnoid injected ; in the second, third and fifth the arachnoid only was reddened ; but in the sixth the pleura were as in the first, and the peri- cardial vessels were injected. Correspondingly, the provers have the characteristic pleuritic pains with fever : and although the symptoms of the head, heart, and abdomen are undecisive, they at least do not forbid the supposition of an affection of their respective serous membranes. Moreover, those close allies of the serous sacs the synovial membranes which are more easily affected by drug action, give plain indication of suffering from Bryony. The joints swell and become tender, es- pecially those of the fingers. Since all the parenchymatous organs influenced 11 162 BRYONIA. by Bryonia are enclosed in serous membrane, I have often tried to account for their symptoms by the primary action of the drug on the investing tissue. I cannot, however, ask you to accept this doctrine at present. I must describe the effects of the viscera as they exist, and leave their relation to the disorder of their envelopes for further investi- gation. 1. It is curious, nevertheless, that as of all the serous membranes the pleura are those most readily influenced by Bryonia, so of all the viscera the lungs are those which suffer most from its action. The short, quick, and oppressed breathing, with heat and pain in the chest, experienced by the provers finds its interpretation in the phenomena presented by the poisoned animals. In these, with similar symp- toms during life, the lungs were always of deeper colour and diminished crepitation, while in two the lower lobes were hepatized. 2. Next to the lungs, the brain is the organ which shows most signs of being affected by Bryonia. There is no perversion of the sensorial functions, as with Belladonna : and the determination of blood does not pass beyond the stage of congestion. But up to this point it is very well marked ; and the provers get a hot and red face, with headache (generally frontal), sense of weight and fulness, and vertigo. Epistaxis also is frequent. 3. Of the two chief viscera enfolded by the peri- toneum, the liver is much more affected by Bryonia than the kidneys. It causes tensive and burning pain in the hepatic region, which is sometimes also sensitive to pressure. In one prover, the skin over BRYONIA. 163 the whole body became yellowish. In the animals the liver was always found gorged, and sometimes friable. In two animals the kidneys also were found congested : but I think the scanty, hot, and high-coloured urine so often passed by the Austrian provers a symptom of general fever rather than of renal implication. II. I come now to the action of Bryonia on the mucous membranes. It is interesting to observe (in connection with its relation to the rheumatic poison) how much less powerfully it influences these than it does the serous and synovial membranes. It is an acrid, and hence large doses cannot but irritate the alimentary membrane as they go down. Ac- cordingly, we have in the provers sore-throat, vomit- ing, and diarrhoea with colic and flatulence ; and in the animals an aphthous mouth and ulcers in the stomach and intestines. But the essential phe- nomena of Bryony in the gastro-intestinal sphere do not seem to depend upon irritation of the mu- cous membrane. They are water-brash (with this there is the characteristic contractive pain at the lower end of the oesophagus), bitter risings and vomitings, pressure on the stomach, feeling of load as if a stone were there, and constipation. These await their physiological expression : but they have received, as we shall see, their full therapeutic application. The respiratory mucous membrane is unques- tionably affected by Bryonia, though I doubt whe- ther the irritation extends lower than the first division of the bronchi. The symptoms of the provers (pain, cough, &c.), whenever localised, are 164 BRYONIA. referred to the trachea and its bifurcation ; and these parts only were found injected in the poisoned animals. The pneumonia set up by Bryony -was never associated with bronchitis, in this strikingly different from that of Tartar emetic and Phosphorus. If Bryonia causes any nasal catarrh, it is dry : and the cough also has little expectoration, and is con- tinuous, irritating, and violent, often causing retching and pains in the walls of the chest (comp. Senega). Of late, our knowledge of the action of Bryony on the air- tubes has received a novel extension from an experiment of M. Curie's.* By administering to a rabbit gradually increasing doses of Bryonia during eight months till he came to 250 drops of the mother-tincture daily, he developed in the ani- mal a firm pseudo-membranous tube, extending from the larynx to the third ramifications of the bronchise. While this fact is of great interest, I do not think it proves that the action of Bryonia on the air-passages is either profound or extensive. Pseudo-membranous formation on their surface is a pathological fact per se : and has no necessary rela- tion to the amount of affection of the subjacent mucous membrane. Upon the urinary mucous membrane I should have said that Bryony had little or no action, but that several of the provers experienced considerable vesical tenesmus, with a feeling after micturition as though all the urine had not been expelled. III. In one of the animals poisoned with Bryony at Vienna, where a very minute autopsy was made by a practised pathologist, it is noted that the sub- * ' Brit. Joum. of Horn.,' vol. xix, p. 455. BRYONIA. 165 stance of the heart and the muscles of the neck were intensely red. Putting this together with the soreness and pain on motion experienced by the provers in so many parts of the body, I venture to set down our drug as a specific irritant of muscular fibre. As we have no other medicine with such an action, we must not lose even the hint of it supplied by these facts. Under these headings I have given you nearly all the pathogenetic effects of Bryonia. There are certain residuary phenomena, however, which must be noted : though at present they defy classifi- cation. 1st. In the female provers, the menstruation was premature and excessive. 2nd. One of the Vienna provers had inflamma- tion of the external ear, which he at any rate ascribes to the medicine he was taking. 3rd. One of the toothache symptoms in Hahne- mann's pathogenesis deserves citing, as it once led to a very pretty cure. " Darting toothache in the evening when in bed, at times in the upper, at times in the lower molar teeth ; when the pain was in a tooth of the upper row, and the tooth was touched with the tip of the finger, the pain suddenly ceased, and affected the opposite tooth of the lower row" Let us now inquire what have been the clinical results of these very extensive provings. To Bryonia, as to all the great Hahnemannian medicines, a special constitution and disposition has been assigned as that to which it is most suitable. It is said to act best in persons of firm and fleshy 166 BRYONIA. fibre, of dark hair and complexion, of "bilious" tendency and choleric temperament, and where much irritability is present. You must not lay too much stress on such indications ; nevertheless, they some- times guide us to the true remedy. The hypothetical haematic action of Bryonia will serve as my text for discoursing on its relation to the two great types of fever, the rheumatic and the typhous. I. After Aconite, Bryonia is incomparably the best remedy for acute rheumatism. In its whole pathogenetic action it reminds one of the rheumatic poison. Its feeble affinity for skin and mucous membrane, and its powerful influence over serous and synovial membrane and muscular fibre, with its fever and sour sweats, point unmistakably to this disease. Accordingly, most of us employ it through- out rheumatic fever, generally in alternation with Aconite, unless the symptoms call urgently for some other medicine. But we need a series of compara- tive experiments which shall demonstrate what part the Aconite and what the Bryonia takes in con- trolling the disease. Bryonia appears equally suit- able for articular and for muscular rheumatism : it is least fitted for affection of the fibrous tissues proper. It continues, of course, to be a homoeo- pathic remedy when any of the serous membranes are inflamed in the course of rheumatic fever : though it may yield in importance to some other medicines. It is a capital remedy for rheumatism attacking particular muscles, as those of the loins or neck, or the diaphragm. In chronic rheumatism it is specially indicated when the pain is increased by BRYONIA. 167 motion, i. e. when the affection is sub-inflammatory in character. II. Hahnemann used Bryonia with great success in many cases of the typhus which ravaged Germany while it was the seat of war in 1813. The medi- cine has hence acquired in the treatment of the essential fevers a reputation greater, I think, than it deserves. Nevertheless there can be no doubt that it has its place here. The head symptoms and the bilious disturbance of Bryonia frequently find their antitypes in cases of fever : and Hahnemann's pathogenesis adds the dry mouth and tongue and the nocturnal delirium. One of his symptoms, indeed, if well authenticated, is a perfect picture of low fever : " she sleeps the whole day, with dry great heat, without eating or drinking, with twitch- ings in the face ; she has six involuntary passages, the stools being brown and smelling badly." Nosologically, Bryonia is especially suitable for relapsing fever (for which Dr. Kidd, who saw so much of it in Ireland in 1847, considers it the best medicine*) ; for particular epidemics of typhus, where the symptoms point to it, and the adynamia is not too profound ; and for the bilious remittent of the western hemisphere. It used to be employed in the first stage of typhoid fever : but as it has none of the abortive influence of Baptisia (q. v.), I for one have abandoned it in favour of the latter medicine. You will find the indications for Bryony in fever well given by Dr. Wolf in vol. viii of the ' Brit. Journ. of Horn./ p. 439. III. I will now speak of the power of Bryonia in * ' Annals,' vol. iv, p. 131. 168 BRYONIA. affections of the serous membranes, and of the viscera which they enclose. Dr. Trinks, than whom we have no hetter prac- tical physician among us, thus characterises the place of Bryonia in serous inflammations. " From no small number of cases which I have carefully marked down, the fact comes out that Bryonia is the sovereign remedy in all inflammations of the serous membrane which have advanced to the stage of serous effusion. This action of Bryonia extends over all the serous membranes which cover the thorax and abdomen, and the organs situated in these cavities, and which are so often attacked by inflammation. " As long as the local inflammatory condition had not reached this stage, the fever being still of a sharp, well-pronounced synochal character, the Bryonia was of no use, but at this time Aconite and Belladonna were the specific medicines which ar- rested the inflammation before it had been developed to the stage just specified. But when on the other hand the inflammation had advanced to the stage of serous exudation, then in all cases Bryonia showed itself a medicine of quick and certain operation, which not only removed the still-existing local in- flammation, but also with the least possible delay effected the absorption of the serous effusion which had already taken place. " I find in my journal many cases of inflamma- tion of the pleura, as they occur very frequently in Dresden in the beginning and end of winter, during the prevalence of strong east and north-east winds, in persons disposed to tubercular phthisis ; BRYONIA. 169 then two cases of inflammation of the pericardium with serous exudation ; and two very noteworthy cases of inflammation of the peritoneum, with very copious effusion of serum into the abdominal cavity." These doctrines of Dr. Trinks' about the place of Bryonia in inflammations of serous membranes have been confirmed by all subsequent observers. Aconite should be given at first, and continued should the exudation be plastic : but if serous effusion occur, its place must be taken by Bryonia. It is especially in pleurisy that this treatment has become classical. You will find some good cases illustrative of it by the late Dr. Beilby of Glasgow in the ' British Journal/ vol. x, p. 283. For peri- carditis you should read our lamented Russell's ' Clinical Lectures/ I myself greatly prefer in this disease Aconite or Colchicum. In peritonitis from exposure to cold I have seen Bryonia act exceedingly well after Aconite : there are two capital cases in Trinks' paper. It is recommended also for the puerperal form of this disease. Arachnitis is the only form of serous inflammation in which Bryonia has not proved curative : but since this malady is generally tubercular, the failure of any given medi- cine to cure it reflects no discredit on the remedy. In non-tubercular cases it would probably act well. Of the viscera enveloped by the serous mem- branes I shall only speak here of the brain, as the lungs and liver will come in under the head of the respiratory and digestive organs respectively. Bry- onia is of supreme value in cases of simple non- inflammatory congestion of this organ. Cases are 170 BRYONIA. on record in which such a condition arising from suppressed menstruation, from exposure to intense cold, and from sea-sickness with long-lasting consti- pation was promptly dissipated by the medicine. It is also frequently useful in congestive headaches, which are seated in the forehead, relieved by pressure, and much increased by stooping which causes a sensation as if the brain would fall out. If as it often is giddiness is present, the patient feels as though he would pitch forwards. Another kind of headache for which Bryonia is useful is a form of hemicrania : the pain is generally on the right side, and is accompanied by retching and bilious vomiting. Before leaving the serous membranes, I must refer to their synovial analogues ; only to say, how- ever, that Bryonia has proved as useful in idio- pathic synovitis when caused by cold or injury as when the affection is the local manifestation of rheumatism. IV. I have now to speak of the power of Bry- onia over affections of the digestive organs. The form of dyspepsia for which it is suitable is again most excellently described by Dr. Trinks. " The pressure on the stomach, a much more frequent affection in the female than in the male, generally caused by irregularity in diet, eating indigestible food, bread not enough baked, coffee, brandy, or bad beer, finds for the most part its radical cure in Bryonia. It comes on when the stomach is empty as well as when it is full, but more frequently immediately after it has been emptied of its con- tents : the patients complain of a pressure at the pit BRYONIA. 171 of the stomach, as if they felt a heavy annoying stone there ; it lasts from two to four hours, some- times longer, and goes off with much eructation. In worse cases, the so-called water-brash is an accompaniment, or there is a great deal of acidity generated, which shows itself by sour risings, heart- burn, and vomiting of a very sour and acrid mucus. In the severer degrees of this pain of stomach, the epigastrium becomes extremely sensitive to external touch and pressure, and the patient cannot bear the clothes to be firmly put on/' Teste notes also of the Bryony dyspepsia, that beer disagrees or gives no satisfaction to thirst, and that water is absolutely required as a dissolvent. As with Nux vomica and Lycopodium, gastric derangement requiring Bryony is generally accompanied by constipation. But whether for this malady occurring independently it is ever better than the other more important medi- cines we have, I cannot say. Dr. C. Dunham considers that Bryonia is specially adapted to torpor of the bowels, as distinguished from the ineffectual urging of Nux vomica. In affections of the liver Bryonia frequently comes into play, often in association with Mercurius. It hardly reaches to true hepatitis ; but in congestive states of the organ, with pain in the right shoulder, giddiness, and slight yellowness of the skin and eyes, it is very useful. V. We come now to the action of Bryonia in affections of the respiratory organs, which from its pathogenesis should be rather extensive. It is the best medicine after Aconite for what is known as a " cold on the chest," i. e. where a nasal 172 BRYON1A. catarrh has run down the air-passages, as far as the first or even second divisions of the bronchi. Heat, soreness, and pain behind the sternum, and an irritative shaking cough with scanty expec- toration make up the Bryony picture. Or, in Dr. Trinks' words, there is " dry, more or less severe cough, often rising to the point of retching, which is excited and maintained by a constant ' tickle' in the lower part of the trachea or under the breast- bone, which is more severe by day than by night, and forces up only a very small quantity of clear, sometimes blood-streaked, expectoration ; gives rise to pain of being shaken in the abdomen, or in the chest and head, and makes the patients often com- plain of an extremely annoying pressure under the sternum, which confines the breathing. These states occur frequently in elderly persons with stuf- fing of the nose, running from the eyes, and derangement of the stomach, at the beginning and end of winter. For this condition Bryonia effects all that can be expected from a medicine, and that very speedily." Another of our veterans, Dr. Schron, has some valuable remarks on the action of Bryony in the respiratory sphere in the ' Brit. Jour, of Horn./ vol. xvi, p. 439. Among other things, he says, " In chronic cough, which becomes very violent at the least excitation of the lungs, as speaking, which is worst morning and evening, and which is accompanied by very little expectoration, as we observe in individuals whose lungs have suf- fered from previous inflammation and frequent attacks of haemoptysis, I have seen Bryonia admin- istered with the best effects. I had such a case in BRYONIA. 173 which the patient coughed for whole nights together. Bryonia 6, given for some length of time, not only produced perfect night-rest, but favoured the pro- cess of nourishment in such a manner, that the patient, who was formerly quite emaciated, picked up flesh, and her appetite improved. '' But besides conditions such as these Bryonia has obtained reputation in the treatment of the three great affections of the respiratory organs, croup, bronchitis, and pneumonia. 1. For croup Bryonia had been recommended by M. Teste (in alternation with Ipecacuanha) long before M. Curie ascertained its powers of develop- ing false membranes. He speaks very confidently of the certainty of this treatment : and in the ' British Journal/ vol. xix, you will find some good cases showing its efficacy. M. Curie himself relies upon Bryonia in the treatment of croup and laryngo-tracheal diphtheria. While I see no reason to oust Iodine, Bromine, and Kali bichromicum from their place in croup in favour of Bryony, yet I think the latter medicine worthy of full trial in the hitherto incurable diphtheria of the air-passages. 2. In most of our text-books and domestic trea- tises, Bryonia occupies the first place among the remedies for acute bronchitis. I myself am quite unable to see its homceopathicity to this disease, when the smaller bronchiae are involved ; and I have never been able to trace any good effects from it in practice. I said so much in a paper which I read on bronchitis before the Brit. Horn. Society ; and found that my colleagues generally had met with the same disappointment in the use of the drug. 174 BRYONIA. Bryonia, therefore, must no longer stand at the head of the medicines curative of bronchitis. 3. It is otherwise with pneumonia. From what has been said, indeed, Bryony can obviously do no good in the broncho-pneumonia of children and aged persons, where the inflammation begins in the bronchial tubes. But in pleuro-pneumonia Bryonia is specific ; and in pneumonia simplex it yields only to Phosphorus. To convince yourself of its action here you have only to read Tessier's cases treated in the Hopital S. Marguerite; in which Bryonia was the chief remedy employed.* It has also been found curative of the epidemic pleuro-pueumonia of horned cattle. Lastly, in the curative as well as the pathoge- netic effects of Bryonia, after the fullest analysis has been made, there are certain residuary pheno- mena to be noted. Of these the most remarkable is the power which it exerts over the mammary glands. Whenever, from the first coming in of the milk, from catching cold while nursing, or from abrupt weaning, the breast becomes swollen, tender, knotty, and painful, Bryonia will almost certainly resolve the inflammation and prevent the formation of abscess. From its extensive range, Bryonia cannot but have many analogues. In its relation to rheumatism, it compares with Aconite, Rhus, and Pulsatilla : in fever it acts like Baptisia and Eupatorium. It affects the serous membranes like Aconite, Arsenic, and Mercurius corrosivus ; the synovial membranes like Pulsatilla; the alimentary canal like Nux and * Tessier ' On Pneumonia,' translated by Hempel. (Turner.) BRYONIA. 175 Lycopodium ; the liver like Mercurius and Cheli- donium ; the air- passages like Nux and Senega ; the lungs like Phosphorus, Chelidonium, and Tartar emetic. The dose of Bryonia, like that of all the poly- chrests, varies widely. As a rule it may be said that the lowest potencies act best in rheumatism and dyspepsia, and medium and higher in pneu- monia. But even to this rule there are exceptions : and in its other applications it is equally in favour with those who use the high as with those who use the low dilutions. That is, as I believe, its action is qualitative rather than quantitative, LETTER XV. CACTUS GRANDIFLORA, CALCAREA ACETICA, CARBONICA, MURIATICA AND PHOSPHORICA, CALENDULA, CAM- PHORA. THERE are, I doubt not, many excellent Homoeo- pathists in Italy ; but hitherto they have contributed little to our literature or our Materia Medica. Dr. Rubini, of Naples, has come forward to redeem the credit of his countrymen in this matter, and has given us a new and valuable medicine in the Cactus grandiflorus. A tincture is prepared by maceration from the youog and tender branches and the flowers. Our chief information concerning Cactus is at present derived from Dr. Rubini's proving, which is translated by Dr. Dudgeon in the ' Brit. Journ. of Homoeopathy/ vol. xxii. Dr. Hale, in the article on the drug in the second edition of his ' New Reme- dies/ has collected all the clinical experience with it which has been published since the appearance of the proving. From the proving it would appear that Cactus has a most powerful influence upon the heart and arteries, closely resembling that of Aconite. General rigor, CACTUS GRANDIFLORUS. 177 followed by much heat and sweat, eveti recurring daily at the same hour, and symptoms (pain and haemorrhage) of acute congestion in the head and chest attest its action on the arterial system : while the heart gives evidence in pain, palpitation, oppressed breathing, and constriction about the chest of being unusually affected. The pulsation in the scrobiculus cordis so characteristic of cardiac disorder is markedly produced by Cactus. It causes also acid risings from the stomach, with sense of weight there ; severe twisting colic, with heat (external and internal) of the abdomen; bilious diarrhoaa, with pain before the stools; inflammatory strangury, followed by copious urine loaded with lithates ; and painful menstruation. There is great prostration ; and the mental condition is one of profound melancholy. From such a pathogenesis as this brilliant results might be anticipated. Dr. Rubini who has been observing the effects of the Cactus since 1848 as- signs to it a wide range of curative power. " The characteristic feature of the Cactus consists in this, that while it develops its action specially in the heart and its blood-vessels, dissipating their conges- tions, and removing their irritations, it does not weaken the nervous system like Aconite." So he writes in the preface to his proving. I must differ from him about Aconite weakening the nervous system. It need never do so, if the dose be uot too large. But if Cactus acts in this manner, it may be a formidable rival to Aconite, as it would obviously be used in the same class of cases. It is said to have cured with striking rapidity acute otitis, acute and even chronic bronchitis, pleurisy, pneu- 178 CACTUS GRANDIFLORUS. monia, haemoptysis, hsematemesis, gastro-enteritis, hepatitis, haematuria, and a quotidian ague. These experiences have yet to be confirmed. For my own part, when I meet with these acute fevers, conges- tions, and haemorrhages, I seem quite content with my tried and valued Aconite, and am loth to experi- ment with any other medicine. It is otherwise in affections of the heart, where Cactus appears to exert a power beyond that of Aconite, and to fill a place hitherto vacant. It seems beneficial in all over-actions of this organ, from nervous palpitations to acute carditis. In the distress arising from hypertrophy ; in the severe sufferings incident to valvular disease (perhaps also in angina pectoris) ; and in chronic palpitation, it generally gives rapid and lasting relief.* In the cardiac complication of acute rheumatism it suits myo-carditis rather than peri- or endo-carditis. It would probably be bene- ficial (at least to relieve pain) in internal aneurisms. English experience, as far as it has gone, has confirmed Dr. Rubini's statements as to the value of Cactus in heart disease. The following admirably narrated case from the * Monthly Homoeopathic Review 'f illustrates its sphere and capability of ac- tion. It is contributed by Dr. O'Brien, of South Shields. " John E , set. 30, had rheumatic fever in the latter part of the year 1858 ; suffered from that time from the distress consequent upon disease of the heart up to the time he first called on me, * The feeling as if the heart were grasped and coinpressed as with an iron hand (i. e. spasm) is very characteristic of Cactus in these cases. t May, 1866. CACTUS GRANDIFLORUS. 179 which was on the 21st April, 1865. I remarked the expression of his face was anxious, the colour pale and ashy ; he complained of great difficulty of breathing ; fixed pain in the region of the heart ; violent palpitation, aggravated by the least exercise ; unrefreshing sleep disturbed by sudden startings ; lassitude and languor ; oedema of the feet (most marked in the evening) and back of the hands ; and there was an indolent ulcer situated on the large toe of the right foot, which had resisted, under allopathic care, a stimulating course of treatment for eighteen months. Pulse 75, weak and intermitting every ten pulsations ; tongue clean ; bowels regular. On auscultation, I discovered a distinct endocardial bruit, clearly audible along the line of the great vessels; increased prsecordial dulness; excessive impulse of heart's action and evident enlarge- ment of right ventricle. On the 21st of April, 1865, I prescribed Cac. grand., 2nd dec. dil., gutt. ij, ter in die ; the toe to be dressed with water dressing. "27th. Expresses himself better ; sleep less disturbed ; breathing less oppressed; heart's action more rhythmical; the bruit less distinct along the great vessels; pulse intermitting every fifteen pulsations ; a most marked improvement in the oedema of feet and hands ; the ulcer much improved ; no very distinct improvement in the colour of his face ; ulcer of the toe nearly healed. Continue Cac. grand, and water dressing to toe. " May 2nd. Cardiac murmur less distinct ; breathing more easily performed ; oedema absent in the early part of the day, and only troublesome in the evening in the feet ; the anxious ashy expres- sion of countenance is most decidedly better ; pulse has ceased to intermit ; ulcer on toe healed. Continue Cac. grand. " 8th. Expresses himself free from any pain, and states that he can go about with activity, without inducing any difficulty of breathing ; oedema absent ; sleep refreshing and undisturbed ; heart's action more regular; prsecordial dulness diminished and bruit scarcely audible ; colour of the urine much improved; com- plains only of a sense of languor, most distressing in the afternoon. Cao. grand., 3rd dec. dil., nocte maneque. " Feb. 25th, 1866. After a careful examination of his chest to-day, I cannot detect the slightest valvular defect ; the cardiac dulness, which was so marked when first under treatment, is barely dis- cernible, and the muscular activity of the heart seems to be per- fectly restored, performing its functions with regularity and ease. 180 CALCAREA ACETICA. He has never altogether given up the use of the drug, taking it twice a week for the last four months." Dr. Lippe states that he has frequently cured with Cactus the pressive headache in the vertex so often met with as a result of menorrhagia. I have myself cured with it the similar headache of meno- pausia. As I have said, the great analogue of Cactus is Aconite. Its influence on the heart resembles that of Naja. Dr. Rubini recommends the mother-tincture in acute disorders and in organic diseases of the heart. In nervous affections of the heart he states that the higher dilutions act well. Of the salts of Lime we use in our practice four, the Acetate, the Carbonate, the Phosphate, and the Hydrochlorate. Calcarea acetica is prepared by solution, first in water, and then in alcohol. Certain of the symptoms in the proving of Calcarea carbonica are said to have been produced by the Acetate. They do not seem to differ in kind from those of the Carbonate among which they appear. Calcarea acetica is sometimes used with ad- vantage in the acute bowel affections of children to O whose general diathesis Lime is suited (see Calcarea carbonica). Beyond this, I know not that it has any uses. Its analogues are, of course, those of the Car- bonate, q. v. CALCAREA CARBONICA. 181 It has generally been given in about the 2nd dilution. Calcarea carbonica, on the other hand, is one of our polychrests, and is possessed of many and great virtues. The form in which we use the salt is not chalk or marble, but the soft white substance which is found between the external and internal hard layers of the oyster-shell. This is triturated in the usual way. The proving of Calcarea (so called par excellence] is in the ' Chronic Diseases.' Noack and Trinks' prefatory remarks there cited ; a paper by Dr. Croserio, translated in the ' Brit. Journ. of Horn./ vol. v; and another by Mr. Nankivell, with the discussion following, in the ' Annals of the Brit. Horn. Society/ vol. ii will give you further infor- mation concerning the action of the drug. The physiological action of Calcarea, like that of most of the medicines whose provings appear only in the ' Chronic Diseases,' is not well under- stood. Happily, our clinical experience with it is so extensive, that we have little difficulty in denning its sphere of action. It is in the large class of diseases due to disorder of the secondary assimilation that Calcarea finds its curative place. I cannot see that it influences the primary gastric digestion, or the results of its derangement as gout and the lithic diathesis. Nor is it of any value where a true animal poison exists in the blood, as in syphilis and the exanthe- mata. But when the assimilation of the digested food to blood and tissue does not proceed as it 182 CALCAREA CARBONICA. should do, there are few agents more powerful than Calcarea for restoring healthy function. The three great forms of assimilative derangement are scrofula, tuberculosis, and rachitis : and in all of these Calcarea is a principal remedy. In the various forms in which rachitis shows itself difficult dentition, imperfect ossification, delay of the power of walking, &c., this medicine is invaluable. It is only when the bones are very much affected that Silicea becomes preferable. No less useful is it when tendency to glandular swellings makes evident the presence of the scrofulous diathesis. It is the constitutional tendency that it controls rather than the local manifestations ; so that when these are severe as in the glands, eyes, and ears other remedies are needed. Nevertheless ulcers, chronic diarrho3a, and incipient mesenteric disease occurring in such subjects have been cured by the sole use of Calcarea. I cannot speak with the same certainty of the power of our medicine over tuberculosis. Nevertheless, the high esteem in which it is held by some of our best practitioners in the treatment of pulmonary phthisis would indicate an influence over this diathesis also. There are many unclassified affections of nutrition, especially in children, where you will see from the remarks I have made that Calcarea is likely to prove useful. Its powers even extend to the new products which result from disorders in growth ; and it has caused the dis- appearance of warts, condylomata, polypi, and even (so it is said) of benignant tumours and of lupus. This is the great sphere of the action of Calcarea. It has other uses, which seem independent of its CALCAREA CARBONICA. 183 influence over assimilation. Thus, it seems capable of curing some chronic headaches depending upon brain-fag : the pain is dull, worst in the morning ; the head is often cold. It has removed a long- standing supra-orbital neuralgia. It appears to in- fluence the female genital organs in a special manner. Hahnemann considers its action here quite characteristic. " Calcarea," he says, " is in- dispensable and curative when the catamenia appear a few days before the period, especially when the flow of blood is considerable. But if the catameuia appear at the regular period or a little later, Calcarea almost never is useful, even if the cata- menia should be rather profuse." It may be that other uses of Calcarea may come from the hints afforded by the ancient applications of lime-water. But I should prefer in such cases using the lime- water itself. Finally, it may be laid down that Calcarea is best adapted to the disorders of women and child- ren, and to persons of leuco-phlegmatic tempera- ment, with tendency to obesity. The analogues of Calcarea are Baryta, lodium, Phosphorus and Silicea. The higher dilutions, from 12 to 30, appear to be most in favour, and are those which I myself always use. Calcarea seems seldom or never employed by the exclusive adherents of low dilu- tions. 184 CALENDULA. Calcarea muriatica, and Calcarea phosphorica, have never been proved. The latter is occasionally \ised as a substitute for the Carbonate. Dr. Hering, on the strength of some unpublished experiments, recommends it for those cases in which fistula ani alternates with chest symptoms. The Calcarea muriatica I find extremely useful in the moist porrigo capitis of infants and children. I give it in the 1st dilution (aqueous). Calendula, the common marigold, owes its place in the Homoeo- pathic Materia Medica to its power as a vulnerary. It has been proved by Dr. Franz, but the symptoms produced are few and insignificant, and it is rarely if ever given internally. But one of our German practitioners, Dr. Thorer, becoming acquainted with the vulnerary virtues ascribed to the marigold by the common people, endeavoured to ascertain by experiment its exact place in the treatment of in- juries. You will find his paper translated in the ' Brit. Journ. of Horn./ vol. v. His cases show that Calendula has a most beneficial influence over wounds, promoting favourable cicatrization with the least possible amount of suppuration. From that time to this, Calendula has always been employed by Homoeopathic physicians to promote the healing process in wounds, ulcers, &c. You will find com- ments on its virtues in various papers by Dr. Yeld- ham in the ' Brit. Journ. of Horn/ and the 'Annals CAMPHORA. 185 of the British Homoeopathic Society/ Of late, it has been used on a large scale by our American colleagues in the treatment of the injuries occurring in the course of their civil war : and it has obtained their warmest commendations. Of course there is nothing Homoeopathic in Calendula ; i. e. it is no instance so far as we know of the working of the law of similars. Never- theless it is Homoeopaths only at least in England and America who give to their patients the benefit of this precious vulnerary. You will find it in- valuable in surgical practice. I shall now speak of Camphora, of Avhich we make two tinctures with alcohol, the one saturated, the other in the proportion of one to six, eight, or ten. There is a proving of Camphor in the ' Materia Medica Pura/ You will do well to supplement its information, however, with the additional material supplied by Hempel and Pereira in their respective articles on the drug. There are recent articles on Camphor worth reading in the ( Monthly Homoeo- pathic Review' and the ' United States Med. and Surg. Journal/' I shall have little or no difficulty in expounding to you the curative virtues of Camphor. But to connect these with its physiological action is not easy; and for this reason, that (in Pereira's words) " there are few remedies whose action on the animal economy is so variable as that of Camphor." 186 CAMPHORA. Hahnemaun notices the same fact, and endeavours to explain it. "The action/' he says "of this substance on the healthy body is extremely proble- matic and difficult to define, for this reason, that the primary action of Camphor alternates too suddenly and is too easily confounded with the re- action of the vital principle." That is, he agrees with those who consider chill and depression to be the first effects of Camphor, and refer the symptoms of stimulation so often observed to a secondary re- action. I am myself disposed to assent to the view, confirmed as it is by many other names of weight. At the same time, I could not complain if an oppo- site interpretation were assigned to phenomena of such perplexing variability. However this may be, there can be no doubt that Camphor exerts upon the functions of circu- lation and calorification, probably through the vas- cular nerves, a most potent and rapid, although evanescent influence. From hence we get its main use in practice, its power of arresting such dis- eases as influenza and cholera in the stage of in- vasion. Every Homoeopathic patient knows how Camphor, taken in repeated doses in the chill of a commencing " cold/' will check the progress of the disorder then and there. It is inferior to Aconite, however, when the true febrile rigor has set in. Of still greater interest and value is the power of Camphor over Asiatic Cholera. When this epidemic first appeared in Europe, Homoeopathists sought diligently for its simillimum, that they might be ready to encounter it. Several medicines were suggested : but at last Hahnemann himself spoke CAMPHORA. 187 out. The one great remedy, he said, was Camphor. Every one must be provided with it, and take it as soon as the first symptoms appear, so that no time may be lost while waiting for a physician. He also suggested Veratrum or Cuprum in later stages and peculiar forms of the disease. In the epidemic of 1849 English physicians had an opportunity of testing this recommendation ; and Dr. Drysdale in Liverpool and Dr. Russell in Edinburgh vie in their praise of Camphor. The latter says " It is our firm belief that Camphor is an almost infallible remedy for Cholera, if given from the very outset." In 1854 the same testimony was given to its value ; and Dr. Rubini, of Naples, states that he treated, together with his colleagues, 592 cases with Camphor alone without a single death.* Much exception has been taken to this statement, as exaggerated : but I think without just cause. Dr. Rubini does not mean to say that all his cases were in collapse. On the contrary, of a set of 200 treated in one institution, it is expressly mentioned that collapse occurred in fifteen only. What our colleague means us to understand is, that in an epidemic of cholera in which 377 cases came under his own treatment, some of which must have been severe, he gave no- thing but Camphor in a saturated tincture, and lost no case. I see nothing incredible in this statement. His success must increase our confidence in the antidotal power of Camphor against cholera ; though whether Dr. Rubini is right in urging us to per- severe with it in every stage of the disease and to * A full account of Dr. Rubini's observations is given in the ' Monthly Homoeopathic Review, 5 June, 1866. 188 CAMPHORA. the exclusion of every other medicine, must be left to further experience. At present, the weight of evidence is against him. Besides this general influence of Camphor, it has a pretty strong local action on the head and the genito-urinary organs. It causes acute cerebral congestion, with delirium, somewhat like the effects of alcohol : and will be found curative when such symptoms occur from the retrocession of an acute exanthem, as measles. It also causes strangury ; which is all the more interesting, as it does not pass off by the urine* In the presence of this fact, Pereira is much astonished at a power of diminish- ing irritation of the urinary organs being assigned to Camphor. But that it has this power, especially when the strangury is the effect of Cantharides, is undoubted. I was called once to a case of acute strangury, where the pain was so intense as to cause collapse. I gave Camphor every quarter of an hour ; and in less than an hour the spasm was relieved, and the urine passed freely and without pain. The attack proved to be the commencement of peritonitis. As with Cantharis, the urinary irri- tation sometimes extends to the genitals, causing priapism, &c. But the ordinary and permanent effect upon these organs is of a depressing character. " Camphora per nares castrat odore mares" is quoted in all Materia Medicas ; and Trousseau and Pidoux have verified the fact by experiment. It ought to prove useful in some cases of sexual weakness com- bined with irritability of the bladder. Besides these uses in disease, Camphor is reputed by Hahnemann an antidote to most vegetable and CAMPHORA. 189 some animal and mineral poisons. Against the majority of these it probably has no true anti- dotal power, and it would hardly neutralise their effects in poisonous quantities. But for the more delicate disturbances produced by minute doses Camphor may be a capital remedy, by substituting a more potent impression than theirs upon the nervous centres. Dr. Holcombe thus sums up the action of Cam- phor. " It is antidotal to almost all the drastic vegetable poisons relieves strangury procures re- action from cold, congested conditions is the great anti-choleraic and quiets nervous irritability some- times better than Coffea, Ignatia, or Hyoscyamus. This is its whole clinical value and a great one it is in a nutshell." Camphor resembles in its influence over the circulation Aconite, Cactus, and Veratrum album ; upon the brain it acts somewhat like Agaricus, Opium, Cannabis Indica, and the triad of Bella- donna, Hyoscyamus, and Stramonium ; its power of causing strangury is like that of Cantharis and Terebinthina, less so that of Belladonna. Camphor does not seem to bear dilution. Hahne- mann himself and his most exclusive followers have always used the primary solution, i. e. one part of Camphor to from six to twelve parts of Alcohol. Dr. Rubini recommends the saturated tincture for cholera. LETTER XVI. CANNABIS INDICA AND SATIVA, CANTHARIS, CAPSICUM, CARBO ANIMALIS AND VEGETABIHS. WE use in our practice both kinds of hemp, the Cannabis Indica and that which grows in colder climates. The difference seems to be that in the former is developed a resin which has powerful neurotic properties. I shall take the latter first, Cannabis sativa. A tincture is prepared from the flowering tops and upper leaflets. Hemp was proved by Hahnemarm, and its patho- genesis appears in the ' Materia Medica Pura/ See also an account of its morbid anatomy from Morgagni in the ' Brit. Journ. of Horn.,' vol. vi, p. 507. From the symptoms produced three groups have led to practical results those of the urinary organs, the eye, and the lungs. 1. Cannabis appears to produce excessive irrita- tion of the mucous membrane of the bladder and urethra, including the prepuce. The latter is dark red, hot, and inflamed ; there is much burning in the urethra, painful and difficult micturition, chordee, and mucous discharge. In one often cited CANNABIS SATIVA. 191 instance observed by Morgagni, the urine had to be drawn off by the catheter ; but afterwards could not even thus be evacuated, on account of the instru- ments becoming clogged with mucus and pus. These effects have led to the successful employment of Cannabis in many similar urinary disorders, but especially in gonorrhoea. I have the highest opinion of it as a remedy for this disease, after acute inflammatory symptoms (if present) have been sub- dued by Aconite. 2. Cannabis is credited by Hahnemann with the production of a pellicle upon the cornea. Whether this symptom be a true one, or not, it is certain that the medicine has some effect in removing such specks when left behind by strumous ophthalmia. 3. Another somewhat questionable effect of Cannabis is "inflammation of the lungs," with delirium and vomiting of green bile. It is recom- mended by Dr. P. P. Wells in cases presenting these complications, to promote absorption of exuda- tion limited to the lower portion of either or both lungs. The cough is frequent, teasing, hard, some- times dry, sometimes even incessant. Besides these affections, Dr. Quin once cured with Cannabis a neuralgia of long-standing, sympa- thetic of uterine disorder showing itself in menor- rhagia. Taking the hint, I have lately given it with much relief in a case of menstrual headache. The first-named action of Cannabis assimilates it to Apis, Cantharis, Copaiba, and Terebinthina : the second to Euphrasia : the third to Sulphur, Phos- phorus, and perhaps Lachesis. It is generally agreed that for gonorrhoea the 192 CANNABIS INDICA. mother-tincture of Cannabis is required, in frequent doses of from one to ten drops. In other affections the high dilutions seem efficacious. Cannabis indica. This drug is not officinal in the Homoeopathic Pharmacopoeia. The ordinary tincture is prepared by dissolving one part of the resin in twenty parts of rectified spirit. One part of this tincture, there- fore, to four of alcohol will make our first centesimal potency. There is no proving extant of Indian hemp, except a short one on himself by Dr. Norton in the ' Brit. Journ. of Horn./ vol. xvii, p. 465. But its physiological effects may readily be collected from the various works on Materia Medica. It is thus a substance whose working is well known to you, and whose effects I need hardly describe. The characteristics of the intoxication it produces seem to be exaggeration of all percep- tions and conceptions, aphrodisia, and tendency to catalepsy.* It is not at all improbable that cases of * Dr. O'Shaughnessy thus describes the effect of the resin on a native of India: "At 8 p.m. we found him insensible, but breath- ing with perfect regularity, his pulse and skin natural, and the pupils freely contractile at the approach of light. Happening by chance to lift up the patient's arm, the professional reader will judge of my astonishment, when I found that it remained in the posture in which I had placed it. It required but a very brief examination of the limbs to find that the patient had by the influence of this narcotic been thrown into that most strange and most extraordinary of all nervous conditions, into that state which so few have seen, and the existence of which so many still discredit the genuine catalepsy of the nosologist." (Pereira's ' Mat. Med.,' sub voce.) CANTHARIS. 193 mania may come before us in which the symptoms resemble those of the Haschisch inebriety. In such cases, in satyriasis or nymphomania, and in catalepsy, the use of Cannabis indica would be a new but most legitimate application of the Homoeopathic principle. I myself have met with one case, pro- bably hysterical at bottom, but in which the attacks assumed a cataleptic character ; and where Cannabis indica proved rapidly curative.* The effects of Cannabis indica on the brain may be advantageously compared with those of Agaricus, Belladonna, Camphor, Crocus, Hyoscyamus, Opium, and Stramonium. In its power of causing catalepsy, it is rivalled only by the Chloride of Tin (Stannum muriaticum] . In the case mentioned I gave the 2nd dilution. I have now once more to introduce to you an old acquaintance in Cantharis. The tincture we use is prepared by digesting the powdered fly in twenty parts of alcohol. There is no proving, in the strict Hahnemannian sense of the word, of Cantharis. This is of little consequence, as its pathogenetic effects are well known and may be read anywhere. In studying the action of Cantharis, I think it best to concentrate our attention on the urinary organs. There is no doubt of the specific influence * In the ' Brit. Journ. of Horn.,' vol. xxiii, p. 446, is a case in which Cannabis (it is not said which) in the 15th dilution effected a speedy cure of puerperal mania. 13 194 CANTHARIS. of Cantharis upon these parts. It inflames the whole mucous tract, from the kidneys to the urethra, causing pain in the loins ; scanty, high- coloured, bloody, and generally albuminous urine, often loaded with tube-casts ; and burning pain and tenderness in the hypogastrium, with severe stran- gury.* Sometimes the urine is even suppressed. With this there is fever and great restlessness. That the genital organs often share in the irrita- tion, there is no doubt. Priapism, inflammation of the external parts, and even of the uterus, causing abortion, have been seen : and with this the sexual passions are often painfully excited. But there is no reason to suppose that Cantharis, like Cannabis indica or Stramonium, is a true aphrodisiac. I see nothing specific in the gastro-enteritis produced by Cantharis when swallowed. It is but another instance of its local irritant action, such as is seen on the skin when the drug is applied in the form of a blister or in the respiratory passages when its powder is inhaled. But its secondary effects upon the nervous system can hardly be doubted. These come on usually some days at least after the ingestion of the poison, and take various forms delirium, tetanic or epileptic con- vulsions, and subsequently coma. It would seem, moreover, that under favourable circumstances Can- tharis can specifically irritate the skin : for Pereira mentions a case in which the application of a blister to the pectoral region caused the development of * See Clotar Miiller in ' Brit. Journ. of Horn.,' vol. xvii, 548. CANTHARIS. 195 ecthymatous pustules not ouly there, but all over the body. Correspondingly with these physiological effects, Cautharis has little or no curative influence beyond the urinary organs : but in their inflammatory disorders it is a prime remedy. In simple acute nephritis or cystitis we should rarely think of using any other medicine. In inflammatory strangury, Cantharis is generally indicated : though when nervous symptoms predominate Belladonna is pre- ferable. In suppression of urine from acute con- gestion, Cantharis vies with Terebinthina ; and hsematuria also, when depending upon active determination of blood to the urinary surface, will find in it a potent styptic. I am not sure whether Cantharis affects the terminal portions of this tract, the secreting cells of the kidneys and the lower end of the urethra. That it cures post- scarlatinal dropsy or Bright' s disease has yet to be proved, though I am far from denying its possi- bility. And it has not hitherto been thought much of in gonorrhoea, save when the inflammation extends so high as to cause irritability of the bladder. In those cases of spermatorrhoea described by Lallemand, which depend upon the spread of gonorrhosal irritation through the ejaculatory ducts along the spermatic passages, Cantharis is one of the most homoeopathic medicines : and Dr. Kidd speaks well of its efficacy in their treatment ('Annals/ vol. v, p. 131). The neurotic action of Cantharis has not yet been made use of for therapeutic purposes. I 196 CANTHARIS. cannot assent to the views of some that it is homoeopathic to hydrophobia. The dysphagia of poisoning by Cantharis obviously results from its local influence on the throat : and is quite different from that of true hydrophobia. The reputation which Cantharis enjoys in France as a remedy for skin disease may depend upon its power of specifi- cally irritating this tissue. We have no homoeo- pathic experience of its use. But before leaving this medicine, I must say something about its action, so familiar to you, when applied locally as a blister. I do not know what theory you have held about " counter-irritation." For ourselves, we seek here also to pathogen etics to explain and guide our therapeutics. We find (to quote Dr. Inman) " that blisters applied to the thorax and abdomen of dogs and rabbits will produce redness and absolute inflammation of the pleura and peritonaeum, in patches distinctly corresponding to the vesicated surface of the skin."* Hence blisters when used (as they principally are) for chronic inflammations are homoeopathic agents, though acting by local absorption instead of by elective affinity. But al- though we thus claim for Homoeopathy whatever benefit blisters may effect in these cases, we do not use them. We have medicines which, given in- ternally, seek out, under the guidance of elective affinity, the part that may be inflamed, and there more pleasantly and at least as effectually ex- tinguish the fire. We do, however, use Cantharis externally, but to disperse blisters and not to * ' New Theory and Practice,' p. 322. CAXTHARIS. 197 cause them. In burns and scalds causing vesica- tion, in vesicular erysipelas, and in herpes zoster we have conditions of the surface more or less resembling the local effects of Cantharis : and in all these affections the external application of the diluted tincture has been attended with great advantage. In its action on the urinary organs Cantharis is only paralleled by Terebinthina : but Arsenic, Mer- curius corrosivus, Kali bichromicum, Apis, Cemnabis saliva, and Copaiba coincide with it at some points of the tract. Its action on the skin should be compared with that of Apis, Antimonium tartari- cum, Arnica, Croton tiglium, Rhus, and Urtica urens. The dilutions from the 3rd dec. upwards have been used in urinary inflammations. For external use, also, the strength of the lotion has varied much in the hands of different physicians. I should not make it stronger than one part of the tincture to fifty of water. [NOTE. In a paper on Diphtheria in the ' Brit. Journ. of Homoeopathy/ vol. xvii, Dr. Black calls attention to the resemblance between poisoning by Cantharides and diphtheria, as described by Breton- neau. After alluding to the albuminuria present in both, as completing the resemblance, he suggests the trial of the drug as a remedy for the disease. I have never used it myself: but I believe that it has disappointed expectations. Dr. Ludlam, how- ever, in his " Clinical Lectures on Diphtheria," speaks highly of it for the prostration which often 198 CAPSICUM. continues after the acuteness of the mischief has subsided.] I give a place to the medicine next on my list, only because it has been proved by Hahnemann himself. Capsicum is prepared by pulverizing the ripe capsules of the Capsicum annuum together with the seed, and digesting the powder with twenty parts of Alcohol. The pathogenesis is in the ' Materia Medica Pura.' Capsicum produces its well-known burning in the mouth, throat, gullet, and stomach along which it passes, and in the urinary passages by which it is eliminated. It has been occasionally used with benefit iu heart-burn and tcnesmus of the bladder. Dr. Drysdale has recorded a case of chronic loose- ness of the bowels remaining after cholera cured by this medicine in the 1st dec. dilution.* Dr. Chap- man recommends it in hiccough. I know of no analogous medicines : and can say nothing about dose. I have next to speak of Charcoal, animal and vegetable. I find that even so late as the last edition of Pereira Charcoal is regarded as utterly inert, and Hahnemann is laughed at for filling thirty-five pages with the symptoms produced by the millionth of a grain. The learned writer has omitted to notice that this millionth of a grain, in * ' Brit. Journ. of Horn.,' vol. xxii, p. 694. CARBO AN1MALIS. 199 which Charcoal was taken by our provers, was ob- tained by trituration : and that it is to this process we ascribe the development of such wonderful powers in a substance inert in its crude state. This is a question of fact, and cannot be decided a priori. We will take first in order Carbo animalis. i v Hahnemann directs this to be prepared from ox- leather. Noack and Trinks recommend in preference meat beef, veal, or mutton as the substance to be carbonized. It probably matters little. The potencies are of course prepared by trituratiou. The pathogenesis of Carbo animalis is in the ' Chronic Diseases.' Some additional information of interest is contained in Hempel's article. That animal charcoal, even in its crude state, is inert, can hardly be affirmed in the face of the ex- periments recorded by Dr. Hempel. Daily doses of from four to twenty-four grains have not only disordered the stomach and bowels, but have caused the breaking out of copper-coloured eruptions, of acne, and of boils; and have developed painful swellings and indurations of the parotid and mam- mary glands. It is in these glandular enlarge- ments, occurring in cancerous rather than scrofulous subjects, that Carbo animalis has chiefly been used. With this exception, its whole sphere of action coincides so closely with that of its vegetable brother, that I shall mention any other applications of it when speaking of the latter more important drug. 200 CARBO VEGETABILIS. The action of Carbo animalis on the glands is somewhat like that of Conium and Hydrastis. The lower potencies have generally been used. Carbo vegetabilis is generally made from poplar, beech, or birch wood ; and raised to the 3rd at least by trituration. The proving is in the ' Chronic Diseases.' For the reasons I have before alleged, I am unable to make much use of this proving for physiological inductions. I must content myself with expounding to you the therapeutical sphere of Carbo vegetabilis, as we understand it. It is singular that in two conditions for which you use charcoal chemically, we find it curative dynamically. These are flatulence and foulness of the secretions. It is my favourite remedy for excessive flatulence. I think it is most suitable for cases where the gas is generated by the walls of the viscera rather than from fermentation of the ingesta ; where it distends the stomach rather than the intestines ; and where the tendency is to diarrhoea rather than constipation (comp. Lycopodium). Where flatulence is associated with acidity or heart-burn, Carbo will often relieve these latter affections also. Again, foulness of the secretions or discharges is always an indication with us, when other symptoms correspond, for charcoal. Carbo animalis in a high dilution is said to be very effectual in offensive lochia. Chronic hoarseness is another affection in which Carbo vegetabilis is powerfully curative. The affection is probably catarrhaj^ only : and does not amount to laryngitis. Carbo also occasionally re- CARBO VEGETABILIS. 201 moves chronic diarrhoea, but generally when this is incidental to other disorders calling for it. In all conditions calling for charcoal, especially the vege- table form, the presence of adynamia of a non-febrile character greatly strengthens the indications for its use (contrast with Arsenic). But I cannot agree with those who see a Carbo adynamia in the collapse of cholera, and recommend it to be given therein. Arsenicum and Lycopodium are the only two medicines I know of which may be advantageously compared with Carbo. I find the potencies from 3 to 12 answer every purpose. The 3rd trituration acts capitally in the dyspepsia of old people. LETTER XVII. CAULOPHYLLUM, CAUSTICUM, CEDRON, CHAMOMILLA, CHELIDONIUM, CHIMAPH1LA. I BEGIN this letter with an account of one of the many indigenous medicines with which our American brethren have lately enriched the f Materia Medica/ the Caulophyllum thalictroides, popularly called "Blue cohosh" or "Squaw root/' The former name hints at its similarity to Actsea racemosa (black cohosh) ; the latter points to its main sphere of action. We prepare a tincture from the root. Caulo- phyllin is also much used. There is a proving of Caulophyllin by the inde- fatigable Dr. Burt in Hale's 'New Remedies/ together with all that is known regarding the drug. The " Squaw root," as may be supposed, acts chiefly on the uterus. No woman having proved it, I am unable to state what are its physiological effects upon the organ. Dr. Hale thinks that it is primarily excitant ; and that it is homoeopathic to dysmenorrhcea, uterine cramps, spurious labour- pains, abortion, and after-pains. It seems especially suitable to affections of the motor nerves sympathetic CAULOPHYLLUM THALICTROIDES. 203 with uterine irritation (Actsea includes also reflex hyperaesthesise). It has been found useful in chorea, in spasms from suppression of the menses, and in uterine paraplegia. Cases are also on record in which it has strengthened labour-pains, where Ergot could not be given on account of the rigidity of the os uteri : and in which flooding after abortion, and long-continuing lochia after parturition have been checked by its use.* It will probably continue to be given indiscriminately as a uterine remedy, until a proving on a woman or the accumulation of clinical experience enables its precise place to be fixed. I have myself had no experience with it. The prov- ing of Dr. Burt reveals a marked power on the part of Caulophyllum of causing acute rheumatoid affections of the small joints, especially those of the fingers. Putting this and its uterine action together, it becomes probable that Caulophyllum will rank with Pulsatilla and Sabina as a remedy for that peculiar form of chronic rheumatism described by Dr. Fuller as secondary to uterine disorder. It has made some brilliant cures of inflammatory rheuma- tism of the hands and fingers, and is said by Dr. Ludlam to be more effectual in females than in males thus affected. I have already pointed out the close relations of Caulophyllum with Actcea racemosa, Pulsatilla, and * " For the prevention of premature labour," writes Dr. Hale, " no remedy in the Materia Medica equals Caulophyllum." And again, " Dr. Helmuth informs me that he has used the Caulophyllin successfully for the removal of those discolorations of the skin of the face, common in women with menstrual irregularities or uterine disease." 204 CAUSTICUM. Sabina. It has some points of analogy also with Secale. The Caulophyllin, in the triturations from the 1st to the 6th decimal, has been most frequently used. My next medicine is Oausticum. What is Causticum ? Hahnemann imagined that quick-lime owed its causticity and solubility to the presence of a substance which he called by this name. He thought that he could separate it by distillation, by adding to the quick-lime a solution of some previously fused Bisulphate of Potash. The liquid distilled from this mixture he styles hydrated causticum. The chemical nature of this substance has always remained uncertain. Dr. Black has lately had it analysed, with the result of considering it a weak solution of caustic potash. He recommends that the dilutions should in future be prepared from the Liquor potassse of the ( British Pharmacopoeia/ as of more certain strength. Twenty parts of Liquor potassse with eighty of distilled water constitute, according to him, the 1st centesimal dilution of what we might now more correctly style Kali causticum. The proving of Causticum is in the ' Chronic Diseases/ Testers article upon it should be con- sulted ; as also Dr. Black's " Notes on Causticum " in the 'Brit. Journ. of Horn./ vol. xxiv, p. 470, and a paper on " Calcarea and Causticum," by Dr. Nankivell, with the discussion following, in the CAUSTICUM. 205 ' Annals of the Brit. Horn. Society/ vol. ii. Hempel omits the medicine altogether. The pathogenesis of Causticum, though too confused for physiological inductions, presents nevertheless certain well-defined groups of symptoms which have led to successful applications of the remedy. It is the best medicine I know of for catarrhal aphonia : and it is said by Dr. Meyhoffer to benefit weakness of voice from over-exertion. The action on the larynx thus indicated has given Causticum an important place among cough medicines : for in- stances of its efficacy here you should read Dr. Black's " Notes" above mentioned. A well-verified indication for its use in coughs is the involuntary emission of urine during the paroxysm. We are thus led to give it for weakness of the neck of the bladder, even irrespective of cough : as in the enuresis of children and old persons. Other urinary symptoms of Causticum induced Mr. Freeman, of Kendal, to select it in some cases where convalescence from typhoid fever was re- tarded by the passing of large quantities of urine loaded with lithic acid and lithates.* The ex- cessive tissue- waste revealed by this symptom was checked by Causticum, and the recovery went rapidly on. In a similar case occurring in my own practice, where after pregnancy this state of the urine was associated with debility, low spirits, anorexia, copious sour perspirations, and persistent aching of the mammae (all, except perhaps the last, Causticum symptoms), speedy recovery ensued upon the administration of this remedy. It should be * Monthly Horn. Rev.,' May, 1866. 206 CEDRON. thought of for that rare disease known as baruria. Causticum has also more than once accelerated the departure of facial paralysis : and is recommended as the best external application to burns of the third degree. It has cured once at least epilepsy and chronic eczema : and is lauded by Teste in alternation with Mercurius corrosivus as capable of even checking the progress of variola in children. I know of no medicine whose range of action points to any real similarity between it and Causticum. The higher potencies about the 12th have been most commonly used. But Dr. Black's experience shows that in coughs at least the dilu- tions from the 1st to the 6th dec. are very efficacious. I have now to speak of a drug which we know as Cedron. It is the fruit of a South American tree (Simaruba Cedron supposed to be a kind of Cedar), whose exact description is not yet ascertained. It should be prepared by trituratiou. Our information concerning Cedron is derived from the proving and clinical remarks contained in Testers ' Materia Medica/ and from Dr. Casanova's articles in vols. v and vi of the ' Monthly Horn. Review.' In Panama, Cedron is considered a specific for the bites of the venomous serpents of the country, and for its endemic iutermittents. Teste's three CHAMOMILLA. 207 provers each experienced a daily paroxysm closely simulating ague. The chills came on towards evening : there was little or no sweat, but much cerebral congestion. Teste reports brilliant results from Cedron in the intermittents of Martinique and of Wallachia. Dr. Casanova's experiments, pathogenetic and clinical, point in the same direc- tion. He considers Cedron a true anti-periodic, like Quinine and Arsenic ; and gives it in neuralgia and other disorders, as well as in ague, when appearing in regularly recurring paroxysms. In simple intermittents, he considers it infallible. I have myself given Cedron only in a single case, and that of quotidian ague of a month's standing ; the chills beginning towards evening. The 2nd dilution caused almost immediate cessation of the attacks. I have already indicated the resemblance of Cedron to Quinine and Arsenic. Testers cures were obtained with the 6th dilu- tion. Dr. Casanova appears to use all potencies, from the 1st dec. upwards. And now we come once more upon a polychrest in Chamomilla. The juice of the recent plant (Matricaria chamomilla) is mixed with equal parts of Alcohol for the mother- tincture. The proving of Chamomilla is in the ' Materia Medica Pura.' Some additional experiments by the Vienna Provers' Union are related in HempeFs article. 208 CHAMOMILLA. "With one of these provers (Dr. Schneller) I fully agree that " Chamomilla affects primarily the nervous system." Its pathogenetic effects are faint and obscure : but its curative power is well-defined. It is when the sensory and excito-motor nerves are morbidly impressionable that Chamomilla is so valuable a medicine. Thus Hahnemann says " Chamomilla seems to moderate excessive sensitive- ness to pain, or the disturbing influence which pain exercises in some persons upon the mind : for this reason it relieves many of the morbid symptoms produced by the excessive use of Coffee and narcotic substances, and is, on the other hand, less beneficial to those who remain patient and composed during their sufferings. I consider this observation of great importance." It has even cured neuralgia of the limbs where this great "nervousness" was present : the pains are much worse at night than by day. The impressionability of the excito-motor nerves which Chamomilla so powerfully modifies shows itself in spasms and convulsions, as in pregnant women and young children. In the former Chamo- milla effectually relieves the false pains, and the cramps and painful twitches of the legs, which trouble the later months of pregnancy. In the latter it plays a most important part during the process of dentition. It probably has some specific action on the pulp of the teeth itself in the gums, for it gives great relief in ordinary inflammatory face-ache. But when in dentition the nervous system becomes irritated, then for restlessness, fretfulness, and spasms there is no medicine like Chamomilla. Even the diarrhoea of teething will sometimes yield to this CHAMOMILLA. 209 medicine ; and when other remedies are strongly indicated, Chamomilla in alternation will help them. The influence of Chamomilla extends to the emo- tional nerve-centres also : and the effects of anger and active vexation even when these go beyond the nervous system, and show themselves in bilious disturbance and jaundice are under its control. The ideational centres the cerebral hemispheres themselves Chamomilla does not reach. Hence when true brain symptoms and epileptiform convul- sions occur during dentition, Chamomilla must yield to Belladonna. In this wide though superficial action on the nervous system I have described the main uses of Chamomilla. It has certain local influences also, making it useful in nervous sore-throat, colic, nodosities in the mammae, strophulusand inter trigo in infants, uterine excitement (as in threatened miscar- riage, especially from mental disturbance), and spasmodic coughs. But even irrespective of these applications of the drug, it is so frequently called for in the treatment of the disorders of women and children that it is in daily use by most Homoeo- paths. The analogues of Chamomilla are Agaricus, Bella- donna, Coffea, Hyoscyamus, Ignatia, and Stra- monium. The facts about the dose of Chamomilla are among the most curious that Homoeopathy presents. Of very little pathogenetic activity in its crude state, " the low dilutions " as Dr. Holcombe truly says " of certainly no more value in disease than catnep or mint teas," Chamomilla begins at the 6th potency 14 210 CHELIDONIUM. to manifest its great curative powers, and may often be given with advantage as high as the 18th. The 12th is my own favourite dilution. These facts are vouched for by Homoeopaths generally : their sig- nificance is at present doubtful. I have now to give you an account of a drug, whose recent exhaustive proving will probably give it a prominent place among our remedies. I refer to the greater celandine, Chelidonium majus. The tincture is prepared from the fresh juice in the usual manner. The proving to which I refer is by Dr. Buchmaun of Alvensleben, and is translated in the ' Brit. Journ. of Horn/ vols. xxiii xxv. The two previous provings by Hahnemann (' Mat. Med. Pura.') and Teste (' Mat. Med/) have their symptoms incor- porated into Dr. Buchmann's schema. Our knowledge of Chelidonium, which has been gradually building, is perfected by what Dr. Buch- mann has now done. Led by the doctrine of signatures, the middle-age physicians supposed that this bitter yellow juice, so nearly resembling bile, must be beneficial in disorders of the liver. The disciples of Rademacher have shown that here at least the signature has proved a true guide, by ad- ducing numerous cases of jaundice, gall-stones, and acute and chronic hepatitis cured by this medicine. Then comes Dr. Buehmann's proving to show that this remedial power obeys the law of similars. The action on the liver is very strongly marked in his CHELIDOXIUM. 211 proving. Pain, both acute and dull, and tenderness of the organ ; pain in the right shoulder ; stools either soft arid bright yellow, or whitish and costive ; and deeply tinged urine, appeared in nearly every prover. In three the skin became yellow or dark ; and in one regular jaundice was set up. Corre- spondingly, Chelidonium bids fair to take high rank in our school as an hepatic medicine. You will find a number of cases illustrative of its value at the end of the proving. Farther experience, how- ever, is required to enable us to define its exact place here, in relation to other hepatic remedies, as Mercurius, Bryonia, Phosphorus, and Podophyllum. Next, the experiments instituted by Teste led him to credit Chelidonium with a specific affinity for the respiratory organs. The two disorders to which he thought its symptoms specially pointed were pertussis and pneumonia. Subsequent experience has confirmed his predictions of its value. In hoopiny-cough it has been found to act specially well after Corallia, as indeed he recommends. And it really seems a most valuable accession to our remedies for pneumonia. It is especially useful where the right lung is affected, and the liver in- volved. Teste thinks it is better than Bryonia in those cases where the patient is of blond com- plexion and placid temperament. All this you will, find confirmed and made clear by Dr. Buchmann's experiments and observations. He shows that in animals poisoned by the drug the lungs are found generally engorged, sometimes hepatized. He deve- Jopes in several of his provers all the symptoms of an incipient pneumonia. And he contributes from 212 CHELIDONIUM. his own practice several cases of the disease, in which the beneficial action of Chelidonium was most manifest. He corroborates also the value of Chelidonium in hooping-cough, and points to the spasmodic cough induced by it as showing its ho- rn oeopathicity. Lastly, the new proving of Chelidonium reveals a hitherto unknown influence exerted by it on the kidneys. Besides the general symptoms of renal irritation, an examination of the urine in one case shewed the presence of tube-casts, of increased uric acid, and diminished chloride of sodium. The mis- chief in this case was so considerable that cedematous swellings of the extremities occurred. We have as yet had little or no experience with Chelidonium as- a renal remedy. Besides the facts embraced under the above head- ings, I would note in the proving the severe pains in the knee-joints, and the itching hemorrhoids developed in one prover (both occasionally symptom^ of hepatic disorder) ; 'the dark redness so often ap- pearing on the cheeks, hinting embarrassment of the pulmonary circulation; the chills and fever; the inflamed scrotum and eyelids ; the itching of the skin, generally in patches ; and the periodical tooth- ache. Dr. Buchmann also points out a group of symptoms which show an action on the diaphragm, He esteems it very highly in all external neuralgias : and gives a good case of prosopalgia cured by it. In the 'Brit. Journ. of Horn./ vol. xx, you will find some cases of supra-orbital neuralgia cured by Che- lidonium, in which also its curious affinity for the right side of the body appears. I have only to add, CHIMAPHILA. 213 that cases are appended to Dr. Buchmann's proving which hint at other fields of action for Chelidonium as yet unexplored. Dr. Madden tells me that he has verified Dr. Buchmanu's recommendation of it in eczema. Bryonia, Phosphorus, and Eupatorium are the analogues of Chelidonium. The dose for adults seems to range from the 1st to the 6th dec. ; from the 6th to the 12th for infants. Before concluding this letter, I must briefly mention one of the American indigenous remedies, the " Pipsissiwa," or Chimaphila. A tincture is prepared from the fresh leaves, bruised. Chimaphila has not been proved : all our infor- mation concerning it is derived from Dr. Male's ^article in his ' New Remedies/ There is one and one only point of interest about this plant. It appears to have a specific influence upon the urinary passages, like that of the Pareira brava and the Buchu, which you know well, but which we have not hitherto used. Dr. Hale has found it a valuable medicine in cases of dysuria with mucous sediment in the urine; and has cured gleet with it. Besides Pareira and Buchu, Chimaphila may be compared with Cannabis saliva, Cantharis, Copaiba, Eupatorium Purpureum, and Uva ursi. One or two drops of the mother-tincture appear to be the most suitable dpse. LETTER XVIII. CICUTA, CINA, CINCHONA, AND QUININE. OF the three very similarly acting Umbelliferse, we have already discussed the JSthusa cyuapium. The (Enanthe crocata is not at present used in our practice : but we have some knowledge of the third, the water-hemlock, or Cicuta virosa. The expressed juice of the root, before the flowering time arrives, mixed with equal parts of Alcohol, constitutes the mother-tincture. Cicuta was proved by Hahnemann : the patho- genesis is in the ' Materia Medica Pura/ The poisonous effects of the plant are fully described by Hempel in his article. From these cases of poisoning it appears that Cicuta causes tetanus as manifestly as does Strych- nine. But it has this difference, that it affects the brain no less than the spinal cord. The cerebral symptoms are various : but in their intensest form they approximate to those of epilepsy, which indeed in poisoning by CEnanthe crocata is exactly simu- lated. The proving adds little to the knowledge of Cicuta we thus derive from toxicology, save that it shows its power of causing local tonic spasms, as of CI\A. 215 the neck and jaw, and of developing pustular inflammation on the face and hands. Cicuta has not been much used in Homoeopathic practice, chiefly in epilepsy and pustular eruptions. Teste calls attention to its double action on the nervous system and the skin : and suggests it as a remedy for cerebral and other nervous affections resulting from re-percussion of eruptions. It is good for hiccough and belching, when these are of a spasmodic character : it has relieved these symp- toms when occurring in cholera. Teste puts Cicuta into his Sulphur group, classing it especially with Bovista, dEthusa, and Asterias. Its neurotic symptoms resemble most closely those of jEthusa and Hydrocyanic acid : next, those of Strychnine and Aconite. It seems to have acted well in all dilutions. I have next to speak of the medicine we call Cina. The Cina or "semen contra" (Qy. ? vermes under- stood) of commerce (vulgo, worm-seed) is said to be the seeds, stalks, &c., of one or two eastern varieties of Artemisia. You know it best by its alkaloid, Santonine. We triturate the latter, and make a tincture from the former. The proving of Cina is in the ' Materia Medica Pura/ Cina has derived its reputation and its names from its activity as a vermifuge. That it does, especially in the form of Santonine, kill and expel the round-worm and occasionally the thread-worm, 216 CINA. there can be little doubt. When morbid symptoms are distinctly traceable to the presence of lumbrici, I for one have no hesitation in poisoning the para- sites by sufficient doses of Santonine. But the experiments of Hahnemanu have revealed this curious fact, that Cina produces on the healthy body nearly if not quite all those symptoms whose presence leads us to suspect the existence of worms. There are the dilated pupils, with dimness of sight and twitching of the eyelids, the ravenous appetite, the pinchings in the abdomen, the itching at the nose and anus, the frequent micturition, the spas- modic cough with vomiting, the restless sleep, the fever, and the twitchings in various parts of the body. General convulsions also have frequently resulted from the large doses of Cina or Santonine given as a vermifuge. From these facts, Homoeo- pathic physicians have come to use this drug as a dynamic remedy for worm-affections. Covering, as it does, the great mass of the reflex disorders produced by the worms, it is calculated on the principle similia similibus to extinguish the morbid results of their presence, even though they still remain in situ. But this benefit would obviously be but palliative and temporary, were it not that our minute doses of Cina and Santonine promote also in some mysterious way the expulsion of the worms. They may be most efficacious against lumbrici : but I have seen them over and over again act most satisfactorily against ascarides. I cannot better illustrate their action than by referring you to a case of chorea treated by Dr. Hamilton.* * ' Brit. Journ. of Homoeopathy,' vol. xiii, p. 254. CINCHONA. 217 .It must not be supposed that Cina is the one specific for worms. When the local irritation is very great, I prefer Teucrium, and in obstinate cases have used with frequent success Teste's course of Lycopodium, Veratrum, and Ipecacuanha in succession. The chromatopsia caused by Santonine is well known, but appears to be a physical rather than a dynamic property of the drug, as the urine is similarly coloured. Nevertheless, it has been used with some benefit in amaurosis. Cina occupies so unique a place in relation to helminthiasis that I am quite unable to find medi- cines analogous to it. The 12th dil. answered marvellously well in the case I have cited. I am very well pleased, how- ever, with the action of the 1st, both of Cina and Santonine. And now we must devote some time and space to the study of your old friend and trusty ally, Cinchona. In our school, this drug is commonly called China : and as far as derivation goes, the one name is as good as the other. But as Hahnemanu proved it, and you of the old school use it, under the title Cinchona, I see no advantage in persisting in the use of a name peculiar to ourselves. We prepare our tincture from the bark of Cinchona flava or C. loxa. Cinchona has been most thoroughly proved by Hahnemann : and the pathogenesis, with valuable 218 CINCHONA. prefatory remarks, appears in the ' Materia Medica Pura.' I have no difficulty in assenting to the usual division of the curative powers of Cinchona : it is tonic and anti-periodic. The latter property we will discuss presently, under the head of Quina. For the present, let us direct our attention to the former. Cinchona is tonic, i. e. it strengthens the body when weak. But is it equally good for all kinds of weakness? Reason and experience alike reply in the negative. Were it otherwise, there would be no need to seek for other tonics : and Cinchona might stand alone in the list, instead of as now being supplemented by a score of other drugs. What, then, is the special kind of weakness to which it is suitable ? Hahnemann has wrought out this problem for us. He points out that the temporary excitement caused by bark in the healthy is soon followed by the opposite condition of depression. Studying, then, the symptoms of this depression as manifested in his provers, he con- cludes that they closely resemble those of the debility which results from exhausting discharge or other loss of fluids. To this condition, where the weakness is itself the disease, China is curative, because homoeopathic. Hahnemann reprobates in a most forcible manner the pernicious practice of giving bark as a tonic in cases where the disease which causes the weakness is still present. For this I refer you to his preface to the proving : where he also points out that the benefit obtained from bark in convalescence from acute disease is just CINCHONA. 219 correlative to the super-added debility caused by the depleting treatment pursued. This brilliant thought of Hahnemann's has opened out to us a wide yet well-defined range of action for Cinchona as a tonic. In the debility occasioned by loss of blood ; by diarrhoea, diuresis, or excessive sweating ; by over-lactation ; and perhaps by too great expenditure of semen, it is a most effectual remedy. Nor does it fail us when the discharge is a morbid one ab initio, as in excessive suppuration. Here the relation of Cinchona to the series of chill, heat, and sweat (of which we shall speak while upon Quinine) makes it also helpful to the sufferer from hectic. This is the grand sphere of the action of Cinchona : and within it it manifests some of the most beautiful curative powers known to the art of medicine. But over and above all this Cinchona does good service to us in several ways, most of which Hahnemann himself has pointed out. 1st. " Its primary effect " he writes " is to open the bowels : hence it will cure certain kinds of diarrhcea, provided the other symptoms correspond." For the last four years I have invariably treated simple summer diarrhoea with China : and regard it as well-nigh infallible. " Absence of pain " is often mentioned in the books as a special indication for this medicine : but I cannot confirm it. In the cases to which I refer severe griping pain was nearly always present : and one of the earliest effects of the China was its relief. China is also recommended for lienteria : I myself have cured a case with it. 2nd. "The fre- quent and morbid excitement of the sexual organs, 220 CINCHONA. resulting in an involuntary emission of semen, and caused even by slight abdominal irritations, is permanently relieved by Cinchona." I give you this as Hahnemann has written it ; I have not verified the statement. 3rd. " Pain which is excited by merely moving the affected parts, and which gradually rises to the most fearful height, has frequently been cured by a single drop of the I2th dilution of Cinchona, even when the attack has returned frequently." The " pain " here spoken of is probably neuralgic in character. In another place Hahnemann notes of the Cinchona neuralgia, that it is "increased by motion and especially by touching the affected parts; but it is likewise characterised by this, that the pain, although it may have disappeared for the moment, may be excited again by simply touching the parts, when it frequently becomes horrid and intolerable." 4th. " Certain forms of jaundice may likewise be cured by Cinchona as their homoeopathic type." Hahnemann also suggests that China is homoeopathic to the humid gangrene of the outer parts and the suppuration of the lungs in which it has occasionally been useful : but I cannot see anything in its power over these affections but instances of its roborant influence. Lastly, he lays down that " bark will scarcely ever be found useful except when the nightly rest of the patient is disturbed similarly to the disturbance which characterises Cinchona." And of this dis- turbance he says " Cinchona is characterised by restless night-sleep with dreams causing anxiety and starting ; when waking from those dreams one finds QUINA. 221 it difficult to come to one's senses, or the anxiety continues." I have cited these remarks of Hahnemann's at length, as he has evidently studied Cinchona very closely. In fact, there is little to add to his enumeration of the curative powers of the drug. I may say, however, that it seems to excite the ovario- uterine functions so as to convert the existing cata- menia into a hsemorrhage, the blood coming off in black lumps. It is thus homoeopathic to menor- rhagia, as well as to the debility it occasions and for which we so often give it. Hahnemann recommends the 12th dilution. I almost invariably use the 1st : and in hectic caused by suppuration the mother-tincture seems preferable. Before leaving Cinchona, I must dwell for a short time upon its well-known alkaloid, Quina. We use, like yourselves, the disulphate (Quinine), making either triturations or aqueous dilutions. Quinine was proved by Dr. Noack : but the only record of his experiments of which I am aware is the pathogenesis in Jahr's ' Manual/ The best account of the physiological effects of Quinine I have met with is in Wood's ' Materia Medica/ where the substance of Briquet's experiments is given. The chief interest attaching to Quinine is un- doubtedly its power over periodic affections, especially intermittent fever. And first, as to the rationale of its action in curing such affections. Is it antipathic, alloaopathic, or homoeopathic ? As we cannot con- 222 QUINA. ceive the opposite of ague, the first of these alterna- tives is impossible. Of the second we prove the nega- tive if we establish the affirmative of the third. Now you are well aware that the power which Hahne- niann discovered (or thought he had discovered) in Cinchona to excite the intermittent paroxysm was the Newton's apple which led him to the law " similia similibus." The worth of his experiments has indeed been questioned, even among our own ranks. But there is now plenty of evidence from other quarters to show that both occasionally in individuals arid regularly on a large scale among those who work in its manufacture, Quinine produces the genuine simile of ague. The facts bearing on this point are so well put together in the ' Monthly Horn. Review' for Dec. 1866, that I need not repeat them here. But secondly, what is the place of Quinine in the therapeutics of intermittent s ? Dr. Wood writes " Anti-periodic treatment is in its nature essentially temporary ; its only effect being to guard the system against the recurring paroxysms, not to secure further immunity, when its direct influence has ceased." Upon this showing, we can only expect Quinine to be permanently curative when the ague is recent : and this all experience confirms. In recent uncomplicated agues, showing the regular series of chill, heat, and sweat, and unmarked by any special phenomena, Quinine is pretty well infallible. But in cases of long standing its use is mere waste of time. If it " breaks up " the paroxysms for a while, they always return : and if the Quinine is pushed, a medicinal cachexia is added to that already induced bv the disease. QUINA. 223 The same remarks apply to the other maladies brow-ague, dysentery, &c. capable of being in- duced by malaria, and characterised by periodical recurrence. If of recent origin, Quinine may ex- tinguish them. But when they have taken anything like deep root in the system, it is powerless. And here comes in the great advantage of Homoeopathy, that it has not one or even two " anti-periodics" only, but a score ; and in one or other of these the specific remedy for the individual case may nearly always be found. Before leaving the sphere of periodical affections, I may mention that I have much faith in Cinchona and its alkaloid as remedies where natural perio- dicity is disordered, as in irregular menstruation in young girls, and where the pains of labour are re- curring in a fitful and worrying manner. There is another property of Quinine which Alloeo- pathy knows only as a nuisance, but which Homoeo- pathy has utilized for the benefit of its patients. It is its action on the head. Dr. Wood gives an ad- mirable description of the symptoms caused by the drug in this region, the abnormal subjective sounds (buzzing, singing., roaring., hissing), with deafness; then the weight, fulness, tension, and pain in the head ; while from larger doses we have vertigo, disturbed visual function, even to blindness, flushing of the face, headache, and epistaxis, these congestive phenomena being followed by depression, tremblings, sighing and yawning, and wandering. I have been led by these facts to give Quinine with much benefit in long-lasting, continuous headaches, of a congestive character, affecting the whole brain ; 224 QUINA. and in deafness with noises in the ears when of nervous rather than catarrhal origin. Of Noack's proving I can only note that there was a very marked increase of lithic acid and lithates in the urine, and that I have seen some reason to believe that this symptom may serve as a valuable indica- tion for the medicine in obscure cases. As a causer and curer of ague, the chief analogues of Quina are Arsenic and Cedron. Its peculiar influence on the brain is unique. Pro dosi, I find two or three grains of the 1st dec. trituration, frequently repeated, amply sufficient for the cure of ague : while the 1st centesimal cures without aggravation the affections of the head. LETTER XIX. CISTUS, CLEMATIS, COCCULUS, COCCUS CACTI, COFFEA, COLCHICUM, COLLINSONIA. I must begin this letter by giving you a short account of the Rock-rose, or Cistus canadensis. The tincture is probably prepared from the whole plant. The Cistus has been proved under the superin- tendence of Dr. Hering. His pathogenesis, with the medical history of the plant, is given entire by Dr. Hale in his ' New Remedies/ It was the great popular reputation of the Rock- rose in scrofula which led to its being proved. The symptoms (which we have only in schema-form) shadow forth, faintly indeed, the manifestations of the diathesis in the eyes, ears, nose, and lymphatic glands ; and in such affections it has been used successfully by Homoeopathic physicians. I am myself much more impressed with its effects upon the throat. The sense of dryness there is more marked in the pathogenesis of Cistus than in that of any other medicine I know, except perhaps Belladonna. The following symptom, too, looks very like shingles. "Below the right shoulder- 15 226 CLEMATIS. blade, extending round to the front of the body, was a very much inflamed spot about the size of the palm of the hand, painfully sore to the touch ; soon after pimples began to appear on this spot in a large group, they caused violent burning. Later, a pain went from this belt-like spot to the left hip, and into the groin ; the pain was like rheumatism, mo- tion increased it." Cistus is said to require a Magnesian soil ; and Dr. Hering suggests that it may be related to that mineral as (for similar reasons) Belladonna is to Lime and Pulsatilla to Iron. The first dilution has been used in scrofula. If the next name on my list were as valuable as a medicine as its sister is beautiful as a flower, it would be precious indeed. Clematis is prepared by mixing the juice of the fresh leaves of the Clematis erecta with equal parts of Alcohol. The pathogenesis is in the ' Chronic Diseases.' Putting the symptoms ascribed to Clematis side by side with its therapeutic virtues, it would seem to influence specifically the genito-urinary mucous membrane, the skin, the lymphatic glands, and the eyes. It has some reputation as a remedy for or- chitis ; but I can hardly recommend its use save in the failure of such medicines as Pulsatilla, Spongia, and Aurum. Hempel, too, adduces arguments against its real curative action in the cases recorded. On the other hand, there seems little doubt of its efficacy in organic urethral stricture, which one COCCULUS INDICUS. 227 would hardly expect to be influenced by medicine at all. This experience deserves, if it does not need,, confirmation. I have certainly seen Clematis act with rapid curative power in symptoms of commencing stricture supervening upon chronic gleet. Impetigo appears to be the type of exanthem in which Cle- matis acts curatively : but it is not a very potent remedy. It seems a favourite medicine in the Leopoldstadt Hospital at Vienna for enlargement of the lymphatic glands; and my friend Dr. Madden esteems it highly in the treatment of iritis. You will see that I have little personal experience with Clematis. I have also taken repeated doses of from 10 to 20 drops of the 1st decimal dilution without obtaining any symptoms. I know of no medicine presenting much analogy with Clematis : nor has its use been extensive enough to enable us to fix its most suitable dose. I have now to bring before you a drug better known to you as a poison than as a medicine, Cocculus Indicus. The tincture is prepared from the pulverised seeds. Cocculus was proved by Hahnemann, and the pathogenesis appears in the ' Materia Medica Pura.' You know Cocculus, I say, as a poison only. Whether used to kill fishes, for the adulteration of beer, or in experiments on animals, it is evident that it acts mainly upon the nervous system. The testimony of those who have experienced its effects 228 COCCULUS INDICUS. on their own persons is that it influences the vo- luntary muscles rather than the intellectual powers. With this Hahnemann's provings entirely agree. I think that the whole range of the curative action of Cocculus becomes intelligible, if we suppose it to influence the motor tract of the cranio-spinal axis, from the corpora striata to the cauda equina. It is of great service in certain kinds of vomiting. These are not of gastric origin : but seem explicable by the excitement of the peristaltic action of the stomach and intestines which takes place when the corpora striata are irritated. " Sea-sickness" is the type of the Cocculus vomiting : and there is little doubt that the seat of this affection is prima- rily cerebral. Cocculus will often relieve even this obstinate affection : and is powerfully curative of nausea and vomiting induced by riding in a car- riage or any similar motion. It is also one of the best palliatives for the cerebral form of " sick-head- ache," where the vomiting is plainly secondary. The presence of giddiness (and perhaps also of salivation, which is readily induced by the " active principle" of Cocculus, picrotoxin) is an additional indication for the medicine in such cases : and may sometimes call for it when occurring separately. The abdomi- nal spasms in which Cocculus is so frequently ser- viceable appear always to spring from the nervous centres either directly or from reflex irritation. It is especially valuable in menstrual colic : though it has no power over true dj smenorrhoea. The con- dition of the nervous system set up by menstruation and pregnancy appears specially favourable to the action of Cocculus, which herein resembles Chamo- COCCULUS INDICUS. 229 milla. Menstrual headache as well as colic, and flatulent " spasms" in pregnant women often yield to its use. From the pathogenesis, I would sug- gest its trial in that troublesome form of flatulence where the wind collects in the small intestines, and disturbs the sleep. The ultimate effect of Cocculus upon the spinal cord appears to be to diminish its irritability : so that while convulsions are produced in acute poisoning by the drug, paralytic symptoms abound in the continued experiments of the provers. Cocculus has considerable reputation in our school as a remedy for paraplegia. It is probably suitable to functional disorder only of the cord, as in the post-diptheritic paralysis, of which Dr. Trinks has given a beautiful instance.* It has also proved curative in hemiplegia following apoplexy : in these cases the effusion had probably taken place in one of the corpora striata. The following case by Dr. Black will illustrate the kind of headache for which Cocculus is suitable. f Miss H , set. 35, of a full plethoric habit, has suffered from her present headaches for now fifteen years ; they came on shortly after the catamenia appeared, and have ever since regularly occurred at that period. Violent headache described as a dull pain affecting the whole head : the patient has a difficulty in describing it minutely ; is unable to lie for a moment on the back of the head j is forced to lie on the side ; unable to bear the least light; any noise excites nausea and vomiting. During the head- ache she feels as if suffering from sea-sickness, and on sitting up the objects around seem to move up and down. The headache lasts from thirty-six to forty-eight hours, and comes on on the third or * ' Brit. Journ. of Homoeopathy,' vol. xix, p. 312. t Ibid., vol. v, p. 429. 230 COCCUS CACTI. fourth day of the catamenial period. The catamenia are abundant, but unattended by local pain. General health good. March 16th. Cocc. 18, M. et N. April 4th. The headache has occurred at the usual time, but not so severe as usual, for she was able to move about, and was not confined to bed as she always was before. A dessert-spoonful of the tincture of Cocculus as above, only of the 6th dilution, was given from every half-hour to every six hours during the third and fourth day of her period with great advantage. Cont. Cocc. April 20th. Kept. Cocc. 18, as on March 16th. May 1st. Has had a very slight headache at the usual period, which was again much relieved by frequently-repeated doses of Cocc. 18 ; she was now ordered Bell. 6, alternately with Cocc. 18, M. et N. This was the last prescription ; for one headache occur- ring after that she took the Cocc. Since October, 1844, to July, 1846, she has continued free from these headaches. Remarks. The principal indication in this case for the selection of Cocculus, was the marked tendency to nausea resembling sea- sickness, as if the stomach heaved up and down. So great was this idiosyncracy that she told me that travelling in a carriage made her feel ill, and that sickness has often been brought on by looking at a vessel pitching up. Cocculus reminds me of no other medicine, save at the point where it touches Chamomilla (which I have noted above). Teste, however, associates it with Causticum, Coffea, and Staphysagria. The dilutions from 6 to 12 have been most fre- quently used. We have next to consider the place aud action of Cochineal, Coccus cacti. The dried insect, powdered, is digested in alcohol for a tincture, or (better) triturated with milk- sugar. COCCUS CACTI. 231 Cochineal has been proved by the Austrian So- ciety in their wonted exhaustive manner. The ex- periments are related in detail in the fourth volume of the ' Austrian Journal:' and the schema of the symptoms may be found translated in Metcalfe's ' Homoeopathic Provirigs.' HempePs article, also, should be consulted. The Austrian proving makes it evident that the virtues popularly ascribed to Cochineal in hooping- cough spring from its homoeopathic relation to the disease. Few of the provers escaped a cough : and with Dr. Wurmb it was " so violent that it caused vomiting, and the expectoration of a great quantity of thick, viscous, and albuminous mucus." I am not aware, however, that the medicine has been used by Homoeopaths against this disease. Again, this proving amply accounts for the reputation of Cochi- neal in the school of Rademacher as a " kidney remedy/' The urinary symptoms are very nume- rous and of a high grade of intensity. Nephritic colic and vesical and urethral tenesmus are plainly pictured therein : you will read in Hempel cases where affections of this kind and also acute renal dropsies have been cured by Cochineal. I have little doubt but that the study of this beautiful proving will lead to a more extensive use of the medicine, especially in sore throat with great dry- ness (comp. Belladonna), in inflammation of the labia (comp. Apis) and in laryngeal irritation and hoarseness (comp. Hepar Sulphuris.) Cochineal has hitherto proved curative only in material doses. 232 COFFEA. We come now to one of those substances which stand on the boundary line between food and medicine, Coffea. "We use the raw, not the roasted bean, preparing it either as a tincture or by trituration. If Pereira be right, however, we should try if the roasted bean be not more efficacious, as he states that its neurotic properties are further developed by this process. The proving of Coffea is in StapPs * Additions/ Teste's article is an important one : and the ordi- nary uses of the drug are given by Hempel, and in an article by Dr. Weitenweber in the ' Brit. Journ. of Horn./ vol. v. You may also, if you like, read Hahnemann's somewhat exaggerated picture of the evil effects of coffee-drinking contained in his 'Lesser Writings/ Stapf well characterises the primary effect of Coffee as " a pathological excitation of all the organic functions. When Coffee acts moderately upon the healthy organism the irritability of the organs of sense is morbidly increased, the visual power becomes more acute, the hearing more sensitive, the taste is finer, the seusorium is more vivid (hence increased susceptibility to pain), the mobility of the muscles is increased, the sexual desire is more excited, even the nervous activity of the digestive and secretive organs is increased ; hence a morbid sensation of excessive hunger, increased desire and facility of the alvine evacuations and of the emissions of urine. To what an extent the nervous and COFFEA. 233 animal activity of the organism is increased by Coffee, appears from the sleeplessness which it excites in various shades and degrees, from the peculiar pathological excitation of the mind and soul, and from the febrile warmth which it excites to a considerable degree." This primary effect of Coffee is made use of in many ways, as you well know ; to arrest the paroxysm of ague and asthma, to relieve headache, and to antidote the depressing effects of vegetable poisons, such as Opium. But it also points to several conditions in which the drug may become homceopathically curative, as when pain is felt excessively (in labour, for instance), in nervous excitement, and especially in sleeplessness. One of the pains often cured by Coffea is toothache : the sufferer is restless and complains much, and the pain is temporarily relieved by cold. The more potent toxicological effects of Coffea and its " active principle" Caffeine have yet to receive their applica- tion to practice. In a case of poisoning related by Hempel, strangury was well-marked : and according to Lehman n, Caffeine, in doses of from 2 to 10 grains, causes violent excitement of the vascular and nervous systems, palpitations of the heart, extraordinary frequency, irregularity, and often intermission of the pulse, oppression of the chest, pains in the head, confusion of the senses, singing in the ears, scintillations before the eyes, sleepless- ness, erections, and delirium. Another important class of disorders produced by Coffea are those which result from its excessive use as a beverage. These are sketched clearly and without exaggera- tion by Teste. The chief practical result to which 234 COLCHICUM. they have led is its successful use in some forms of hemicrania ; the attack comes on in the morning, and lasts all day : there is increased sensibility, chilliness, and nausea. Coffea admits of close and profitable comparison with Chamomilla and Ignatia. It seems to be one of those medicines which act in almost any dilution. Thus of Dr. Hale's cases of toothache to which I have referred, two were relieved by the 3rd dilution, and the remaining one by the 200th. My next medicine is your old acquaintance Colchicum. We prepare the tincture from the root, by ex- pressing the juice, and treating the residue with alcohol. There is a short pathogenesis of Colchicum in Jahr's ' Manual,' taken from the Archiv. ; and a full (though not very fruitful) proving by Dr. Reil in the ' Brit. Journ. of Horn./ vol. xix. You will need to supplement the information derived from these sources with that afforded by Pereira, Teste, and Hempel. The physiological effects of Colchicum, though often described, have yet to receive their interpreta- tion. The vomiting and purging which always prominently appear are usually set down as the result of an inflammatory irritation : but without, as I think, sufficient evidence. Colchicum is undoubtedly a local irritant, when applied in substance. But when introduced into a vein, the COLCH1CTTM. 235 stomach only is found inflamed : and there have been several instances of poisoning by the tincture or wine, in which the autopsy has revealed no gastro-enteric inflammation whatever, although there had been constant and profuse evacuations. The clue to these phenomena seems afforded by a case cited by Hempel, in which the vomiting and purging, with the other symptoms, closely resembled those of Asiatic cholera. It would appear from this that Colchicum (like Veratrum, q. v.) vomits and purges not by local irritation, but by an influence upon the vaso-motor nerves of the ali- mentary canal similar to that exerted by the choleraic poison. Next to the stomach and in- testines, Colchicum acts most powerfully upon the kidneys. It is supposed to be diuretic : but I apprehend that the notion has arisen from observa- tion of its action in disease. In a short proving of it which I made some years ago upon my own person the quantity of urine was very notably decreased ; and suppression often occurs in cases of poisoning. Again, Colchicum was supposed to increase the proportion of uric acid in the urine, and thus to benefit gout. But Bocker has ascer- tained that it actually diminishes the quantity of organic solids in this excretion, leaving the salts and earthy phosphates unaffected : and Dr. Garrod has demonstrated the same thing as regards uric acid in particular. These seem to be the main points worthy of note about the physiological action of Colchicum. It appears also to increase the biliary and salivary secretions, and to depress the circulation. In one case the pleura were found 236 COLCHICUM. inflamed. Dr. Reil's proving, though very thoroughly carried out, adds little to our knowledge of Colchi- cura. A good many rheumatoid pains were caused, more in the muscles than in the joints : and Teste's statement seemed confirmed, that the neck is specially influenced by the drug. Several provers, moreover, had decided pleurodynia : and one a very severe occipital headache. And now what shall we say of the therapeutic virtues of Colchicum ? In Asiatic cholera, to which it is strikingly homoeopathic, it has never been used ; while you know it as a specifically acting remedy for gout, no symptoms of which disease (at least of its typical paroxysm) appear in its patho- genesis. You will say that Colchicum is no good instance of the operation of the law of similars. The aspect of the matter is, however, somewhat changed when we remember how important a place Veratrum holds in the treatment of cholera ; and that Colchicura is just Veratrum with a difference, the two having Veratria for their common alkaloid. I would even suggest the use of Colchicum in pre- ference in some cases, should much nausea be pre- sent, and the cramps attack especially the soles of the feet. I once effected a rapid cure of an obsti- nate case of diarrhoea with Colchicum, guided to this medicine by the deathly nausea and prostration which were present. As to gout, the question is more difficult. Although Colchicum undoubtedly has a specific power of allaying the pain, and even shortening the paroxysm of acute gout, it cannot be said to exert any curative influence over the morbid diathesis. Pereira writes "That Colchicum COLCH1CUM. 237 alleviates a paroxysm of gout I have before men- tioned ; but that alleviation is palliative, not cura- tive. It has no tendency to prevent a speedy recurrence of the attack ; nay, according to Sir C. Scudamore, it renders the disposition to the disease much stronger in the system. Furthermore, by repetition its power over gouty paroxysms becomes diminished." If this be a fair statement of the case, Colchicum would seem to act upon the part affected only ; and as a specific, indeed, but anti- pathic remedy, just as Gelseminum influences a painful uterus. Our treatment of gout is not so satisfactory as to enable us always to dispense with its aid ; but it is well that we should know on what principle and with what prospect we are acting in using it. So far as that the action of Colchicum in gout is local instead of general, I have little doubt of these views being correct. But I am not so sure about the antipathic nature of its influence, for this reason. You know that the gouty poison attacks many other parts besides the small joints the head, the heart, the stomach, and so on ; that we have gouty neuralgia, pleurodynia, urethritis, oph- thalmia, orchitis, and angina. Now Colchicum does simulate pretty closely some of these maladies ; and in very small doses relieves or cures them. I have put in a note a reference to a case of pleuro- dynia to illustrate this statement.* On the whole, then, I think we may conclude that Colchicum acts upon the tissues so far similarly to the gouty poison as to be capable of relieving many of its local mani- * ' Annals,' vol. ii. 238 COLCHICUM. festations ; but has no power over the primary source of the production of the poison. Rheumatism is so similar, also in its local mani- festations, to gout that it is not surprising that Colchicum should be one of its remedial antidotes. It is homoeopathic mainly to muscular rheumatism ; but in one case of Dr. Kidd's* and one of Dr. Laurie's f showed such remarkable power of con- trolling rheumatic pericarditis, that it ought to be more frequently used in the treatment of this affec- tion. Teste recommends it in rheumatic torticollis ; and says that " the arthritic pains to which it corre- sponds are generally tearing. In warm weather they are principally felt at the surface of the body ; as the air grows cooler they seem to penetrate the deeper tissues and bones/' This is all I have to say about the therapeutic power of Colchicum. But I know of no drug which seems to promise more extensive applications in the future. Actaea racemosa, Arnica, Bryonia, and Veratrum seem to me the closest analogues of Colchicum. The mother-tincture and the lowest dilutions appear to be its most successful form of adminis- tration. Another valuable contribution to our Materia Medica from the indigenous plants of the American continent is the * ' Brit. Journ. of Homoeopathy,' vol. xiii, p. 198. t Ibid, vol. v, p. 314. COLLINSONIA CANADENSIS. 239 Collinsonia canadensis. The tincture should be prepared from the whole plant. In Dr. Male's ' New Remedies' may be found a short proving of Collinsonia, together with all that is known about the drug. From this proving, and from the considerable clinical experience now accumulated, we are able to define pretty clearly the sphere of action of Collin- sonia. It affects the whole gastro-intestinal canal, but especially the rectum. The presence of flatu- lence, spasm, and colic in the parts above confirm the indications for the remedy drawn from the con- dition of the rectum itself; but these last alone are decisive. From Dr. Burt's proving it appears that Collinsouia in small doses causes constipation, with straining and dull pain in the anus after stool. Here is shadowed forth the most important action of the drug. It is in constipation and haemorrhoids from congestive inertia of the lower bowel that Col- linsonia proves such a precious remedy. We fre- quently meet with such a condition in the middle and latter months of pregnancy ; and here I have the greatest confidence in the drug. Nor, though acting primarily on the rectum, does it confine its curative influence to that one only of the pelvic viscera. In many uterine affections connected with constipation it is of great value. Cases are collected by Dr. Hale in which dysmenorrhcea, pruritus, and even prolapsus uteri have under such circumstances yielded to its use. One of the cases of pruritus was a woman in the eighth month of pregnancy : so 240 COLLINSONIA CANADENSIS. that Collinsonia should be remembered when we meet with that distressing form of the affection. In larger doses, Collinsonia irritates the rectum so much as to set up diarrhoea, soon running on into dysentery : there are severe colicky pains in the hypogastric region before and after the stools, and much tenesmus. It has not been used to any extent in complaints of this kind ; but in proctitis and rectal dysentery it should rival Aloes. The rectum is thus the main field of action of Collinsonia; but you will see from Dr. Hale's article that it is gaining considerable reputation as a cardiac remedy. Time will show its real place and value here. I have already hinted that Aloes is a close ana- logue of Collinsonia. So also is JEsculus, and more remotely Hydrastis, Nux vomica, and Sulphur. I have nearly always used the 2nd dilution ; but others seem to have done as well with the 3rd, and others with more material doses. Herein also Collinsonia resembles JSsculus. LETTER XX. COLOCYNTH, CONIUM, COPAIBA, CORALLIA, CROCUS, CROTALUS. THE medicine of which I now have to speak is a crucial instance of the fruitful results attainable by our process of " proving." Here is a drug which you of the old school know simply as a purgative. A few physicians agree to test its effects upon their own bodies ; and lo ! a range of action is revealed which at once puts it in a high place among specific remedies. Colocynth. The dry pulp of the fruit may be either triturated, or macerated in alcohol to make a tincture. There is a short pathogenesis of Colocynth in ' Hahnemann's Chronic Diseases/ But our know- ledge of the drug has been immensely increased, and indeed pretty well perfected, by the exhaustive proving of the Austrian Society. The account of this proving, with introduction and clinical cases, by Dr. Watzke, is translated from the ' Austrian Journal' in MetcalPs ' American Provings.' As I have said, you know Colocynth only as a purgative. You are probably aware, however, that this action is specific, and not merely local ; being 1C) 242 COLOCYNTH. induced by its external application as well as by its introduction into the stomach. It seems most pro- bable that it purges the lower bowel only, as the rectum is the only part of the alimentary tract found inflamed when a poisonous dose is injected into a vein. As under such circumstances there is no manifest irritation of the stomach, the vomiting which has been observed as a consequence of its external application would appear to result from an influence upon the (gastric) nerves. Still more certain evidence of such an influence is the severe colic which always accompanies the purgative action of Colocynth, and which is more marked with it than with any other cathartic. The pain is generally about the umbilicus, is increased by food, and relieved by the accompanying diarrhoeic evacuations. I have only to add to this part of the subject, that in one case of poisoning by Colocynth the intes- tines were glued together by recent lymph, showing its power to inflame the peritoneum. The colic and diarrhoea so characteristic of Colo- cynth were experienced by all the provers. But in most of them other symptoms appeared, showing the power of the drug to act upon the nervous trunks on the surface as vigorously as we have already found it to act upon the abdominal plexuses. The trigeminus is not uncommonly affected, causing toothache and hemicrania. But the nerves about the hip-joint suffer most severely, the pain darting sometimes down the anterior crural and sometimes down the sciatic trunks, even to the foot. This local affinity of Colocynth is so strong, that it seems to aft'ect the ovaries : the only two provers COLOCYNTH. 243 of the female sex complaining of deep stitches as from a needle in these organs. Once or twice, too, Colocynth has shown signs of affecting the testicles and spermatic cord. The therapeutical virtues of Colocynth are a true reflection of the pathogenetic powers now de- scribed as belonging to it. It is occasionally but rarely indicated in dysentery. It is homoeopathic to this disease only when the morbid process is confined to the rectum, when the evacuations consist chiefly of blood, and when severe colic is present. So also it may now and then be of service in peritonitis : Dr. Ludlam recommends it especially when that portion of the membrane which envelops the ovaries is affected. In both these inflammations, however, I prefer Mercurius corrosivus as a rule. The grand sphere of Colo- cynth lies among the neuroses, especially where pain is the most prominent feature. In Dr. Watzke's article you will find collected a number of cases in which neuralgia of the fifth nerve, of the solar and other abdominal plexuses, and of the lumbar and femoral nerves have been cured in a brilliant manner by this medicine. It is in colic and sciatica that its greatest triumphs have been achieved. I have myself been disappointed with it in the latter disease, greatly preferring Arsenic. But for colic I rarely require any other remedy, save in those cases for which Plumbum is the obvious similimum. I have only to add a case mentioned by Dr. Carroll Dunham,* in which Colocynth, given because of the presence of its cha- * ' Amer. Horn. Review,' vol. vi, p. 84. 244 CONIUM MACULATUM. racteristic symptoms in the abdomen and about the hip caused the permanent disappearance of an en- larged ovary. In one of the provers, too, it removed neuralgic pain and swelling of the right testicle and spermatic cord the result, as he believes, of his previous provings of Natrum muria- ticum. The medicine which seems to me most closely allied to Colocynth is Bryonia. It has some points of analogy, moreover, with Arsenicum, Chamomilla, Chelidonium, Cocculus, Gamboge, and Nux vomica. In colic and the other neuralgias the higher dilu- tions (6 30) have made the most brilliant cures. The lower potencies would be preferable where inflammation is present. We have next to study the action of the true hemlock, Conium maculatum. Our tincture is made from the expressed juice of the whole plant, and is hence a far more certain preparation than the tincture and extract in common use. This your own Harley has lately discovered (' Lancet/ March 23, 1867). There is a proving of Couium (to me a very un- satisfactory one) in the ' Chronic Diseases/ Teste gives a good account of Storck's cases said to have been cured by the medicine. Much has been written about the action of hem- lock upon the nervous centres. After all it seems to me that we have no better description of the phenomena of poisoning by it, than in Plato's ac- CONIUM MACULATUM. 245 count of the death of Socrates.* I make no apology for gracing these pages with the passage from the Phsedo which contains it. " Socrates, having walked about, when he said that his legs were growing heavy, lay down on his back; for the man so directed him. And at the same time he who gave him the poison, taking hold of him, after a short interval examined his feet and legs; and then having pressed his foot hard, he asked if he felt it. He said that he did not. After this he pressed his thighs ; and thus going higher, he showed us that he was growing cold and stiff. Then Socrates touched himself, and said that when the poison reached his heart he should then depart. But now the parts around the lower belly were almost cold ; when, uncovering himself, for he had been covered over, he said (and they were his last words) " Crito, we owe a cock to JEsculapius ; pay it therefore, and do not neglect it/' " It shall be done," said Crito, " but consider whether you have anything else to say." To this question he gave no reply ; but shortly after he gave a convulsive move- ment, and the man covered him, and his eyes were fixed : and Crito, perceiving it, closed his mouth and eyes." If now you go oil to read the admirably described case of hemlock-poisoning, which Dr. Hughes Ben- nett has given us in his ' Clinical Lectures/ f the * It is now well -established that the KMVIIOV with which the Athenians poisoned their criminals is identical with our spotted hemlock (Conium maculatum). f Dr. Harley obtained the same results from his recent experi- ments. 216 CONIUM MACULATUM. identity of the phenomena will need no demonstra- tion. During the 2000 years which separate the two cases much has been observed and written relative to Conium. But I cannot doubt but that we see in them the essential phenomena of its poisonous influence : that it directly paralyses the spinal cord from below upwards, killing at last by gradual asphyxia. Cases indeed are mentioned by Pereira in which coma, delirium, or convulsions were the predominant features. But there has always been so much confusion between Conium maculatum and the other Umbelliferse, that until these symp- toms are confirmed by experiment as truly belonging to it, I feel compelled to refer them to the action of other plants of the same order. While this is the main action of Conium, there is no doubt of its exercising an influence also in the vegetative sphere, as shown by its action on the glands and the skin. Wasting of the mammse and the testicles, with agalactia and amenorrhoea, have not uncommonly resulted from its use : and the provings confirm Pereira' s statement that it " oc- casionally causes an eruption on the skin." The provings also reveal an action on the larynx or laryngeal nerves which has been so often confirmed in practice as to be no longer doubtful : it shows itself in a dry, hacking, almost continual cough, worse on lying down and at night. When we turn to therapeutics, we cannot but feel that the neurotic action of Conium has not yet been utilized in practice. Given on the antipathic principle, it has (as Pereira admits) utterly failed : and Homoeopathy has not yet applied it to the treat- CONIUM MACULATUM. 247 ment of that paraplegia to which it so characteris- tically corresponds. In our school, indeed, Conium has been used as a vegetative remedy only. It is considered a specific for engorgements of the mam- mary and other glands resulting from mechanical causes. It is of some repute in the treatment of cutaneous diseases, especially of the scaly and tuber- cular orders : it frequently relieves irritative coughs having the characteristics I have mentioned above : it is considered beneficial where presbyopia comes on prematurely : and is said to be a capital medicine for old people, especially old womeu. So far as I have used Conium, I can confirm these recommenda- tions. But a perusal of the remarkable cases which Storck has published leaves on the mind, after all deductions, an impression that the virtues of Conium are more extensive than we yet suppose. I would especially suggest its freer use in ovarian depression, showing itself in scanty menstruation and unready conception, as well as in chronic passive inflamma- tions of the organs themselves.* In its action on the spinal cord Conium resembles Rhus and Argentum nitricum ; in the vegetative sphere its analogues are Iodine, Mercury, and Baryta. The Homoeopathic uses of which I have spoken * I have said nothing about the action of Conium in cancer. There is no evidence that it exerts any influence over the carcino- matous diathesis. And as to the disappearance of local cancers under its use, the word " scirrhus" was used so vaguely in the last century, that we cannot depend upon its clinical records in this particular. Neither Alloaopathy nor HomcEopathy has produced for the last thirty years a case cured by Conium, which our improved diagnosis has warranted to be true cancer. 248 COPAIBA. have been obtained with dilutions such as the 12th. It remains to be seen whether lower potencies will not be needed for its more extended application. The medicine next on our list is Copaiba. Our tincture is a solution of the balsam in strong alcohol. There is a pathogenesis of Copaiba in Jahr's ' Manual/ which seems made up of the symptoms observed as a result of excessive medicinal doses. Teste gives us a proving made on himself and several others, but only with the 6th dilution. The interest of Copaiba centres in its action on the urinary mucous membrane. It is generally acknowledged that it acts here as an irritant, the influence being strongest in the urethra and becom- ing weaker as it ascends towards the kidney. Some- times indeed the irritation travels along the seminal tracts, and the testicle swells and is tender. Even rheumatism, according to Pereira, has been ascribed to the use of the balsam. But without building upon this latter statement, enough has been said to show the perfect homosopathicity of Copaiba to gonorrhoea, in the treatment of which disease it has so high a reputation. I must refer you to Dr. Yeldham's book for the indications of choice of Cannabis and Copaiba respectively. You will bear Copaiba in mind in other non-specific disorders of the urinary mucous membrane. I have found it especially valuable in irritation of the urethra and neck of the bladder occurring in old women. I am CORALLIA RUBRA. 249 unaware that the eruption now measle-like, now urticarioid, now erythematoid which so often ac- companies the action of Copaiba has ever been utilized in practice. Nor am I able to affirm that its reputation in bronchial affections depends upon its power of specifically affecting that membrane ; though Testers proviugs would point in this direc- tion. Cannabis sativa, Cantharis, and Terebinthina are the nearest analogues of Copaiba. There seems nothing gained by raising Copaiba above the 1st dilution : and in gonorrhoea Dr. Yeldham advises several drops of the 1st dec. for a dose. I have but a few words to say of the next name on my list, Corallia rubra. It is prepared by trituration. There is a short pathogenesis of coral in Jahr's ' Manual :' but our only real knowledge about it is derived from Teste. " In the provings," he writes, " which I made with this drug on my own person, some years ago, I elicited a few exceedingly cha- racteristic symptoms, which induced me to prescribe it, sometimes with striking success, for nervous cough, asthma Millari, and endemic hooping- cough." In his ' Treatise on Diseases of Children/ M. Teste places Corallia first among the remedies for laryngismus stridulus and the spasmodic stage of pertussis, and says that a patient to whom he had given this medicine for a chronic convulsive 250 CROCUS SATIVUS. cough, said to him, " it is like water thrown upon fire." I have myself once or twice given Corallia in hooping-cough with very satisfactory results. More recently, I have made a striking cure of a hysteric cough with Corallia : you will find the case in the ' Brit. Journ.' for July, 1867. If the laryngeal nerves be the seat of the action of Corallia, its analogues will be Nitric acid, Bella- donna, Drosera, Hyoscyamus, Ipecacuanha, and Nux Vomica. For dose, M. Teste recommends for children the 30th dilution. I come now to a medicine which Homoeopathy has revived out of long neglect and disuse, the saffron, Crocus sativus. We prepare a tincture by maceration from the saffron of commerce. There is a very fair proving of Crocus in StapFs ' Additions to the Materia Medica.' Hempel and Teste should also be consulted. The ancient reputation of Crocus as an emmena- gogue, though ignored by modern therapeutists, has been confirmed by our provings. We of course use the drug medicinally for precisely the opposite purpose, viz., to restrain menorrhagia. It is specially recom- mended where the menstrual blood is blackish and clotted. I have cured with Crocus many a case of menorrhagia so characterised, giving this drug during the period, and China in the intervals. Crocus has some power of affecting the brain, CROTALUS HORRIDUS. 251 causing determination of blood thereto, with epis- taxis ; and exciting in some persons immoderate fits of laughter. It might be useful in hysteria or even in recent insanity in which this symptom was prominent. I am myself most struck, in reading the pathogenesis of Crocus, with the eye-symptoms. It ought to be very useful in that form of weak vision in which the patient feels as if there were a gauze before the eyes, and tries to wink or wipe it away. The analogues of Crocus are Belladonna, Platina, Sabina, and (most complete of all) Ruta. I have always given the 2nd dilution : and should prefer descending to ascending the scale. With a few words upon the medicine we know as Crotalus horridus I will conclude this letter. In this case it is fortunately unnecessary that we should use the creature which yields the venom as the subject of our trituration or maceration ; which would indeed be rather inconvenient. The virus only is prepared, preferably by trituratioc. There is a pathogenesis of Crotalus, taken from Hering on the Poison of Serpents, in Jahr's 'Manual.' Dr. Neidhard's Monograph on the use of Crotalus in yellow fever should above all be consulted. For the general principle of the use of animal poisons as medicines I must refer you to my pre- vious remarks introductory to Apis. The virus of the rattlesnake has many effects in common with 252 CROTALUS HORRIDUS. that of other venomous serpents. Of these I shall speak more fully when I come to Lachesis and Naja. Crotalus is so much less used than these other two that I shall content myself with men- tioning Dr. Neidhard's observations regarding it. He calls attention to the general resemblance between the effects of snake-bites and the pheno- mena of yellow-fever. He then relates how Dr. William Humboldt conceived the idea of preserving the body against the contagion of yellow-fever by inoculating it with snake poison : and this on the ground of the close resemblance between the effects of viper-bites and the symptoms of this malady. He carried out his idea on a large scale in New Orleans and Cuba, and with considerable success. The symptoms produced by the inoculation, and closely watched, made the resemblance to yellow- fever still more striking. Finally, Dr. Neidhard gives his own experience with the triturated virus in the curative treatment of the disease, which seems to have been very satisfactory. He has also found it very useful in the severe bilious remittents from which we are happily free. I have only to add that my friend Dr. Hilbers has much confi- dence in Crotalus as alleviating the symptoms (especially the cough) of phthisis. I have already mentioned Lachesis and Naja as the analogues of Crotalus. Dr. Neidhard used the triturations 1 3. LETTER XXI. CROTON, CUPRUM, CURARE, CYCLAMEN, DIGITALIS. I commence my present letter with an account of the Homoeopathic uses of Croton tiglium. The expressed oil is triturated with milk-sugar, or dissolved in alcohol. There is a short pathogenesis of Croton in Jahr's ' Manual/ Its physiological effects are better studied, however, in the articles upon it in Pereira, Hempel, and Teste. Croton is another of those drugs whose use well illustrates the difference between the old Medicine and Homoeopathy. It is found to have drastic and rubefacient properties. Hence, says Old Medicine, we will use it to purge and to counter-irritate whenever we think such processes likely to be beneficial. Nay, replies Homoeopathy : Croton will rather be a remedy for certain forms of diarrhosa and of cutaneous inflammation, resembling those which it causes. And this we have indeed found it to be. The purgation produced by Croton seems not the result of inflammatory irritation, but rather of such a transudation of the watery part of the blood as is 254 CROTON TIGLIUM. caused by Elaterium and Veratrum album, and obtains in Asiatic cholera. The accompanying symptoms in severe cases, indeed, are strikingly choleraic in character : and Croton might fairly take rank among the remedies for choleraic diarrhoea. It has not, however, been so much used in this sphere as in that of cutaneous disease. Teste was the first to call attention to the specific nature of its action on the skin, and to recommend it as a cutaneous remedy. Later, Dr. Bahr of Hanover has followed in the same track : you will find his observations translated in the ' Brit. Journ. of Horn.,' vol. xvi. It is agreed that eczema is the special form of exanthem developed by Croton : and that the face and the external genitals are its favourite habitats. It is precisely in such eczematous rashes that both Teste and Bahr have found it curative : and I can add my mite of confirmation to their statements. The rapid and permanent manner in which Croton relieves the itching attendant upon eczema is one of the prettiest things in medicine. The analogues of Croton as a drastic are Elaterium, Veratrum and Colchicum ; as a cutaneous irritant it ranks with Rhus, Apis, and Anacardiurn. The dilutions from the 3rd decimal to the 6th centesimal have been successfully used. I myself nearly always employ the latter potency. I come now to one of the great mineral medicines CUPRUM. 255 Cuprum. Triturations are made of the precipitated metallic copper, or aqueous dilutions of the Acetate. The proving of Cuprum is in the ' Chronic Diseases.' A good collection of cases of poisoning by the metal and its salts may be found in HempeFs article. The poisonous action of Copper, like that of most metals, seems exerted primarily upon the alimentary canal, and secondarily, after absorption, upon the nervous centres. The primary action has led to little practical use : but you are surely prescribing homceopathically when you give sul- phate of copper for chronic diarrhoea. The neurotic influence of Copper is very decided. Pereira puts its homoeopathic relationship to nervous disorders very plainly. " The effects produced by the long- continued use of small doses of the preparations of copper have not been satisfactorily determined ; they are said to be various affections of the nervous system, such as cramps and paralysis," and so on. Then he writes " If the cupreous preparations be used in very small doses, they sometimes give relief in certain diseases principally of the nervous system, without obviously disordering the functions ; in other words, in these instances the only apparent effect is the modification observed in the morbid condition." This is pretty well : but we must individualise rather more closely. The cramps mentioned by Pereira are especially characteristic of the action of Copper. They may be either tonic or clonic, local or general ; and sometimes they are 256 CUPRUM. exchanged for spasmodic cough or difficulty of breathing. Here is the first great homeopathic use of Cuprum, to relieve cramp or spasm. Its applications in this direction are numerous. The chief of these are to spasmodic affections of the respiratory organs, as laryngismus stridulus, hooping-cough, and asthma, in all of which it has been found beneficial,* and in Asiatic cholera. It is of course the tendency to cramp which obtains in the latter affection which gives Cuprum a place among its remedies. The alvine evacuations of cholera are altogether different from those produced by Copper : and I see no evidence that the latter has the power of causing anything like the choleraic collapse. .But there is testimony from many quartersf that it is the best medicine we have for checking the cramps and also the vomiting of Asiatic cholera. We give Cuprum also occasionally for chorea and epilepsy ; but less frequently than you do.J Another noticeable point in the neurotic action of Cuprum is its powerful influence upon the brain. Almost every form of cerebral disorder has been induced by its poisonous action : at the same time autopsy shows no sign of organic mischief. The power of Cuprum in this sphere has received special study from Dr. George Schmid of Vienna. You will find his paper on the subject translated in the ' Brit. Journ. of Horn./ vol. i. He strongly * For laryngismus see a case in ' Brit. Journ. of Horn.,' vol. xxiii, p. 675 : for asthma read Dr. Russell's ' Clinical Lectures.' t See especially Dr. Drysdale in ' Brit. Journ. of Horn./ vol. viii, p. 158, and Mr. Proctor in ibid., January, 1867, p. 94. J For epilepsy see Dr. Bayes in ' Monthly Horn. Rev.' for March, 1867. CURARE. 257 recommends the use of Copper (in the form of the Acetate) in the cerebral symptoms which result from the retrocession of any of the acute exanthe- mata, or from difficult dentition in children when the condition is scarcely active enough to require Belladonna. These suggestions have been con- firmed by the after-experience of most Homoeopaths, and this use of Cuprum may be considered esta- blished. Less certain is its value in the other affections for which Dr. Schmid recommends it, as in the delirium which supervenes in the last stage of chronic diseases (as phthisis), in cerebral distress from over-study, in puerperal mania, in mania from repelled erysipelas, and in nervous apoplexy. But his whole paper is well worth studying. The natural analogues of Cuprum are the other metals, Argentum, Arsenicum, and Zincum. It has points of resemblance, moreover, to Nux vomica and Secale. The higher potencies of metallic Copper, the lower of Cuprum aceticum, have been most frequently given with success. My next medicine is one of almost purely physio- logical interest to you, but which Homoeopathy has lately begun to employ in practice. It is the Indian arrow-poison, variously called wourali, woorara, or (as we have it) Curare. It is prepared for our use by solution in water. After the third potency, the higher dilutions may be made with alcohol. 17 258 CYCLAMEN EUROPIUM. Our knowledge of the poisonous action of Curare is well put together by Dr. Carfrae in the 'Annals,' vol. iv, p. 97. Cases illustrating its curative power have been given us by Mr. Freeman in the ' Monthly Homoeopathic Review' for September, 1865. The poisonous effects of Curare are very well ascertained. It seems to act purely and simply upon the motor portion of the nervous system, paralysing it, and doing so from the periphery towards the centre. You have very naturally tried it in tetanus : but without success. We on the other hand have as naturally endeavoured to put it to use in the treatment of paralysis. Mr. Freeman's observations are the only records of its use which we have at present. He specifies his cases as ]. Paralysis of the parts supplied by all the motor cranial nerves, pain being absent. 2. Lateral paralysis after apoplexy. 3. Paralysis from me- chanical injury. 4. The class of cases known as nervous debility. 5. The debility of aged persons. 6. Debility after exhausting illness. In all these forms of nervous depression Curare seems to have been more or less useful. But we need further experience to enable us to fix its precise place in our therapeutics. The dilutions from 3 to 12 were used in Mr. Freeman's cases. The next medicine on my list is the common sow- bread, Cyclamen europseum. The tincture is prepared from the fresh plant, by DIGITALIS PURPUREA. 259 cutting it in pieces and macerating it in double its weight of alcohol. The original proving is in the ' Mat. Med. Pura.' There is an additional proving by the Vienna provers in the ' Austrian Horn. Journal': and some remarks and cases illustrative of its therapeutic virtues by Dr. Eidherr may be read in the ' North Amer. Journ. of Horn./ vol. x, p. 113. The only constant and remarkable actions of Cyclamen are upon the head and eyes, and upon the female sexual organs. Headache with dizziness, and obscuration of sight are the symptoms of the former parts. When these have been present in cases of chlorosis from checked menstruation, Cycla- men has proved in Dr. Eidherr's hands a most valuable remedy, restoring the menses and with them the general health. The resemblance to Pulsatilla is most obvious. In Dr. Eidherr's cases the 15th dec. dilution was that used. We come now to a medicine which is deservedly a favourite, both with yourselves and with us, the purple foxglove, Digitalis purpurea. A tincture is prepared by expressing the juice of the fresh leaves. The dried leaves also may supply us an alternative form, being triturated : and tritura- tions should be made of Digitaline. Our literature bearing on Digitalis is rather extensive. There is the original proving in the 1 Chronic Diseases/ which is not worth much, being 260 DIGITALIS PURPUREA. little more than a badly arranged collection of symp- toms produced by Digitalis upon sick persons. Then Dr. Bahr, of Hanover, has contributed a prize essay on the drug, a full account of which is given in the ' North Amer. Journ. of Homoeopathy/ vol. vii. Our own Dr. Black has written a no less valuable monograph on Digitalis, which you will find in the ' Brit. Journ. of Homoeopathy/ vol. iv. In this paper Jorg's experiments are detailed. Dr. Black^s conclusions with respect to the nature of the action of Digitalis upon the heart have been reviewed in the light of more recent investigations by Dr. Madden and myself, in a paper on this subject in the same Journal, vol. xxi. If to this you will add what Hempel and Teste on our side, and what Christison and Taylor, Pereira and Wood on yours have written about Digitalis, you will have before you all that is known regarding the drug. In the following re- marks, I will endeavour to put this mass of material into some intelligible expression. I. The most interesting and important action of Digitalis is that which it exerts upon the heart. In the paper above referred to, after bringing together all available evidence upon the subject, we conclude that Digitalis acts directly upon the muscular tissue of the heart, which it weakens even to the extent of paralysis ; that the increased frequency of the pulse which results from small doses depends mainly upon cardiac debility, nature endeavouring to make up by greater frequency for decreasing power ; and that the retardation of the heart's action which is caused by large doses is due to an influence trans- mitted through the vagi. The irregularity and DIGITALIS PURPUREA. 261 intermission of the pulse so characteristic of the drug we also ascribe to the cardiac debility it induces. We then consider the grounds on which Dr. Hand- field Jones and others have lately impugned these generally received doctrines about Digitalis. They are struck with its remarkable curative virtues in cases of enfeebled heart. To admit the ordinary view of its pathogenetic action is to grant the truth of the Homoeopathic law in this instance. Such a conclusion would be very unpalatable : and so Dr. Jones inquires whether it is not possible that the action of Digitalis is, after all, stimulating rather than depressing. He performs some experiments on animals, and finds the heart, after poisoning by Digitalis, contracted and empty. He argues that this implies tonic contraction rather than paralysis of the muscular tissue : and therefore that Digitalis acts (probably through the nerves) as a cardiac tonic and excitant. Upon this apparent contradiction we bring to bear the researches of M. Claude Bernard. He shows that Digitalis is one of the poisons which act directly upon the muscular tissue, paralysing and killing it. It affects that portion of muscular tissue which constitutes the heart earlier than any other ; so that in cold-blooded animals (as frogs) the heart's action may cease for four hours before general death ensues, there is, as Dr. Harley expresses it, a dead heart in a living body. Rigor mortis sets in exceedingly early ; and on opening the thorax immediately after death, the heart is found contracted, rigid, motionless, and totally empty. A farther examination discloses remarkable chemical and electrical changes in the heart and 262 DIGITALIS PURPUREA. other muscles. The muscular juice is acid instead of alkaline ; and the external surface is electrically negative to the cut surface, instead of (as normally) positive. These results we consider to establish beyond doubt that pathogenetic influence of Digitalis which has been inferred from the symptoms it occasions. By them also Dr. Handfield Jones' experiments obtain their elucidation. The heart poisoned by Digitalis is indeed contracted, and not dilated : but the contraction is the rigor mortis. The immediate cause of this phenomenon has been shown to be the change of the muscular juice from alkaline to acid : and this very change is involved in the destructive action of the drug upon the integrity of the muscular tissue. II. Digitalis has thus far shown itself to be a very important myotic poison : and, so far as the pneumogastrics are concerned, to act also as a neurotic. Farther observation shows that its neurotic influence like that of Tartar emetic and some other drugs is confined to these nerves. Upon disturbance of their function depend the nausea and vomiting so readily induced by Digi- talis. III. Tissue irritation is not a prominent feature in the pathogenesy of Digitalis. It exerts, how- ever, a considerable influence of this kind upon the kidneys; and shows some signs of affecting the brain and special senses, the genital organs, and some mucous and serous membranes. 1. To call Digitalis a diuretic is a very imperfect way of expressing its action upon the kidneys. It by no means invariably increases the secretion of DIGITALTS PURPUREA, 263 urine in healthy persons ; and in poisoning by large doses suppression is often noticed. It is in all pro- bability a specific irritant of the renal tissue, like Arsenic, Terebinthina, and Kali bichromicum. 2. The influence of Digitalis upon the brain is evidenced by various cerebral symptoms, and by consentaneous subjective disorders of the sight and hearing. Headache, chiefly frontal, heavy and throbbing in character, has often been observed : there is buzzing in the ears ; and the sight is dim, with sparks and frequently colours before the eyes. The only clue to the meaning of these symptoms (which remind one of those of Quinine) is that in post-mortem examinations the cerebral meuinges are found highly injected. Vertigo and restlessness, when induced by Digitalis, are due, I think, rather to its cardiac than its cerebral influence. 3. The genital organs were pretty uniformly excited in Jorg's provers. I am unable to say upon what part of the sexual apparatus, or in what manner Digitalis here acts. 4. Of the mucous membranes, the stomach and descending colon are specifically inflamed by Digitalis. It causes ash-coloured stools : but not, I think, through any influence on the liver. Dr. Inman has shown that the faeces do not become brown until they reach the colon, and that the green stools of infants assume their peculiar colour at this point also. It would appear therefore that the secretion from the follicles of the colon has an inportant influence upon the colour of the faeces. It is in this way I conceive that Digitalis whitens the stools : for it causes no other element of jaundice 264 DIGITALIS FURPUREA. or sign of hepatic disorder. Upon the respiratory organs the influence of Digitalis is more problem- atical. Dr. Bahr, however, states that in his ex- periments nasal catarrh and hoarseness were very common ; while one prover experienced slight pain and oppression in the chest, with a dry cough, and afterwards ending in lumpy expectoration, and shortness of breath at first continuous and later in paroxysms. I will now discuss the therapeutical uses of Digitalis, following the same categorical order as that in which I have arranged its pathogenetic effects. I. From our considerations relative to the action of Digitalis upon the heart it follows that this medicine is homceopathic to every form and stage of cardiac weakness up to complete dilatation and paralysis. Simple enfeeblement of the muscular walls of the heart I apprehend to be a very common morbid condition. Vertigo, tendency to syncope, breathlessness on exertion, and palpitation some or all of these are its symptoms : and it finds in Digitalis a potent and rarely-failing remedy. The physicians of the old school are beginning to find this out : and Dr. Handfield Jones proclaims that Digitalis is " our cardiac tonic /car' t^o^rjv, spe- cially to be resorted to in cases of asthenia and peril from failing circulation."* But if, according to his theory, Digitalis acts upon the heart only through its nerves, it is difficult to see how it can * I would add my mite of confirmation to Dr. Jones's estimate of the value of Digitalis in these cases. It is one of those few medicines with which one can fight the king of terrors face to face, and overcome him. DIGITALIS PURPUREA. 265 exercise more than a temporary stimulant influence upon it. A drug can surely give strength to a tissue only by acting directly upon the tissue itself, or upon the blood which nourishes it. The result and organic form of enfeebled heart is dilatation of the right ventricle, leading sooner or later to drop- sical effusion. In these cases, though cure is hardly to be hoped for, Digitalis is of immense service in prolonging life, keeping off dropsy, and quieting distressing symptoms. These virtues of the medicine are known to our alloeopathic brethren, who are somewhat puzzled thereby. " The enlarged and flaccid heart," observes Sir H. Holland, " though, on first view, it might seem the least favourable for the use of the medicine, is, perhaps, not so. At least, we have reason to believe that in the dropsical affections so often con- nected with this organic change, the action of Digi- talis as a diuretic is peculiarly of avail." And Pereira, who has previously stated that " in a consi- derable number of instances the pulse becomes irre- gular or intermittent under the use of foxglove," writes farther on " In patients affected with an intermittent or otherwise irregular pulse, I have several times observed this medicine produce regu- larity of pulsation, a circumstance also noticed by Dr. Holland." II. The neurotic influence of Digitalis, which (as we have seen) is limited to the pneumogastric nerves, has hitherto been unused in practice. It might sometimes help us in cases of nausea and vomiting such as those for which we think of Tartar emetic, Lobelia, and Tabacum. 266 DIGITALIS PURPUREA. III. 1. The so-called " diuretic" influence of Digitalis has led to its being extensively used in ordinary practice in the treatment of dropsy. From what we have said I think you will agree with me that when it has proved curative of this disease it must have been in virtue of its homoeopathicity. Cardiac dropsy it would benefit by toning the heart : and in the renal form its specific influence on the kidneys would render it well-calculated to restore these organs to a healthy state. It has occa- sionally been used successfully in dropsy in our own school. 2. The indications for Digitalis in certain forms of headache and certain functional derangements of the retina and auditory nerve are well-marked, but have as yet received no therapeutical application. Hahnemann writes " Hardness of hearing, with hissing as of boiling water, has been frequently cured by Digitalis, when the other symptoms corresponded likewise to that drug." It has some repute, I believe, in your school as a remedy for acute hydrocephalus : but I do not see my way to its action here. There is a case, however, in the ' Brit. Journ. of Horn./ vol. vii, in which Dr. Watzke apparently cured this disease with Digitalis and Veratrum, given in alternation.* When delirium depends (as it sometimes does) on failing power of the heart, Digitalis will quiet it. Hence, I apprehend, its occasional value in delirium tremens. 3. Of the genital organs I can only say that * There is another case in which Digitalis seems to have been curative, in the same Journal, vol. xii, p. 496. DIGITALIS PURPTJREA. 267 Digitalis has been given with reported advantage as an anti-aphrodisiac, and in spermatorrhoea. 4. It is no uncommon thing to be consulted about children whose liver is said to be locked up, because they are passing white chalky stools. There is no jaundice or other hepatic symptom : and I do not believe that the liver is here at fault at all. I believe it is just such an affection of the colon as we have found Digitalis to cause : and this drug has proved a capital remedy for it. I must tell you, however, that true jaundice is said to have been occasionally cured by Digitalis. The interest of the action of Digitalis in the respiratory sphere lies in its reputed power over pulmonary phthisis. It is, I suppose, pretty well abandoned now : but Teste, after considering the eighty three cases of reported cure of this disease by Digitalis collected by Bayle, concludes that some at least must have been true phthisis. I have no experience with it here. Digitalis finds a good many parallel medicines in its many sided action. As a myotic, its only fellows are Arnica, Arsenic, and Phosphorus : myalgia, cramp, and fatty degeneration being to these drugs respectively what paralysis is to Digi- talis. In its influence on the pneumogastric, Digitalis resembles Tartar emetic, Lobelia, and Tabacum ; as a renal poison its analogues are Colchicum and perhaps Scilla. In its action on the heart it stands quite alone Arsenic and Kalmia alone approaching it at all in character. The question of dose as regards Digitalis has some interesting points about it. It seems strange 268 DIGITALINE. that a drug so perfectly and primarily homoeopathic to weakness of the heart should not aggravate rather than improve this condition in the full doses prescribed in the old school. Yet they seem to obtain none but beneficial results from doses of the tincture varying from 5 to 15 minims. Lately, a still more surprising administration of the drug has taken place. The tincture has been given in half- ounce doses, several times repeated, as a remedy for delirium tremens ; and does not seem to have done any harm. Any attempt, however, to give the same quantity of the infusion will bring on distress- ing and sometimes alarming symptoms, while yet the tincture is eight times stronger. It is a fair inference from these facts, that the presence of alcohol as in the tincture directly opposes the action of the drug : which in its turn may be antidotal to alcohol, and perhaps in this way be beneficial in delirium tremens. If, then, the tinc- ture be used for Homoeopathic purposes, the counteracting influence of the alcohol must be borne in mind, and the lowest potencies selected. I have never seen any benefit from the dilutions above the 1st centesimal : and generally use the 1st decimal or mother tincture. A word in conclusion about Digitaline, which appears to possess at least the cardiac and renal influence of the mother-drug. It has occasion- ally been used in heart-disease with dropsy instead of Digitalis, in the 2nd and 3rd decimal tritura- tions.* I have rather a partiality for it myself. * See ' North. Amer. Journ. of Horn.,' vol. vii, p. 401. LETTER XXII. DROSERA, DULCAMARA, ELATERIUM, EUPATORIUM, EUPHORBIUM, EUPHRASIA, FERRUM. I have before me in this letter a group of minor medicines, which we shall soon get through. The first is the sun-dew, Drosera rotundifolia. The tincture is prepared from the fresh juice of the whole plant. The proving of Drosera is in the ' Materia Medica Pura/ Dr. Curie's observations and ex- periments may be found in the ' Brit. Journ. of Horn./ vol. xx, p. 39. The only significant fact in the pathogenesis of Drosera is the spasmodic cough it produces. Hah- nemann's wonted sagacity led him to perceive this and recommended the medicine accordingly in pertussis. If after experience has not quite verified his statement that a single dose of Drosera 30 will cure hooping-cough in a week, it has nevertheless sustained the drug in the first rank of remedies for this disease. I myself nearly always give it in the second stage of ordinary cases, where no peculiar symptoms exist : and Dr. Bayes has lately added his testimony in the same direction. Nor is it 270 DROSERA ROTUNDIFOLIA. essential that a spasmodic cough should be true pertussis for Drosera to cure it : in sympathetic and nervous coughs of this kind it often acts admirably. Dr. Curie's most valuable experiments, however, have widened the range of action to be ascribed to Drosera. Struck by the statements of the herbals and of the country people that Drosera causes in sheep a cough under which they waste away, and finding that it had a popular reputation as a cough medicine, he determined to ascertain by experiment its real action. He reports to the French Academy of Sciences that he has slowly poisoned three cats with daily doses of Drosera. Diarrhoea at the commencement, and weakness of voice about six weeks later, are the only symptoms mentioned as observed during life. But on post-mortem ex- amination, the trachea was found unchanged, but the pleural surface of both lungs was studded with what the microscope decided to be true tubercle. In one cat the mesenteric glands were much enlarged ; in another the sub-maxillary glands, with the solitary glands of the large intestine and Peyer's patches. Now as cats are not at all liable to tubercle, I think it cannot be doubted that Drosera here caused the deposit, with the con- sentaneous enlargement of the lymphatic glands. Putting this together with the effects ascribed to it in sheep, it looks very much as if Drosera would turn out a true simile for phthisis pulmonalis. Dr. Curie, indeed, asserts that in the incipient stage of this disease a cure may nearly always be brought about by Drosera, given in doses of from four to twenty drops of the mother-tincture in the twenty- SOLANUM DULCAMARA. 271 four hours. I can only say that I once gave drop doses four times a day, with the effect of setting up a most violent spasmodic cough, which subsided to the ordinary cough of phthisis when the medicine was discontinued. Acidum hydrocyanicum, Acidum nitricum, Bella- donna, Chelidonium, Cina, Corallia, Cuprum, Hyos- cyamus, Ipecacuanha, Nux vomica, and Sambucus should be compared with Drosera in their relation to spasmodic cough. I suspect that Dr. Curie's mother- tincture will have to be modified no less than Hahnemann's 30th. I myself am very well satisfied with the 1st and 2nd dilutions. My next minor medicine is the bitter-sweet, woody nightshade, Solanum dulcamara. The tincture is prepared by maceration from the green stems. Hahnemann's proving of Dulcamara is in the ' Chronic Diseases.' I must also refer you to Professor darns' s experiments, which you will find translated in the ' Brit. Journ. of Horn./ vol. xviii. One of those happy generalizations which abound in Homoeopathic therapeutics has been arrived at regarding Dulcamara. Its general effect upon the body has been compared to that of damp ; and for the result of exposure to damp it is certainly a capital remedy. I am myself very liable to catch cold if I get at all wet : but since I have (acting on a suggestion of Dr. Chapman's) taken Dulcamara on 272 SOLANUM DULCAMARA. such occasions as a prophylactic, I have hardly ever suffered. Twice, too, I have arrested in myself incipient results of moist air by Dulcamara ; the first time it was angina, the second time stiff-neck. This medicine is also useful in diarrhoea resulting from a chill in damp weather; in catarrh of the bladder from the same cause ; and indeed in almost any mild catarrhal irritation of the mucous mem- branes owning this origin. Its influence extends also to sub-acute rheumatism in this way set up : as you may see in a case of the late Dr. Petroz' in the ' Brit. Journ. of Horn.,' vol. xxiii, p. 642. Besides the effects of damp, Dulcamara exerts a good deal of influence over cutaneous eruptions of a moist character, i. e. impetigo, ecthyma, &c. Its specific action upon the skin is undoubted : some of the symptoms produced by it have led to its use in urticaria, where, however, I think it very inferior to other remedies, especially Apis. We have no knowledge of the power over lepra with which it has been credited by some of the older physicians. So far extended our knowledge of Dulcamara before the experiments of Professor Clarus. These were made upon himself and upon rabbits : and some with the extract of Dulcamara, some with the acetate of Solania, its " active principle." Two very important phenomena were observed. 1st. The respiration became much slower, the heart's action much quicker (though at the same time feebler). Since this curious antagonism is also caused by division of the vagi in the neck, Professor Clarus fairly infers that Dulcamara acts by depressing these very nerves. Such depression is also indicated DULCAMARA. 273 by the filling of the pulmonary tissue with a serous exudation, and the emphysematous distension of isolated portions of the lung, which were observed in the rabbits killed by Solanine : these phenomena having resulted also from division of the vagi. Other symptoms also indicate an action on the medulla oblongata, as vomiting, spasms of the thoracic muscles extending to those of the extremities, snap- ping of the jaws, and a pendulum-like motion of the head. After death, the membranes of the medulla oblongata, and of the parts just above and below it, were found highly injected, but the nervous substance healthy. 2nd. The kidneys were nearly always found hypersemic, and the urine, whenever examined, was highly albuminous. No application of these facts to practice has as yet been made, though their bearing is pretty obvious. On the one hand, they perhaps add Dulcamara to the remedies we have for the first stage of Bright's disease. On the other, they give us a homoeopathic medicine for that threatened paralysis of the lungs which we meet with in old people at the first setting in of cold weather. It may also be helpful to the same subjects when from weakness they have to cough a long time to expel phlegm.* For these latter purposes I should suggest that Solania be administered. Dulcamara has so very unique an action that I hardly see my way to putting down any other medicines as true analogues to it. Since writing the above, I have used Solania 2 with the utmost benefit in one case of this kind ; and Solania 6 with equally good results in a case of threatened paralysis of the vagi in an infant. 18 274 ELATERIUM. The sources of the reputation of Dulcamara would lead us to expect the higher dilutions to be most suitable for the effects of damp, the lower in cutaneous disease. Next we have an old acquaintance of yours, Elaterium. An alcoholic tincture is prepared from the fresh fruit, so as to secure the active portion. There is a short proving of Elaterium, with a number of clinical cases, in the ' Materia Medica of American Provings/ It is needless to describe to you the physiological action of Elaterium. Nevertheless, it has been so graphically put by Dr. T. K. Chambers, that I cannot refrain from quoting his account of the drug. " It causes/' he says, " an enormous flow of watery serum from the first mucous membrane that absorbs it. If its vapour be drawn up into the nostrils for a short time, it is a powerful errhine, and is followed by the secretion of floods of water from the Schnei- derian membrane : if it is dissolved in the oesophagus it causes such a deluge of the gastric fluids, that the stomach cannot contain them, and they are rejected by vomiting : if it succeeds in passing the pylorus, a choleraic diarrhoea gushes forth, stripping the membrane of its epithelium just like its morbid prototype." Elaterium would thus seem homo30pathic to choleraic diarrhoea and vomit- ing. There is this difference, however, that the prolonged action of Elaterium sets up gastro- enteritis, which the cholera poison never does. I think that EUPATORIUM PERFOLIATUM. 275 nevertheless I should be disposed to try it where the excessive quantity of the evacuations was espe- cially noticeable. There are several cases of endemic cholera reported at the end of the proving, in which Elateriura was successful after Veratrum had failed. Some well-marked rheumatico-neuralgic pains, also, appear in the proving, amd have led to a cure of one case of rheumatic sciatica. Intermittent fever, too, counts Elaterium among the numerous medicines which at various times have cured or seemed to cure it. Elaterium forms a group with Colchicum, Croton, and Veratrum. The 2nd dilution was given in nearly all the cases reported in the proving. We now come to an American medicine, the thorough-wort, bone-set, ague-weed, Eupatorium perfoliatum. The tincture is prepared from the whole plant. The proving of Eupatorium, also, is in the ' Materia Medica of American Provings.' Cases of cure with it are there given : but the most com- plete collection of all pathogenetic and clinical records of the action of Eupatorium is to be found in the second edition of Dr. Male's New Remedies. Eupatorium has long been highly esteemed on the American continent as a remedy against ague ; hence its popular name among the Indians, " ague- weed." Its other appellation, " bone-set," is ob- tained from the remarkable power it showed in relieving the bone-pains of influenza in an epidemic 276 EUPATORIUM PERFOLIATUM. of this disease. The pains were so severe that the malady was spoken of as the " break-bone fever." The provings of Homoeopathy have enabled us to define the precise sphere of Eupatorium in the treatment of these maladies. In intermittents the setting in of thirst before the chill, which usually occurs in the morning, bilious vomiting during the paroxysms, and scanty perspiration at the close, are characteristic symptoms calling for its use. If, also, the peculiar bone-pains are present, the medi- cine is doubly indicated : you may read a case of this kind by Dr. Bayes in the 1st vol. of the ' Annals' of the Society. I have no experience of Eupatorium in intermittents : but can add my testimony to its extreme value in relieving the bone-pains of influenza. Dr. Carroll Dunham has lately directed attention to the marked hepatic action of Eupatorium, which he compares with that of Bryonia.* The group of symptoms to which he refers are intense headache, with soreness of the scalp, soreness of the eyes, redness of the face, nausea and prostration, soreness in the region of the liver, constipation, and high-coloured urine. He gives a capital case of " bilious fever," in which these symptoms, with violent bone-pains, were present, and which was broken up by Eupatorium 3 with marvellous rapidity. Besides the Bryonia already referred to, I do not know of any true analogue of Eupatorium. Dr. Dunham points out as elements of distinction between these two 1st, that the perspiration is free in Bryonia, deficient in Eupatorium ; 2nd, that * ' Amer. Horn. Rev.,' vol. vi, p. 229. EUPHORBIUM. 277 Eupatorium pains make the patient restless, those of Bryonia make him keep very still. The range of recorded use has been from the 3rd dil. to the mother-tincture. My next medicine, Euphorbium, is, as you are probably aware, the milky juice of the Euphorbia canariensis or officinarum. Of late, the American Euphorbia corollata has been introduced into practice : it is prepared by triturating the dried root. Euphorbium was proved by Hahnemann : its pathogenesis is in the ' Chronic Diseases/ There is an Article on Euphorbia corollata in Hale's ' New Remedies/ Euphorbium, belonging as it does to the family which includes Croton, Ricinus, and Jatropha, is another instance of the drastic purgative, and gives us another remedy for endemic cholera and choleraic diarrhoea. The E. corollata has been a good deal used in America in cholera infantum. It is much less liable to cause inflammation than the other Euphorbia, and is accordingly better suited to these non-inflammatory disorders. When applied to the skin, Euphorbium, like Croton, causes an eczematous inflammation : but it is not known whether this is a specific effect of its action. Besides the members of its own family already mentioned, Euphorbium is closely allied with Veratrum and Colchicum ; with Elaterium ; and with Tartar emetic. 278 EUPHRASIA. We have no records in any degree fixing its dose. We come now to a medicine which is an especial favourite of mine, the eye-bright, Euphrasia. The tincture is prepared from the whole plant. There is a pathogenesis of Euphrasia in the ' Mat. Med. Pura/ Some additional experiments with it may be found in ' Brit. Journ. of Horn./ vol. xvi, p. 671. The great charm of Euphrasia as a medicine is that it has a distinct and limited sphere of action, beyond which it advances no pretensions, but within which it manifests virtues which are as unvarying as they are potent. It acts upon the upper portion of the respiratory mucous membrane, i. e., upon its con- junctival and nasal portions, hardly reaching the larynx. It developes in this region a catarrh al inflammation, generally characterised by profuse secretion. Hence it takes a first place among the remedies for fluent coryza, when this is a local affection, and not a symptom of general influenza, in which case Arsenic is preferable. The involve- ment of the conjunctiva in the catarrh is a special indication for Euphrasia ; and sometimes the secre- tion from the eyes is acrid, while that from the iiares is bland, the opposite condition obtaining with Arsenic. The coryza which accompanies the com- mencement of measles is one to which Euphrasia is well suited : and I nearly always give it in this stage in alternation with Aconite, and have reason EUPHRASIA. 279 to believe that the eyes are the better for it at the time and afterwards. The eyes themselves, indeed, are the special seat of the influence of Euphrasia. Its name in most languages refers to its healing power over these organs (as Engl. eye-bright, Germ. Augen-trost, Fr. casse-lunettes) ; and you know how the Archangel in Milton, when he would clear the vision of our first parent, " purged with euphrasy and rue The visual nerve, for he had much to see." This is one of the many instances in which Homoeo- pathy has revived and confirmed, while defining, the old traditions about herbs. Conjunctivitis is very marked in the provings, and there are even indica- tions of affection of the deeper tissues. Correspond- ingly, Euphrasia is among the chief of our eye- medicines. In simple acute conjunctivitis it is rare that any other remedy is required : and in the chronic stage it has often effected cures. Given at the commencement of strumous ophthalmia, it will nearly always check incipient liberation : but its action needs sustaining by constitutional medicines, especially Sulphur. It comes in again later to re- move specks on the cornea, for which it is very effi- cacious. Lately Dr. Dudgeon has communicated two cases to the ' Brit. Journ. of Horn/* in which a rapid cure of rheumatic ophthalmia (sclerotitis and iritis) was effected by Euphrasia, after other reme- dies had failed. Used in this manner, I know of no medicine which will less frequently disappoint expectation than the little eye-bright. * Vol. xxii, p. 355. 280 FERRUM. The analogues of Euphrasia are AZthusa, Allium cepa, Apis, Argentum nitricum, Arsenicum, Bella- donna, Hepar sulphuris, Kali bichromicum, Kali iodidum, Mercurius solubilis and corrosivus, Pulsa- tilla, and Sulphur. The higher dilutions have sometimes been used : but the lower potencies and the mother-tincture appear to answer all purposes sufficiently well. I shall conclude this letter with an account of the Homoeopathic doctrine and practice concerning one of your most valued medicines, Ferrum. Several of the preparations of Iron have been used in Homoeopathic practice : the Acetate most frequently, as with this the provings were made. I myself prefer the perchloride, as a more certain preparation from which to obtain the specific effects of Iron. As a chalybeate, I know of nothing equal to the Ferrum redactum of the British Pharma- copoeia. Iron was proved by Hahnemann, and its patho- genesis is in the ' Mat. Med. Pura,' vol. ii. It is very unaccountably omitted by Hempel in his trans- lation. Another proving made by the followers of Rademacher, with examinations of the blood, may be read in the ' Brit. Journ. of Horn./ vol ix, p. 243. I suppose that you consider the treatment of anamia by Iron as one of the most satisfactory things in your therapeutics. I do not think you would be at all pleased if Homoeopathy required you to give it up. Let me say at once that if Homoeo- FERRUM. 281 pathy did require its renunciation, I myself should have to renounce Homoeopathy. I always give Iron as some part of the treatment of anaemic patients. And yet I am far from claiming its action as an ex- ample of the operation of the law of similars. Per- mit me to cite what I said upon this subject in a paper on the ' Chemical Treatment of Disease/ read before the British Homoeopathic Society.* " Who of us that has known anything of old- school practice does not feel that the treatment of anaemia by full doses of Iron is one of the brightest spots in its field ? And who has treated such cases by Homoeopathic remedies alone without profound impatience and dissatisfaction ? I confess that were I limited to dynamic agents in my practice, I should feel bound to advise an anaemic patient to go to the most ignorant country Allopath rather than to come to me. I know that my friend Dr. Russell will bring forward his case, in which anaemic symptoms rapidly gave way to drop-doses of the 1st dilution of the Ferrum aceticum. But let me ask Dr. Rus- sell, and the rest of my colleagues, whether such a case is not quite exceptional ? Upon Homoeopathic principles, indeed, it must be so : for Ferrum is homoeopathic, not to anaemia, but to plethora. In Rademacher's provings, Iron in all cases increased the number of the red-corpuscles, and induced symptoms of commencing plethora ; and it was not till its continued use had upset the stomach, and impaired digestion, that the opposite condition began to obtain. If, therefore, Iron is to do good in * Printed in ' Annals,' vol. iv. 282 FERRUM. ansemia, it would seem to be on chemical principles, and therefore in chemical doses. " I think it is time that we all spoke out plainly on this matter. Ansemia is a condition of very fre- quent occurrence, both as a substantive malady, and as a concomitant of other disorders. Our bre- thren profess to obtain the utmost benefit from Iron in this condition, and regard it indeed as well-nigh infallible. Do we treat it better with Homoeopathic remedies, or with Iron itself in infinitesimal doses ? And if general experience accords with my own in saying ' No,' then must we not avowedly admit Iron among our dietetic agents, and administer it in suitable quantities ? For my own part, I have long been in the habit of giving Iron as food in all cases of ansemia. I believe natural Chalybeate waters the best mode of its administration. But when these are not to be had, I am well satisfied with giving two or three grains of the Ferrum redactum of the British Pharmacopoeia, once daily, at meal time." You will see from this that I regard Iron as a food rather than as a medicine, and administer it accordingly. I know there are difficulties in the way of this view. In ansemia from haemorrhage, indeed, the dietetic theory would be plausible enough; but in its two most common forms that induced by deficiency of air, light, and suitable food, and that which supervenes upon checked menstruation it seems as if the malady lies farther back, in the blood-making organs rather than the blood itself. Still the fact remains, that in all cases of ansemia Iron, and the red corpuscles of which it is an essential element, are deficient in the blood : and FERRUM. 283 that the administration of Iron as food goes very far at least to supply the want.* I say, as food : for it acts best when given with meals, and is not eliminated (so far as I know) by the emunctory organs. Given in the quantity I have mentioned, it does not even blacken the stools ; and so may be considered as wholly absorbed by the stomach. The uses of Iron as a dynamic agent, given upon the law of similars, are not numerous. It is occa- sionally beneficial in vomiting of the ingesta and in lienteria. It certainly exerts (especially in the form of the chloride) a specific action upon the urinary organs, and is often very useful in chronic catarrh of the bladder, and in gleet. Lately, Dr. Clotar Miiller has commended it to our notice as a homoeopathic remedy in phthisis florida. You will find his paper translated in vol. xviii. of the ' Brit. Journ. of Horn/ As a haematic, Iron has no true analogue, unless it be Manganese. Of the dose of Iron as a chalybeate I have already spoken. The tincture of the perchloride of the British Pharmacopoeia contains about a twentieth part of the salt, and may be used in one or two drop doses for urinary affections and phthisis. * The influence of the non-irritant salts of Iron upon plants illus- trates still farther its character as a food. They have no poisonous influence upon vegetation : while, if the plants are sickly, watering them with a solution of one of these salts will improve their colour and aid their growth. LETTER XXIII. GELSEMINUM, GLONOINE, GRAPHITES, GRAT10LA, GUIACUM, GUMMI GUTTLE, HAMAMELIS. The medicine with which I begin my present letter is one of the most valuable of the American contributions to our Materia Medica. It is the yellow jessamine, Gelseminum sempervirens. The tincture of the root is that used in our practice. So exhaustive an account of the virtues of Gelse- minum is contained in the 2nd ed. of Dr. Hale's ' New Remedies/ that you need not go any further to possess yourself of all available knowledge regarding it. The most striking thing about Gelseminum is its power of extinguishing muscular activity. Here are the symptoms of a case of accidental poisoning, " Complete loss of muscular power ; was unable to move a limb, or even to raise his eyelids, although he could hear and was cognisant of circumstances transpiring around him. His friends, greatly alarmed, collected around him, watching the result with much anxiety, and expecting every minute to see him breathe his last. After some hours he gradually recovered." I cannot say whether it GELSEMINUM SEMPERVIRENS. 285 produces this effect, like Curare, through the nerves, or, like the Upas aiitiar, by direct action on the muscular substance. Post-mortem investigations on animals poisoned by the drug can alone solve this question. In the mean time, we must use it in this sphere phenomenally only. To one to whom " contraria contrariis curantur" seems an axiom, Gelseminum at once suggests itself as a remedy for muscular cramp and spasm. I do not deny that there are certain ephemeral conditions of this kind, in which we may, with advantage, avail our- selves of the antipathic action of the drug. Thus it has effected speedy relaxation of hysterical trismus, of laryngismus stridulus, and of rigidity of the os uteri during parturition. I have myself the highest opinion of its efficacy in relieving simple dys- menorrhosa and after-pains, both of which I suppose to be essentially spasmodic in their nature. But for spasm of any long standing or frequent occur- rence, I should greatly prefer a homosopathically acting remedy : and on the other hand, should recommend the trial of Gelseminum rather in local paralysis. Of this nature are the enuresis of old persons, from weakness of the sphincter vesicae, and the post-diphtheritic paralysis of the parts about the throat, both of which have yielded to its use. I should not have supposed that Gelseminum had any special action on the sensational centres, but for the fact that blindness is a pathognomonic symptom of its full constitutional action, as much so as salivation is of mercurialization. It has been given with success in the araaurosis caused by Quinine. "While I am speaking of the eyes, I 286 GELSEMINUM SEMPERV1RENS. must notice the very marked disorder of the accom- modating power experienced by one of the provers. Whether this depended upon serai-paralysis of the muscles of the eye-ball, or upon the cerebral con- gestion which (as we shall see directly) is caused by the drug, I cannot say. At any rate, Gelseminutn must be borne in mind in cases of ptosis, diplopia, and strabismus. I turn now to the action of Gelseminum in the sphere of the circulation. It is said to have caused in highly-sensitive persons a decided febrile chill, with subsequent reaction. But this effect is very rarely produced, and Gelseminum has no pre- tensions to rival Aconite. From clinical experience, I am disposed to consider the remittent type of fever as that to which Gelseminum is specifically applicable. Whether this would hold good with malarious remittents, 1 cannot say ; but Gelse- minum is one of the many medicines which have repute in the treatment of ague. I have especially in my mind the remittent fever of childhood, for which, acting on a suggestion of Dr. Ludlam's, I began to use Gelseminum instead of Aconite five years ago. I have continued it ever since, and can assert that it as certainly breaks up and cuts short this fever as Baptisia does with the gastric, and Aconite itself with the simple fever. Even in adults having febrile symptoms of this type, i. e. marked exacerbation towards night, and decline of the heat without perspiration towards morning, I have prescribed Gelseminum with the utmost ad- vantage. Still within the sphere of the circulation is the cerebral congestion caused by Gelseminum. GLONOINE. 287 It is of a passive venous character : showing itself mainly by dull headache and vertigo. A case of Dr. Madden's, in the ' Brit. Journ. of Horn./ vol. xxiii, p. 256, illustrates the kind of headache for which Gelseminum is likely to prove serviceable. Dr. Hale also recommends it for the drowsy stupor (not hepatic) which some persons complain of in hot weather. These are the leading forms of disorder in which Gelseminum plays a curative part. It has also been recommended or successfully used in the epidemic cerebro-spinal meningitis of America ; in acute myalgia, as from long-continued exertion ; in the distressing sensations about the head caused by cardiac disease ; in scarlatina ; in Eustachian deaf- ness ; in nasal catarrh ; and in sleeplessness from mental excitement. For these and all other points about this valuable medicine, I once more refer you to Dr. Hale's exhaustive article. The nearest analogues of Gelseminum areAgaricus, Baptisia, Cannabis indica, Conium and Opium. The 1st dilution is that which I have always given for remittent fever. The 2nd and higher potencies have been used for paralytic and amau- rotic affections ; and the 1st dec. or mother tincture for antipathic purposes. I come now to the curious substance which its introducer into practice has called by the fanciful name of Glonoine. It is, as you probably know, prepared by dissolving 288 GLON01NE. glycerine in nitric and sulphuric acids. It is some- times called nitro-glyceriue : and is becoming well- known and dreaded for its explosive properties. We dissolve it in alcohol for the dilutions. Provings and clinical reports of Glonoine abound in our journals. If you will look it out in the index of the ' Brit. Journ. of Homoeopathy/ vols. vii, x, xvi, xviii, xix, and xxiii, you will find about as much information concerning it as you can desire. The action of Glonoine lies within a very small compass. If you will touch your tongue with a five per cent, solution you will find that in a few minutes your pulse will have increased by from 20 to 40 beats, and your head will begin to throb and beat until a pretty violent bursting headache deve- lopes itself. With this there will be some giddiness, and a sense of constriction about the throat. If you are sensitive to the drug, nausea and faintness may supervene, and even complete insensibility ensue. This is the nearly uniform action of Glonoine upon every one who has taken it : as you may best read in Dr. Dudgeon's paper in the Journal, vol. x. What is the rationale of these striking symptoms ? The sudden increase in the frequency of the heart's action may be caused either by direct stimulation of its substance or ganglionic nerves, or by depres- sion of the influence of the pneumogastrics (comp. Dulcamara). The rapidity with which it supervenes, especially, leads me to ascribe it to the latter mode of action. On what, then, depend the head symp- toms? At first sight they would seem secondary to the increased action of the heart. But if this were so, the whole body should be similarly affected, GLONOINE. 289 which it is not. And what entirely excludes this theory is that, in one of Dr. Dudgeon's provers, the head was not affected at all, although the pulse rose very high indeed. We need a special action upon the cerebral blood-vessels to account for the promi- nence of the head-symptoms. I think that the phenomena of both head and heart can be accounted for by supposing that Glonoine acts as a direct sedative upon the medulla oblongata. From this centre come off the vagi, to whose depression we have referred the cardiac symptoms of the drug. Through the medulla oblongata also (according to SchifFs observations) the vaso-motor nerves of the brain proper can be excited or paralysed. The same sedative influence of Glonoine, therefore, upon this nervous centre, would through the vagi set the heart off palpitating, and through the vascular nerves would dilate the cerebral arteries, so as to give us the phenomena I have described. We have already made use of this bit of physiology to explain the action of Hydrocyanic acid, which through the medulla oblongata contracts the cerebral arteries and stops the heart. Glonoine is thus its precise opposite, and might be used as an antipathic anti- dote for its poisonous effects. As the medulla oblongata is also in all probability the starting-point of the epileptic paroxysms, it would be worth trying if it could stop their access in cases where there are premonitory signs. The extreme rapidity of its action (only paralleled by that of Prussic acid itself) would help to render it efficient for these purposes. Glonoine was first introduced into medical practice by Dr. Hering of Philadelphia in 1850. Its 19 290 GLONOINE. pathogenetic action obviously recommended it in active disturbances of the cerebral circulation : and in many of these it has been used with the utmost success. In Dr. Dudgeon's paper (published in 1853) you will find some capital cases of congestive headache, in which Glonoine gave relief with magical rapidity. It has proved the great remedy for sun- stroke : I have myself obtained striking benefit from it in the distressing after-effects of this casualty. It has checked puerperal convulsions, where cerebral hypersemia was prominent. It is a capital medicine for the disturbance of the intra-cranial circulation which obtains in menopausia, and for that which often results from menstrual suppression. Glonoine has been suggested for apoplexy ; but I am not aware of its having been used, and am unable to see its true homceopathicity to this disease. It should be, however, and has been, of great service in nervous palpitation, of emotional origin. So far extended our knowledge of Glonoine until 1858, when its powers became accidentally known to my friend Mr. Field, a surgeon in this town, who communicated it to his brethren in the pages of the Medical Times and Gazette. Some contradictory experimentation followed : but on the whole the effects of Glonoine were admitted to be identical with those observed by the Homoeopathic provers. It was not of course to be expected that the drug should be used therapeutically on our principle : it was given rather as a " sedative." In this capacity it exhibited in many hands a striking power of relieving the paroxysms of neuralgia : and we have occasionally availed ourselves of its power in this GRAPHITES. 291 direction. Whether it has any specific action in neuralgia I cannot say: but certainly cases have been relieved by the 3rd attenuation, and some permanently cured. Glonoine is another of those medicines which has no true analogues. Hamamelis (q. v.) has once at least acted on the head like it: and our choice at the bed-side often lies between Glonoine and Bella- donna. It has acted beneficially in all dilutions, from the 3rd dec. to the 12th centesimal. The 1st and 2nd dec. have been used, but are liable to aggravate. The drug which follows owes its place in the Materia Medica to the Hahnemannian process of trituration, by which its virtues have been developed. It is the black-lead of our pencils, plumbago, or Graphites. It is prepared by trituration, after careful washing. The proving is in the ' Chronic Diseases:' and the prefatory remarks from Noack and Trinks' ' Handbook ' in Hempel's translation give a fair outline of its therapeutical virtues. It seems probable that the primary action of Graphites is on the skin. At any rate, it is as a remedy for cutaneous affections that it first be- came known to medicine : and although it has been lost sight of in this capacity in the old school, it retains its place among ourselves. It is perhaps rather to unhealthy states of the skin, leading to rhagades, excoriations, and ulcers, that Graphites is suitable, than to fully formed eruptions. I would 292 GRATIOLA. not, however, have you limit its efficacy on my word : for you may find it more successful than I have done in psoriasis, herpes, &c. Graphites more- over produces, and has frequently cured an obstinate constipation ; the stools being large and knotty, and requiring much straining for their expulsion. Lastly, it has a decided action on the ovaries and testes, causing delaying and scanty menses, and having several times proved curative of hydrocele. It is especially where these affections co-exist that Graphites is efficacious : as when retarded and deficient menstruation accompanies costiveness, or the latter condition complicates a cutaneous erup- tion. Graphites is pretty closely allied with Pulsatilla, Lycopodium, and Plumbum. The potencies from 6 to 30 have been most used. Concerning the hedge-hyssop, Gratiola, I will content myself with the following quotation from Taylor on ' Poisons/ 1st Ed., p. 515. " A series of cases observed by M. Bouvier are reported by Orfila, in four of which the plant was used, under the form of a decoction, as an enema. The result was that in one instance violent vomiting and purging, with syncope, were induced, and in all a strong attack of nymphomania. In other cases there was constriction of the throat, with hydro- phobic symptoms and convulsions." There is a proving of Gratiola by Hartlaub and Trinks, the GUMMI GUTTLE. 293 schema of which you will find in Jahr's ' Manual.' I have no knowledge of its therapeutic use. I can devote but little more space to my next medicine, which is your old acquaintance, Guiacum. Our tincture is prepared from the resin. There is a short pathogenesis of Guiacum in the * Chronic Diseases.' This proving, so far as it goes, makes it probable that Guiaeum is really homeopathic to some of those syphilitic, gouty, and rheumatic pains for which it has so long been employed, Pearson's statement that its continued use causes heart-burn, flatulence, and costiveness points also to its useful- ness in gout, for which it has some repute as a prophylactic. It is probably also a remedy like Mezereum and Phytolacca for periosteal and syphi- litic rheumatism. Of late there has appeared some evidence that Guiacum specifically affects the throat. It has been recommended by some of your writers as abortive of quinsy : and one of our American colleagues speaks highly of it in diph- theria. Here again it resembles Phytolacca. The mother-tincture will probably have to be given in most cases. In diphtheria it may be ad- ministered in warm milk. Gummi guttse i is the name by which, in the German ' Materia Medica,' Gamboge is designated. There is a patho- 294 HAMAMELIS VIRGIN ICA. genesis of it in Jahr's ' Manual/ taken from an unpublished monograph by Dr. Cajetan Nenning, the " Ng." of Hahnemann's provings. Gamboge is, however, only used in cases of acute diarrhcea, where the symptoms resemble those of its well- known purgative action. It ranks of course with such medicines as Jalap and Senna. It has no pretensions to such a range of action as that of Colocynth. I now come with great pleasure to another precious American contribution, the witch-hazel, Hamamelis virginica. We prepare a tincture from the bark. All known pathogenetic and curative actions of Hamamelis are collated by Dr. Hale in his article on the medicine in the 2nd edition of his ' New Remedies/ Hamamelis is a remedy whose use illustrates a principle I referred to in my first letter : viz., that the true specific sphere of a drug may be de- termined ex usu in morbis alone. Until lately Hamamelis had never been properly proved, nor had it poisoned anybody. Yet we knew with great accuracy that its remedial sphere lay in affections of the venous system. Dr. Preston, in some valuable papers in the ' North American Journal of Homoeopathy/ first established this fact ; and his reasonings were based almost entirely upon clinical experience. So far as subsequent pathogenetic results go, indeed, they point in the same direction HAMAMELIS VIRGINICA. 295 (see especially those of Dr. Davidson and myself). But the usus in morbis gave us the truth. The three leading affections of the venous system in which Hamamelis has proved curative are phlebitis, varicosis, and haemorrhage. In phlebitis I hardly know whether to give the palm to this medicine or to Pulsatilla. They are both exceedingly effica- cious. But in the various forms of varicosis I have no doubt of the superiority of Hamamelis. In varicose veins of the leg, you will be delighted with the way in which the 1st or 2nd potency will ease the pain, while the external application of the diluted tincture will cause the dilated vessels to shrink up. In varicose ulcer of the leg, and in varicocele, the same treatment has frequently proved curative. It is good for varicosis of the throat, where the parts look bluish from distended veins, and there is more or less discomfort, with pain on swallowing, and hawking of mucus with blood. But it is in this same condition at the other end of the digestive tube, viz., h&morrhoids, that Hama- melis has won its greatest triumphs. I have cured case after case of " bleeding piles" by the internal use of this medicine, and indeed do not remember to have ever failed with it. Numerous testimonies to the same effect are to be found in Dr. Hale's article. We are thus led to the use of Hamamelis in hfsmorrhage, for which mischance it is indicated perhaps more frequently than any other medicine. The general evidence of those who have used it agrees with that of Dr. Preston that it is in venous hsemorrhage, where the blood flows steadily and without much expulsive effort, that Hamamelis is 296 HAMAMELIS VIRGINICA. likely to cure. I have myself farther suggested that it is more suitable when the state of the vessels leads to the haemorrhage, than where this is dependent upon altered composition of the blood itself. Obeying these laws, Hamamelis has been given with most satisfactory results in epistaxis, haemorrhage after tooth- drawing, hsematemesis, melaana, haematuria (qy. ?), haemoptysis, and even purpura. It has also cured vicarious menstruation ; and helped much in the treatment of dysentery. I have myself used it in most of these affections, and have so much confidence in its power that I would never be without it in my pocket-case. If you ask me what is the rationale of this haemostatic power of Hamamelis and some others of our medicines, I have no answer to give you. It certainly does not depend on the astringent action of the Tannin which Hamamelis, like many other barks, contains : for the medicine acts well as high as the 2nd and 3rd dilutions. I can only say that, phenomenally at least, the process is a homoeopathic one : for Hamamelis has caused haemorrhage from parts which readily allow of it, as the nares and the uterus. I have only to add that our indefatigable prover, Dr. Burt, has lately experimented on himself with Hamamelis, and has developed a marked action on the testicles, characterised especially by neuralgic pains, which were at last so severe that he was compelled to discontinue the proving. Sometimes the pains migrated suddenly to the stomach (qy. solar plexus ?), causing nausea and faintness. He has added some capital cases of ovarian neuralgia, HAMAMELIS VIRG1NICA. 297 in which, guided by the above pathogenetic effects, he has prescribed Hamamelis with curative results. The nearest analogue of Hamamelis is Pulsatilla. In haemostatic virtue it has associates in Ipecacu- anha and Millefolium. I have generally used the 1st dec. in acute haemorrhage : the 1st and 2nd centes. in other cases. LETTER XXIV. HELLEBORTJS, HELONIAS, HEPAR SULPHURIS, HY- DRASTIS, HYOSCYAMUS, HYPERICUM. I begin this letter with an account of a medicine which I think very unworthy of the position Dr. Hempel has assigned it among the polychrests : yet one which has its own place among our therapeutic agents. I speak of the Christmas rose, Helleborus niger. The tincture is prepared either from the juice of the recent plant, or from the dry root. The proving is in the ' Materia Medica Pura/ It was either the black Hellebore, or some closely allied species, which was used by the Greek phy- sicians for the treatment of mental disorders. They supposed it to act by its evacuant properties : but it is probable that it had some specific influence. Hahnemann makes the following remark in point : " I infer from various observations that stupor, an obtusion of the sensitive nervous system, imperfect and heedless sight, although the eyes are perfectly good, imperfect hearing, although the organ of hear- ing is perfectly sound, imperfect or no taste, although the organ of taste is in a good condition, constant or frequent absence of thought, want of recollection HELLEBORUS NIGER. 299 of the things which had just taken place, indiffer- ence, light slumber without the sleep being re- freshing, desire to work without having the power or attention necessary to do something, is a primary effect of Hellebore." Teste recommends it in eclampsia infantum, when occurring before dentition has commenced. But the chief use of Hellebore is in the various forms of dropsy. All I know of its physiological action in this sphere is the symptom of Hahnemann's proving, " Sudden dropsical swelling of the skin," upon which he remarks, c< This symptom, with others belonging to the kidneys, appears to show that Hellebore will be a great remedy in certain swellings." The renal symptoms referred to are, " Frequent micturition. Frequent desire to urinate, emitting but a slight quantity. Emits a quantity of watery urine." In poisonous doses, Hellebore acts simply as a drastic purgative and gastro-intestinal irritant, and shows no sign of influencing the kidneys. Nevertheless, Hahnemann's prediction has been realised, and Hellebore has taken a high rank among our reme- dies for dropsy. It has cured hydrothorax, auasarca, and ascites following upon scarlatina, and dropsy consequent upon intermittent fever. Its chief re- putation, however, is in hydrocephalus. I see no evidence that it has ever removed the effusion of true tubercular meningitis. But in cerebral effu- sion from other causes, as from insolation, from typhus, from the retrocession of mumps or the exanthemata, Helleborus may be given with every prospect of benefit. Even in chronic hydrocephalus it may powerfully aid the constitutional remedies 300 HELONIAS DIOICA. (Sulphur, Calcarea, &c.) on which we rely for the main treatment of the disease. The medicines most allied to Helleborus are Apis, Apocynum, Arsenicum, Bryonia, Kali lodidum, and Veratrum. The medium and higher dilutions have been most frequently used. I insert the next medicine on my list solely on the authority of Dr. Hale. It is the Helonias dioica, a plant indigenous to the United States. A tinc- ture is prepared from the root ; and the concentrated preparation, Helonin, is triturated for our use. Dr. Hale's article, in the 2nd edition of his ' New Remedies/ contains all that is known of the medicinal action of Helonias. From some fragmentary provings, it would appear that Helonias is a specific irritant of the genito-urinary mucous membrane. It causes pain and weight in the kidneys, frequent and copious urination, and burning in the urethra : drawing pain from the back through the womb, metror- rhagia, and swelling and tenderness of the mammae. Correspondingly, its chief use has been in affections of the kidneys and the uterus. I am disinclined, however, to claim these uses of the medicine for Homoeopathy : as it is for atonic conditions of the parts (to say nothing of the semi-material doses) that it has proved so successful. Nevertheless, the action is certainly of a dynamic and specific nature : and we know too little of the essential HELONIAS DIOICA. 301 nature of the phenomenally homoeopathic operation to justify us in rejecting a remedy for its seeming want of conformity thereto. You will accordingly read and appropriate the cases of phosphatic urine, of urinary irritation with impotence, of diabetes, and of albuminuria cured by Helonin which are given by Dr. Hale. It reminds one in this sphere very much of Phosphoric acid, plus irritation of the mucous membrane. From its power over affections of the womb, Helonin has obtained the appellation of "uterine tonic." In prolapsus, menorrhagia, leucorrhcea, and other atonic states of this organ, it seems really possessed of very great curative virtues. And an interesting point is this, that in all these disorders it markedly improves the co-existing de- bility and even anaemia. Its action is compared, by all who have used it, to that of Iron. As it cannot directly nourish the blood, like that metal, it pro- bably acts by improving the digestive and assimila- tive powers. It is possible that it specially promotes the assimilation of Iron : and hence might be help- ful in chlorosis. I have already mentioned the analogy between the virtues of Helonias and some of the effects of Phosphoric acid and Ferrum. As a uterine remedy, it most resembles Stannum. The mother-tincture of Helonias, and the 1st dec. trit. of Helonin, have generally been used. My next medicine is one of the old Hahne- mannian stock, the sulphide of calcium 302 HEPAR SULPHURIS CALCAREUM. Hepar sulphuris Calcareum. We prepare the salt specially for homoeopathic purposes, by " mixing equal portions of finely- powdered clean oyster-shell and quite pure flowers of sulphur, and keeping the mixture for ten minutes heated to a white heat in a crucible hermetically closed. The resulting salt must be kept in a well- closed bottle" (Hahnemann). The potencies are made by trituration. The proving of Hepar sulphuris (so we commonly call it) is in the ' Chronic Diseases/ and is unusually precise in its indications. Hepar sulphuris, being a compound of the two great constitutional remedies, Sulphur and Calcarea, is itself a medicine of the same character. It has points of resemblance to each of its elements like Sulphur influencing the skin, and like Calcarea affecting the glands. But like many other com- pounds it is something over and above its con- stituent parts ; and strikes out (so to speak) an action of its own. I think that Hahnemann hit upon the nature of this action when he recom- mended Hepar as a dynamic antidote to the effects of Mercury. This recommendation has been so frequently acted upon with success that there seems little doubt of its being well founded. Hepar accordingly finds a place in the treatment of three great dyscrasise the syphilitic, the scrofulous, and the psoric. It has very little relation to primary syphilis, except to the suppurating bubo of soft chancre : but in ulcers and scaly eruptions which HEPAR SULPHURIS CALCAREUM. 303 can be traced to a far back syphilitic infection it is often very useful. It is frequently the most important medicine in strumous enlargements of the glands, especially when these can only be cured through suppuration. It is good for the enlarged tonsils of scrofulous children, and in acute quinsy stands second only to Baryta carbonica. I cannot diagnose between it and Sulphur in those eruptions which we refer to a psoric taint (do not be fright- ened at the word " psoric/' but wait till we get to Sulphur itself) : I can only say that it has frequently cured them. Hepar sulphuris, having this relation to certain diatheses or dyscrasise, manifests a special elective affinity for the respiratory mucous membrane. You will find every part of this tract giving out signs of distress if you read the symptoms of the patho- genesis. Hepar has accordingly been used with considerable success in many of its affections. In blepharophthalmia, where the meibomian glands are much involved ; in recurring ulcers of the con- junctiva, in strumous constitutions ; and in head- ache at the root of the nose (ethmoid cells), it has frequently been given with success. I find it remove very speedily the hoarse, rough, laryngeal cough which follows measles. I have never had occasion to use it in membranous croup ; but it had considerable reputation in this disease among the older Homoeopaths. In acute and chronic laryngo-tracheal catarrh, with much hoarseness, it may often prove the best remedy. I have no knowledge of its action in bronchitis, nor do I know of its having cured pulmonary phthisis ; but 304 HEPAR SULPHURIS CALCAREUM. the testimonies to its power of giving relief in this disease are so numerous that I cannot regard them lightly. Hepar is also credited with the power of removing the exudation of pleurisy, when this is plastic rather than serous. Besides the glands, the skin, and the respiratory mucous membrane, Hepar shows a good deal of power of affecting the joints ; and stands high among our remedies for scrofulous disease of these parts. It is supposed in all these cases to be specially indicated when we wish to influence suppuration to promote it when desirable^ or to check it when excessive. I have not, however, seen any reason to suppose that Hepar has that direct control over the suppurative process as such which we shall see to be exercised by Silicea. It is rather, I apprehend, that it excites a healthy action in those parts and in those forms of diseases where pus is readily pro- duced ; and so seems sometimes to further and sometimes to hinder its formation, as the curative process requires. I have drawn this account of the therapeutic powers of Hepar sulphuris mainly from the testimony of others. I must confess that it is not a favourite medicine of mine : but perhaps I do not use it rightly. I hope you will be more fortunate. It is given so high a place by most practitioners of our school that it cannot but be possessed of many and great virtues.* * Some of these virtues, additional to those noticed above, are mentioned by Dr. Bayes in the ' Monthly Horn. Review/ June, 1867. His remarks on its power over hepatic engorgement are especially valuable. HYDRASTIS CANADENSIS. 305 Besides Sulphur, Calcarea, and Mercurius, Hepar has a close analogue (especially in the respiratory sphere) in Kali bichromicum. The higher dilutions have generally been used. In laryngo-tracheal affections, however, I am very well pleased with the 3rd dec. trituration. I have now to introduce to you another American contribution to our Materia Medica in the shape of the Golden Seal, Hydrastis canadensis. The tincture of the fresh, or the triturations of the dried root are used in our practice. Dr. Hale's article contains as usual all that is known concerning the drug. Hydrastis has been very fairly proved by Dr. Burt and some other physicians. Catarrh of the eyes and nose, with profuse thick white secretion, was Dr. Burt's most prominent symptom : another had sticky mucus about the fauces, with a broad yellow stripe down his tongue : a third had the catarrhal symptoms, with hoarseness, headache, and great prostration. A patient of Dr. Bayes, who took twenty drops of the tincture in mistake, had sinking at the epigastrium and violent palpitation next morning, and later an erysipelatoid rash, with burning heat and intense irritation. The local application of an infusion has produced a crop of varioloid pustules, with swelling of the parts. I cannot say that these physiological results throw much light upon the therapeutic action of 20 306 HYDRASTIS CANADENSIS. Hydrastis. It has indeed been applied to the eyes in catarrhal ophthalmia and to the face in small-pox with reported advantage. But the three morbid conditions in which it has won its spurs are con- stipation, ulcers, and cancer. 1. lu simple constipation I know no medicine so generally beneficial as Hydrastis. In very chronic cases a short preliminary course of Sulphur is advisable. As Hydrastis has a decided action upon the liver, and has cured jaundice, it is possible that through this organ much of its power over constipation is exerted. You will find a number of cases illustrative of its influence in Dr. Hale's article. 2. As an application to ulcers, not varicose, and not simple enough for Calendula, there is no medicine like Hydrastis. Of this power also Dr. Hale gives us many instances. He recommends its application to ulceration of the mucous outlets, as the mouth and throat, the nose and eyes, the rectum, and the vagina and uterine cervix. Dr. Yeldham also commends it as an injection for gleet. 3. By far the most interesting aspect of Hydrastis is its relation to cancer. It was first used by Dr. Pattison, as an ingredient in the caustic paste with which he was accustomed to enucleate scirrhous tumours. Drs. Marston and McLimont, taking up Dr. Pattison's practice, also gave the Hydrastis internally, and were astonished at its good results.* Relief of pain and improvement in general health nearly always followed its administration : and in * ' Brit. Journ. of Horn.,' vol. xxi, p. 611. HYDRASTIS CANADENSIS. 307 some cases its conjoined external application as a lotion so improved or even removed the symptoms that a contemplated operation was abandoned. To Dr. Bayes, however, we owe the best knowledge we possess of the power of Hydrastis over cancer. He, too, learnt its value from Dr. Pattison, as he acknowledges. In papers in the ' Brit. Journ. of Horn./ vol. xix, p. 150, and vol. xx, p. i, and in the ' Annals of the Brit. Horn. Society/ for Dec. 1864, Dr. Bayes gives us a number of cases treated by Hydrastis externally and internally. His final conclusion is that it has no influence over the cancerous dyscrasia as such ; is of little or no us in cancer of the womb; but in scirrhous tumour developed in glandular structure is of great value, through a specific influence upon the gland itself. What makes it probable that Dr. Bayes is right is that Hydrastis has great power of dispersing simple glandular tumours, as in the breast. But however this may be, it is certain that in every suspected mammary scirrhus we are bound to give our patients the benefit of the local and internal use of Hydrastis: and that we may do this with a very fair prospect of success. As you may think this a somewhat bold statement, I shall cite two cases showing what Hydrastis can do in these cases. The first is from Dr. Bayes, the second from Drs. Marston and McLimont. 1. " Miss G , set. 38, consulted me on February 26, 1861. She had two extremely hard knotty tumours in the right breast, about the size of eggs, and one in the left, rather smaller ; they gave a feeling of metallic hardness to the touch ; the axillary glands on both sides were also enlarged and painful, and hard strings appeared 308 HYDRASTIS CANADENSIS. to lead from each breast to the glands in the axillae. This patient had been for some long time under allopathic care. She suffered great pain at times, and her general health was much broken down ; she was highly nervous, her tongue loaded, her whole health disordered, and she looked dark and almost dusky. Ordered Hydrastis, in increasing doses, and Hydrastis lotion. " I saw her again in March, when her general health was greatly improved ; the pains had almost entirely subsided, and the tumours were less. "In April there was a still farther improvement. " On May 4 she came, considering herself quite well, but the tumours in the right breast are still the size of a walnut, and that in the left breast is but little diminished; the mammae have enlarged, and she is very 'much stouter. She is still under treat- ment, and improving steadily." 2 " Mrs. F had suffered for six months from a swelling in her left breast, for which she sought relief. The pain, which was com- pared to knives being thrust into the part, had become almost unbearable, and the patient was already beginning to assume that worn appearance so characteristic of the cancerous diathesis. The tumour, which had attained a considerable size, was hard, heavy, and adherent to the skin, which was dark, mottled, and very much puckered, the nipple being also deeply retracted. The patient was at once advised to come into town in order to the enucleation of the tumour. This, however, her circumstances prevented ; and without any expectation of affording much relief, a lotion of Hydrastis was ordered with the internal use of the same medicine. The pain almost immediately ceased, and the tumour so speedily decreased in size that at the end of two months it had altogether disappeared, leaving but the puckered skin, which had otherwise regained its natural appearance. When we last heard of this patient she con- tinued perfectly well. It is needful to state that her health rapidly improved during the treatment, and that her countenance regained the aspect of health." I know of no true analogues to Hydrastis. The lowest potencies have been of most service in constipation. As an external application the tincture largely diluted, or a weak infusion, has been HYOSCYAMUS NIGER. 309 used. Dr. Hale now recommends the Muriate of Hydrastia (the latter being an alkaloid of Hydrastia) for this purpose, in the proportion of gr. j. x to eight ounces of water. In cancer, Dr. Bayes recom- mends a gradual descent from the 30th dil. to half- drop doses of the mother-tincture. Drs. Marston and McLimont's doses range from the 6th dil. down- wards. My next medicine is as familiar to you as the last was novel. It is the henbane, Hyoscyamus niger. The tincture is made from the expressed juice of the whole plant. The proving of Hyoscyamus is in the ' Mat. Med. Pura/ It adds little, however, to the know- ledge of the drug which you already have in your treatises on ' Toxicology ' and c Materia Medical If I wanted to illustrate how often you of the old school are unconsciously Homoeopathizing, I should take Hyoscyamus as my example. You use it medicinally as a "calmative": and you do well. But what is its physiological action, its effect upon the healthy body ? You know that it is a blood- relation of Belladonna and Stramonium ; that Pereira classes it with these among his " deliriafacients "; that, in a word, it excites as a poison that very nervous system on which as a medicine it " has a calming, soothing, and tranquillisiug effect. This is especially observed/' Pereira goes on to say, " in persons suffering from great nervous irritability, and from a too active condition of the sensorial func- 310 HYOSCYAMUS NIGER. tions." He would have been more correct had he said that it is in these only that it is observed. Since, then, you know the physiological action of Hyoscyamus, and already use it homoeopathically, you may think that I need say no more about it here. But it is not so. Does your knowledge of the medicine teach you what are the forms and shades of nervous irritability to which Hyoscyamus specifically corresponds ? If you look for informa- tion to Toxicology, it tells you that the virtues of Belladonna, Hyoscyamus, and Stramonium depend upon a common " active principle," and that their action is therefore essentially identical. If, disap- pointed with this most untenable generalization, you turn to your writers on Therapeutics, you hear nothing more about the relation of Hyoscyamus to Belladonna or Stramonium ; but find it classified as a substitute for Opium in cases where the cerebral or intestinal influence of the latter drug is unde- sirable ! So you must come to Homoeopathy after all, if you wish to learn how to use henbane as a specific. We lay down, then, as the result of our patho- geuetic experiments and clinical observations, that Hyoscyamus does act whether as poison or as medicine like Belladonna and Stramonium : but with a difference. The cerebral condition which it produces is equally one of excited and perverted function, i. e. delirium with hallucinations : but there is little or no determination of blood. Hyoscyamus hence takes no place in the treatment of those cerebral hypersemiae for which we rank Belladonna so high. Nor does it reach that height of maniacal HYOSCYAMUS NIGER. 311 disturbance to which Stramonium is applicable. But in delirium of a less violent and inflammatory type, as in many cases of delirium tremens ; in the milder forms of mental disorders, especially when occurring in children ; and where sleep is restless or too dreamful from simple cerebral excite- ment, Hyoscyamus is a most valuable remedy. It is often useful, moreover, in what may be called " local chorea" in children, as squinting, stammering, twitching of the face, &c. There is some reason, ab usu in morbis, for supposing Hyoscyamus to have an h&matic action. At any rate, it is more fre- quently indicated for the cerebral complication of fever than either Belladonna or Opium : and in the less sthenic forms of puerperal fever, is sufficient single-handed to accomplish a cure. For painless diarrhoea occurring in this same puerperal state Hyoscyamus is accounted a specific in our school. Lastly, we use Hyoscyamus a good deal in nervous coughs, especially when the irritation begins or is aggravated as soon as the patient lies down. In Belladonna and Stramonium I have already named the only true analogues of Hyoscyamus. The largeness of the doses of Hyoscyamus you use depends, I believe, very much upon the inertness of your tincture and extract. I once gave drop doses of our tincture to a phthisical patient to ease her cough : but it caused her to dream so deliriously that I had to suspend it. I commonly use the dilutions from the 1st to the 4th dec. : but in children have seen capital results from the 6th and 12th. 312 HYPERICUM PERFOLIATUM. Of Hypericum perfoliatum. I have only to say that I find it even more useful than Arnica where an injury has affected an indi- vidual nerve, as of the arm. Dr. Ludlam of Chicago has published two good cases of injury to the spinal cord with a view of showing that Hypericum is to injuries of the nervous what Arnica is to injuries of the muscular system.* Its pathogenesis, which is in Jahr's ' Manual/ ought to lead to other applica- tions : which, however, it has not yet received. I use, as did Dr. Ludlam, the 1st dilution. * ' Brit. Journ. of Horn.,' vol. xvii, p. 523. LETTER XXV. IGNAT1A, INDIGO, IODIUM, KALI HYDRIODICTTM. THE first medicine of to-day's letter is one whose use is almost peculiar to the school of Hahnemann. It is the seed of the Strychnos S. Ignatii, S. Ignatius' Bean, Ignatia amara. It is either triturated, or macerated to form a tincture. The original proving is in the ( Mat. Med. Pura/ Experiments have been made with it by Jorg also, an account of which you will find in Hempel. Ignatia contains, as you probably know, a con- siderable amount of Strychnia. It is doubtless to this alkaloid that it owes much of its energy. But this is quite another thing from assuming that Ignatia and therefore Nux vomica are merely vehicles for the administration of Strychnia, and might well be abandoned in favour of the pure alkaloid. Yet to this the one-sidedness of Toxi- cology seems to be leading the therapeutists of the old school. On the contrary, our pathogenetic ex- periments and therapeutic observations teach us that Ignatia and Nux vomica differ essentially both from Strychnia and from one another, however 314 IGNATIA AMARA. great be the family resemblances. I have already had occasion to combat this error in reference to Belladonna, Hyoscyamus, and Stramonium. In poisonous quantities Ignatia simply produces tetanic spasms, and death by dyspnoea. But these phenomena are resolved into their elements by the symptoms resulting from smaller doses. Ignatia exalts the impressionability of the incident nerves all over the body. We have hence pains and other morbid sensations well-nigh everywhere ; increased susceptibility of the special senses ; emotional sen- sitiveness ; and probably from reflex excitation twitchings, constrictions, and spasms. This action of the drug, however, is not deep and lasting. An alternating series of symptoms numbness, torpor, depression soon appear, which are themselves as superficial as their predecessors. The febrile symptoms of the drug have the same characteristics. Its chill is readily removed by external warmth ; and its heat is unaccompanied by thirst. The symptoms of particular parts are just instances of this general action : Ignatia seems to have few local affinities. I will only note that it causes excessive flatulence and premature menstruation : and will then refer you for farther information to Hahnemann's exhaustive proving. I turn to its therapeutic properties. The general hyperaesthesia, the rapid alternations of mood, and many of the local phenomena pro- duced by Ignatia point to it as a remedy for hysteria : in the treatment of which malady it has ever been the most potent of our drugs. It is rapidly curative of such local symptoms as the IGNATIA AMARA. 315 clavus and globus hystericus, while its continued use will greatly improve the fundamental perversion of the nervous functions. It is also valuable for some of the manifestations of hypochondriasis in the male sex. It comes pretty frequently into play against convulsive affections of children, when these are not cerebral so as to require Belladonna. The reflex convulsions caused by worms are in- stances of what I mean. Ignatia could hardly but be of value in some forms of neuralgia, for which accordingly it ranks high as a remedy. The indi- cations for its choice in prosopalgia are well given by Dr. Gerson in the ' Brit. Journ. of Horn./ vol. xx, p. 415. They correspond with the general character of the drug's action which I have here sketched. In proctalgia it has more than once effected a cure, sometimes alone, sometimes aided by Nitric acid. Finally, Ignatia is the best medi- cine for the effects of disturbing emotions, especially those of fright and of grief. Besides Nux vomica, the allies of Ignatia are Chamomilla, China, Coffea, Hyoscyamus, Lachesis, Platina, Stramonium, and Valerian : the first only, however, being a near relative to it. Hahnemann recommends the 9th or 12th po- tency. The cures of proctalgia were made by the 30th. But Ignatia seems to be in favour alike with those who use high and with those who use low potencies : and is probably one of those reme- dies whose quantitative action has little to do with the result. I am myself very well satisfied with the dilutions from the 2nd to the 6th. 010 IODIUM. I have now a few words to say about Indigo. The dye of commerce is triturated for medicinal use. Our authorities for Indigo are a pathogenesis translated in Teste's ' Materia Medica ' from Dr. Roth's collections ; and a proving by Lembke, of which an account is given by Hempel. I am unable to see in the disturbance of the system produced by Indigo anything that is charac- teristic. The urinary organs seem most irritated. As a remedy, it has been used in the old school with occasional success in epilepsy and chorea. Teste states that he has cured with it some worm fevers in children : and has found it of service in chronic catarrh of the bladder, and in urethral stricture following gonorrhoea. It is a drug I have never myself used. I can give you no information about analogous medicines or dose. And now for the remainder of this letter I shall dwell upon a medicine which though not taking quite the first rank is a very especial favourite of mine, Iodine or lodium. Our mother-tincture is a saturated alcoholic solu- tion, and therefore contains about one-tenth part of Iodine. For the other potencies it should be treated as the 1st dec. dilution. Hahnemann has left us a pathogenesis of Iodine IODIUM. 317 in his ' Chronic Diseases/ which (according to Teste) is in great measure composed of the poisonous effects of the drug observed by alloeopathic authors as results of over-dosing. There is a valuable monograph by Dr. Cogswell, " Prize Essay on Iodine and its Compounds" (Edinburgh, 1837) : and a useful collection of " Observations on the curative and noxious effects of Iodine/' by Dr. Wilcox, in the first vol. of the 'Annals of the Brit. Horn. Society/ A " Study of Iodine/' by Dr. Madden and myself, founded on these and other materials, is contained in vol. xxi. of the 'Brit. Jouru. of Horn/ To that paper I must refer you for the filling in of the details of my present sketch; and for the authorities for the statements I make. The pathogeuetic action of Iodine is rather ex- tensive. Of most interest and importance are its effects upon the various glands ; but it sets up a good deal of tissue-irritation, and manifests some neurotic and haematic properties. I. Let me first call your attention to the in- fluence of Iodine upon the nutritive functions. Its continued use has not unfrequently brought about general emaciation, with colliquative sweats and diarrhoea, and with fever of the hectic type. In our paper we have discussed at length the probable rationale of this remarkable effect. After rejecting the theories which make Iodine stimulate the ab- sorbents, impair primary digestion by setting up gastro-enteritis, and cause liquefaction of the tissues, we conclude that its true action is one of a depressant character exerted upon the lacteal vessels and mesenteric glands. Given a sluggish 318 IODIUM. taking up of the fatty elements of the food by the lacteals, and an insufficient elaboration of their con- tents by the mesenteric glands ; and we have at once a most important channel of nutrition choked up and rendered useless. The fatty aliments being those taken up by the lacteals, the emaciation becomes more rapidly apparent than if it had been the albuminous constituents of the diet whose supply was cut off. But Dr. Hughes Bennett has shown that the presence of oil is essential to the assimilation of albumen; and infers that if the fatty elements of food be insufficiently supplied, the albumen, remaining unassimilated in the blood, will be deposited in the tissues as tubercle. Accord- ingly, in more than one instance there has been a development of phthisis pulmonalis in iodized subjects, in whom no previous tendency to tubercle had existed. The action on the glands of which the emaciation of Iodine is thus a prominent instance, displays itself also in the salivary glands, the liver, the glands of the generative system, and the thyroid. Salivation is produced by Iodine more frequently than by any other drug save Mercury. From two cases of poisoning with their autopsies Christison concludes that Iodine has the power of inflaming the liver. In one " after the emaciation had far advanced a hardened liver could be felt;" in the other there was, post-mortem, " enlargement and pale rose-red colouration of the organ." Upon the glands of the generative system it exerts a depress- ing and atonizing influence. The mamrnse and testes have more than once wasted and disappeared IODIUM. 319 under its use ; and a diminution of the functional energy of the ovaries makes it probable that these are similarly affected. It has caused barrenness in young females previously prolific, and in full iodism the menses are commonly suppressed, less often becoming profuse and watery. But the pathogenetic action on the thyroid has so important a bearing on the general question of Homreopathy, that I must state it at length. I infer that Iodine is a specific irritant of the thyroid gland on the following grounds. 1st. Coiudet, Graefe, and others bear witness to a primary aggravation of bronchocele as frequently produced by Iodine. Dr. Wood states that " some- times the tumour, instead of yielding immediately, seems to be stimulated into inflammation, swell- ing, and becoming somewhat painful." And I myself have seen a case in which this phenomenon occurred during the first week of the administration of the hundredth part of a grain each of Iodine and Iodide of Potassium three times a day. 2nd. In the eleventh vol. of the ' Brit. Journ. of Horn/ you will find the following observation by Dr. Goullon. "A man 62 years of age, very bilious, and from his youth affected with gout, got from an allopathic doctor for sciatica two scruples of Iodide of Potassium in four ounces of water, with directions to take morning and night a tablespoon- ful (i.e. gr. v. of the salt). After about eight days there came on an extremely rapidly growing swelling of the thyroid gland, with some sensitive- ness to the touch and feeling of oppression." I wish that the account of this case had been given in 320 IODIUM. more detail : but, putting it together with the before-noted aggravations caused by Iodine, I think that it establishes my point. II. The tissue-irritant influence of Iodine is nearly as extensive as that of Arsenic ; but, except in the upper part of the respiratory mucous mem- brane, is by no means so intense. It affects the mucous and serous membranes, and the skin. 1. When taken internally, Iodine acts as an irritant of the wb le alimentary canal. The only part of this tract, .owever, in which we have proof of specific action is the stomach, which has become inflamed by the external use of the drug. The bulimia often caused by Iodine is probably not gastric, but a symptom of the disappointment of the tissues whose supply is inadequately furnished through the depressed mesenteric glands. The respiratory mucous membrane feels the irritation of Iodine in its whole extent, but especially in the upper portion. Catarrh al symptoms in the nose and frontal sinus are frequently produced in a very severe form by Iodide of Potassium : and from Iodine itself the larynx and trachea experience various sufferings, running on from dry cough to hoarseness, aphonia, chronic inflammation, and even phthisis trachealis. The irritation extends to the lungs. There is frequently congestive oppres- sion and hemoptysis : and once at least actual inflammation has occurred, ending in death. The genito-urinary mucous membrane seems un- affected. 2. Our knowledge of the specific influence of Iodine upon the serous membranes is derived from IODIUM. 321 therapeutical rather than physiological evidence. Nevertheless Dr. Hempel tells us that Wallace states pleurisy to have been three times occasioned by his large doses of Iodide of Potassium ; and in Zink's autopsy, recorded by Christison, there was found serous effusion into the pleura and perito- neum. 3. Like most irritants of mucous membrane, Iodine has a corresponding influence upon its ex- ternal continuation, the skin. The forms of erup- tion most commonly caused by it are erythematous, papular and pustular. Dr. Vogel saw it produce a dingy appearance of the surface similar to that which Mr. Hunt describes as characteristic of Arsenic. III. The influence of Iodine upon the nervous system is only seen in very severe cases of poison- ing, or when the system is saturated with it ("iodism"). It has most power in the motor sphere, causing here a trembling of the extremities resembling the tremor mercurialis, which sometimes goes on to twitchings and other convulsive move- ments, and sometimes shows its essentially asthenic character by terminating in paralysis. In the sen- sory sphere there are manifested in some suscep- tible persons various derangements of sensation, as obscuration of vision, partial deafness, illusions of the sense of touch, &c. In the ideational and emo- tional sphere Iodine acts much like Arsenic. There is great and lasting anxiety and despondency which " differs from hypochondriasis in this respect, that the patients occupy themselves with the present instead of with the future. Patients 21 322 IODIUM. describe it commonly as a feeling of discouragement and dispiritedness, which is particularly depressing : and they have been heard to complain of this even when suffering violent pain." IV. The haematic influence of Iodine is still rarer and more remote than the neurotic. It is, like Mercury, an antiplastic : and tinder its long- continued influence the blood and the secretions become thin and watery. There are two organs upon which Iodine acts with some intensity, which have found no place in the foregoing analysis. These are the head and the heart. Iodine nearly always sets up more or less determination of blood to the head, causing head- ache with sense of fulness, giddiness, drowsiness, epistaxis, and even a kind of intoxication. And for the heart palpitation, with corresponding frequency of pulse, is a constant feature of iodism. In Dr. Goullon's very susceptible patient, after the develop- ment of goitre, there appeared " all the symptoms of an acute endocarditis (qy. ?) : oppression of the chest; weakness to fainting; intermitting, heavy, and tumultuous pulsation of the heart, and inter- mittent pulse ; tense pain across the chest ; loss of appetite, and vomiting." A peculiar symptom mentioned by Hahnemann is sensation as if the heart were squeezed or compressed (comp. Cactus). With one or two exceptions, I have not described minutely the physiological effects of Iodine. They are set down in your ordinary books of reference : and Homoeopathy has added little to our knowledge of them. Of its therapeutic power, however, I must write with some detail. IODIUM. 323 I. The peculiar influence of Iodine over the nutritive functions, and its special affinities for the glands and the lungs, make evident its homoeopathic relationship to those tuberculous and scrofulous affections in which it has so high a reputation. In this light you will continue to use it as experience has taught you in the torpid inflammations of the lymphatic glands, and in the ulcerations, the ophthalmia?, and the caries which depend upon these constitutional taints. But I would call your especial attention to its value in two of the most important of these local manifestations, tabes meseu- terica and phthisis pulmonalis. 1. In the fully developed form of tabes mesen- terica the marasmus of children we have an exact picture of the morbid effects of Iodine. There is rapid emaciation, with dry laryngeal cough, profuse night-sweats, and slow fever; the appetite is some- times ravenous/ sometimes lost ; and the bowels tend towards diarrhoea. I have already suggested that Iodine produces its nutritive disorder mainly through these very mesenteric glands. Its power over the idiopathic disease is very great. Under its use, the night-sweats usually disappear in a few days ; and the remaining symptoms, if proper diet and hygiene can be secured, steadily subside. I consider the action of Iodine in this disease one of the most satisfactory bits of treatment we have. 2. Not less striking is the resemblance between the effects of Iodine and the symptoms of phthisis pulmonalis. Locally, it has the pneumonia and haemoptysis; constitutionally, the emaciation and night- sweats, the wasting fever and rapid pulse, the 324 IODIUM. cough, the diarrhoea and vomiting, and (in females) the amenorrhoea. I wish I could go on to say that Iodine was as curative of pulmonary consumption as it is of mesenteric atrophy. I cannot credit it with this power ; but you must remember that the virtues of cod-liver oil depend in part, so many think, upon the Iodine it contains. I shall discuss this question presently : but in the mean time let me say that from Iodine itself I have seen more benefit than from any other drug in the treatment of this terrible disease. It appears capable of doing everything but checking the deposition of fresh tubercle. A fatal " but/' you will say ; and so it is, as far as cure is concerned. But palliation of symptoms and prolongation of life are no slight boons ; and these may often be procured for a time by Iodine. It is most interesting to observe how non-tubercular cases of this kind, however severe, get well under the use of this agent. Many a suspicious cough with haemoptysis, wasting and night-sweats ; many a chronic pneumonia where abscesses form and discharge have I seen cured by Iodine. Whereas, when tubercle is actually present, temporary improve- ment is always followed by a fresh outburst of the disorder. Having thus ascertained the diathetic relationships of Iodine, we can proceed to study its curative power in disorders of those organs and tissues which it specifically influences. 1. You are as well acquainted as we with the virtues of Iodine in mercurial stomatitis and saliva- tion. It is one of the many instances of unconscious homoeopathy in old school practice. In idiopathic IODITJM. 325 salivation, as from pregnancy, it will sometimes effect a cure where Mercury fails. A striking case of this kind is recorded by Dr. Wilcox. The pancreas is a gland so nearly identical, both in structure and in function, with the salivary glands, that a drug which acts upon the latter may be fairly expected also to influence the former. Iodine accordingly appears as the leading pancreatic medicine in the organology of Rademacher : and several cases of acute and chronic disease of this gland are cited by Wilcox in which Iodine effected a cure. I must refer you to his paper, or to our own, for the details. I would only add that the rare disease known as diarrhoea adiposa has several times been ascertained to exist in connection with pancreatic disease. This may serve as a hint for the trial of Iodine as its remedy. 2. After what we have seen of the effects of Iodine on the liver, I think I may claim for homoeo- pathic action any benefit obtained from it in hepatic disease. I know nothing of it here, save that Dr. Dudgeon once cured with it an obstinate case of jaundice in which he suspected organic disease of the liver.* 3. The specific influence of Iodine upon the (/lands of the generative system would suggest its frequent employment in morbid states of these glands, especially when occurring in scrofulous and tubercular subjects. In such patients amenorrhcea, galactorrhoea, and leucorrhcea have been cured by it. I speak with more diffidence when I suggest that to such an influence is due the dispersion of mam- * ' Brit. Journ. of Horn.,' vol. xxii, p. 357. 326 IODIUM. mary, ovarian, and uterine tumours which has sometimes been accomplished by Iodine. It is worth noting, however, that the tumours of the uterus which have in Dr. Ash well's words " melted down " under the action of Iodine appear invariably to have originated in the cervix, i. e. in the glandular and secreting portion of the organ. In inflammations and indurations of this part, moreover, Iodine is a remedy of tried value. It should be borne in mind, I think, in cases of sterility where the strumous diathesis exists. 4. I come now to the power of Iodine over bronchocele. I need not here give any account of the history of this practice, or of the testimony borne to its success. I would only say that I am by no means satisfied that the virtues of the original burnt sponge were due entirely to the Iodine it contained : and think that we may often with advantage give Spongia instead of Iodine in the treatment of the disease. The pathogenetic action of Iodine on the thyroid clearly points to the kind of goitre in which we may expect it to prove curative. It certainly will not cure the exophthalmic form ; nor that which results from cysts developed in the gland ; still less its carcinomatous enlarge- ment. But " in all cases of pure hypertrophy, or resulting from an obscure chronic irritation or sub- inflammation in the tissue, in other words, all cases of pure goitre, as distinguished from other special diseases which may be seated in that as well as in any other tissue a cure may be reasonably hoped for."* It is unnecessary to give Iodine * Wood, ' Mat. Med.,' vol. ii, p. 334. IODIUM. 327 in large doses, or to apply it externally, for the cure of bronchocele. If you will read the three admirable cases reported by my friend Dr. Kidd in the number of the ' British Journal ' for April, 1867, you will, I think, be satisfied as to these points. So much for the place and value of Iodine in glandular affections. I come now to the uses of this medicine which are based upon its tissue irri- tant influence. 1. Iodine is not a leading remedy in affections of the mucous membrane of the alimentary canal. The few uses to which it has been put in this region are mentioned in our " Study." Anatomically, catarrhal deafness must be placed in this category, as it appears to be an extension of a sore-throat along the Eustachian tubes. Iodine is perhaps inferior to Pulsatilla when this affection is recent : but in chronic cases it is unequalled as a remedy. I have cured several with it. But upon some morbid conditions of the respiratory tract it exerts a curative power of a very high order. I prefer it in the form of Iodide of Patassium (of wbich I shall speak directly) when the nasal passages are affected, and of Spongia when the mischief is in the larynx. Iodine itself has become our chief remedy in true croup. The history of its use in this disease is parallel with that of its employment in goitre. Hahnemann, led by one of the symptoms in the pathogenesis of Spongia, suggested its trial in mem- branous croup. The result was extremely satis- factory. But in 1841 Dr. Koch communicated to the ' Hygea' the results of his expedience in the treatment of croup, which led him to believe that 328 IODIUM. Iodine was a more potent remedy therein than Spongia ; and indeed that the virtues of the latter medicine depended mainly if not entirely upon the Iodine it contains. Since that time the use of Iodine in croup has become very general, and its only rivals are Bromine and the Bichromate of Potash. I would refer you to the admirable mono- graph on this disease by Dr. Elb of Dresden, which you will find translated in vol. x. of the ' Brit. Journ. of Horn/ More recently, the advantage of conjoining inhalation to internal admiuistration in croup has been enforced and illustrated by Drs. Arnold* and Drake. f Dr. Meyhoffer, moreover, has attempted the differential diagnosis of Iodine and Bromine, by calling attention to the general influence of the former as excitant, of the latter as depressant. Hence he infers that Iodine is most suitable for sporadic croup occurring in previously healthy subjects : while Bromine is preferable when the false membranes in the air-passages are pro- duced by the diphtheritic poison. 2. Of most of the uses of Iodine in affections of the serous membranes I shall speak under Iodine of Potassium. I will only mention here its curative power when injected into the sac of a hydrocele. You may be surprised at my referring this action to any specific influence : you will say that it rather consists in the setting up of an adhesive inflamma- tion in the walls of the sac, and that the Iodine is merely a more manageable substitute for the port- wine of our predecessors. But M. Jousset of * ' North Amer. Journ. of Horn./ vol. vii, p 236. f Ibid., vol. x, p. 296. TODIUM. 329 Paris, in an able article which you will find trans- lated in vol. xvi. of our Journal, has adduced numerous facts to prove 1st, that the production of inflammation is not essential to the success of this operation ; but, 2ndly, that it rather prejudices that result than otherwise : 3rd, that a cure has several times been effected by the injection of a watery solution of Iodine, water being incapable of taking up more than its 7000th part. To this I may add that the first successes with Iodine in hydrocele were obtained by M. Ricord from the topical use of compresses dipped in the diluted tincture, and (in one case) from the Iodide of Potassium given internally. I cannot, therefore, but assent to M. Jousset's conclusion, that Iodine cures in these cases by a specific alterative influence exerted upon the serous walls of the sac. 3. The use of Iodine as distinct from Iodide of Potassium and cod-liver oil in cutaneous disease has been limited to chronic eruptions occurring in scrofulous children. A remarkable improvement in the beauty of the hair and cleanness of the scalp has been observed to follow its use in these subjects. The neurotic and haematic conditions characteristic of Iodine rarely, if ever, come before us as substan- tive maladies. They concur in strengthening the indications for its choice in the diseases we have already considered. Nor can I mentidn any affec- tions of the heart in which it has been, or is likely to be, useful. I have, however, found it of great value in chronic congestive headaches and vertigoes, especially in old people. 330 KALI HYDRIODICUM. As regards other medicines, Iodine stands about midway between Mercury and Arsenic, overlapping the sphere of either with its own. Its action on the air-passages compares with that of Bromine and of Kali bichromicum. I have always used the 3rd dec. dilution of Iodine in the mesenteric and pulmonary affections, the deafness, the croup, and the cerebral congestions for which I esteem it so highly. In bronchocele the 1st or 2nd dec. seems required : and I should think that these latter would be more useful than higher potencies in strumous affections. I confess that I have rarely used Iodine myself in these latter conditions. Of the compounds of Iodine we use in our practice the Iodides of Mercury and of Potassium. Of the former I shall speak when treating of their base : the latter will more appropriately be con- sidered here. We call it by the old name, which is unfortunately based upon an incorrect theory of its composition, Kali hydriodicum. It is prepared by trituration or (better) aqueous solution. There is a pathogenesis in Jahr's ' Manual/ taken from Noack and Trinks. It is merely, however, a collection of symptoms which have been observed as a result of too large doses or too long-continued use of the drug, and which you may read as well or better in Pereira. The physiological action of Iodide of Potassium, KALI HYDR1ODICUM. 331 so far as we know it, is very much that of Iodine, becoming intensified at certain points. The coryza of the Iodide is very marked, involving the con- junctival and nasal mucous membranes and that of the frontal sinus. I have collected in vol. xxiii of the ' Brit. Journ.' some notices of this affection. It is noted of the watery nasal discharge that it feels cool, and causes no excoriation, herein differing from the coryza of Arsenic. In vol. xi of the Journal you will find some observations by Pro- fessor Langston Parker as to the effects of the long- continued use of Iodide of Potassium upon the tongue. The organ became in four cases tender, swollen, lobulated, and fissured. Purpura, too, has been more than once caused by it, which coincides with the hsematic influence of Iodine : and erythema and pustular eruptions have evidenced its action upon the skin. I have already mentioned the effects on the pleura ascribed to it by Dr. Wallace. Certain of the therapeutic uses of Iodide of Potassium are undoubtedly based upon its known physiological effects. Thus it is very useful in severe local coryza, especially where the nose is red and swollen. In a case of profuse dark discharge from the nose, without constitutional symptoms, occurring in a child after exposure to the contagion of diphtheria ; when Kali bichromicum, Biniodide of Mercury, Muriatic acid, and Arsenic had failed, immediate improvement and rapid cure took place under the 1st dilution of Iodide of Potassium. Then it is stated by your own men to have cured some desperate cases of acute hydrocephalus in the stage of effusion ; to have reduced a chronic hydro- 332 KALI HYDRIODICUM. cephalus to normal dimensions ; and more than once to have dispersed the fluid of hydrothorax. Moreover, Dr. Neligan considers it superior to any other drug in cutaneous diseases : he names psoriasis, lepra, icthyosis, and lupus as the forms in which he has found it most useful. But you know well that the therapeutic virtues of Iodide of Potassium are much more extensive than these. When we step out into its great field of action as a remedy for secondary and tertiary syphilis and chronic rheu- matism, pathogenesy fails us as a guide. It is one of the weakest points in our theory that we cannot account upon the law of similars for the power of this remedy. Nevertheless, I cannot doubt that it is specific in its nature, and depends upon the elective affinity of the medicine for the tissues affected by the morbid poisons. Thus, it is as beneficial in simple periostitis from an injury, as when this membrane is attacked by syphilis or rheumatism. The affection of the tongue, moreover, described by Professor L. Parker, is quite syphilis- like in appearance. For myself, I use Iodide of Potassium very much as you do in syphilis, for its ulcers on tonsils and soft palate, for its nodes, and so forth. And I do not see how we can do better than follow your practice so often crowned with success of treating with this remedy those paralyses and epilepsies which seeni to own a syphilitic origin. In chronic rheumatism I have less ex- perience with it : and we have many similarly acting medicines here. The dose of Iodide of Potassium need not, as your experience proves, be infinitesimal. I doubt OLEUM JECOR1S ASELLI. 333 whether it is ever used by our high dilutionists. All of our school who have mentioned it Drysdale, Hempel, Yeldham, and Cl. Miiller advise it to be given in material doses. I generally give my patients a bottle of the 1st dec. dilution, which they take in increasing doses till improvement begins. Before leaving Iodine, I must say a few words upon Oleum jecoris aselli. When this potent therapeutic agent was first introduced into practice, it was a common opinion that its peculiar virtues were due to the Iodine it contained. To the homoeopathic physician, the infinitesimal proportion (one part in 40,000) in which the drug existed occasioned no difficulty ; and he could point triumphantly to the perfect homoeopathicity of Iodine to most of the maladies in which cod-liver oil was found beneficial. Of late years, however, so much evidence has accumu- lated as to the importance of oily matters in the nutritive operations, that it has become usual among ourselves as well as in your ranks to regard cod oil as a purely dietetic agent. I cannot myself subscribe to this conclusion. Without questioning for a moment the great value of an easily-digested animal oil as an article of diet in badly nourished frames, I do strongly doubt whether the whole virtues of cod-liver oil can be ascribed to this mode of action. When we remember that in a teaspoon- ful of this oil we are administering a dose of Iodine 334 OLEUM JECORIS ASELLI. equal to a drop and a half of its 3rd dec. dilution, and that we are generally giving it in cases to which the drug is thoroughly homoeopathic can we doubt that it exerts a curative action ? If we disbelieve this, we have no reason for believing in the action of infinitesimals anywhere. Moreover, were it the oleaginous matter per se which cures, why should all attempts to find a substitute for the oil of fishes be so unsuccessful ? I conclude, then, that the virtues of cod-liver oil are due, in a great measure, to the Iodine which it contains, and that the pathogenesy of this drug should always be borne in mind in our prescription of the oil. Iodine will obviously be given best in the form of cod-liver oil where there is much wasting, as we then introduce at one and the same time both the specific to cure the pathological tendency, and the most suitable pabulum wherewith to repair the material injury done to the organism by the ravages of disease. LETTER XXVI. IPECACUANHA, IRIS, KALI B1CHROMICUM. THE first medicine I shall consider to-day is one deservedly a favourite in both schools, Ipecacuanha. We make a tincture or trituration of the dry root. There is a short but characteristic proving in the ' Mat. Med. Pura/ and Testers remarks sub voce are worth consulting. Much of what I shall now say is contained in a paper of mine on the drug, which you will find in the ' Brit. Journ. of Homoeopathy/ vol. xxiii. The emetic action of Ipecacuanha is that by which it is best known. Let us study this for a minute. The vomiting is " specific," for it is set up when the drug is introduced into the system in other ways than by iugestion. Nevertheless, it would seem that the primary emetic impression is made upon the mucous membrane of the stomach, for some irritation of this tissue is always present when a large quantity of the drug has been intro- duced into the organism. Furthermore, the excita- tion which results in the complex process we call vomiting is conveyed to the nervous centre through the vagi, for, when these nerves are divided, no 336 IPECACUANHA. gastric irritation produced by Ipecacuanha or other- wise will have an emetic effect. The action of Ipecacuanha in this sphere may accordingly be thus defined : " a moderate inflam- matory irritation of a mucous surface, resulting, through a reflex excitation conveyed by the incident nerves of the part, in vigorous expulsive muscular movement." Its curative action in the same sphere is a capital illustration of the law of similars. It cures the same kind of vomiting that it causes. It is of little value when the mucous membrane itself is solely at fault, and the persistent nausea is a more prominent symptom than the occasional vomiting (Pulsatilla, Antimonium crudum). It does nothingfor the vomiting of true gastritis (Arsenicum), or for the sympathetic sickness of cancer, phthisis, diphtheria, and such like diseases (Kreasote), where the stomach is not primarily affected. But it is almost certainly curative in gastric cases where, without any serious affection of the mucous mem- brane, there is frequent retching and vomiting. Let me give you two brief cases in point. I have already recorded them in our Journal. 1. " August 19th, 1864. Mrs. F , set. 39. Lost her appetite nine months ago, without assignable cause ; then followed vomiting of all food, with great debility. The bowels are much relaxed ; the catamenia regular. Finding also some smarting of the eyes, I sus- pected that arsenical influence might be at work here, and desired her to bring me some of her wall-paper, which was green. In the mean time I prescribed " Ipecacuanha, 1st dilution, a drop three times a day for six days. " 26th. The vomiting has ceased, and she feels much better. (I had examined the green paper, and found it non- arsenical.) Repeat. IPECACUANHA. 337 " September 2nd. No vomiting ; gaining strength. Continue. " She took the Ipecacuanha for a fortnight more ; and then Sacch. lact. for three weeks, that I might keep her under observa- tion. The symptoms all subsided : and she became quite well." 2. " August 1st, 1865. Frederick G , eat. 54. Has vomited everything he has taken for three months past. The food causes pain during the short time it remains in the stomach ; the tongue is coated brown, and is cleft ; the bowels are regular ; the urine thick. " Ipecacuanha 1, a drop three times a day. " 8th. There has been no vomiting after the first two or three days. The feeling of nausea persists, and there is some pain after food. Repeat. " 15th. Continues to improve. Repeat. " 22nd. Nothing now but slight nausea and a little foulness of tongue. Pulsatilla 3, a drop three times a day. " He came to the dispensary on September 14th to get some medicine for his wife, .and reported himself as continuing quite well." Turning now to the respiratory organs, we find a group of symptoms produced by Ipecacuanha which, though somewhat idiosyncratic, are yet sufficiently common to be regarded as characteristic of the drug. You know that there are many persons who cannot remain in a room where Ipecacuanha is being powdered without feeling its influence upon their respiratory organs. Sometimes the conjunctival and nasal membranes are most affected ; the eyes are reddened, smart, and water, and there is copious defluxion from the nose, with incessant sneezing. More commonly the influence is felt lower down : there is dyspnoea, wheezing, and cough, ending in profuse mucous expectoration. It is evident that our former definition of the action of Ipecacuanha will hold good here also. Again we have a moderate inflammatory irritation 22 338 IPECACUANHA. of a mucous surface connected with expulsive muscular efforts ; and these latter quite dispropor- tionate to the amount of mucous irritation, and pointing to an involvement of the extremities of the incident nerves in the morbid process. Once again, moreover, clinical experience points in the same direction. The respiratory affections in which Ipecacuanha is curative are hay-fever, hooping-cough, croup, and certain forms of bronchitis and asthma. The sneezing of hay-fever; the violent expulsive cough of pertussis ; and the spasmodic paroxysms of croup bring these respective diseases under the definition I have given of the action of Ipecacuanha. And there are cases, half-bronchitis and half-asthma, as much neuroses as phlogoses, in which Ipecacuanha supersedes all other medicines. You will find one such case of my own in No. xxvii of the ' Annals of the Brit. Horn. Society/ I have written this down much as it stands in my paper in the Journal. My aim was to show that the usus in morbis often concurred with patho- genetic experiment to help us to the precise sphere and mode of action of our medicines. Ipecacuanha was a good instance in point. I have nothing new to add as to its gastric uses. But the application we make of it to affections of the respiratory organs must be interesting to you, as it is in many respects common to both schools. You must, however, admit that it is strictly homoeopathic. In hooping- cough and croup, too, where you have given it only as an emetic, you see now its specific operation. Let me say as regards the former disorder, that it is during the first fortnight after the hooping has IPECACUANHA. 339 commenced, when there is much mucous expectora- tion and vomiting, that Ipecacuanha (generally in alternation with Aconite) is so beneficial. After this Drosera in most instances becomes more ap- propriate. In simple spasmodic coughs resembling pertussis, with much retching and mucous expectora- tion, Ipecacuanha is rapidly curative. Of croup I speak only on Testers authority, who regards Ipeca- cuanha in alternation with Bryonia as its almost unfailing remedy. Dr. Elb, in the excellent paper I have already referred to, shows that croup is truly a " neuro-phlogosis," that there is a spas- modic as well as an inflammatory element in it. Hence he gives Aconite alternately with his Iodine. Of similar character is this prescription of Testers. As Bryonia (q. v.) is capable of setting up mem- branous inflammation of the respiratory tracts, its share must be the extinguishing of the phlogosis, leaving to Ipecacuanha the dealing with the ac- companying neurosis. I have never hitherto tried this treatment. I do not know whether you have ever verified the former reputation of Ipecacuanha in dysentery. Hahnemann objects to its being considered a remedy for this disease, since its pathogenetic action is limited to the production of simple diarrhoea. But it is impossible to suppose that the "radix anti- dysenterica" has gained this name from no cause whatsoever ; while its mode of action, where curative, can hardly be chemical or physical, or other than dynamic. And when we consider the phenomena of dysentery, we find that one of its most character- istic symptoms is identical with that which in other 340 IPECACUANHA. parts of the body we have seen to call for Ipeca- cuanha. I speak of the tenesmus. This is a violent and recurring expulsive action, not necessarily proportionate to the amount of irritation present on the raucous surface. When such muscular actions are known as cough or vomiting, the indication for Ipecacuanha is plain. It is no less so, even in the absence of pathogenetic analogy, when it is called tenesmus, and takes place at the lower bowel. Only here, as in croup, the amount of mucous irritation is generally too great to be overcome by Ipecacuanha alone. As there Teste alternates it with Bryonia, so here it usually requires to be supple- mented by Mercurius corrosivus. There is another element in dysentery which Hahnemann himself admits may be overcome by Ipecacuanha. " It is capable," he says, " of diminishing the quantity of blood/' The power of Ipecacuanha over haemorrhage is very curious, but undoubted. In intestinal haemorrhage (not from ulceration) I have seldom known it fail : and in haemoptysis, menorrhagia,, and hsematemesis it holds high rank as a remedy. There are some faint hints in the pathogenesis that it is homoeopathic to these maladies : but neither pathogenetic nor cura- tive action seem to bear any relation to that already described as characteristic of the drug. So that, while the practical fact remains for our edifica- tion, the theoretical explanation is at present impossible. The analogues of Ipecacuanha are Antimonium tartaricum, and perhaps Lobelia and Tabacum ; also Iris. IRIS VERSICOLOR. 341 For dose I rarely go higher than the 1st or at the utmost the 2nd dec. dilution. I come next to a plant which, though not peculiar to the American continent, has been made known as a medicine by American practitioners. It is the common blue-flag, Iris versicolor. A tincture is prepared from the root. In Dr. Hale's article on Iris in his ' New Remedies } you will find several provings made with it, and a collection of all known records of its clinical use. Iris is known in America as a very active emetic and purgative, and as an excitant of the salivary and biliary secretions. Our provings, while they agree with this description, both enlarge and precisionise it. Enlarge, for they show that the pancreas is irritated as much as or more than the salivary glands and liver. This is shown by the continual burning felt in this region by one of the provers, who at the same time was passing frequent watery evacuations ; and by the highly congested state of the organ in animals poisoned by Iris. And precisionise, for they indicate the vomiting and diarrhoea of Iris to be the result of hypersecretion along the alimentary tract, and that the morbid condition set up has little tendency to run on to inflammation. In these last words I have described pretty closely the pathological condition which obtains in what we call English cholera, which, however, I 342 IRIS VERS1COLOR. suppose exists in all parts of the globe. The acute vomiting and purging, predominantly bilious, which characterise this autumnal scourge are checked in the promptest manner by Iris. I mentioned this at the meeting of the Brit. Horn. Society, in Oct. 1865, and was pleased to read in the ' Monthly Horn. Review' of the following January that Dr. Lade of King's Lynn had met with a similar ex- perience. It is occasionally of use in other forms of acute vomiting and purging. It is the prince of remedies for "sick-headache" rapidly relieving the vomiting even in the cerebral form of the disease ; and in the gastro-hepatic variety by its continued use preventing the recurrence of the paroxysms. I was at one time in hopes that it would prove a specific for cholera infanlum ; but I fear that, although it promptly arrests the vomiting, it does not strike at the root of the disease, for the purging continues unabated. It has cured idiopathic and mercurial salivation, and should be thought of in acute affections of the pancreas. This is the main sphere of action of our medicine : but I must add that it has caused and cured vesiculo-pustular eruptions, neuralgia of the right side of the face, and sthenic seminal emissions. The provings indicate a still wider range of utility, for which we must look to the future. The analogues of Iris are Aniimonium tartaricum, Colchicum, Ipecacuanha, Mercurius, Podophyllum, Stannum. The low dilutions only have been used : I always carry about with me the 1st. KALI B1CHROMICUM. 343 Of the compounds of Chromic acid with Potash we use two, the Chromate and the Bichromate. The former we know only as a remedy, and can hardly distinguish between its action and that of the Bichromate. The latter, under the name of Kali bichromicum, is the best proved, and among the most valuable of all the medicines we possess. Exhaustive provings of Kali bichromicum were made almost simultaneously in England and iu Vienna. The English proving may be read in the appendix to the ' British Journal of Homoeopathy' for 1844 ; the Vienna experiments are recorded in the ' Austrian Journal' for 1847. The two are collated in a very thorough manner by Dr. Drysdale in the Hahnemann 'Materia Medica/ Part I. Numerous clinical cases are appended ; and ad- ditional ones are given also by Dr. Drysdale in the ' Brit. Journ. of Horn./ vol. xv. Kali bichromicum is a drug of which the old- school Materia Medica knows nothing. I must therefore expound it to you ab initio. Dr. Drysdale well characterises it as " a pure irritant to the organic tissues/' Comparing it with Arsenic, we observe that neurotic, haematic, and myotic influences are altogether wanting : but its sphere of tissue irritation is wider, omitting indeed the serous membranes, but extending beyond the mucous membranes and the skin to the fibrous tis- sues on the one hand, and to many of the glands on the other. I will endeavour to describe its physiological actions under these headings. 344 KALI BICHROMICUM. 1. The action of Kali bichromicum on the mucous membranes should be compared with that of Arsenic, of Mercury, and of Tartar emetic. It causes a marked increase in the quantity of mucus formed, which mucus is sometimes tough and stringy, and sometimes degenerates into pus. Higher grades of the inflammatory process are seen in the respiratory mucous membrane, and (when the poison has been swallowed) along the alimentary tract. In the former region, false membranes have been formed ; in the latter, the tendency is towards ulceration. The portions of the mucous tracts chiefly affected are the mouth, throat, cardiac portion of the stomach, duodenum and jejunum, and rectum ; the whole respiratory membrane, including the conjunctiva ; and the ureters. These toxicological actions are well pic- tured in the physiological provings. The provers have sore and injected fauces; sour eructations and heartburn, slow digestion, bitter taste, nausea and vomiting, with thickly coated tongue ; dysenteric purging ; coryza, hoarseness, and cough. 2. The action of Kali bichromicum on the skin, like that of Croton and of Tartar emetic, is most fully displayed as the result of its external applica- tion ; although, as also with them, the effect is specific, and may appear under other circumstances. In the account of the English proving given in the ' British Journal of Homoeopathy/ you will find some coloured engravings of the effects of the poison upon the skin. Papules, pustules, and ulcers are the most characteristic forms : the ulcers have hard bases and overhanging edges, are deep and generally dry. KALI BICHROMICUM. 345 3. The glands chiefly affected by Kali bichromicum are the liver and the kidneys. On the former its action is very marked. Here is a group of symptoms occurring in one prover. " Aching for some days in the right hypochondrium ; scanty, pale, clay- coloured stools, sometimes twice a day ; metallic taste, foetid breath, and confusion in the head." In animals poisoned by it, the liver is found con- gested, enlarged, friable, of a dark reddish-brown colour, but presenting on its surface whitish-yellow spots extending into its substance, of soft consistence, and slightly depressed. The kidneys are also found intensely congested, the tubular portion softened and undistinguishable from the rest, and the urine either purulent or altogether suppressed. 4. The fibrous tissues are much irritated, as shown by the marked tearing pains experienced by the provers, especially about the joints. Still more striking is the effect upon the periosteum, which manifests not only pain at certain spots, but its characteristic hard swellings. These symptoms are observed especially in the parietal, malar, and maxillary bones, and in the tibia. I see no evidence that Kali bichromicum influences the bones them- selves : but its curious effects upon the nasal septum show a decided power of destroying the cartilages. Dr. Drysdale thus describes what happens to the workers in chrome. " For the first days there is discharge of clear water from the nose, with sneezing, chiefly on going into the open air; then soreness and redness of the nose, with sensation of a foetid smell. Then they have great pain and tenderness, most at the junction of the 346 KALI BICHROMICUM. cartilage, and the septum ulcerates quite through, while the nose becomes obstructed by the repeated formation of hard elastic plugs (called by the work- men clinkers). Finally, the membrane loses its sensibility and remains dry, and with the septum gone, and frequently loss of smell for years (sic}." The pathogenetic effects I have now described are faithfully represented in the clinical use of the drug, of which we have large experience and exten- sive record. Kali bichromicum is of no service in idiopathic nervous affections, or in toxsemic fevers. The apparent exception of supra-orbital neuralgia, which it has often cured, is probably not a real one : as this is the neuralgia most frequently induced by gastric derangement. Two leading forms of ca- chexia, however, are prominently pictured in its pathogenesis, viz., syphilis and chronic rheumatism. I. Of syphilis, Dr. Drysdale writes, " The resem- blance in many respects between the action of this medicine and that of the syphilitic virus, and also its analogy to Mercury, would lead us to hope that we may find in it another remedy for that disease. Though we would not place any weight on such a merely superficial resemblance, yet we cannot refrain from noticing the likeness that the chronic ulcer when healed presents to the indurated chancre. A more correct way of judging of the resemblance is iu the further development of the constitutional symptoms. We have in this remedy the rash on the skin ; then the sore-throat, which has been mistaken for syphilitic ; then the periosteal pains ; then the rheumatism ; and lastly the diseases of the skin, chiefly of the pustular character, which have KALI BICHROMICUM. 347 the hard dark scab, and leave the depressed cicatrix." Experience has confirmed the hope here expressed, as will be seen in the remarks I shall make upon its curative power over affections of the throat, eye, skin, and periosteum. IT. The rheumatoid pains induced by Kali bichromicum are so numerous and characteristic, that it can hardly fail to take its place as a remedy for rheumatic affections. Experience has here also confirmed the indications of pathogenesy. It is espe- cially on the middle ground between rheumatism and syphilis in periosteal and syphilitic rheuma- tism that Kali bichromicum plays so distin- guished a part. It will be seen, however, that its action is by no means limited to cases such as this. The rheumatism calling for Kali bichromicum is chronic, and of the " cold" variety. Let us now follow the curative action of the drug along the road we have already traversed in describ- ing its pathogenetic effects. 1. In chronic catarrhs and ulcerations of the ali- mentary mucous membrane Kali bichromicum is often our very best medicine. The common chronic ulcer of the pharynx rapidly heals under its action. I agree also with Drs. Watzke and Russell in rating it very high as a remedy for syphilitic sore-throat. It will not, I believe, arrest the de- structive ulceration sometimes set up (requiring Mercurius or Kali iodidum) ; but will subdue chronic inflammation and heal up superficial ulcers very effectually. In dyspepsia and vomiting from chronic gastric catarrh, where the tongue has a thick yellowish coat (a white coat indicates Anti- 348 KALI BICHROMICUM. monium crudum in preference), Kali bichromicum is very successful. It should be the best medicine for ulcer of the stomach, as it has proved to be for ulcers of the duodenum resulting from burns. In chronic duodenitis our choice lies between our present drug and Arsenic. In chronic intestinal ulcer ation it vies with Mercurius corrosivus, and has effected some brilliant cures. Still more striking is the power of the Bichromate in affections of the re- spiratory mucous membrane. In acute coryza, influenza, catarrhal laryngitis, tracheitis, and bron- chitis it is often rapidly curative ; especially (as I think) when the digestive mucous membrane is simultaneously involved. There is also a large accumulation of evidence tending to show that it is a potent remedy for true membranous croup. I have never used it in this disease : but have been disappointed with it in laryngeal diphtheria. It is, however, more especially in the chronic affections of the respiratory mucous membrane that Kali bichromicum is efficacious. For a chronic " cold in the head" there is no medicine like it. It has cured polypus narium, and is recommended in ozsena; but this disease I have found it as little able to cure as indeed, are all other remedies I know. In chronic hoarseness, laryngitis, and tra- cheitis it has proved curative ; and should be useful in ulceration of the nose and larynx, syphilitic or simple. But it is especially in chronic bronchitis that Kali bichromicum has gained its great reputa- tion. It is indicated when the sputa are tough, difficult to detach, and come up in strings rather than in lumps. Before leaving the mucous mem- KALI B1CHROMICUM. 349 branes, I must tell you what Kali bichromicum can do for the eyes. It stands high among our reme- dies for catarrhal and strumous ophthalmia ; and has even cured rheumatic and syphilitic affections of the sclerotica and iris. 2. The Bichromate has often been used with great advantage in pustular eruptions ; and is one of the best remedies, externally as well as internally used, for ulcers of the legs. A syphilitic origin would specially indicate it in these cases. I have cured with it an obstinate case of acne faciei. 3. Kali bichromicum is a decided hepatic medi- cine, much resembling Mercurius. Dull pain in the right hypochondrium, especially when limited to a small spot, and whitish stools are indications for its use. Its action on the kidneys has led to its use in the suppression of urine which sometimes follows upon Asiatic cholera : and so far with appa- rent success. 4. The action of Kali bichromicum upon fibrous tissue has led to its successful use in a number of local rheumatisms, and such-like maladies. In Dr. Drysdale's article you will find cases of rheumatic headache, of lumbago and sciatica, and of perios- titis which have been very satisfactorily cured by it. The chief medicines whose general action is similar to that of Kali bichromicum are Kali iodidum, Hepar sulphuris, and the salts of Mercury. In its influence on the mucous membranes and skin it resembles also Arsenic and Tartar emetic. Spongia, Iodine, and Bromine act like it upon the 350 KALI B1CHROMICUM. larynx and trachea ; Mercurius on the liver ; and Mezereum and Phytolacca on the periosteum. I recommend by way of dose the first six dilu- tions. The 3rd is most commonly used, except in syphilis, where the lower potencies of this salt and of the neutral chromate have been used with most benefit. In acute affections, however, I nearly always prefer the 6th. For external use, as to ulcers, one grain of the pure salt to six or eight ounces of water will be found quite strong enough. LETTER XXVII. KALI CARBONICUM, CHLORICUM, NITRICTTM, AND PERMANGANICUM, KALMIA, KREASOTE, LACHESIS. OF the compounds of Potassium and salts of Potash we have already studied the Bromide and Iodide of potassium, and the Bichromate of potash ; and Potash itself has come before us under the name of Causticum. We have now to consider the remaining drugs of this order which we use in our practice. The first of these is the Carbonate of potash, Kali carbonicum. It is prepared by solution, at first in water, later in alcohol. The proving is in the ' Chronic Diseases/ If we are to believe the pathogenesis there detailed, we must credit Kali carbonicum with being homoeo- pathic to most of the ills that flesh is heir to. As a matter of fact, its sphere is very limited. It is best known in affections of the respiratory organs. It has occasionally proved curative in those pulmo- nary affections which were called "phthisis" before physical exploration was known : and it is strongly recommended in Noack and Trinks' ' Handbuch/ I 352 KALI CHLORICUM. know not on what grounds, in pleurisy. It appears, also, to have some influence over the ovario -uterine system. Hahnemann commends it in suppression of the menses, or when these delay making their first appearance at the time of puberty. It is spoken of so highly for aching in the back in pregnant women,* and for the effects of want of care after miscarriage that I suspect it has some power over uterine congestion. It will be seen from this that Causticum is not so close an analogue of Kali carbonicum as their chemical relationship would suggest, Natrum muri- aticum is perhaps the medicine which most resembles it. As Kali carbonicum was used by the earlier Hahnemannians much more than it is now, I should have supposed that the higher dilutions were the most efficacious. Dr. Clotar Miiller, however, writes "As long as I employed this medicine in 6 or 30, I saw little or no benefit. But since I have for many years by Dr. Gruber's advice, given it in 1 and 2, I have seen better results, especially in some cases of pulmonary tuberculosis." We come next to the Chlorate of potash, Kali chloricum, which is prepared as the Carbonate, or by tritura- tion. There is a short pathogenesis of Kali chloricum in Jahr's ' Manual.' A paper on its external use * I have just lately given it (6th dil.) in a case of this kind with most satisfactory results. KALI CHLORICUM. 353 by Mr. Evan Frazer in the 'Brit. Journ. of Horn./ vol. xviii, should also be consulted. From what I read in your journals I fancy that no medicine is in more general favour among your practitioners just now than Chlorate of Potash. You seem to believe in its power of improving cachectic states of the system, and give it accordingly in such diseases as syphilis, cancer, and phthisis where the general condition is of this character. Of the same nature appears to be its deodorizing influence when applied in solution, which you know well, but which I have never seen better illustrated than in Mr. Frazer's cases in the paper referred to. There is a growing tendency to revive the old notion that Chlorate of Potash produces these effects in virtue of the large proportion of oxygen it contains. At one time this theory was supposed invalid, because the salt was found unchanged in the urine. I cannot pronounce upon this question. If the theory be true (and I must say that the parallel action of the Permanganate gives countenance to it) the internal use of Chlorate of Potash is as open to us as its external application. It stands on the same footing as the inhalation of oxygen. I must claim, however, for dynamism and for Homoeopathy one of the best established uses of Chlorate of Potash, its power over stomatitis. Let me refer you to a case reported in the ' Med. Times and Gazette ' for May 22nd, 1858. A child had been taking from March 16th to May 18th three times daily at first ten and then five grains of the salt for strumous ophthalmia. " On May 18th, she came with a very sore mouth. The saliva dripped 23 354 KALI NITRICUM. from her lips, there were numerous follicular ulcers on the tongue and inside of lips, and one large one occupied a surface the size of a shilling on the back part of the dorsum of the tongue. The salivary glands were enlarged and tender, and the mouth full of saliva, although the ptyalism was not extreme, nor were the gums sore. In this latter respect and in the existence of the larger ulcers on the tongue, the stomatitis differed from that caused by mercury." Mr. Jonathan Hutchinson, also, mentions it as a curious fact that Chlorate of Potash causes a form of stomatitis very similar to that which it cures. Our experience is quite at one with yours as to the value of the Chlorate in these cases. Mr. Frazer thinks it has a specific power over ulceration, and gives a good case where this process in the throat of a syphilitic patient was arrested by it. In this action of Chlorate of Potash it has for analogues Mercury, Iodine, Nitric and Muriatic acid, and Iris. Your use of the drug shows that material doses will manifest its specific properties. I commonly use the 1st dec. trituration. Mr. Frazer finds ten grains to a pint a sufficient strength for local applica- tion. The third salt of Potash which comes before us here is the Nitrate, Nitre, or Kali nitricum. The nitre of the shops, dissolved in hot water and deposited in crystals as it cools, is triturated for our use. KALI NITBICUM. 355 The proving is in the ' Chronic Diseases/ sub voce "Nitrum." By far the best account, however, of the pathogenetic effects of the salt is given in Hempel. While I was an Alloeopath, Nitre was a very favourite remedy of mine in the febrile affections of children. I supposed it to act chemically on the hyperinotic blood, and dynamically on the excited circulation. I see no reason for supposing that I was wrong. Hahnemann says that "inasmuch as the production of cold in the system is the primary effect of Nitrum, its action in inflammatory fevers must be palliative only." I dare say it is; but in these ephemeral fevers a palliative answers much the same purposes as a curative. I have better remedies now : but I look back with affection to my former Nitre. I confess, moreover,, that I have not yet found a place for it in my new therapeutics. The pathogenetic effects it has occasionally produced are not a little remarkable. Besides its anti-plastic influence upon the blood, and its power of reducing the circulation, it manifests active neurotic properties. In one of the cases of poisoning by it collected by Dr. Hempel is caused general paralysis, with blind- ness, in another chorea, in another acute oedema of the whole body. Its well-known diuretic action, moreover, is worth noting and studying. Altogether I think that Nitre bids fair to become one of the " medicines of the future." I can say nothing at present about allied remedies or dose. The Permanganate of Potash 356 KALI PERMANGANICUM. Kali permanganicum, has been best known hitherto in the form of " Condy's Fluid," where it disinfects and deodorizes by means of (as it is supposed) the large proportion of oxygen it contains (comp. Kali chloricum). I mention it here because it has lately been proved, and bids fair to fill a gap in the treatment of malignant diphtheria which has long remained to our cost open. The heroic proving of Dr. H. C. Allen (which you will find in the ' Brit. Journ. of Horn/ for April, 1867) has shown the power of the Permanganate to set up acute inflammation of the throat, extending to the nares, larynx, and salivary glands, and along the Eustachian tubes. With these symptoms there were diuresis and obstinate consti- pation. Putting together this elective affinity for the throat and its neighbourhood, and the chemical power of the drug in dissolving the false membrane and destroying the offensive emanations of diphtheria, Dr. Allen tried it in a desperate case of the malignant form of this disease, with the most rapid and brilliant results. The usual remedies had been given without effect : the odour of the breath had become almost unbearable ; a dark-coloured offen- sive diarrhoea had set in, while, " with vomiting, fluids taken by the mouth were returned by the nose, and a general prostration seemed to be the precursor of a fatal termination. At this stage I dissolved three grains of Permanganate in one half- glass of water, gave her a teaspoonful at 9 p.m., to be repeated every hour until I saw her. Called at 12 p.m., found her much improved, breathing KALMIA LATIFOLIA. 357 easier, and a warm perspiration had made its appearance. Continued the medicine. The next morning found her sitting up in her bed, and her whole appearance changed. On examining the throat, to my astonishment, I found the membrane hitherto so extensive almost gone, a small patch on the left tonsil only being visible. The offensive character of the breath was completely changed ; in fact, I could discover no odour at all. Continued the medicine every three hours while awake, and she went on to a speedy convalescence." Dr. Allen adds,