ELEMENTS
HOMOEOPATHIC PRACTICE OF PHYSIC.
C AND 3. ADLAK.D, PRINTERS, nARTHQLOMKW CLOSE.
ELEMENTS
HOMOEOPATHIC PRACTICE
PHYSIC.
J. LAURIE, M.D.
LICENTIATE OF THE ROYAL COLLEGE OF SURGEONS, EDINBURGH ;
FORMERLY ONE OF THE PHYSICIANS TO THE WESTMINSTER AND LAMBETH HOMOEOPATHIC
MEDICAL INSTITUTION AND DISPENSARY.
LONDON:
J. LEATH, 5, ST. PAUL'S CHURCHYARD.
THOMPSON AND SON, CHURCH STREET, LIVERPOOL.
TURNER, PICCADILLY, MANCHESTER.
HEADLAND, HANOVER STREET, EDINBURGH.
1847.
CONTENTS.
INTRODUCTION.
PAGE
Regimen . . ' xvii
Choice of the Remedy. Potencies of the Medicaments ..... xix
The Choice of the Proper Remedy xx
The Potency, Attenuation, or Dilution of the Medicament xxi
The Dose and its Repetition . . . . xxvi
Remarks . . . . xxxi
NATURE AND FORM OF HOMOSOPATHIC MEDICINES . . XXXU1
Of Vehicles which serve for the Preparation of Homoeopathic Medicines . . xxxvi
1. Of Alcohol ib.
2. Sugar of Milk xxxix
3. Sugar Globules , xli
4. Water ib.
5. Ether xliii
Of the Preparation of Medicines in their Primitive State xliv
1. Observations and General Rules ....... ib.
2. Particular Rules for the Preparation of Fresh Plants — Tinctures . . xlvii
3. Preparation of Exotic Vegetable Products xlviii
4. Preparation of Mineral and Animal Substances — Triturations • . 1 Of Homoeopathic Attenuations lii
1. Of Attenuations in general ib.
2. the Preparation of Attenuations ....... lix
Of the Dispensation and of the Preservation of Homoeopathic Medicines . . lxiii
1. Of the Dispensation of Medicines ib.
2. the Preservation of Medicines lxiv
List of Medicines adapted to particular temperaments, &c. ... . . lxvii
Table of Medicines, with abbreviations . lxix
VI CONTENTS.
PAGE
List of Medicines 1
Synopsis of the Rules for Diet under Homoeopathic Treatment .... 3
Aliments allowed ib.
Aliments prohibited - » ■ 4
PART I.
ON THE SYMPTOMS, CHARACTER, DISTINCTION AND TREATMENT OF DISEASES.
FEVERS.
General consideration of Fever 5
Causes . . . .... . . . . t . . ib.
General Treatment in Fever and Diet 7
Simple or Ephemeral Fever. Febris simplex 8
Inflammatory Fever, Synochal Fever. Febris inflammatoria simplex. Synocha.
Febris synochalis. ............ 9
Nervous Fever. Slow Fever. Febris nervosa. Typhus ..... 12
Putrid Fever, Pestilential Fever, or Malignant Typhus. Typhus putridus. Typhus
abdominalis . . . , . . . ■.. . . . 27
Contagious Typhus, Camp Fever, Jail Fever, Petechial Fever. Typhus contagiosus . 29
Accessory Treatment. Prophylaxes, &c. . . .... , . ib.
— . Febris lent a nervosa . . .. . . . . . . . ... 30
Intermittent Fevers. Ague. Febres intermittentes .. . . . . . . 31
Raphania. Morbus cerealis, Convulsio cerealis. Eclampsia typhoides . .. 41
The Plague. Pestis. Pestis bubonica. Typhus pestilentialis . .. .. . . 44
Remittent Fever. Yellow Fever. Febris flava. Typhus icterodes . . . 47
Hectic Fever. Febris hectica . . 48
Mucous Fever. Febris pituitosa. Febris mucosa ...... 52
Gastric Fever. Bilious Fever. Febris gastrica biliosa 56
Eruptive Fevers , 58
Scarlet Fever . . . . ib.
Scarlet Rash. Purpura rubra, s. Miliaris Hahnemanni. . Scarlatina miliaris, mili-
' formis, papulosa. Miliaria purpurea ........ 64
Measles. Rubeola , 81
Smallpox. Variola 84
Chickenrpock. Variola spuria, Varicella . . . . . . . . 90
Miliary Fever. Miliaria. Miliaria alba. Miliaris sudatoria. Sudor miliaris . 91
Nettle-rash. Urticaria 94
CONTENTS. VII
DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM.
PAGE
Toothache. Odontalgia . . .... . . . . . 96
Sore Throat, or Quinsy. Aphthous Sore Throat. Angina faucium, Tonsillitis
phlegmonoides, Cynanehe tonsillaris. Angina aphthosa, 8fc. . . . 100
Ulcerated Sore Throat. Malignant Quinsy, Malignant, Putrid or Gangrenous Sore
Throat. Angina maligna, Tonsillitis, maligna, Cynanehe maligna . . 107
Inflammation of the (Esophagus. Oesophagitis . . . . . . . Ill
Mumps. Parotitis. Angina par otidea . . . . . . . . 112
Indigestion, or Dyspepsia .......... . 114
Want of Appetite. Apepsia. Anorexia . . . . . . . • 125
Derangement of the Stomach, Eructations, &c. . . . . . . . 129
Flatulency. Flatulentia. Flatus. Tympanitis intestinalis . . . . 132
Spasm of the Stomach. Gastrodynia, Cardialgia, Gastralgia . . . . 134
Heartburn. Black-water. Water-brash. Pyrosis ... . . . 140
Vomiting of Blood. Hcematemesis ib«
Costiveness, Constipation, Obstipation. Cpnstipatio, Obstipatio, Obstructio alvi . 143
Piles. Hemorrhoids ,.,... 148
Stricture of the Rectum 151
Abscesses, in Ano. Fistula in Ano . . . . 154
Proctalgia 157
Protrusion of the Intestine. Prolapsus ani 158
Colic. Enteralgia ..... . . . . , . . 159
Determination of Blood to the Abdomen. Congestio viscerum abdominis. Con- gest™ ad abdomen ........... 163
Looseness of the Bowels. Diarrhoea 164
Dysentery. Dysenteria. Febris dysenterica . . . . . . . 170
Cholera 177
Cholerine 200
Liver Complaint ... . . . . . . . ib.
Acute Inflammation of the Liver. Hepatitis ib.
Liver Complaint, or Chronic Inflammation of the Liver, Hepatitis chronica . 204
Jaundice. Icterus . . . . 205
Inflammation of the Spleen. Splenitis ....... . 207
Stomach. Gastritis ... ... . . 209
Bowels. Enteritis . . « . . . . •■ . . 212
Peritoneum. Peritonitis ... . . . .218
Invermination. Worms. Helminthiasis. Febris helminthiaca . . . . 219
Blenorrhoea 226
Vlll CONTENTS.
DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM.
PAGE
Catarrh, or Common Cold. Catarrhal Fever 231
Inflammation of the Larynx. Laryngitis ... . * . . . . 236
Hoarseness. Raucitas . . . . . . . . . . . 238
Cold in the Head. Coryza 240
Cough. Tussis 242
Hooping-cough. Tussis convulsiva. Pertussis . . 254
Croup. Angina membranaced. Angina perniciosa. Cynanche laryngea. Cynanche
tracheitis, s. trachealis, 8fc. 8fc. . , 258
Influenza ° 262
Determination of Blood to the Chest. Congestio ad pectus . . • . 265 Inflammation of the Mucous Membrane of the Bronchial Tubes. Cold on the Chest.
Pulmonary Catarrh. Bronchitis . . 268
Inflammation of the Lungs. 'Pneumonia vera, Peripneumonia., Pneumonitis, PuU
monitis ? . . . . . . . . . , . . 276
Peripneumonia Notha, s. Occulta. Catarrhus Bronchiorum. Spurious Peripneumony 299
Typhoid, or Congestive Pneumonia 301
Inflammation of the Pleura. Pleurisy. Pleuritis . . . . . . 302
Spurious, or Bastard Pleurisy. Pleurodynia, Pseudo- Pleuritis, Pleuritis muscularis 311
Diaphragmitis 312
Spitting of Blood. Hemorrhage from the Lungs. Sputum cruentum. Hamorrhagia
pulmonum. Haemoptysis . . . 314
Pulmonary Consumption. Phthisis Pulmonalis . ... . . 319
Asthma 324
DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM.
Determination of Blood to the Head. Congestio ad caput ..... 331
Inflammation of the Brain and its Tissues. Brain Fever. Phrenitis, Encephalitis 335
Apoplexy. Apoplexia 339
Acute Inflammation of the Spinal Cord and its Membranes. Myelitis. Meningitis
spinalis 345
Palsy. Paralysis 347
Tetanus * 348
Delirium Tremens Potatorum 351
Epilepsy. Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Morbus
herculeus. Morbus comitialis 353
Neuralgia. Cephalalgia. Cephalcea. Cephalalgia arthritica. Cephalalgia nervosa.
Hemicrarlia (megrim). Clavus hystericus . 358
DISEASES OF THE CIRCULATING SYSTEM.
Angina Pectoris 367
Pericarditis 370
Endocarditis * 381
Carditis 409
CONTENTS. IX
CUTANEOUS DISEASES.
PAGE
St. Anthony's Fire. Rose. Erysipelas . 413
Boil. Furunculus. Abscessus nucleatus . . . . . . . . 416
Carbuncle. Anthrax. Furunculus malignans. Pustula nigra . . . . 417
Chilblains. Perniones ib.
Corns. Clam pedis . . 419
Abscess. Lymphatic Tumours. Disease of the Conglobate Glands ... ib.
Itch. Scabies. Psora ... . 422
Whitlow. Paronychia. Panaris . . 425
Irritation, or Itching of the Skin. Prurigo 426
Ringworm (Herpetic or Vesicular). Herpes circinnatus. Herpes serpigo . 427 Ringworm of the Scalp. Pustular Ringworm. Porrigo scutulata. Tinea capitis.
Tinea annularis. Favus confertus . . . ■ * . . . . 428
Intertrigo . . . . 432
Psoriasis ib.
Pemphigus. Febris bullosa, Pompholyx . . . . . . • 433
Shingles. Zona. Herpes zoster. Cingulum. Ignis sacer, 8fc 435
Ulcers. Ulcera . . . 437
DISEASES OF THE URINARY AND GENITAL ORGANS.
Inflammation of the Kidneys. Nephritis . . 444
Inflammation of the Bladder. Cystitis . * ' 447
Retention of Urine. Ischuria 449
Difficulty in Discharging the Urine. Dysuria. Stranguria . . . . 451
Suppression of Urine . . . . . . . . . • . 454
Stricture of the Urethra . . . . . . . . . . . 456
Urinary Abscess and Fistula. Fistula in perinceo 458
Incontinence of Urine . . . 459
Diabetes 461
Hematuria. Nictus cruentus 463
Discharge of Blood from the Urethra. Urethrorrhagia. Hemorrhagia urethra.
Stymatosis . . . ... 466
Inflammation of the Urethra. Clap. Urethretis. Gonorrhoea. Blenorrhoea . ib.
Inflammation of the Glans Penis. Balanitis. Balano-blenorrhoea . . . 472
Inflammation of the Testis. Swelled Testicle. Orchitis. Hernia humeralis . 473
Sarcocele . . . . . . . . . ■ . . ■ . . . 474
Varicocele 475
Hydrocele . . . 476
Venereal Disease. Syphilis. Lues Venerea 479
Phimosis 494
Paraphimosis 495
Herpes Preputials 496
Sycosis < 497
CONTENTS.
DISEASES OP PARTICULAR ORGANS AND REGIONS, OR OF THE SYSTEM IN GENERAL.
PA^GE
Gout. Arthritis . , .. . . 515
Rheumatism. Rheumatic Fever. Febris rheumatica. Rheumatismus . . . 517
Lumbago . . ............ . . . 525
Inflammation of the Psoas Muscle. Psoitis . . . . . . . . 526
Sciatica ... . . . 527
Pain in the Hip. Hip-gout. Rheumatism in the Hip. Coocalgia, Coxagra. Ischias 528
Hip-disease. Morbus coxarius ... . . . . . . 530
Determination of Blood to the Abdomen, Congestio viscerum abdominis. Con-
gestio ad abdomen . . . . . . , . • 533
Acute Inflammation of the Eye*§. Ophthalmia . . . . . . . 534
Hordeolum. Stye . . . . • 540
Ectropium . . . . • . . • 541
Entropium. Irichiasis 542
Inflammation of the Ears and Earache. Otitis. Otalgia . . . . . 543
Bleeding of the Nose. Epistaxis . . 547
Swelling of the Nose 550
Canker of the Mouth. Scurvy in the Mouth. Cancrum oris. Gangrena oris.
Stomacace ............. 552
Scurvy. Scorbutus . 554
Inflammation of the Tongue. Glossitis . . . . . . . . 556
Offensive Breath 557
Cramp in the Legs . . . . . 558
Bronchocele. Goitre. Derbyshire neck 559
Sweating Feet. . . . . . . 560
Sleeplessness. Agrypnia . . . .... . . . . . 561
Nightmare. Incubus. Ephialtes 577
Rupture. Hernia • 578
Incarcerated Ruptures {Hernice incarcerated) . . . . . . . 582
Fainting. Swooning. Syncope . . 589
Pains in the Loins. Notalgia 591
Dropsy. Hydrops . ..... . . . . . . 592
Ascites 593
Dropsy of the Cellular Tissue. Anasarca . . ... . . . 596
Dropsy of the Chest. Hydrothorax. Hydrops pectoris. Hydrops thoracis . 600
Scrofula . • . . • • 602
Ostitis. Caries. Necrosis. Exostosis. . • 604
Rickets. Rachitis . . . . • • 612
CONTENTS.
XI
CASUALTIES.
PAGE
Concussion, Bruises, Sprains or Strains, Wounds, Dislocations, and Fractures . 613
Burns and Scalds. Ambustiones . ... . .... 628
Fatigue . . . . ■ . . . ... ... . 630
Overheating. Exposure to Heat . . . ... . . . 631
Stings of Insects . . . . . 632
Sea-sickness ib.
Apparent Death. Asphyxia -.■■.-. . 633
Hydrophobia .... . . 637
Mental Emotions . . .... . . . . : 644
PART II,
TREATMENT OF FEMALES, AND OF THEIR PECULIAR AFFECTIONS.
Chlorosis. Emansio mensium
Amenorrhoea. Suppressio mensium
Menstruatio Nimia. Menorrhagia
Dysmenorrhea
Hysterics. Hysteria. Passio hysterica
Inflammation of the Ovaries. Ovaritis
Inflammation of the Labia Majora and Vagina
649 652 653 655 ib. 657 659
OBSERVATIONS ON PREGNANCY*
Air and Exercise . ' . . . . 662
Clothing . . . ... ...... . . 663
Diet . ... . ... . . , . . . 665
Employment of the Mind and Habits during Pregnancy ib.
Influence of External Objects upon the unborn Infant , 666
Mental Emotions . . . ib.
Xll CONTENTS.
DERANGEMENTS DURING PREGNANCY.
PAGE
Menstruation 668
Morning Sickness ' ib.
Constipation . , . , , . . 669
Diarrhoea during Pregnancy . , 670
Fainting and Hysteric Fits . ibT
Toothache 671
Swelled Face 676
Varices, or Swelled Veins 677
Pains in the Back during Pregnancy. Lumbosacral Pains . . . . 678
Miscarriage. Abortus ib.
TREATMENT BEFORE PARTURITION.
Preparation of the Breasts 684
Remedies before Labour . . .. . 685
False Pains ib.
Parturition . 687
Tedious or Complicated Labours ib.
Spasmodic Pains, Cramps, and Convulsions 690
TREATMENT AFTER DELIVERY.
After-pains 693
Duration of Confinement 694
DISEASES FOLLOWING PARTURITION.
Suppressed Secretion of Milk 696
Excessive Secretion of Milk 697
Perspiration after Delivery, Suppression or Excess of ib.
Milk Fever 698
Irregularities of the Lochial Discharge . . 699
Diarrhoea in Lying-in Women 701
Abdominal Deformity ib.
Falling off of the Hair . . 702
Leucorrhcea after Parturition 703
Internal or Uterine Swelling and Prolapsus ib.
Inflammation of the Womb. Inflammatio uteri. Metritis 704
Weakness after Delivery 706
CONTENTS. Xlll
OBSTACLES TO SUCKLING.
PAGE
Disinclination of the Infant 707
Excoriation of the Nipples . . , . ib.
Inflammation of the Breasts 708
Mental Emotions affecting the Milk . .. .. . . . 710
Deficiency in the Secretion of Milk. Suppressed Secretion of Milk ... ib.
Deterioration and Discoloration of Milk . . 711
Mothers not Suckling their Children ib.
PART III.
TREATMENT OF INFANTS AND CHILDREN.
Introductory Remarks . • • 715
Treatment after Birth _ ... 716
Asphyxia 717
Swelling of the Head 718
Navel Rupture in Infants ib.
Meconium, Expulsion of ■ . « < • 719
Suckling of the Infant . * 720
The Choice of a Nurse 722
Diet during Nursing ib.
Supplementary Diet of Infants 723
Duration of Suckling. Weaning 725
Sleep. Sleeplessness 727
Exercise 729
DISEASES OF INFANCY.
Inflammation of the Eyes in New-born Infants . 732
Cold in the Head .... 733
Crying and Wakefulness of New-born Children 734
Regurgitation of Milk. Acidity, Flatulence, &c. 736
Spasmodic Asthma. Spasms in the Chest . . . ; . . . . 737 Milk-Crust. Milk-Scab. Milk*Blotches. Crusta lactea. Porrigo larvalis. Eczema
faciei. Tinea faciei 738
Thrush, or Aphthae 739 '
Constipation. Obstructio aim neonatorum 741
Bowel Complaints of Infants. Diarrhoea neonatorum ib.
XIV CONTENTS*
PAGE
Excoriations. Eoocoriationes neonatorum. Intertrigo 750
Jaundice. Icterus neonatorum ib.
Induration of the Cellular Tissue. Infantile Erysipelas. Erysipelas infantum . 751
Lockjaw of Infants. Trismus nascentium . . . . . . . . 752
HeatSpots 753
Derangements during Teething . . ib.
Convulsions in Children ... 756
Water in the Head. Dropsy of the Brain. Dropsy of the Head. Hydrocephalus
membranarum et ventricularum . . 760
Asthma of Millar. Laryngismus stridulus . . . , . '. . . 762
Infantile Remittent Fever 763
Atrophy. Atrophia 768
Vaccination , . 769
Index . 771
PREFACE AND INTRODUCTION.
A considerable portion of the contents of this work has already appeared under the title of ' Homoeopathic Domestic Medicine, arranged to serve, in some measure, as a Practical Work for Students.5 But, in consequence of the growing attention which medical men are beginning to bestow upon our science, the Author has been advised to give the result of his labours in a separate form to the professional public. He has accordingly made considerable alterations in those parts of the aforesaid work which must necessarily be retained in the present one, and has added many articles which were purposely omitted in what was chiefly designed to be a treatise on domestic medicine. The Author therefore trusts that, notwithstanding its manifold imperfections, this humble effort to furnish the professional inquirer with ' an elementary practice of physic according to the homoeopathic principle/ may be viewed with that kind indulgence which the occasion calls for, and ardently hopes that it may be instrumental in creating a desire for more extensive infor- mation to be gleaned from works of greater pretensions.
In compiling the work, the Author has derived much assistance from Hahnemann's Kronischen KranMeiten, Jahr's Nouveau Manuel de Medecine Homceopathique, Hartmann's Therapie akuter Krankheitsformen, Boeninghausen's Manuel de Therapeutique Homceopathique, Hering's (of Philadelphia) Hausarzt, andKnoack
XVI INTRODUCTION.
and Trinks's forthcoming Handbuch der Homceopatischen Arz- neimittellehre ;# which, together with the Materia Medica Purax the Organon of Hahnemann, that of Rau, Hamilton's Guide to Homoeopathy, Black's Principles and Practice of Homoeopathy, and the following periodicals — the British Journal of Homoeopathy, the American Homoeopathic Examiner, the American Journal of Homoeopathy, the Archiv fur Homceopatische Heilkunst, the Allgemeine Homceopatische Zeitung, the Hygea, the Oesterreichische Zeitschrift fur Homoeopathic, the Journal de la Medecine Homceopathique, and the Journal Hahnemannien, the Author would particularly recommend to the professional student who may be desirous of cultivating an intimate ac- quaintance with the science of Homoeopathy.
It will he found that the Author has introduced into the work a number of diseases which are not ordinarily included in writings on the practice of physic. In deviating thus from the beaten track, he has been led by the conviction that the line of demarcation which has been attempted to be drawn between diseases that are considered to belong to the province of the surgeon, and those which have been allotted to the sphere of the physician, is by far too artificial to admit of its being rigidly adhered to in a practical point of view. Palpably apparent as this must be to the allopathic practitioner^ it is still more strikingly so to the experienced homoeopathist who has had repeated opportunities of witnessing the cure of a variety of affections by the instrumentality of medicine, which he had formerly been taught to believe to be removable by the knife alone.
The principal points it is now purposed to allude to are the Regimen— the Choice of the Remedy — the Potencies in general use-— and the Dose.
* English translations of all the above works have already been, or are in the course of being published either in this country or in America.
INTRODUCTION. XV11
REGIMEN.
The homoeopathic regimen consists merely of the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the actions of the medi- cines and the proper functions of the alimentary system. Consequently, among liquids, the articles generally proscribed, particularly in the different forms of dyspepsia, as also in affections of the liver, in gout, hemorrhoids, and in dis- orders of the bladder, are, green tea, or strong black tea, coffee, malt liquors, wine,* spirits, and stimulants of every description, lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters. Cocoa, unspiced choco- late, toast-, rice-, or barley-water, oatmeal gruel sweetened with a little sugar, or raspberry or strawberry syrup, if desired ; whey, milk and water, or pure milk, not too recent from the cow, boiled milk, and in some instances buttermilk, or in fact any non-medicinal beverage is allowable.!
In animal food, pork, young meats — such as veal, lamb, &c.j -and among poultry, ducks and geese, had better be avoided, especially when derangement of the digestive func- tion exists. Beef, mutton, venison, and most descriptions of game, if not too long kept (high), pigeons, larks, rabbits, are allowable at discretion.! (Vide Synopsis, p. 3.) Ham, and neats' tongues under certain restrictions.
* Wine should invariably be forbidden in cases where Nux v. is the remedy prescribed ; and coffee when Puis., Ignatia, &c, are being taken.
f The idiosyncrasies in some individuals, in respect of diet, are remarkable; as for example, some cannot take the smallest quantity of milk without serious inconvenience ; others throw out a rash after partaking of fish ; and again, others loathe the very sight of animal food. These peculiarities should not only be attended to in prescribing a suitable course of regimen, but should also be taken into account in the selection of the remedies.
J In some forms of dyspepsia meat requires to be prohibited for a short time, or taken only every second or third day. (See Dyspepsia.) The same rule, it may be added, may sometimes be advantageously followed when the patient is under the action of particular remedies, such as Calcarea, Silicea.
a
XV111 INTRODUCTION.
Fish is a wholesome article of diet, and may, in most cases, be partaken of without scruple, with the exception of the oleaginous species, such as eels, salmon, &c, or shellfish, as oysters, lobsters, &c.
Eggs, raw or soft boiled; butter, if free from rancid or unusual taste ; cream, plain unseasoned custards, and curds.
Stimulating soups and made dishes are so evidently op- posed to homoeopathic regimen, as scarcely to require further notice. Beef-tea, veal, or chicken broth, &c, thickened with rice, macaroni, or sago, and seasoned merely with a little salt, are of course allowable.
Among vegetables, all of a pungent, aromatic, medicinal, or indigestible description, or greened with copper, are pro- hibited ; such as onions, garlic, eschalots, asparagus, radishes, horseradish, celery, parsley, mint, sage, mushrooms, tomatoes, beets, artichokes, parsnips, &c. ; but others free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, spinach, seakale, &c, may be used with the needful precaution of avoiding any particular article of diet, whether of the animal or vegetable kingdom, that may seem to disagree with the individual. Lemon or orange-peel, laurel-leaves, bitter almonds, peach-leaves or kernels, fennel, aniseed, marjoram, are objectionable ; acids, and the ordinary condiments, such as pepper, mustard, pickles, &c, and salads, ought either to be sparingly partaken of, or entirely abstained from, particularly by the dyspeptic. Salt and sugar in moderation are admissible.
Acid or unripe fruits are clearly objectionable, and even ripe fruits possessing little or no acidity, if fresh or prepared by cooking, such as peaches, raspberries, sweet cherries, grapes, and dried or preserved fruits, as figs, prunes, apples, pears, should be used in moderation, particularly by dys- peptic individuals, and by those subject to colic or diarrhoea not at all. Cold fruits, such as melons, and raw vegetables*
INTRODUCTION. XIX
such as cucumbers, &c., are inhibited; nuts of every de- scription are forbidden.
All kinds of light bread* and biscuit, free from soda or potash and such like, not new-baked ; also simple cakes com- posed of flour or meal, eggs, sugar, and a little good butter ; or light puddings, such as bread-, rice-, sago-, semolina-, without wines, spices, or rich sauces, are admissible; but coloured confectionary, pastry, and also honey, are not so. Regularity in the hours of meals should be observed, and too long fasting, as well as too great a quantity of food at one time, should be avoided.-^
During fevers and inflammatory affections, the patient must of course be kept upon a low regimen ; gruel, barley-water, &c. ; and at the commencement of convalescence a light pudding, with a little weak beef-tea or mutton or chicken broth, should form the whole of the nourishment given. Nature, however, is our best guide, and when she takes away appetite, thereby intimates the necessity of not taxing the digestive functions. (See also Synopsis of the diet rules.)
The use of any medicinal or aromatic substances in the arrangement of the toilet, such as camphorated or otherwise medicated dentifrices, lip-salve, smelling salts, or cosmetics, is detrimental to the action of the medicines, and had therefore better be avoided.
*■ Unfermented bread is perhaps to be recommended in preference to any other. There are instances, however, in which bread so made does not agree, and produces symptoms of indigestion. In such cases the use of bread, in the making of which German yeast has been employed, will often prove of easier digestion.
f In almost every instance where it is necessary to make a great alteration in the diet of the patient, it is advisable to do so gradually and cautiously, particularly in the case of those persons who have been long accustomed to the daily use of stimulants of various kinds.
XX INTRODUCTION.
CHOICE OF THE REMEDY. POTENCIES OF THE MEDICAMENTS. DOSE AND ITS REPETITION.
In homoeopathic practice there are three points which merit most particular attention : the first and principal is the Choice of the Proper Pemedy ; the second the Potency at which it should be exhibited ; and the third the Dose and its Bepetition.
THE CHOICE OF THE PROPER REMEDY.
To accomplish this, in accordance with the law similia similibus, Hahnemann has directed us to form "a correct image of the disease/' by committing to writing every detail of the case ; commencing, in the first place, to note down all those particulars which bear generally on the case, as its history, the previous health of the patient, hereditary predis- position, presumed cause of the disease ; the former treat- ment; the patient's age, temperament, and appearance; his mode of living, occupation, and disposition, and whether his malady has in any degree altered his normal disposition.
In the next place, the questions put must bear minutely upon the disease itself, not only for the purpose of ascer- taining those of an important and primary description, but also those which are purely sympathetic or secondary, from the circumstance that the latter, in addition to their being frequently very characteristic of the disorder, are moreover the indices to the selection of the individual specific remedy from amongst a class.
This part of the examination* as a general rule, is to be commenced at the head, external and internal, proceeding to the senses — sight, hearing, smell, and touch — thence to the
INTRODUCTION. XXI
mouth, tongue, throat, and the digestive organs ; from thence to the genital, the urinary, and the thoracic organs ;' and then the back and the superior and inferior extremities. Afterwards the skin, with particulars as to its temperature, secretion, appearance (the anterior or present existence of eruptions), the sleep, dreams, moral symptoms, pulse, &c.
The character, as well as the seat of the symptoms is of great importance. Thus it is of little use to our purpose when the patient intimates that he has a severe pain, but he must describe its nature as accurately as possible, as whether it is gnawing, throbbing, aching, burning, shooting (darting), pricking, cutting, dragging, piercing, &c. Whether the symptoms are increased by movement or by rest (walking, lying, standing, or sitting), at night or during the day, in the house or in the open air, by heat or cold, dampness or dry- ness ; after eating, drinking, or during abstinence. If worse after particular kinds of food ; if continuous or periodical ; and if increased by mental exertion, emotion, &c.
With females, it is essential to pay attention to the fol- lowing additional particulars : pregnancy, labour, lactation, miscarriage, sterility, and the state of the menses. In refer- ence to the latter, it is requisite to learn whether an irregu- larity exists, such as too short or too long an interval between the returns ; if the discharge exudes uninterruptedly or only at intervals ; if it is copious or scanty ; its colour ; and if attended with pain ; the state of the body and mind previous to, during, and subsequent to the catamenia should also be inquired after ; and if the patient is affected with leucorrhcea, its nature, quantity, the periods at which it occurs, or the circumstances under which it manifests itself should be ascer- tained. The selection of the proper remedy is, farther, materially facilitated by the nature of the cause of the disease ; we should never omit, therefore, to elicit that information when practicable.
XX11 INTRODUCTION.
THE POTENCY, ATTENUATION, OR DILUTION OF THE
MEDICAMENT.
In proceeding to the consideration of this second point, I may make the preliminary remark that it is a subject which is as yet by no means finally determined under what circum- stances and conditions the lowest (viz. the 1st, 2d, 3d, and 6th, &c.) the highest (the 18th, 24th, 30th), or the recently pro- mulgated so-called highest potencies (the 100th to the 2000th, and even upwards), are to be preferred. The majority, how- ever, especially amongst the more modern homceopathists, may be said to have decided hitherto in favour of the lower, and particularly the 3d and 6th, in acute, and the higher, especially the 18th, 24th, 30th, &c, in chronic diseases. The main point to be attended to is the correct selection of the remedy ; nevertheless, as the Author is of opinion that some importance is to be attached to the dilution, attenuation, or potency in the treatment of the multifarious forms of disease which come under the observation of the medical man in extensive practice, he ventures to throw out the following suggestions, premising at the same time that much depends upon the discrimination of the practitioner, and that it is almost impossible to give any rule to which there are not exceptions.
The principal points to be attended to are, the susceptibility of the patient to medicinal influence, how far modified by cir- cumstances, the age, sex, temperament, and habits — the disease itself, and further, the nature of the medicament employed.
As regards the first, the susceptibility of the patient, we find four classes :
First class. Those who are comparatively insensible to medicinal influence, particularly at high potencies, upon whom
INTRODUCTION. XX111
the medicines show neither marked action nor reaction. Such individuals are generally of what is denominated the leuco- phlegmatic temperament ; they require generally low potencies and frequent repetition — such cases are not without their parallel in allopathic practice. Also, in disease, we find some persons who appear to enjoy a peculiar exemption from infec- tious and even contagious influence. To this rule, however, of giving the low potencies in such cases, there are exceptions ; I have found in practice, after a careful study of the individual, and a selection of a remedy suitable to temperament, a marked action and reaction produced by a very high potency, where a lower of the same medicament had failed to elicit any apparent effect, &Ti&*vice versa.
Second class. A marked susceptibility to medicinal action without a corresponding reflex action : such patients are gene* rally of a highly nervous temperament, exceedingly difficult to treat, and require particular study ; here the higher potencies are generally called for, although we frequently find benefit in resorting to the lower.
Third class. Those in whom no marked or a scarcely per- ceptible medicinal action declares itself, but a well-marked reaction ; in such cases we must be guided by other indica- tions in the selection of the potency ; watch the effect care- fully, and avoid too frequent a repetition.
Fourth class. Those in whom the medicines show; a well- marked action and reaction ; here, also, we must be guided by other circumstances in the selection of the potency, so as to obtain the greatest possible benefit without materially increas- ing the sufferings of the patient.
We generally find a particular susceptibility to medicinal influence, at any potency, in persons dwelling in the country, of robust frame, simple habits, and regular lives, who are not
XXIV INTRODUCTION.
subject to any peculiar dyscrasia. In towns, particularly in large densely-populated cities, this susceptibility is greatly developed^, but the reaction less evident ; however, much depending upon the individual's employment, habits, and pursuits, it is difficult to give any fixed rule.
Age. In infancy and early childhood, we find a marked receptivity to medicinal influence, a decided action and speedy reaction, consequently the higher potencies are the most appli- cable in their diseases, and they rarely require so frequent a repetition ; however, in acute diseases of any of the more noble oy gans, we may exhibit lower potencies, particularly of some of the less energetic medicines, fo* example, Sambucus, Ferrum, Ipecacuanha, Chamomilla, etc., a globule constituting the maximum dose. Some further remarks upon this subject have been made in Diseases of Infancy.
Sex. Females, for the most part, possess a higher degree of susceptibility than males, in which they approach nearer to children ; for them the higher and medium potencies are generally most suitable; to this rule, however, there are many exceptions, particularly in those who are engaged in laborious employments.
Temperaments. In the Sanguine temperament, there is considerable susceptibility to all the potencies and a speedy reaction. In the Nervous, we find great susceptibility, some- times without an equivalent reaction : here we should be cautious in administering, and generally use the higher potencies. In the Bilious, there is generally but little suscep- tibility, but the reaction, when roused, is powerful, and pro- longed ; hence a necessity for low potencies, generally given at long intervals. The Lymphatic being the least susceptible of all temperaments, the medicines may be given at low potencies, and frequently repeated till some effect is produced.
INTRODUCTION. XXV
Since these temperaments often occur in a mixed form, the rules above given must be modified accordingly.
We may observe that the remarks above made refer princi- pally to chronic and subacute diseases.
The Disease. In severe acute diseases, we are usually in the habit of resorting to the low potencies^ and in tinctures, from the circumstance that we have commonly found them more certain in their effect than the 12th, 18th, or 30th in such affections. In the cases of children, an exception may be made, as already observed. In ordinary cases the best range is from the third to the twelth potency ; this rule should of course, be modified according to the remedy itself, the disease, and the individuality of the patient. The seat, character, and the exciting cause of the disease are generally considered of im- portance in regulating the dose and potency: thus, in inflam- mation of the brain, or in erysipelas of the head, with implication of the meninges and delirium, Belladonna is not required at so low a potency (2, 3, or 6) as it is called for in erysipelas of the extremities. Dulcamara is more efficacious at a low potency (3) in catarrhal affections, or diseases of any kind proceeding from exposure to cold, than at a high one. Aconitwn is more suitable at a low attenuation, when given to allay the violence of the accompanying fever in inflammations, than when it is prescribed as the specific remedy to the inflammation itself. And, finally, the low dilutions are held to be the best adapted to inflammations of a torpid character ; the high to inflammatory affections with increased arterial action. It is undeniable, however, that deviations from the above rules may often be made without disadvantage.
The Nature of the Remedy. Medicaments which, in their crude state, possess little or no appreciable medicinal property, but whose virtues have been developed by tritura-
XXVI INTRODUCTION.
tion and segregation of particles, such as Lycopodium, Ndtrum muriaticum, Calcarea carbonica, Sepia, Carlo vegetabilis, Silicea, &c, should generally be used at the higher potencies. Others also, which have been found from experience to display con- siderable efficacy, even when greatly attenuated, such as Sulphur, Lachesis, Acidum nitricum, Arsenicum, &c. On the contrary, some which have a short-lived, but well-marked action, may be used in some cases in the original substance ; for example, Moschus, Valerian, and Camphor, but in exceed- ingly small doses. Others again have been found most useful at the first, second, or third potency, such as Tartarus emeti- cus, Ferrum, Ipecacuanha, Hepar sulphuris, Stannum, Rhus toxi- codendron, Opium, and in many cases Cinchona. Still, all these remedies, in peculiar cases, act well at the higher.
THE DOSE AND ITS REPETITION.
Although it is almost impossible to give any general rule that will serve in all cases, much more depending upon the discrimination of the administrator, and a careful observance of the symptoms than routine, the following remarks may prove of some service to beginners, for whom indeed, as has already been intimated, the contents of the entire work are almost exclusively intended.
From the diversity of opinion which as yet exists as to the " potency of the medicament," it may readily be sur- mised that various differences prevail as to the mode of prescribing or administering the homoeopathic remedies. Some there are who invariably give one or more drops, or grains ; others, again, adhere as rigidly to globules ; whilst a third party give drops in acute, and globules in subacute, and in chronic cases.
To the beginner, whose former habits may very naturally
INTRODUCTION. XXV11
incline him to err on the side of excess, by invariably flying to mother tinctures, low dilutions, first triturations, &c., in large and rapidly-repeated doses, we should say, " strive ever to cure by means of the smallest possible dose, and do not imagine that because with a minute dose you have done much, that by increasing it you will do more — more indeed you may do, but that may as likely prove to be to the detriment as to the welfare of your patient." For our- selves, we may state that on most, although by no means on all occasions, we are in the habit of prescribing drops, in the diluted form we have mentioned in certain parts of the work (see Pneumonia, Pleuritis, &c), in the treat- ment of acute diseases ; whereas in subacute and in chronic affections, we very generally, if not exclusively, confine ourselves to the employment of globules, varying the form of prescription according to the age, sex, and temperament of the patient. On ordinary occasions, in the treatment of chronic maladies, we order a couple of globules to be taken every night in a dessert-spoonful of pure cold water at bed- time for a week, and then allow the remedy to act for from four to eight days, and even upwards in particular cases and under particular circumstances, before repeating the remedy, or selecting another. But where the patient is extremely susceptible to the action of the medicines, and, usually, in young subjects, we give only one, or at the most two doses, (one night and morning) consisting of one or of two globules, either undissolved or in a teaspoonful of water, and allow the remedy to act for the same period as above specified. In many cases of a chronic description, and particularly when the patients are found to be moderately sensitive, we give a dose for four successive days, and then wait for two to six days for a development of improvement.
We, as already stated, occasionally vary our mode of prescribing, being guided in doing so by the sex and constitution of the patient, the character of the disease, and
XXV111 INTRODUCTION.
the nature of the remedy (see art. Potencies of the Medicaments), but ever prefer the smallest possible dose to a large one, and globules in place of drops of the tincture, even when from no other motive than that of prescribing a medi- cine free from taste— an advantage of no small importance in the treatment of children — whenever we feel convinced that we can do so without fear of allowing the disease to gain head, or of retarding recovery by the insufficiency of the dose.
Slight diseases are often removed by a single dose of a well-chosen medicine, but more severe and deeply-seated disorders require a frequent repetition.
In acute diseases, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or amelioration declare itself, after an interval of from two to four hours at the utmost, but the disease seems to gain ground, repeat the medicine. In cases of high inflammatory action, or the severest forms of acute diseases, ajs cynanche lar ngea, cholera, pneumonia, pleuritis, dysenteria, febres nervosa, phrenitis, cystitis, &c, attended with signs of imminent dan- ger, the dose must be repeated every quarter, every half, every hour, or every three or four hours.
If a medicinal aggravation* take place, followed by amelio- ration, we must let the medicine continue its action, until the amelioration appears to cease, and the disease again make head ; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but an ameliora-
* It is necessary to remark that very striking medicinal aggravations are, comparatively speaking, very rarely met with. In chronic maladies, occurring in highly sensitive persons, and proceeding from or attended with cerebro-spinal irritation, we encounter them more frequently than in acute diseases. They are, in general, more prone to take place in the instances alluded to, with considerable intensity, after the employment of the higher than the lower attenuations. So at least the author's experience teaches him to conclude.
INTRODUCTION. XXIX
tion follow, we may safely await its approach to its termina- tion, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine which seems best fitted to meet them ; but refrain from changing the remedy as long as benefit results from its employment.
In chronic, subacute, and indeed almost all cases, when a very striking improvement takes place, it will generally be found advantageous to cease to administer the medicine as long as the improvement continues, and only to repeat as soon as the slightest symptoms of activity in the morbid phenomena reappear. But when a sudden or marked improvement of comparatively short duration follows the first dose of a remedy, and, on repeating the dose, the symptoms of the complaint increase instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selection of which it will be necessary to choose one related to the remedy first pre- scribed.
When the action of a well-chosen remedy has been disturbed or arrested by some incidental cause, such as an error in diet, exposure to cold, &c, some intermediate medi- cine should be prescribed against the new symptoms thus developed, and on their removal the remedy first employed should again be resorted to.
The distinguishing of the medicinal aggravation from that of the disease being a point of material consequence, we shall here endeavour to give the usual characteristics of each. The medicinal aggravation comes on suddenly and with- out previous amelioration : the aggravation of the disease more gradually, and frequently following an amelioration. Moreover, in the former, several of the medicinal symptoms, some of which we may meet under the indications for the remedy, and not before remarked, declare themselves.
XXX INTRODUCTION.
Too much stress cannot be laid upon the necessity of carefully watching the effects of each dose, as, in addition to the temporary aggravation of the symptoms which some- times sets in, a development of collateral or pathogenetic signs occasionally takes place, particularly after frequent repetition of different remedies in susceptible patients ; by a wrant of attention to this important point, we may incur confusion, and may be unconsciously treating a medicinal disease of our own creation. Such, unhappily, but too frequently occurs in allopathic practice from ignorance of the real properties of the drugs employed. We must also guard against falling into the opposite extreme, and allowing the disease to gain head unchecked.
In severe acute affections we may often repeat the same medicine at the same dose, at regular intervals, as long as it does good; but this rule has many exceptions, and the directions already given at the commencement of this article should be borne in mind.
In chronic cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible; in such instances, if the improvement remain stationary, or progress slowly, we may alter the attenuation, or, still better, give at suitable intervals some other remedy or remedies of as nearly analogous medicinal properties to that first adminis- tered as possible, and then return to the original remedy, if needful ; if, on the other hand, decided amelioration follows each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility to the medicinal influence remains unimpaired until the cure is completed.
In rare cases, this susceptibility increases; in such instances a higher potency should be selected, or vice versa if that employed has been one of the most minutely subdivided — provided the remedy still appears to be appropriate, — and the intervals between the exhibitions lengthened. This occa-
INTRODUCTION. XXXI
sionally occurs when the medicine has been frequently repeated, and given in solution. When the beneficial effect of a medicine is interrupted by an attack of cold, diarrhoea, &c, some other medicine must be given for the new affection, on the removal of which, the medicine which was previously acting favorably must be recurred to.
REMARKS.
In the Selection of the Hemedy, it is not necessary that all the symptoms noted should be present; at the same time taking care that there are no symptoms not covered by the medicine, or more strongly indicating another. When the symptoms are few in number, not characteristic or well- marked, attention to the following points is of material assistance : the period of the day at which they occur, or become most prominent; the side of the body which is affected ; the disposition of the patient ; his propensities or- peculiar habits and likings ; the agreeing or disagreeing of different kinds of food ; the longing and craving for, or the unconquerable aversion to certain aliments, &c.
When it is requisite to keep a medicine in solution for some days, a few drops of proof spirit may be added to the water, which should be as pure as possible, in order to pre- serve it from decomposition.
Homoeopathists prescribe only one medicine at a time ; but in some complicated cases considerable advantage is to be derived from the alternate employment of two remedies, which are equally indicated in the case under treatment.
It may be scarcely necessary to explain the Pharmaceutical Signs used in this work, to signify the potency and quantum of the dose ; but as the book is intended for beginners, and
t
XXXii INTRODUCTION.
may fall into hands otherwise wholly unacquainted with the science, we do so as a measure of precaution ; it will therefore be sufficient to remark, that Tinct. Aeon. 3 gtt. ij, means two drops of the third attenuation or potency of Aconite ; Tinct. Bry. 6 gtt. iij, three drops of the sixth of Bryonia, and the same with any other medicine. The Germans commonly make use of the Roman numerals to denote the attenuation, and as only every third attenuation is very generally used (particularly in northern Germany) the above signs would be written thus : Tinct. Aeon. I, gtt. 00 or 2. Tinct. Bry. II, gtt. 000 or 3. The Roman numeral multiplied by 3, indi- cating the attenuation meant. When we wish to prescribe globules, the contraction gl. is usually employed.
The medicines should be taken fasting, and food or drink, as also excessive bodily or mental exertion, abstained from for half an hour to an hour afterwards. The homoeopathic remedies should be kept in a clean, dry, dark place, free from odours. Every description of allopathic medicine, patent or domestic, is prohibited ; likewise bleedings, blisters, medicated fomentations, perfumery, and everything con- taining camphor. In cases of obstinate constipation, recourse may be had to an enema, or lavement of cold or of tepid water when the former disagrees, to which may be added, if necessary, a tablespoonful of olive oil.
We shall conclude these introductory observations with some extracts from Jahr's New Homoeopathic Pharmacopoeia andPosology* for the information of those of our readers who are ignorant of the method in which the homoeopathic medi- cines are prepared, &c.
* Translated, with additions, by James Kitchen, M.D., Philadelphia.
INTRODUCTION. XXX111
f NATURE AND FORM OF HOMOEOPATHIC MEDICINES.
u 1. We make use of the same simple substances in homoeopathy as in the old school ; but, instead of making of them, as in it, compound remedies, we seek, on the contrary, to procure each medicine in all its purity, and to administer it without any admixture which might alter its proper virtues. Without going into detail here on the preference to be given to this mode of administration, we should, nevertheless, observe that it is bound to the principle of homoeopathy in so firm a manner, that it cannot be sundered without injury to the practice. In consequence of the principle, that no medicine can be employed with success, except so far as it is known in its pure effects, homoeopathy has subjected to examination a number of simple medicines, which it is important now to reproduce, such as they have been experimented on, if we wish to rely on these observations. Even for the medicines which have not yet been experimented on, it is not the less impor- tant to submit them to these experiments in all their purity and simplicity ; for though each compound remedy forms, after all, also a kind of remedial unity, which maybe studied in its effects, still we can never reproduce a second time precisely the same effects as the first, whilst the productions of nature exhibit at all times and in every place the same properties.
"2. In thus rejecting all the compound remedies of the old school, as improper to be submitted to study and to be employed in practice, homoeo- pathy claims not, however, the pretension to use only perfectly simple bodies, such as sulphur, for example, metals and other elementary substances ; she derives, on the contrary, her medicines from three kingdoms of nature, the same as the old school, and all the various chemical combinations, which, after invariable laws, are constantly produced in the same manner, can be of use to it as remedial means.
" In one word, the simplicity of homoeopathic preparations, of which we speak, has no reference to the primitive substance, •which serves for the medicine, but to the medicine itself, which, as such, ought to be composed of only one remedial substance, and prepared in such a manner that the virtues of that substance be as pure and as developed as possible.
" 3. If all substances endowed with remedial virtues, presented themselves under a form as convenient as some mineral waters, for example, nothing would be more natural nor more rational than to employ them as nature pre- sented them. But with a great many of these substances, the real virtue is found in a state more or less latent, and could not be put into activity except
b
XXXIV INTRODUCTION.
by the destruction of the primitive matter, and the addition of another sub- stance, which, in quality of simple vehicle, receives the developed virtue, and transmits it to the organism. In other substances, on the contrary, the remedial virtue is found developed, but it is so energetic that, without the addition of a substance which can moderate the effects, we cannot employ them without danger to the health, or even the lives of the sick. In fine, there are yet other substances which, though their virtues need not to be either developed or moderated, present themselves under a power which opposes as well to their dispensation as preservation, and which, in consequence, equally exacts the addition of foreign substances in order to be conveniently prepared for use.
" 4. The preparation and administration of medicines being then impos- sible under any mixture, it is important to discover substances which, at the same time operating under the form of medicines, are innocent enough in themselves not sto alter the virtues of them. This condition, simple as it may appear in theory, is not, however, so easy to fulfil as it appears — for, perhaps, there exists not a substance in the world, which, under such and such circumstances, may not exercise a pathogenetic influence, and, conse- quently, alter the specific effects of a medicine with which it may be mixed. Even pure water, the substance the most innocent that we know, is not completely exempt from this inconvenience, and even were it so, it would not suffice alone, neither for the preparation nor the preservation of medi- cines. In consequence homoeopathy has substituted two other vehicles, viz. : 1, Alcohol or spirits of wine, for the preparation of liquid or soluble sub- stances ; 2, Sugar of milk, for the preparation of dry substances : and though these two substances are not entirely void of medicinal effects, the practical facts are still the same as if these substances were entirely pure, since all the preparations which are made in this manner, are constantly the same among themselves.
"5. By means of these two substances, pure alcohol and sugar of milk, homoeopathy makes all its medicinal preparations, without exception, whether under the form of tinctures or powders. The first are" obtained, that is, the tinctures, in mingling with alcohol the juice recently expressed from fresh plants, or in infusing in this liquid the dry substances, the active principles of which can be extracted in this way. The powders, on the other hand, are obtained by the trituration of the insoluble substances with a suitable quan- tity of sugar of milk. The alcoholic tinctures and the powders are then the only preparations known in homoeopathy. All kinds of essences, syrups, pastes, ptisans and other inventions of the old school, are entirely foreign to it.
" 6. From this, however, it does not follow that homoeopathy always employs the primitive preparations of medicines ; on the contrary, in the majority of cases she considers them too energetic to be administered such
INTRODUCTION. XXXV
as they are obtained. But, instead of seeking to diminish their energy by the means which the old school call correctives, homoeopathy endeavours to obtain this end by the simple attenuation of the primitive substance. It is thus that, seeing that a grain or a drop of the primitive preparation of a poisonous substance, for example, would be too active, she attenuates this drop or this grain in mingling it with a new quantity of vehicle, until a preparation is obtained, which is neither too strong nor too weak to operate the cure, nor too energetic to fear any unfortunate consequences. Homoeo- pathy thus prepares out of each substance a series of attenuations, of which the following one contains ordinarily the 100th or sometimes the 10th part of the active principle of the preceding one, and it is generally from one of these attenuations, and rarely from the primitive preparation of a medicine, that the homoeopathic physician administers to his patients.
" 7. Finally, as to the form under which the homoeopathic physician dispenses his medicines, it is not less simple than the preparation, and is equally made without any other mixture than that of the least medicinal substances, such as alcohol, pure water, sugar of milk and globules com- posed of sugar and starch. The attenuations of each medicine being previously prepared, the patient receives of them the dose prescribed, either in form of solution, with a convenient quantity of pure water, or water mixed with alcohol, or in form of powder, mixed with a small quantity of sugar of milk, or yet again in form of globules impregnated with the alco- holic attenuation of the medicine.
"8. How simple soever may be the preparation of homoeopathic remedies, as to its principle, it nevertheless exacts much precaution and very particular care, if we would be^ sure to have medicines as active and as sure as possible in their effects. To this end also homoeopathy has prescriptions and positive rules, which it is important to know before all, in order to follow them with exactitude, and to prevent thus the faults, which, diminutive as they may appear in themselves, are, nevertheless, very serious in practice. In the following chapters we shall pass in review all these rules and prescriptions in treating in succession — 1. Of vehicles which serve for the preparation of medicines. 2. Of the preparations of medicines in their primitive state, 3. Of attenuations. 4. Of the dispensation and preservation of homoeopathic medicines. These four chapters containing all that has reference to the general pharmacopoeia, we shall occupy ourselves in the second part of this work with the special pharmacopoeia, that is to say, with the rules to be observed in the preparation of each medicine in particular, and with the description of primitive substances which homoeopathy has introduced into its pharmacy.
XXXVI INTRODUCTION.
" OF VEHICLES, WHICH SERVE FOR THE PREPARATION OF HOMCEOPATIIIC
MEDICINES.
" 9. The vehicles which homoeopathy uses for the preparation of its medi- cines are, in all, of the number of four, viz. : 1 . Alcohol, or spirit of wine. 2. Sugar of milk. 3. Globules composed of sugar and starch. 4. Pure water. Some physicians have wished to add a fifth to the above, viz, ether, and we shall see below (28) to what destination this liquid is suitable. As to the four vehicles which we have just cited, homoeopathy has thus far used them for all its preparations ; and it is important to obtain them as pure as possible, in order to be sure to obtain preparations, in every respect, identical with those with which Hahnemann and his disciples have made their pure and clinical observations. This purity is not, however, always the distinctive quality of the objects which we find in commerce or that nature furnishes, and that is the reason why it is almost indispensable that homoeopathy should know how to prepare herself vehicles, or at least to render them proper for the use she makes of them. We shall endeavour to give in#this chapter the instructions necessary to this end.
"10. Alcohol {spiritus vini, spiritus vini alcoholisatus, spirits of wine, alcoholized spirits of wine) is never found in nature — it is always the product of art — but it is formed every time that sugar is found in contact with a fermentable matter in water, and at a suitable temperature ; that is to say, that it is developed in the course of fermentation, to which has been given, after this phenomenon, the name of spirituous or alcoholic. As all liquors which have undergone the spirituous fermentation contain alcohol, and as those which abound in the saccharine material, are by that susceptible of affording it, it results that we may obtain it from a great number of vegetable substances, such as wine, beer, cider, malt, grape dregs, sugar-cane juice, germinating cerealia, pounded cherries, molasses, juice of carrots or beets, potatoes, honey, &c. The Tartars extract it even from the milk of their mares.
"11. From whatever substance we obtain it, alcohol is identical ; but we must always have recourse to means more or less complicated to obtain it pure. In every case it contains a more or less ]arge quantity of water, and very often it is mixed either with acetic acid, or a small proportion of prussic acid or empyreumatic oil, &c, according to the substances from which it has been extracted. The alcohol which seems to be the best for homoeopathic preparations is that obtained from the dregs of grapes (marc de raisin)*
* This is the refuse of the grape, after the juice has been pressed out, in the process of making wine.
INTRODUCTION. XXXV11
without the addition of other substances/ or else the alcohol of rye or wheat. The least suitable kinds are such as come from the laboratories of chemists or pharmaceutists, and which, for the most part, are drawn from the residue of some chemical preparation, such as the resin of jalap, &c. Alcohol extracted from potatoes is not more suitable for homoeopathic preparations, since it contains a large quantity of empyreumatic oil, of which even the chemical proceedings, which consist in clearing it by the chloride of lime and powder of charcoal, do not entirely purify it. This oil is often found even in the alcohol from rye or wheat ; but in this case it is sufficient to mingle this spirit with a suitable quantity of pure olive oil, and to shake it from time to time for several days ; in this way the empyreumatic oil combines with the olive oil, and swims on the alcohol, whence it may he easily taken.
"■12. Alcohol pure and perfectly anhydrous is a colourless liquid, of a remarkable fluidity, of a sweet and penetrating odour, of a hot and burning flavour, and whilst it is ruhbed hetween the hands, it should not lather nor emit any foreign odour. Its specific weight is much less than that of water, in which it dissolves perfectly, and in all proportions, with disengagement of heat. Exposed to the air, it evaporates in part, and the part which remains loses its power in becoming saturated with the humidity of the atmosphere, of which it is exceedingly greedy. At the approach of a candle, or by the effect of the electric spark, alcohol burns rapidly, with a flame white at the centre and blue at the edges, and leaves no residue. Put in contact with other substances, it dissolves a great many, such, among others, as phosphorus and sulphur' (both in small quantities), the fixed alkalies, halsams, resins, camphor, sugar, volatile oils, extractive matter, &c. Acids have a marked action on it ; some dissolve in it simply, whilst others are transformed into ether.
"13. Alcohol, in the state of complete purity, has a specific gravity of 0*791. It then contains not a trace of water, and marks hy the alcoholmeter 100 degrees of force. But it is never employed at this stage of concen- tration ; that which commerce presents, as well as that which we find in medicine, is always more or less weakened. According to the proportions with which water is mixed with it, we may generally distinguish four kinds, viz. : 1st. Spirits of wine of commerce, the weakest quality, having a specific gravity of but 0*910 to 0*920. 2d. Rectified spirits of wine, the quality which is obtained by mingling 7 parts of water with 17 parts of the best rectified spirits of wine (see 3d) ; the specific gravity of this spirit is from 0*890 to 0*900, and its degree of concentration 60°. 3d. The best rectified spirits of wine, superior quality, the specific gravity of which is from 0*830 to 0*840, and its degree of concentration 85°. 4th. Alcoholized spirits of wine, or absolute alcohol, the most concentrated quality, having a specific gravity of 0*810 to 0*820, and containing from 96° to 100° of alcohol. For the preparation of the mother tinctures of homoeopathy, the most suitable
XXXV111 INTRODUCTION.
quality is the absolute alcohol of 95° ; for the attenuations, we may, in the majority of cases, be content with a spirit of wine of 60° to 70°.
"14. In order to obtain an alcohol as anhydrous as possible, recourse has been had to various chemical measures, which succeed well enough, as regards the concentration, but the majority of these measures (lime, acetate of lime, sulphate of soda, alum, &c.) constantly produce a more or less powerful alteration in this liquid. Even chloride of lime is not exempt from this fault, which may easily be recognised, in burning rectified alcohol by this means, after having added to it nitrate of silver, and afterwards examin- ing the residue. This is the reason why the homceopathist should never make use of alcohol rectified in these chemical ways, but endeavour to obtain the desired quality by more innocent proceedings. That which appears to be the most suitable, consists in obtaining the concentration by simple evaporation. For a long time it has been remarked, that alcohol preserved in vessels' closed with prepared bladder acquires strength, whilst it loses strength if. closed by caoutchouc, insomuch that to concentrate it, it is only necessary to put it in beef- or pig-bladders, and suspend them in a warm and dry place. To this effect, after having carefully cleansed the bladder, we paint it with a thin coat of fish-glue ; then we fill it with the alcohol we wish to concentrate and suspend it, well closed, in a perfectly dry place, and at a temperature of 20° to 25° E». The drier the air that surrounds the bladder, the more prompt is the evaporation of the water ; and in leaving the bladder in proper conditions until we perceive the odour of alcohol, we may be sure of obtaining a quality as anhydrous as possible.
"15. The most simple and the most sure method of obtaining an alcohol as concentrated and as pure as homoeopathy wants, would then be, to take the first-quality brandies and to concentrate them after the method indicated above. Alcohol obtained in this way is generally in a state of concentration of 95° to 96°, and thus is perfectly suitable for the preparation of alcoholic extracts ; only, before employing it, it should be once again rectified by a new distillation. For this, we should be careful to use only glass apparatus, since copper or tin vessels often give out to the product of distillation some of their material, an adulteration, which is the more to be guarded against, as, often, chemical means are not capable of revealing it, though it should be strong enough to alter the effects of medicines which might be prepared with a product of that kind.
"16. Respecting the brandies from which we might wish to obtain alcohol, we have said above that the best were those obtained from the dregs of grapes or else from rye. But in taking these liquors such as they are found in commerce, we should always be well assured that they are pure. Often we find in them lead, which we may detect By treating them with the liver of sulphur, which causes a brownish or blackish precipitate. Should they contain copper, liquid ammonia produces a blue colour. The adulteration of
INTRODUCTION. XXXIX
brandies by alum may be discovered by the addition of a solution of potash, and the mineral sulphates by acetate of barytes. In fine, to be sure that the alcohol we use is really made of the wished-for substance, we mingle 30 parts of it with 0*15 parts of liquid caustic potash, and heating this mixture with spirit of wine, we permit it to evaporate until there remain but four parts. We take this residue, to which we add four parts of weak sulphuric acid, in a well-stoppered small flagon, taking care to shake the mixture ; in unstoppering the flagon afterwards, we shall perceive a perfect odour of the substance of which the brandy has been made.
" Sugar of Milk.
" 17. Sugar of milk (saccharum lactis), is a salt of a sweet taste, slightly sugary ; it forms masses moderately thick, hard, crystalline, semi-transparent, colourless, and inodorous. By its properties, both physical and chemical, this substance, which is exclusively proper to the milk of different animals, seems to be intermediate between sugar and gum. Sufficiently purified, sugar of milk contains no azote ; it dissolves in 12 times its weight of cold water, and four times its weight of boiling water. Alcohol dissolves it but in a. very small proportion, and ether not at all; it does not alter by the air, is not susceptible of undergoing the vinous fermentation, melts, puffs up, and is transformed into a kind of gummy matter by the action of fire, decomposes the acetate of copper the same as common sugar ; in fine, treated with nitric acid, it forms mucic acid, and by sulphuric acid or muriatic acid diluted, the sugar of grapes. Its proportion, as that of the other constituent principles of milk, varies in the different kinds of mammiferse. In general it abounds more in the milk of the ass than in that of the cow, or mare, or goat, &c. According to Berzelius, one thousand parts of skimmed milk give 35, and the same quantity of cream gives 44 parts of sugar of milk, mingled with saline matters.
" 18. It is in the mountains of Switzerland that the sugar of milk is pre- pared which we find in commerce. It is prepared from the evaporation of the whey, which they obtain in such large quantities in the preparation of cheese. It presents many varieties, according to its degree of purity. The crystalline sugar in grape form is considered the most pure ; the other kinds always contain more or less animal matter. We often also find in commerce, under the name of sac. lac. inspissatum, the whey of milk solidified and dried ; but this is a kind that in nowise is proper for homoeopathic preparations. The sugar of milk which we find at the druggists is, in the majority of cases, more or less altered by mortars of copper or iron in which it has been pul- verized, and still more often impregnated with exhalations of a quantity of aromatic substances, in the midst of which it is preserved. Hence the neces- sity of the homoeopathic physician to prepare it himself, every time that he has it in his power, or at least to purify it by a new crystallization, if he is
Xl INTRODUCTION.
obliged to provide himself with it from the druggist. This, however, is not without difficulty, since the sugar of milk does not crystallize, in watery solution, but very slowly, and always in an incomplete manner. It is only by treating it with equal parts of alcohol and water that we can succeed well ; the operation, it is true, becomes more costly, but considering the advantages which this procedure offers, we think that the cost is no reason for its rejec- tion.
"19. To purify the sugar of milk in this way, we dissolve about two and a half pounds of the best quality in ten pounds of rain-water or distilled water in a boiling state, then filter the solution through filtering paper, in a vessel of porcelain or glass, and mix it with four kilogrammes of absolute alcohol; after which place the vessel containing this mixture in a dry place, and leave it perfectly still. The sugar of milk being insoluble in absolute alcohol, and this being very attractive of water, drawing away a large quantity, the crystallization advances pretty rapidly, and often at the end of three or four days a crust of white and brilliant crystals may be obtained, of the weight nearly of the sugar of milk that was dissolved in the water. When this crust is formed, it is taken away, washed with distilled water, to which has been added a little alcohol, and then dried on blotting paper. That done, we may consider the sugar as altogether suitable for all the homoeo- pathic preparations, even the most delicate ; it is completely colourless and inodorous — tested by the most active reagents it shows not a trace of foreign salts.
" 20. Notwithstanding the process we have described above, it would be of little avail, were the sugar of milk not of a good quality in the first instance. In order to be sure of that, it should be separated from all fatty substances and other foreign matters which milk contains, which is recognisable by its perfectly white colour, by its due degree of resistance to the atmospheric air, and its odour and pure and natural taste. The adulteration of sugar of milk with common sugar may be known by its sugary taste— -with alum, by the aid of acetate of lead or oxydulated nitrate of mercury. To examine sugar of milk that has been boiled in copper vessels, we dissolve a certain quantity in water and pour on it some caustic ammonia, which colours it blue, should it contain any of that metal. Nitrate of silver detects the presence of kitchen salt, and acetate of lead that of sulphuric acid. When prepared from sour whey, it reddens the tincture of tournesol.
"21. To reduce the crystallised sugar of milk to powder, we first break the crust in the direction of the crystals, upon a sufficiently thick piece of wood, with a wooden hammer and a strong knife ; then we put the pieces in a mortar of porcelain, when we break and triturate them until the powder becomes sufficiently fine for use. That done, we pass the powder through a sieve of crape which we have fitted above and below with parchment. The finest part, after being sifted, is found below the sieve, whilst the grosser
INTRODUCTION. xll
part above should be triturated again. To preserve sugar of milk, it should be placed in a dry place, in order to keep it from the moisture of the air and prevent it from spoiling.
"3. The Sugar Globules.
' ' 22 . The sngar-globules (globuli saccharini) are small nonpar eilles destined to be saturated with homoeopathic medicines, in order to be able to dispense these last with more facility. They are generally found at the confectioners, who prepare them from sugar and starch ; but as the sugar of the cane or the beet, which enters into this preparation, is not pure enough for the purpose indicated, it is better to have globules made expressly from sugar of milk, or else with the ordinary purified sugar. As to the size of these globules they should not be too large, so that we may be able to dispense the smallest doses. Hahnemann proposed to give them the size of a poppy seed, so that about 40 of them would weigh about one and a half grains, (one centi- gramme.) This form has been adopted by the majority of homoeopaths ; some, however, use them of the size of a millet seed.
"23. To charge these globules with the active principles of the medicine, and to prepare them so that in a large quantity they may not deteriorate, we imbibe them first with those alcoholic attenuations which we desire ; then, after being well assured that all have been well impregnated, we dry them and put them in a well-stoppered bottle. The complete desiccation of the globules before bottling them is absolutely indispensable, since without that precaution they fall into powder in a short time, and afterwards lose, in becoming decomposed, their medicinal virtue. This is the reason why, after imbibition in a suitable bottle, it is well to turn them out on paper with raised edges, where they may be agitated until they do not adhere one to the other. Should we wish afterwards to put them into the same bottle in which we have imbibed them, we should take care to dry it also, before making use of it, or to empty it afresh and dry the globules until they do not adhere to the bottle. All the globules so imbibed have a dry and smooth hue, whilst in their natural state they are white and brilliant.
"4. Water.
" 24. Among all the vehicles there is not one that is more free from medicinal virtue, properly so called, than pure water; but, on the other hand, nothing is more rare than to find in nature this fluid in a perfectly pure condition. Under whatever form water presents itself, it is more or less charged with foreign matters, such as gas, salts, earths, &c. The purest quality of water is rain-water, which, as well as distilled water, has neither odour, nor taste, nor colour; besides atmospheric air, which this water contains, there is but a small portion of fixed matters, —only after a storm, we find, occasionally, a trace of nitric acid combined with ammonia. The
Xlii INTRODUCTION.
water of springs and wells constantly contain many kinds of neutral salts, earths, and muriatic compounds. As to the waters of rivers, lakes, and ponds, in inhabited countries, it is far from the conditions of pure water to merit attention here.
"25. Homoeopathy uses water for three different purposes, viz. — l,for the chemical operations, which require the purification of many primitive sub- stances ; 2, for the preparation of some of the attenuations ; and 3, for the administration of medicines in the form of watery solution. For the last of these uses we may well enough make use 6f river or spring-water well filtered ; for the chemical operations, rain-water procured during a calm answers in all cases ; but for the preparation of the attenuations, we must have the purest water we can possibly obtain. For this, distilled water, which is found in the pharmacies, is not suitable ; for even if it has not been distilled in copper or other metallic vessels, it is always to be feared that it is impregnated with foreign matters, derived from substances which, perhaps, but a short time previously had been distilled in the same apparatus, and of which the ordinary care employed in cleansing them is far from discharging the whole.
" 26. To obtain a perfectly pure water, the homoeopath must himself undertake the distillation in vessels of porcelain or glass, as indicated under the head of alcohol. The most suitable water to distil is rain-water, above all, if we take care, as we have above remarked, not to procure that which falls during a storm, or when the sun shines. We must not, even in an ordi- nary rain, gather the first rain that falls, since this commonly contains the impurities suspended in the air ; it is only after rain has fallen four or six hours that we are able to gather it in its purest possible condition. Still this water contains a certain quantity of carbonic acid, and hence, Uefore submit- ting it to distillation, we shall do well to boil it in a porcelain vase and let it cool. Respecting the distillation itself, we must be cautious gradually to augment the fire under the apparatus, and to preserve, by wet cloths, the neck of the retort at a moderate temperature, so that the vapour, in passing, may not dissolve from the sides of the vessel even a trace of silex or alkali. The first distillation should be rejected, and when the liquid in the retort is diminished two thirds we must cease. A good distilled water should leave no residue on evaporation ; it should be perfectly limpid, insipid and inodo- rous, and neither precipitate by muriate of barytes, nor nitrate of silver, nor hydrosulphuric acid, nor the hydrosulphates. To preserve it, it should be put into bottles or new jars of yellow glass, that we have been careful to cleanse at first with a part of the same water, and which we put afterwards in a place as cool as possible.
INTRODUCTION. xliii
"5. Ether.
" 27. Sulphuric ether, or ether par excellence (ather sulphuricus, spiritus sulphurico-ethereus), is a light, volatile, odorous and inflammable liquid. Like the other hydratic ethers, as the phosphoric, arsenic ethers, &c, it is composed of two volumes of bicarbonated hydrogen gas and one volume of vapour of water, so that it may be considered either as alcohol deprived of a certain proportion of the elements of water, or as a hydrate of bicarbonated hydrogen. Recently prepared, it is neither alkaline nor acid, and when burnt, it shows no trace of sulphuric acid, an evident proof that the sulphur enters for nothing into its composition. It unites with difficulty with water, which requires ten times its weight to dissolve it, but with alcohol and all the essential oils it unites in all proportions. The fixed oils, also, the strong acids, balsams, several kinds of resins, phosphorus, sulphur, bromine, and many hydrochloric salts, are perfectly soluble in ether.
"28. In homoeopathy, we as yet are not acquainted with any etherial preparation, except phosphorus, which some have proposed to substitute for the alcoholic preparation of this substance. This substitution of etherial tinctures for alcoholic tinctures, not only for phosphorus, but also for many other substances, appears to us to be suitable in a great many cases, and we should not hesitate in the least to advise it to all the homoeopathic physicians and pharmaceutists, were we well assured that the medicines would not undergo any modification in being indifferently treated by the one or the other of these vehicles. The knowledge of the chemical constituents of which ether is composed is not sufficient for us to conclude on its patho- genetic effects, and so long as this doubt is not settled by pure experiments, we think that all those who wish to be guided by the observations contained in the homoeopathic materia medica will do well to procure such prepa- rations as have been employed by the authors of these observations. From this, however, it does not follow that we should not prepare any etherial tincture, and we are ourselves far from wishing to interdict it here, but we only insist on the necessity not to confound them with those of alcohol, and to note at least on the label the vehicle with the aid of which they have been prepared.
"29. Ether, such as it is found in our shops, under the name of rectified ether, is qrdinarily pure enough ; it only sometimes contains a little alcohol, of which, however, it ought to be freed. To do this, we shake it a short time with double its volume of water, and when it is separated from it we pour it on quicklime, with which it should be shaken at intervals for some days. In afterwards distilling this mixture, until there remains in the retort about two thirds, the third which has passed into the recipient is perfectly pure ether. Often, however, we find it adulterated with a quantity of
Xliv INTRODUCTION.
sulphuric acid or other acids. The adulteration with water is known by the watery residuum evident, whilst at a mean temperature we expose a small portion of ether to evaporation. The presence of sulphuric acid betrays itself by its disagreeable odour, and that of other acids by its reddening tournesol. Finally, to preserve ether free from all deterioration, it should be put into little bottles, the mouths of which terminate in points, so that they may be hermetically sealed by the flame of a lamp. When ether has been deteriorated by the action of the air or the light, it is less volatile, of an acrid and burning taste, and miscible with water in all proportions.
" OF THE PREPARATION OF HOMOEOPATHIC MEDICINES IN THEIR PRIMITIVE
STATE.
" 1. General Observations and Rules,
" 30. Tn order to obtain good homoeopathic preparations, it is necessary, first of all, to procure the primitive substances of the best possible quality, and in the state most suitable for their destination. All the substances which are furnished us by the animal and vegetable kingdoms always lose more or less of their power in drying, and this is the reason why every homoeopathic physician and pharmaceutist should endeavour to procure them himself, as much as possible, in the fresh state, and immediately to submit them for preparation. As to the substances which are only found in far distant lands, and which, in consequence, we can only obtain in the tincture, prepared on the spot where they grow, or else the substance itself in a dry state, it is better to accept this last, in this state, than to trust to a preparation, of the purity of which it is impossible to be sure. The cunning of our age has carried to such an extent the falsification of drugs, that it is impossible, with confidence, to make use, for homoeopathic preparations, of the products of commerce, and among them, the tinctures are those which are the worst, and consequently, the least proper. As to the substances, which are generally sold in powder, we need equal precaution ; above all should they be clear, as amber, castor, &c. Should it be impossible to procure them in their natural state, we should never accept them, unless we are perfectly assured of their purity. The same may be said of all the chemical products which are found in commerce ; there is not a single one which homoeopathy can make use of without a previous careful examination of its quality.
" 3L A point, not less important than the good quality of substances, is the exact choice of the particular kind which homoeopathy makes use of, and this is a point upon which we believe ourselves bound to insist so much the more, since not only some pharmaceutists, but also homoeopathic physi- cians, have often thought to introduce a real advantage, in substituting, for substances used in homoeopathy, others which appeared to them either more
INTRODUCTION. xlv
energetic or more pure in their chemical qualities. However great these advantages may be in a scientific view, it is not the less certain, that the least essential change introduced into the preparation of a medicine may cause the most disastrous consequences to the safety of practice. What is most important to the practitioner is, not that the preparation should be more or less scientific, but that it should be similar with that which has been employed in the experiments, and the more the conformity in this point of view, so much the more the preparation will be perfect to the end it ought to fulfil. Thus, to obtain the calcarea or subcarbonate of lime, for example, such as is employed in homoeopathy, it is absolutely necessary to prepare the oyster-shell just as Hahnemann prescribed, though such preparation is far from containing the pure subcarbonate of lime. It is thus also that cinchona, opium, nux vomicaj &c, such as are used to prepare the tinctures of the same names, can never be replaced by the quinine, the morphine, the strychnine, &c, without inconvenience, notwithstanding these last substances are reputed to contain the active principles of the first in a perfectly pure state.
" 32. It is absolutely the same as- to the measures adopted by homoeopathy in the pharmaceutical preparations of its medicines. Here, as in the gathering and chemical preparation of substances, the strictest observation of prescribed rules is binding. All the substances which homoeopathy transforms into tinctures, should be prepared alone with alcohol, and those which are neither soluble in this fluid nor in water, by the simple trituration with sugar of milk. The vehicles, such as alcohol, sugar of milk, water, &c, ought to be perfectly pure and good. At the same time, the proportions indicated for the mixtures, as well as the manipulations prescribed for the solution and division of substances, ought to be observed with the utmost possible exactitude. Often, it is true, these indications and prescriptions are of a nature to leave a certain latitude in their execution, according to the use we wish to make of the medicines, or the degree of energy which we propose to give to them ; but even in this last case, the principles which have dictated the rules ought always to serve as guides in their application ; and in every case, where the indications are positive, homoeopathic phy- sicians and pharmaceutists have no business, under any pretext whatsoever, arbitrarily to depart from them.
"33. In addition to the precision to be observed in the process of the preparation, it is also necessary to prevent, with the greatest care, any foreign influence, so that the virtues of the medicines be not changed, and the action thus rendered uncertain. For this it is requisite, in the first place, to make them in a place where the temperature is not above that of houses in general, and where the substances are not exposed to the direct rays of the sun. At the same time, the atmosphere in which we work should be pure and exempt from every odour or vapour, but, above all, of every medi-
Xlvi INTRODUCTION.
cinal emanation, such as are generally found in the pharmacies in ordinary ; for all these exhalations, placed in contact with homoeopathic preparations, are liable to change their virtues. The same may be said respecting vessels or other instruments which have been used for the preparation of substances very odorous or susceptible of adhering tenaciously, as musk, essences, arsenic, corrosive sublimate, &c. We should never make use of such vessels, without having previously cleansed them with the most perfect care. As to small bottles and corks which have already been in use, they should never be employed but for the same substance, no more than the cloth which has been used for filtering or expressing the juice of a plant ; for, notwithstanding all the endeavours we may use to clean them, we can never be sure that we have entirely purged them of all particles which may adhere to them.
" 34. Homoeopathy exacts a much greater cleanliness than is ordinarily given to vessels of pharmacy, notwithstanding the care bestowed on it. Even the washing in large quantities of water, as in rivers, which has been recommended, are far from fulfilling the conditions. No matter how we look on it, a vessel, for example, which has served for the trituration of substances such as sulphur, musk, assafcetida, &c, constantly preserves its odour, even after having been washed and dried several times. As to the cleansing with certain chemical articles, such as acids, chlorine, lime, potash, &c, it cannot be tolerated in any case, since these substances themselves, whilst they have been in a vessel, need to be carefully cleaned out. Some have still imagined to clean the vessels with spirits of wine, but even this is a great error, for either the spirits of wine dissolves the substance we wish to get rid of, or it does not dissolve it ; in this last case, it will clean out nothing, and, in the first, it will form, with the rest of the substance, a medicinal preparation, which, though weak, will always be stronger than one of the last dilutions, and no homoeopath in effect will look upon these preparations as suitable for the end proposed. The best way to obtain the perfect purity of vessels is, at first to clean them with boiling water several times, and then to expose them to the continual action of a strong heat, as for example of an oven, or else to burn, several times, in them absolute alcohol of the greatest purity. As to the stones which have served for the pulverization of a metal, we should cleanse them before employing them again for the preparation of another substance, by scraping their surface with a piece of glass.
"35. Finally, as to the vessels themselves, it is necessary that all which are used in homoeopathic preparations should be of a substance not calcu- lated to alter the effects of substances. Hence, all the mortars, pestles, and spatules, as well as the spoons and other instruments needful, should be of quartz, porphyry, glass, porcelain, or horn ; those of metal, marble, serpen- tine, or wood are absolutely inadmissible. To close the bottles, stoppers of glass are always to be preferred to those of cork, above all for the substances
INTRODUCTION. xlvii
prepared with sugar of milk, to which the cork stoppers often give a disagreeable odour. For the corrosive substances, such as the acids, iodine, kreosote, &c, glass stoppers are indispensable. If, for the alcoholic prepa- rations, we would, nevertheless, use stoppers of cork, we should procure them of the best quality, never used before. Before making use of them, we should temper them in pure water, after which we should wash them in spirits of wine, and let them dry at a moderate temperature. It has also been advised to boil them, in order to make them larger and softer ; but prepared in this way, they become very susceptible of imbibing the humidity of the air and of constantly changing their size.
"2. Particular Rules for the Preparation of Plants in the fresh State.
Tinctures.
"36. That the plants may be entirely suitable to medical use, we should gather them a little before or, better still, during their flowering, and we should never take those which grow on a very humid spot and deprived of the sun and of the free air, unless the nature of the plant require those conditions. In the majority of cases, it is important not to gather the flowers and the leaves during a continued cold or damp time, since then the etherial oils, the corrosive resins, and the alkaline matters do not become developed as they should, and it permits the separation of albumen but in a very incomplete manner. The most favorable moment is when, after several warm days, there has been a shower of rain ; for it is then that the formation of the active principles and the free development of hydrogen are the most favored. In every case, where homoeopathy indicates nothing particular, we constantly use the entire plant, flowers, body and root. Before submitting it to preparation, we wash it carefully with fresh water, in order to wash away the dust and other impurities adhering to it.
" 37. After this, to prepare the plant, in order to bring together all the properties of its different parts, we cut it up as small as possible, we put it into a mortar of stone and reduce it to a fine paste, which is put into a piece of suitable cloth, in order to submit it to the action of a press of wood expressly constructed, thus to obtain the juice of the plant. This juice is at once mixed intimately with an equal quantity of alcohol, and put into well-stoppered bottles. At the end of 24 hours we decant the clear liquor, which swims on the precipitate of fibrine and albumen, and we put it apart for medical use. Alcohol prevents fermentation from taking place in the vegetable juice, and the virtue of this is thus preserved completely, without alteration, and for ever, provided we only take care to keep it from the rays of the sun and in well-stoppered bottles. The medicine thus obtained by expression, and by the mixture of the juice with an equal quantity of alcohol, is the mother tincture of the plant, obtained by expression {per expressionem).
Xlviii INTRODUCTION.
" 38. The preparation of the mother tincture, by expression, is, however, only applicable to plants abounding in juice; for those plants containing much thick mucilage and albumen, it is better to make their preparations by macerating them in a double proportion of alcohol. To do this we should at first half dry them in exposing them in the shade, in an airy place, and at a slightly elevated temperature, after which we cut them as fine as possible, and then add the necessary quantity of alcohol. As to those plants which have but an excessively small quantity of juice, such as the laurel, rose, thuya, &c, we should begin by pounding them alone ; then, after reducing them to a fine and moist paste, we imbibe this paste with the double of alcohol, so that the juice, thus mixed with this liquid, may be expressed more easily. The medicine obtained after this method is the mother tinc- ture by maceration {per macerationem) .
" 39. In addition to these two measures for obtaining the mother tinctures, there is yet a third, which, though inferior to the two preceding, deserves, nevertheless, to be mentioned, as convenient in some particular cases. It is, above all, whilst the circumstances do not permit us to express the juice of the fresh plants, immediately after having gathered them ; and that, fearing that their withering, no matter how little, may injure their virtues. Under these conditions we may remedy this inconvenience in digesting separately in alcohol each part of the plant. To do this we begin by sundering the root into four, and cutting it into little pieces — we do the same with the leaves ; then, after putting each of these two parts into a separate bottle of sufficient size, we pour upon them an equal quantity of alcohol. In thus digesting the separate parts during some time, and reuniting afterwards in one bottle the obtained products, we have a mother tincture by digestion {per digestionem), which will not only be perfectly pure, but also sufficiently impregnated with the active principles to merit confidence. For the rest, in every case, unless absolutely obliged to have recourse to this proceeding, the preparation of the mother tinctures by expression and maceration is far preferable ; but every time that we are obliged to hunt the plants which we want, in distant coun- tries, where we cannot carry the apparatus necessary for expression, we should prefer preparing them at once, by digestion, to carrying them home withered and bereft of their active principles.
"3. Of the Preparation of Exotic Vegetable Substances.
" 40. All exotic vegetable substances used in homoeopathy, such as plants, bark, grains, resins, wood, &c, should be selected in the crude state, and never when in powder. For, even should we fear no adulteration with other matters, the ordinary means employed in pulverising them are not of a kind to prevent all adulteration possible. All vegetable substances, even when perfectly dried, still contain, when entire and in the crude state, a certain
INTRODUCTION. xlix
amount of humidity, which becomes useless in the state of powder, and which, if not dissipated, deteriorates the powder in a short time.
" If, then, the homoeopath would be perfectly sure of having a powder not only pure, but also susceptible of preservation without any alteration, he must himself undertake the necessary preparation.
" 41 . Hahnemann first taught the best method to reduce foreign substances to an unalterable powder, and free from all humidity. This consists in spreading the powder on a flat surface of tin with raised borders* and to shake it till it no longer forms lumps, until all the particles equally and easily slip on each other, like fine sand. To succeed well, we must take care to keep the heater constantly full of water of an equable temperature, so as not to expose the powder to a too elevated heat, as it would destroy organic substances. By inclosing the powders thus obtained in bottles well stoppered and sealed, and protecting them from the sun's rays and the light of day, we may preserve them a long time without deterioration. It is still doubtful whether, by this procedure, those substances of volatile principles do not lose their virtues during the operation, and whether, in consequence, it would not be preferable to make an alcoholic tincture of them immediately after pulverization.
"42. To prepare the tincture of dry substances, we begin by breaking them in a mortar of marble; then, after having reduced them to a fine powder, we add twenty parts of alcohol, in which we digest them six or eight days, after which we decant the clear liquor, to preserve it for use. Those substances which are very susceptible of attracting the humidity of the air? should either be deprived of it before pulverization, or powdered in a warm mortar, and, if particularly hard and tenacious, they should be grated or filed. As to the proportion in which alcohol ought to be added, many physicians have proposed to make it 1 to 10, instead of 1 to 20, that is to say, to pour but 10 parts of alcohol on the pulverized substance ; but, inde- pendent of the certainty there is in the proportion of 1 to 20, the vehicle will necessarily take up all the medicinal virtues, and the tinctures of many, as cinchona, opium, ratanhia, &c, seem to be so fully saturated in this pro- portion, that it is very doubtful whether, in the proportion of 1 to 10, they would really acquire more energy.
" 43. Lately, Hahnemann has advised that dry vegetable substances should not be prepared in the form of tincture, but made after the manner of solid mineral substances ; that is to say, by triturating them with the necessary quantity of sugar of milk. It is evident that, for all the substances which we wish to employ at a certain degree of concentration, and to mix with the vehicle in the proportion of 10 to 100, this procedure would, as far as regards the preservation of the preparations, be subject to all the inconvenience that we have spoken of in the beginning of this article. Even in weighing the substance with the vehicle, in the proportion of 1 to 1 00, the humidity it
c
1 INTRODUCTION.
would communicate to the trituration would still be too sensible to obviate all fear of the alteration of the preparation, should it be put into stoppered bottles. But the question differs when we wish to use only a preparation of a low attenuation (6, 15, 30) ; in this case, the proposed plan would do, in effect, not only for dry vegetable substances, but also for all the fresh plants which contain too small a quantity of juice to afford tinctures by expression ; when we do not wish to preserve any of the low attenuations above the third trituration, this would always be sufficiently exempt, for example, from vege- table humidity, to leave nothing to desire, and the triturations being, in general, less subject to alteration than the tinctures, this proceeding would unite the double advantage of preserving all the active principles of the medicines, and of rendering their preparations as unalterable as possible.
"4. Of the Preparation of Mineral and Animal Substances — Trituration^
" 44. All the non-vegetable substances made use of in homoeopathy, such as animal substances, mineral bodies, and chemical products, are generally prepared by trituration with sugar of milk, whether, in their natural state, they are liquid or solid, soluble or non-soluble in alcohol. Certain substances only, such as the acetate of copper, several acids, and all those of which the chemical qualities do not permit a mixture with sugar of milk, should be prepared in a particular way, which will be specially indicated under the head of each substance. As to the substances which are soluble in alcohol, we can equally well prepare the tinctures of them by solution in 20 parts of this liquid ; but for the safe preservation of the preparations, and the develop- ment of the medicinal virtues, the trituration with sugar of milk merits by far the preference. Even for those recent animal substances which are commonly prepared by digestion in 20 parts of alcohol, after a reduction to a fine paste, trituration is infinitely better.
" 45. To submit all these substances to trituration, we may, in the majority of cases, take them as they are found in their pure state ; only as to the metals, if we cannot procure them in very thin leaves, like gold, silver, tin, &c, it is necessary to reduce them to powder. To effect this, we may treat them in two ways : the first of which consists in rubbing under water a small fragment of the regulus against a good hone, until we have obtained a sufficient quantity of metallic powder. The majority of homoeopaths employ this measure, but should the stone we use be too soft, the powder obtained in this manner is rarely pure, and, in such a case, it is better to obtain it by the decomposition of the solutions of these metals in acids. In plunging in such solution a small polished rod of a metal whose affinity with oxygen is stronger than that of the metal in solution, it is immediately precipi- tated on the rod, and adheres to it in the form of powder. To obtain, then, this powder perfectly pure, we wash it frequently with distilled water, until it does not show a trace of acid. The reduction to powder of metals by the
INTRODUCTION. li
file is a proceeding which is suitable to iron alone, since, by the observation of Wells, it is proved that the metal thus obtained easily acquires the virtues of that against which it has been rubbed.
"46. As the trituration of substances with sugar of milk has chiefly in view the development of all the active principles, by the division of mole- cules, it is essential that the proportion in which the medicine is mixed with the vehicle be not too great, and that the quantity that is submitted to tritu- ration at one time be small enough to be well manipulated. - To effect this, Hahnemann has proposed never to make a trituration which contains more than 5 grammes (100 grains) of sugar of milk, and to mingle the medicine in the proportion only of 1 to 100, that is to say, of the weight of 5 centigrammes (1 grain) nearly, so that the trituration being made, each gramme of this contains but one centigramme of the primitive medicine. This proportion of 1 to 100 is, in general, that upon which all the hpmceo- pathic physicians rely; but as for many substances, the volume of ^.ye centigrammes of their weight is too small in proportion to that which the sugar of milk makes, and as it is essential that the whole should be impregnated with the medicine, many physicians have lately preferred making all the fast triturations in the proportion of 10 to 100. In conse- quence, instead of taking but five centigrammes (1 grain) of the medicine, they take 50 (10 grains) to mix with five grammes (100 grains) of sugar of milk, so that each gramme of the trituration, wrhen finished, contains 10 centigrammes of the medicine. It is easy to see that this proceeding has the preference in every case, since it not only affords a greater surety for the exactitude of the mixture, but also because afterwards, to establish the proportion indicated by Hahnemann, we have *only to take 50 centi- grammes (10 grains) of the obtained trituration, and triturate them anew with five other grammes (100 grains) of sugar of milk.
"47. As to the operation of trituration, Hahnemann recommends the following. After having weighed the necessary quantity of the medicine and .of the sugar of milk, take about a third of this last and place it, with the entire quantity of the medicine, in a mortar of porcelain ; mix these two portions with a spatula of bone or horn, and triturate with sufficient force six minutes ; detach with the spatula the mass from the sides and bottom of the mortar and pestle, and mingle them anew, after which continue the trituration for another six minutes; that done, again detach the matter from the mortar and pestle, and add the second third of the sugar of milk, which mingle with the rest with the spatula and triturate afresh during six minutes ; detach, triturate and detach afresh as for the first third ; finally add the last third of the sugar of milk, which is mingled, triturated and detached in the same way and during the same space of time as with the first two. In thus triturating each third during twice six minutes, and counting about four minutes for the time
Hi INTRODUCTION.
taken up in detaching and remingling the powder, we shall occupy one hour in the preparation of each trituration.
"48. In the first article of this chapter we have already observed that, for the triturations, mortars of serpentine can in no way be admissible, and that the best are of porcelain. Wood and glass are not more suitable either : the first, on account of its porosity; the second, because the rubbing detaches from it particles, which contain sodium. As to those of porcelain, the unpolished ones are to be preferred, since the smootKer the surface the less true is the rubbing, and this is the reason why, if we can only obtain mortars of polished porcelain, we must unpolish them by working them previously with sand. The pestle should be of the same material as the mortar, and treated in the same way. To prevent, with the greatest certainty, all possible alteration of the preparations, either by particles of silex which the porcelain might afford, or by the remains which previous triturations might leave in the mortar, it has been proposed to coat this, as well as the pestle, with a thin covering of pure ichthyocolla, mingled with a little sugar of milk, and to renew this covering for each new preparation. We cannot decide on the absolute necessity of this method, but we think, nevertheless, that it merits, at all times, the serious attention of practitioners.
" 49. As to the form of mortars, it is easy to see that those with flat bottoms are no ways suitable, since, in such, the substance would tend to enter the corners, which would impede the trituration being made equally. The best form to give the interior of mortars is that of the butt-end of an egg. At the same time, it should have a large enough capacity to allow the rubbing with the necessary force, and hindering the powder from dispersing; its sides should be level and without the least inequality, and its weight such as, during the process, it can easily be held in the left hand without fatigue. The pestle should be large enough at its base to fit exactly to the concave bottom of the mortar. In order to detach the triturated mass which adheres to the pestle and mortar, Hahnemann advises us to use a spatula, but this operation is much better accomplished with a hard brush of a suitable form, made for the purpose. As to the other necessary instruments, such as the spatula, spoon, &c, we have already said that they should be of bone, or horn, or porcelain, and that those in metal are absolutely inadmissible, except the mortars of iron to break down certain substances of considerable hardness before preparing them for trituration.
"OF HOMCEOPATHIC ATTENUATIONS.
" On the Attenuations in general.
"50. In speaking of the nature and form of homoeopathic medicines, we have already observed that, instead of correcting the too energetic effects of
INTRODUCTION. liii
some substances by the addition of another medicinal substance, homoeopathy seeks to mollify them by the preparation of a series of attenuations, in which the medicine is found mingled in the vehicle but in a very small proportion. In the commencement of his medical career, Hahnemann limited himself in these attenuations to 1 to 100; that is to say, in mingling a very small quantity of the concentrated substance with a quantity 100 times larger of a substance non-medicinal; but seeing that these preparations often acted too powerfully still, he soon went further and prepared a second, and then a third attenuation, in mingling for the second the 100th part of the first, and for the third the 100th part of the second with 100 parts of the vehicle. This third attenuation, though only containing the medicine in the proportion of 1 to 100-3, or of l.to 1,000,000, Hahnemann still found at times too active, which induced him to carry the attenuations yet further, and to go from attenuation to attenuation, in order to find the one the most appropriate. It is thus that, latterly, he has carried the number of attenuations, for all the medicinal substances without distinction, up to 30, so that, in this last attenuation, the medicine is found mingled with the vehicle but in the pro- portion of 1 to 100-30, or of 1 to 1,000,000-10.
"51. However absurd the first view of these infinitesimal attenuations may appear, it is not the less true that, even the 30th, far from having lost all efficacy, often shows itself too energetic; and Dr. Korsakow, of St. Petersburg, who has carried the attenuations as high as 1500, has declared the same fact as to the last preparation of his series. In effect, on examin- ing attentively the degree of intensity with which the various homoeopathic attenuations act, we may easily perceive that the diminution of their energy is in no way proportioned to the diminution of their matter. On the con- trary, many substances which, in their state of concentration, have little or no action on the body, as lycopodium, vegetable charcoal, &c, often become very active at the second or third attenuation, so that we are almost inclined to * believe that the mode of preparation adopted by Hahnemann rather contributes^to develop than to weaken the virtues of medicines, or, at any rate, to render them more apt to exercise, in the smallest doses, their influence on the organism. Hence Hahnemann has, for a long time, ceased to look upon these preparations as dilutions, in the true acceptation of this word ; and if, at the present time, he wishes all the medicines to be carried to the 30th attenuation, it is only in the supposition that by this procedure they can best develop all their active principles,* and become more suitable for practice.
<"52. To explain the extraordinary fact of the efficacy of his attenua- tions, Hahnemann has endeavoured to set down as a principle, that the
* Or be more readily received into the system in consequence of the minute subdivision or segregation of the particles. — J. L.
liv INTRODUCTION.
more we destroy the material parts of a substance, so much the more we develop or loosen the dynamic force, or, in other words, the spirit of the medicine ; and that, to augment the energy of preparations to an incredible extent, we have only to carry them from attenuation to attenuation, in submitting them at the same time to a great number of triturations and shakes. If this principle were conformable to experience, it would result that, from a substance, for example, of which one grain would be sufficient to cause death* the same dose of the 30th attenuation would produce the same effect in a much more certain manner* which, however, is not the fact. If we would even limit this principle to those substances which only exhibit their virtues by attenuation, it is still equally adverse to observation that the 30th attenuation, for example, of these substances have an action absolutely more energetic than the 6th, 12th, 15th, &c. On the contrary, to judge from the experience of many homoeopaths, the degrees of energy among the attenuations of a medicine are so small, that thus far a decision has not been formed with certainty whether it is the first or the last attenua- tions which exhibit the strongest action. This is the reason why, in admitting the efficacy of the attenuations, many homoeopaths have rejected the explanation given by Hahnemann, and have considered the procedure by which they acquire their efficacy as analogous to the infection by miasm. According to them, the active principle of the drug being set free by the destruction of the matter, it communicates itself to the vehicle, which thereby becomes infected and as active as the drug itself.
"53. As to the comparison with miasms, this last opinion is, without contradiction, that which merits the most attention ; but the explanation it gives is far from satisfying all demands, since, instead of explaining the difficulty, it refers it to another order of facts, which, though generally admitted, are not, however, themselves yet explained. Miasm, though being an imponderable body, is not the less for that, a body ; that is to say, matter, and amenable to the laws of matter. Now, every action of matter, whether mechanical or dynamical, is proportioned to the quantity of active atoms which a given volume presents ; and every one knows, that not only a large stone weighs more than a small one, but also that a magnet of considerable volume is capable of developing and of manifesting a much stronger action than another which is less voluminous. If, then, we would pretend that there is manifested somewhere the action of a body either ponderable or imponder- able, we are absolutely obliged to admit also the presence of a certain quan- tity of atoms ; and, what is still more certain is, that as this quantity diminishes in a given volume, the action of it will also diminish in energy. Thus we see that, even should we prove that our attenuations, to be able to act, only require to be impregnated with imponderable particles, like miasms, we shall still have accomplished nothing in demonstrating that their energy does not diminish in proportion to the loss of matter which they suffer ; or
INTRODUCTION. lv
in explaining how an attenuation, for example, which contains but the billionth part of the medicinal atoms of another, manifests an intensity not only equal, but often also superior to that of this last.
" 54. These facts are, however, such as we cite them ; and, perhaps, we should not have found anything astonishing if, at the beginning, we had reflected better on the manner in which our medicines act in general, and on the changes which substances undergo by our mode of preparation. We ought to have noticed that each medicinal dose contains a great number of atoms which are perfectly inactive, in consequence of their being shut up in the interior of the molecules, and not brought into contact with our organs ; it therefore follows that every time we, by any means whatever, come to divide these molecules into smaller corpuscules, and thus augment their whole surface, the energy of the dose will so increase that the smallest part will become capable of exercising an influence, if not superior, at any rate equal to that of the entire dose in its primitive condition. It is thus that Dr. Doppler, of Prague, has explained the efficacy of our attenuations ; and such is, according to him, the effect which the infinite division produces on the molecules, that if the molecules of a fine powder are, at the dose of 5 centigrammes (1 grain), in a condition to constitute, by the sum of their surface, a total superficies of 100 metres square, and if each trituration of 20 minutes only divided each molecule into 100 lesser corpuscules, the molecules of the 30th attenuation would be so divided that, at the dose of one drop only, they would occupy, by the sum of their surfaces, a total superficies of many millions of decametres square.
" 55. If this calculation, which any one can easily verify, is just, there is nothing, in truth, more easy than to conceive, not only how the 30th attenua- tion may yet be able to exhibit efficacy, but also how a single globule of this attenuation may still have virtue enough to render a tumbler of water almost as energetic as the pure drug. For let us suppose that the total superficies of a drop of the 30th attenuation can cover, by the surfaces of its infinitely small molecules, even only four thousand decametres square, on imbibing with this drop 200 sugar-globules, each globule will contain enough to cover a superficies of at least 200 metres square, and will act, in consequence, with a force not less than that which 10 centigrammes (2 grains) of a non- attenuated substance would exhibit, but which will be reduced to a powder fine enough for the molecules of each centigramme to cover a total superficies of 20 metres square. Now, if one globule of the 30th attenuation has such power, it is clear that, in dissolving it in a volume of 8 spoonfuls (4 ounces, or 120 grammes) of water, the preparation we shall obtain will in no instance be less efficacious than a mother tincture, which, in 30 grammes (one ounce) of liquid, will contain 5 centigrammes (one grain) of the pre- ceding, and dissolved so that the molecules of this grain may cover a total superficies of 500 metres square. All these calculations are, it is true, not
lvi INTRODUCTION.
rigorously exact ; but if there is error, it is rather on account of having placed the ciphers too low than too high ; and if we suppose, which is more than probable, that each trituration of 20 minutes changes each molecule of the primitive substance into more than two or three smaller corpuscules, the result will be still more astonishing.
"56. Arguments have been raised against homoeopathic preparations, that if the influence exercised by trituration and succussion were really such as the homoeopaths pretend, the energy of the attenuations ought not only to increase with the number, but also increase in a prodigious manner, since more powerful means are employed in each attenuation to effect the division of the molecules. This is undoubtedly true in principle, and we should daily obtain practical evidence of the fact, were it always possible to make use of the increase in surface which a given volume has gained in the said manner. But the total surface which, after the usual triturations and succussions, a single globule of the 20th attenuation would afford is really so vast, that if time be not allowed, it will never find sufficient space in the organs to develop itself so that all its infinity of molecules can enter into action ; and it is thus that all that we could add to this quantity of molecules would only increase the number of those which remain inactive. This is the explanation, also, why two, three, or four globules, and even a whole drop of an attenuation, often appear to produce no more effect than a single spoonful of a solution of a globule in eight spoonfuls of water ; and if we seek the reason why these last attenuations are not distinguishable from the first by any other quality than that of a more prolonged action, it is still in the same way that we shall find the means to account for it.
"57 '. There are, however, certain substances, whose energy really augments in a sensible manner as the attenuations advance, and which, often alto- gether inert in their natural condition, become by this method of preparation not less active than the most energetic medicines. Such are those sub- stances which, even in the state of the finest powder, have probably their truly active molecules still shut up in a species of envelope, which prevents them from coming into immediate contact with the organs, and which the ordinary means of pulverization and of solution are incapable of destroying. For in rubbing, as is ordinarily done, the substances by themselves, the molecules of a powder, already very fine, escape the force which tends to render them still finer, and it is only in triturating them with another sub- stance, against the corpuscules of which they can be rubbed, that we can succeed in accomplishing an infinite division. But we shall only accomplish this in a very incomplete way, if, at the same time, we do not take care to separate the newly obtained particles as much as possible, in proportion as the trituration increases the number ; since the more the molecules remain agglomerated one with the other, so much the less easily will the whole be divided. This is the reason why many substances frequently do not seem
INTRODUCTION. Ivii
to develop all their virtue till after three successive triturations, prepared so that each new trituration shall contain the 100th part of the preceding.
" 58. What we have just said of the trituration of substances in powders, equally applies, in the same way, to the attenuation of liquid substances, and to the succussion of soluble substances with a liquid vehicle. For though the molecules of liquids, on account of their globular nature, are absolutely incapable of being divided by any kind of ordinary rubbing, being triturated with a vehicle in form of powder, or being treated by succussion with a liquid vehicle, they undergo, as well as solid substances, infinite division. The same holds good for all substances ordinarily insoluble in water or alcohol, whilst, by sufficient triturations, their molecules are sufficiently divided to be held in suspension between the molecules of these liquids ; they then become abstracted not only from the law which held them in a state of aggregation, but being shaken with the vehicle, which has dissolved them, they also receive all the other ulterior divisions of which liquid substances are susceptible. It is thus that, after the third trituration, the attenuation even of metals may be continued, without the least incon- venience, by the succussion of these substances with the liquid vehicles ; and it is thus also that all the attenuations made in this way tend, as well as the triturations, to increase the resources of our doses, so that if we submit to new succussions the solution made with a single globule of the 30th in 8 ounces of water, we may render this solution such that each drop of it shall form a dose much stronger than that of the globule which was dissolved in it.
" 59. If then there is a method more than any other capable of furnishing energetic medicines, it is, without contradiction, the mode of preparation adopted by homoeopathy. As to the substances which, in their natural state, have their virtues already suitably developed, this proceeding will not, it is true, augment the energy of the usual doses of the school, since, as we have above said, there is scarcely a means of making use of all the resources which these doses may create ; but the advantage we shall derive from them will always be that of finding the attenuations of these substances, at the dose of a single globule, not only equally as efficacious as the entire dose of which they have been made, but also more appropriate in exercising a longer and more continued action. The same may be said of those substances whose virtues are latent, when their virtues have been fully developed ; the attenua- tions made beyond this point cannot act with any more striking effect over the energy of usual doses, but the farther we carry them, the more we shall see that the smallest possible dose is still more than sufficient to produce all the effects that can be produced by medicines, given in the strongest usual doses ; that may even be carried to the point that if, by simple mixture and without any succussion, we dissolve a single globule of a sufficiently high attenuation in a volume of three or four glasses of water, and even more,
lviii INTRODUCTION.
each teaspoonful of this mixture would still be equal to produce all that could be obtained from an entire drop of the ordinary medicinal prepara- tions.
"60. From this we see that if we wish to obtain much from little (multum per pauca), it is indispensable to prepare the medicines after the prescribed method of homoeopathy ; whilst, if we wish to render the effects of the usual doses, at times already too violent, more prompt and more violent still, this proceeding will be not only useless, but altogether contrary to the end we propose. For though the resources of doses augment by this method of preparation, it is, however, not the less ascertained, that many sub- stances also lose their primitive energy by attenuation, as for example, all poisons, which, as all homoeopaths well know, are much less to be feared in their attenuations than in their primitive state. This will even be the case with all substances whose molecules, besides the property of being easily ab- sorbed and spread in the organism, have likewise that of undergoing a certain solution or division. In the attenuations they will still possess the first of these properties, but as soon as art has divided them more than the organism can do, none of the subsequent attenuations can, at a given dose, be in a state to furnish to the absorbing faculty as many active elements as the substance in its primitive condition. Up to this point the energy of doses will even gradually diminish ; whilst, this limit passed, their resources will augment in proportion as art shall operate, in the subsequent attenuations, the ulterior division of molecules the same as that which takes place in other substances.
."61. All the theoretic explanations which we have just given would be entirely without value, if practice did not confirm all the facts which we have above mentioned. Many homoeopaths, it is true, have supposed that they have observed that the last attenuations which they make use of do not always produce effects conformable to those which they had the right to look for, if the theory, upon which this doctrine is based, were correct. But, according to our view, these exceptions are rather made to confirm the theory than to destroy it ; above all, if we remember that these contradictory observations have been made for the most part by individuals who did not prepare the attenuations they employed, or who did not conform more or less exactly to the indispensable rules to be attended to in their peparation. For it is certain that if we neglect to produce in each new attenuation a new division of molecules, the first attenuations thus obtained may still have sufficient resources ; but as we advance in this way, the more will they become exhausted. If the division of molecules in the first triturations has been carried to a sufficiently high degree, it is even possible that, without any new division, we may continue the simple partition of doses up to the 30th, without this last failing in its resources ; but the preparations thus obtained will not the less be pure dilutions and not dynamizations, as they
INTRODUCTION. lix
would be if, in each one, we had anew augmented the resources of the doses. In the following article we shall give the rules and precautions to be observed, in order to prepare the attenuations so that they shall all be true dynamiza- tions.
te 2. Of the Preparation of the Attenuations,
" 62. We have already said that the homoeopathic attenuations are ob- tained, in general, in such a way that the first contains one grain (5 centi- grammes), or one drop of the medicine mingled with 100 grains (5 grammes) of sugar of milk, or 100 drops of alcohol; and that, after sufficient tritura- tions and succussions, the second is obtained in manipulating, in the same manner, the 100th part of the 1st with 100 new parts of vehicle; the 3d, in submitting to the same process the 100th part of the second, and so on to the 30th. This way of making the attenuations, in the proportion of 1 to 100, is that of Hahnemann, and which is always understood when we indicate an attenuation by its number. Latterly, however, it has been found more suitable to make the mixtures only in the proportion of 10 to 100, so that instead of mingling only one grain or one drop with 100 parts of vehicle, we mingle 10 each time. This process has the advantage of giving more certitude that in each preparation the molecules of the medi- cine are well mingled with those of the vehicle, though, on the other hand, it permits less extension. But as we can easily repair this inconvenience in preparing two attenuations each time, in the proportion of 10 to 100, instead of 1 to 100, we recommend this process to all the homoeopathic physicians and pharmaceutists; cautioning, however, these last that every time that they make use of another proportion than that of 1 to 100, they shall take care to indicate it on the label of the preparations, in order that we may know in what proportion the number which each attenuation bears, is made.
" 63. In general, we can lay it down as a principle, that the smaller the proportion in which the medicine is mingled with the vehicle, the more difficult will it be to obtain a perfectly intimate mixture, and to spread the molecules of the drug over all the points of the preparation ; likewise, the larger the volume of each preparation, the less easy will it be to make the necessary division of the medicinal molecules. One drop of a medicine poured into a lake will never make a homoeopathic attenuation, though the proportion which this drop bears to the lake in question is far from being a fraction so small as that which is found in the 30th attenuations. But that which causes this attenuation, notwithstanding the infinitely small proportion in which it contains the drug, to possess, nevertheless, all its virtues is, that it has been obtained by degrees, in preparing at first, at the farthest, but 100 grains, or 100 drops, of a vehicle with 1 or 10 of the drug, and in not employing this preparation to make a second, until it has been thoroughly impregnated
lx INTRODUCTION.
with the molecules of the drug. It is thus that we are successively enabled to spread out and increase the number of infinitely small particles, so that at last, at the 30th, they are as much disseminated through the whole pre- paration as in the first. This is the reason, also, why the attenuations obtained in the proportion of 10 to 100 are much more sure than those of 1 to 1 00 ; and it is also the reason why we should never 'prepare any attenuation which contains more than 100 grains {five grammes), or more than 100 drops of the vehicle,
"64. The attenuations of substances which, from the commencement, have been prepared under the form of tinctures, are made of alcohol from first to last. For this purpose, if we wish to preserve all the attenuations, we prepare, for each substance, 30 small bottles, quite new, each of the capacity of 150 drops; we fill all these bottles with alcohol to two thirds of their capacity, and mark, on the label as well as on the cork, the name of the sub- stance we are to attenuate. This done, we take one of these bottles and pour into it, after the process of Hahnemann, one drop of the mother tincture, and give to it 100 or 200 sufficiently strong shakes, after which we mark on the bottle the cipher 1, to indicate that the preparation it contains is the first attenuation. Of this attenuation we in like manner pour one drop into another of these bottles, containing about 100 drops of alcohol, and after having sub- mitted it also to 100 or 200 shakes, we mark it with the cipher 2, to indicate that this one contains the second attenuation. In this manner we continue to prepare and to label to the 30th, in pouring each time one drop of the attenuation just obtained into the bottle which will contain the following attenuation. The rule is the same when we wish to prepare each attenuation in the proportion of 10 to 100 ; but instead of pouring but one drop each time, we must pour ten; but as, after this method, we want two attenuations each time to equal one in the proportion of 1 to 100, the same ciphers will not be suitable to indicate these two sorts of attenuations, but we may make them agree, in using, for the preparation of 10 to 100, halves, in such a way as to designate the first of this series by j, the second by 1, the third by 1^, the fourth by 2, and so on to the 30th.
"65. For the substances which, from the first, have been prepared by trituration, we prefer to obtain the first three by the same process. To effect this, we take one grain (five centigrammes) of the first preparation, obtained by the trituration of one grain of the primitive substance with 100 grains (five grammes) of sugar of milk, and which carries the name of the first attenuation ; we mix this grain (five centigrammes) with 100 other grains (500 centigrammes) of sugar of milk, and triturate this mixture as described in the article on the .Preparation of Dry Substances. This trituration made, we give to it the name of the 2d attenuation, and we take of it one grain to mingle with 100 other grains of sugar of milk to obtain the 3d attenuation. Of this trituration we then take one grain, which we
INTRODUCTION. lxi
dissolve in a bottle filled with 100 drops of water to two thirds of its capa- city, and shake this mixture, as in the attenuations made with alcohol, to which we give the name of 4th attenuation. This 4th attenuation should be made with water, or at least with equal quantities of water and alcohol, because the sugar of milk does not dissolve in the least in pure alcohol, but all the following attenuations are then made with pure alcohol, the same as the tinctures. Should we wish to make the triturations, for the first as well as the subsequent ones, not in the proportion indicated by Hahnemann, but in that of 10 to 100, we shall be obliged to make six of them instead of three, and designate the first of this series by the cipher §, the second 1, the third by \\, and so on. The attenuation made with diluted alcohol should then bear the cipher 3±.
"66. As we rarely preserve all the attenuations, and we seldom use in practice any but the 1st, 3d, 6th, 9th, 12th, 15th, 18th, 24th, 30th, it would be useless to sacrifice, each time, more bottles than necessary, since, for example, if we do not wish to preserve the 2d attenuation, it will suffice, in order to obtain the 3d, to decant nearly to the last drop the bottle which contains the 2d, to fill it afresh with 100 drops of alcohol, and to submit this mixture to the necessary number of shakes. It is thus that, should we wish to have but the 30th attenuation of a substance, we can make all the intermediate attenuations, by pouring off to nearly the last drop of the attenua- tion last obtained, and filling up this with 100 fresh drops of alcohol. In a series of attenuations of such a length we can even, as regards those we throw away, make use of distilled water ; but for the last two, that which we wish to preserve and that which precedes it, it is most proper to use alcohol. The alcohol, which is proper for the preparation of the attenuations, should not be so concentrated as that used for the preparation of the mother tinctures, but it ought not to be less than 60° or 70° Centigrade.
"67* There was a time when Hahnemann, for fear of imparting too great a force to his preparations, advised only one or two shakes to be given to each attenuation, whilst, at present, he counsels the contrary; that is to say, to give each attenuation a considerable number of shakes (200 to 300), so as to be sure of obtaining preparations sufficiently efficacious. It is in starting from this last point of view that many homoeopaths have even tried to construct machines of succussion, by means of which they might submit their attenuations to 2000 or 3000 shakes of the greatest force; whilst others have dreaded even to displace a bottle, lest the movement beyond the prescribed cipher might impart too great energy to the dose. The fact is, that as we have shown the succussion increases the effect of the doses, and if each attenuation ought to be a new dynamization, the succussion consisting of two shakes only is insufficient. If, as we have also shown, the first attenuations have produced a considerable division of the molecules, we may obtain, per- haps, 10 or even 12 subsequent attenuations, each of which shall possess sufficient power without having been subjected to any new succussion ; but,
lxii INTRODUCTION.
in continuing in this way, we shall inevitably arrive at nothing but mere dilu- tions, which, deprived more and more of their active elements, shall be by degrees weakened, even to the utter extinction of their virtue.
" 68. Hence, however, it does not yet result that, to obtain as many new dynamizations as attenuations, it is indispensable to make use of machines, such, among others, as the famous catapult, invented and recommended by M. Mure, as the only means to obtain efficacious preparations. For, after the explanations which we have just given in the preceding paragraph, it is easy to see that, so soon as the succussions have given sufficient medicinal power to an attenuation, all the surplus added to it can be of no advantage, not even in the small homoeopathic doses, from the circumstance that there would be no means of making use of them. This is why we believe that if we bestow 1 00 or 200 shakes on each attenuation, this number will be more than suffi- cient in every case ; and those who have no machines, will find that, apart from the inconvenience of being fatigued, their arms are as appropriate as the best mechanism to communicate to the attenuations the indispensable resources. Do we not constantly find that the homoeopathic preparations which have been carried great distances, during which they have been shaken for weeks at a time, do not show more intensity in their effects than those which have not undergone, at the farthest, but 200 shakes at each attenuation ; an evident proof that the resources which, by this process, they should have gained, had no effect on their indispensable elements, but on what was superfluous.
"69. Another question of no less importance would be to know if, to obtain all the advantages that attenuations can give, it is indispensable to go as far as the 30th. What is certain is, that the mass of new particles which is furnished by the division of molecules must be diminished from time to time, in- order to permit a greater extension* of the surface of those which remain, and thus to facilitate their ulterior division. But what is equally certain is, that this division of molecules can no longer have any object, as soon as it has succeeded in developing all the virtues of substances of latent virtue, or even in rendering too energetic substances incapable of experiencing any further solution in the organism. This is the case, in all probability, after having arrived at the 6th or even at the 3d attenuation; and if we, examine the manner in which all our attenuations act, from the 15th, or even the 10th, up to the 30thj it is easy to discover that this process ceases to exert any influence, in a sensible manner, even in the smallest possible doses ; so that we are almost inclined to think that all that we do, beyond the 12th, must be superfluous. Nevertheless, as the attenuations carried out farther do not become less suitable for use than the preceding, provided they have been well prepared* we have not hesitated to carry, according to received usage, the officinal number to 30, leaving to those who may find it too high, as well as to those who would go still higher, the choice of the cipher which may ^appear to them the most suitable.
" 70. In the commencement of his homoeopathic carveer, Hahnemann had
INTRODUCTION. lxiii
fixed, for each particular substance, the attenuation at which it appeared to him to be employed with the greatest success ; but latterly, to simplify the preparation of medicines, and render it more uniform, he has advised to carry them all, without distinction, to the 30th. So in the old homoeopathic pharmacopoeias we find, carefully noted, the number of attenuations suitable to each substance — numbers, which many persons respect as a sort of gospel, imagining that all would be lost if they had not the medicine at the attenua- tion which the authors of pharmacopoeias have been pleased to mark out. All homoeopaths, even Hahnemann himself, make use of different attenua- tions, from the 1st to the 30th, and not one of those who have entered the least into the spirit of homoeopathy any longer regard those ancient ciphers than as purely arbitrary marks.
" OF THE DISPENSATION AND PRESERVATION OE HOMOEOPATHIC MEDICINES.
" 1 . Of the Dispensation of Homoeopathic Medicines.
"75. Homoeopathic medicines are generally administered in the form of powder. To effect this, we mix the drop or the prescribed number of globules with a few grains of sugar of milk, and inclose it in a paper, to be administered to the patient either dissolved in a spoonful of water or in the dry state. The sugar of milk being only intended in this case to act as the vehicle and not to produce a new dynamization, we have no need of rubbing it up with the medicinal dose ; we should even guard against doing it, if we wish that this last should not act with too much force, since by doing so we should still increase the power. Again, should we wish this dose to act more promptly and with more energy, we dissolve it in a spoonful of water, which immediately develops more powers, and presents them to the organs in a greater extension than when the dose is taken dry. In some cases also, in order to avoid the continued administration of a white powder, which might in time become disgusting to the patient, we may add to the sugar of milk a small portion of the powder of cocoa, liquorice, or salep ; these powders will give to the doses another colour, without interfering in the least with their virtues. The quantity of sugar of milk we ought to add to the dose is usually two, three, or four grains ; but for those patients who would not be satisfied with such small powders, we may add as much as they seem to wish.
"76. Another method, not less frequently made use of in homoeopathy, is to dissolve the dose we wish to administer in four or six ounces of water^ and to give to the patient a single spoonful, or several, at intervals, more or less extended. As, in this case, the water is no more designed than the sugar of milk to augment the powers of the doses, but only to develop
lxiv INTRODUCTION.
them, and render the reception easier, it would be equally adverse to the end proposed to submit this solution to new succussions. In general, the best way to obtain these solutions is, to put the dose in a bottle of a sufficiently large size to permit the wished-for quantity of filtered water to be poured on it, and to leave the medicine to dissolve of itself ; after which we give a few shakes to this solution, sufficient only to mingle the parts well, without, however, operating a new division of molecules. We will only add, that if for each solution we employ a new bottle, we shall do better than if we make the solution in a tumbler belonging to the patient himself, for, not- withstanding the most careful recommendations on the part of the physician, these tumblers are scarcely ever cleansed with sufficient care, to prevent an alteration of the medicine by the particles which might remain of the pre- ceding one.
" 79. In cases where the imagination of the patient must be gratified, we add to the medicinal doses a few powders of sugar of milk alone.* Thus, for example, if we wish to give the patient six powders, of which three only contain the medicine {durum for instance), we should write, if these powders are to be taken alternately,
Aur.3/15. No. 1. 3. 5.
Pulv. sacch. lact. q. s. No. 2. 4. 6. Or else, if the first three are to contain the medicine : Aur. 3/15. No. 1. 2. 3.
Pulv. sacch. lact. q. s. No. 4. 5. 6. A still more simple plan consists in not indicating the sugar of milk in the prescription, but placing the numbers which are to contain this vehicle behind those which are to contain the medicine, and separating them by the follow- ing sign ($), as for example :
Aur. 3/15. No. 1. 3. 5. # 2. 4. 6. Or else :
Aur.3/15. No. 1. 2. 3. #4. 5. 6.
ff 2. On the Preservation of Homoeopathic Medicines.
^f8L All the medicines, not excepting the powders, ought to be preserved in bottles ; boxes afford too great access to air, and allow too much evapora- tion. For the alcoholic tinctures, cork stoppers are the best, since they adapt themselves to the bottle in a more exact manner than those of glass, and more effectually guard against evaporation. As to very strong and very volatile substances, it is better to tie a piece of prepared bladder over the stopper. Moreover, these stoppers ought to be changed from time to time,
*■ A procedure which is often necessary where patients have long been accustomed to the daily use of medicine under allopathic treatment. — J. L.
INTRODUCTION. lxv
above all, those of bottles which contain metallic solutions ; and in general, we should not neglect to do so as soon as we discover that their extremity begins to change colour ; for in the latter case, alcohol may, without this precaution, dissolve a little of their medicinal virtue, and impair the efficacy of the prepara- tion. Acids do not admit of the use of cork stoppers, they attack them imme- diately, and the portion dissolved alters the purity of the medicine ; we must, therefore, use stoppers of ground glass ; but in order to prevent evaporation they, as well as the neck of the bottle, should be coated with wax.
•■"82. As nothing has more influence on the preservation of homoeopathic medicines than heat, the rays of the sun, and light of the day, we must be very careful to exclude these as much as possible. The action of the solar light and of the light of day easily acidifies alcohol, and, besides, destroys the virtues of the medicines. This is the reason why we should preserve homoeopathic preparations in a cool and dark place, and assure ourselves, from time to time, that they are in a good state of preservation. We discover when they have become acidified by letting a drop fall on the sur- face of a piece of pure carbonate of lime, flattened by pressure ; if the drop insinuate itself tranquilly, the tincture is still good, but if it form bubbles, it it has become acid, and cannot, in consequence, be made use of anymore. As to substances and their dilutions, which are more especiajlysensible to the action of the light, astheprussic acid, phosphoric acid, &c, it is prudent to preserve them in bottles of black glass, or, at any rate, covered with black paper. Finally, it is also advisable to put the homoeopathic medicines, particularly the acetate of lime, hepar sulphuris, barytes, and all the preparations which are preserved in the form of powder, beyond the reach of humidity, — as they become dete- riorated when exposed thereto.
LIST OF MEDICINES
WHICH ARE WELL ADAPTED TO PARTICULAR
TEMPERAMENTS, CONSTITUTIONS, AND DISPOSITIONS.
Lymphatic Temperaments (characterized by superabundance of the humours with repletion of the cellular tissue, giving a considerable bulk to the whole body, which is, moreover, distinguished by roundness of form, softness of the muscular system, fair hair, pale clear skin, and a lustreless, or hazy, inanimate eye. The circulation is slow, the brain inactive, and the passions languid.) Merc, Sulph., Calc, Puis., Caps., China, Ars., Acid, nit., Bella., Hyos., Phosph., Hell., Dulc, Sep., Ant., Lye, Card, v., Am., Dig., Con., Clem., Sil, etc.
Sanguine Temperament (indicated by predominant activity in the circulating system, with a moderately full habit, soft skin, florid complexion, blue eyes, red, auburn, or yellow hair ; corporal and mental activity.) Aeon., Am., Bella., Calc, Hep., Merc, Cham., Nwc v., Bry., Lach., Phosph., Ac nitr., Ars., Cocc, etc.
Bilious Temperament. (By this term is meant that habit of body which is distin- guished by black hair, dark eyes and skin, the latter generally inclining to yellow, moderate fulness, but much firmness of flesh ; the countenance strongly marked, and expressive of the great energy of character which this temperament obtains ; the passions violent, the pulse strong, hard, and frequent.) Aeon., Bry., Nux v., Cham., Cocc, Ars., Am., China, Sulph., Plat., etc.
Melancholic Temperament. (A modification of the bilious, with less activity of the nervous and muscular systems ; black hair, dark complexion ; the disposition grave, meditative, suspicious, and gloomy. Derangement of the functions of the nervous system, with sluggish bowels, dry habit of body, hard, slow, and habitually contracted pulse, usually attend this, so to speak, abnormal modification of the bilious tem- perament.) Nuos v., Lach., Sulph., Aurum, Staph., Veratr., China, Con., Grat., Mosch. natr., Phosph., Stann., Viol, odor., Acid, nitr., Plat., Amir a, Ars., Bry., Sil, Puis., Sep., Magn. m., etc.
Nervous Temperament. (Defined by fine thin hair, thin skin, small, attenuated muscles, paleness of countenance and often indifferent or delicate health. Pre- dominant activity of the brain and entire nervous system; suddenness and muta- bility of decision and judgment ; quickness in muscular motion.) Aeon., Coffea, Bry., Cham., Nuoc v., Sep., Plat., Lach., Ac nitr., Cocc, Ambr., Ars., China, Zinc, Cup., Jgn., Phosph., etc.
lxvili LIST OF MEDICINES.
Constitution or Habit of Body, Cachectic. Ars., [Sulph., Calc, China, Merc, Ac nitr., Phosph., SiL, Natr. m., Carl, v., Am,, etc.
Debilitated or Exhausted : Ars., Sulph., Calc, Phosph., Phosph. ac,
Ars., Carl, v., Nux v., China, Lach., Merc, Natr, m., Staph., Ac nit., Sep., Veratr., SiL, Ant. c, Kali, Am., Can., etc.
- ■■■ Dry : Bry., Nux v., Ac nitr., Amlra, China, etc.
— Plethoric, Corpulent, Leuco-phlegmatic : Aeon., Bella., Calc, Am., Baryt. c,
Ant,, Sulph., Pals., Hell., Merc, Sep., etc*
Lean Habit of Body : Nux v., SiL, Lach., Ac nitr., China, Amlra, Bry., etc,
Disposition, Choleric : Bry., Nux v., Cham., Cocc, Aeon., Sulph., China, etc.
- Hypochondriacal : Nux v., Sulph., Staph., Veratr., Aurum, China, Con.,
Stann.) Phosph., Grat., Mosch., Puis., Asa., Bella., Cham., Magn. m., HelL, Plumb., Mez., VaL, Zinc, etc.
— Melancholy ; Aeon., Ign., Natr. m., Lach., Ars., Nux v., Bry., China,
Merc, Graph., Calc, Staph., Aur., Lye., Plat., Puis., Veratr., SiL, Sep., Ac nitr., Stram., Calc, Con., Chel., etc.
— — Mild (quiet, easy) : Puis., Ign., Amlra, Cic, Mag. arct., Stann., Sulph., Calad.,
Lye, SiL, etc
Phlegmatic, (inactive, inanimate, indolent) : Caps., Cocc, Puis., Ac phos.,
Sep., Anac, Ars., Hell., Bella., ScilL, SiL, Sulph., Zinc, Ac mur,, Natr. m., Cyc, u, etc.
Sensitive : Ign., Cap., Phosph., etc.
As we very frequently meet with mixed forms of temperament, such as a combination of the sanguine and lymphatic, the nervous and lymphatic, and the nervous and bilious, forming the sanguine-lymphatic, the nervo-sanguine and the nervo*bilious temperaments, the remedies which correspond to the two pure varieties which form the compound one ought to be selected where possible, or those which correspond best to the more prominent development of temperament, when a medicament cannot be found which is equally well adapted to the two different temperaments form- ing the mixed variety. We must* of course, be guided by the entire morbid picture in making a selection from amongst the medicaments which are most appli- cable to particular temperaments.
TABLE OF MEDICINES
CONTAINED IN THIS WORK,
TOGETHER WITH THE ABBREVIATIONS EMPLOYED,
1. Aeon. — Aconitum napellus.
2. Act.— Acteea spicata.
3. iEth. — iEthusa Cynaphmi*
4. Agar.— Agaricus muscarius*
5. Agn.— Agnus castus.
6. Al. — Aloes.
7. Alum. — Alumina.
8. Ambr* — Ambra grisea*
9. Am. c— Ammonium carbonicuim LO. Am. in. — Ammonium muriaticum. LI. Anac.< — Anacardium*
L2. Anis.— Anisum stellatum. L3. Ang. — Angustura vera.
14. Ant. — Antimonium crudum,
15. Arg. — Argentum.
16. Arn. — Arnica montana.
17. Art.— Artemesia vulgaris.
18. Ars.— Arsenicum album.
19. Arum.— -Arum maculatum.
20. Asa. — Asafcetida.
21. Asar.— Asarum europeeum.
22. Aur. — Aurum foliatum.
23. Aur. m.r- Aurum muriat.
24. Bar. c. — Baryta* carbonica.
25. Bar. m. — Baryta muriatica*
26. Bell.— Belladonna.
27. Berb.— Berberis vulgaris.
28. Bis. — Bismuthum.
29. Bor.— Borax veneta.
30. Bov.— Bovista.
31. Bry.— Bryonia alba*
32. Bruc.< — Brucea anti-dysenterica.
33. Cal. — Caladium seguinum.
34. Calc. — Calcarea carbonica.
35. Calc. ph.— Calcar. phosphorata.
36. Camph. — Camphora.
37. Cann. — Cannabis.
38. Canths. — Cantharis.
39. Caps* — Capsicum.
40. Carb. an. — Carbo animalis.
41. Carb. v. — Carbo vegetabilis.
42. Case— Cascarilla.
43. Cast. — Castoreum.
44. Caus. — Causticum,
45. Cham.— Chamomilla.
46. Chel.— Chelidonium.
47. Cin.— Cina.
48. Cic— Cicuta virosa.
49. Cinch., Chin. — China, Cinchona offi-
cinalis.
50. Cinn.— Cinnabaris.
51. Cinnam. — Cinnamomum.
52. Cist. — Cistus canadensis.
53. Citr. — Citri acidum.
54. Clem. — Clematis erecta.
55. Coccion.— Coccionella.
56. Cocc. — Cocculus.
57. Cof.— CofFea cruda.
58. Colch.— Colchicum. 59* Coloe— Colocynthis.
60. Con. — Conium maculatum.
61. Conv.— Convolvulus arvensis.
62. Cop. — Copaivse balsamum.
63. Coral. — Corallia rubra.
64. Croc— Crocus sativus.
65. Crot.— Crotum Tiglium.
66. Cub.— Cubebffi.
67. Cupr. — Cuprum.
68. Cyc. — Cyclamen.
69. Daph. — Daphnee indica.
70. Diad. — Diadema.
71. Diet.— Dictamus albus.
72. Dig. — Digitalis purpurea,
73. Dros.— Drosera rotundifolia.
74. Dulc. — Dulcamara.
75. Eug. — Eugenia Iambos.
76. Euph. — Euphorbium officinale. ,77. Euph.— Euphrasia.
78. Evon. — Eyonymus europseus.
79. Fer. — Ferrum.
80. Fer. ch. — Ferrum chloratum.
81. Ferr. mg.— FeiTum magneticum.
82. Fil.— Filix mas.
83. Frag. — Fragaria vesca.
84. Gran. — Granatum.
85. Graph. — Graphites.
86. Grat. — Gratiola officinalis.
87. Guai. — Guaicum officinale.
lxx
TABLE OF MEDICINES.
88. Haem. — Hsematoxyl. camp.
89. Hell. — Helleborus niger.
90. Hep. — Hepar sulphuris calcareum.
91. Hyos.-— Hyoscyamus niger.
92. Jalap.— Jalappa.
93. Iatr.— -Iatropha.
94. Ign. — Ignatia amara.
95. Ind. — Indigo.
96. Iod. — Iodium.
97. Ipec. — Ipecacuanha.
98. Kal.— Kali carbonicum.
99. Kal. ch. — Kali chloroticum,
100. Kal. h. — Kali hydriodicum.
101. Kreos. — Kreosotmn.
102. Lach. — Lachesis.
103. Lac. — Lactuca virosa.
104. Lam.— Lamium album.
105. Laur.— Laurocerasus.
106. Led.— Ledum palustre.
107. Lye. — Lycopodium.
108. Magn. — Magnesia carbonica.
109. Magn. m. — Magnesia muriat.
110. Magn.s. — Magnesia sulphur.
111. Mang. — Manganum oxydat.
112. Men. — Menyanthes.
113. Meph. — Mephitis putorius.
114. Merc. — Mercurius.
115. Merc, c— Mercur. subl. corr.
116. Mez. — Mezereum.
117. Mil.— Millefolium.
118. Mosc. — Moschus.
119. Mur. ac. — Muriatis acidum.
120. Natr. — Natrum carbonicum.
121. Natr. m. — Natrum muriaticum.
122. Natr. n. — Natrum nitricum.
123. Natr. s.— Natrum sulphuricum.
124. Nic — Niccolum.
125. Nitr.— Nitrum.
126. Nitr. ac. — Nitri acidum.
127. Nitr. sp. — Nitri spirit, dul.
128. N. mos. — Nux moschata.
129. N. vom. — Nux vomica.
130. Oleand.— Oleander.
131. 01. an.— Oleum anim. aether.
132. 01. jec. — Oleum jecoris morhuae.
133. Onis. — Oniscus asellus.
134. Op.— Opium.
135. Pceon. — Pceonia.
136. Par. — Paris quadrifolia.
137. Petr. — Petroleum.
138. Petros. — Petroselinum.
139. Phell. — Phellandrium aquat.
140. Phos. — Phosphorus.
141. Phos. ac— Phosphori acidum.
142. Pin. — Pinus.
143. Plat.— Platina.
144. Plumb. — Plumbum.
145. Prun.— Prunus spinosa.
146. Puis.— Pulsatilla.
147.
148. 149. 150.
151. 152. 153. 154. 155. 156. 157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200.
Ran. — Ranunculus bulbosus.
Ran. sc. — Ranunculus sceleratus.
Rat. — Ratanhia.
Rhab. — Rhabarbarum (Rheum palma-
turn). Rhod. — Rhododendron. Rhus. — Rhus toxicodendron. Rhus v. — Rhus vernix. Rut. g. — Ruta graveolens. Sabad. — Sabadilla. Sabin. — Sabina. Samb. — Sambucus nigra. Sang. — Sanguinarius canadensis, Sap. — Sapo domesticus. Sass. — Sassaparilla. Sec. — Secale cornutum. Selen. — Selenium. Seneg. — Senega. Senn. — Senna. Sep. — Sepiae succus. Sil. — Silicea.
Sol. m. — Solanum mammosum. Sol. n. — Solanum nigrum. Spig. — Spigelia. Spong. — Spongia. Squill. — Squilla (scilla) maritima. Stann. — Stannum. Staph. — Staphysagria. Stram. — Stramonium. Stront. — Strontiana. Sulph. — Sulphur. Sulph. ac— Sulphuris acidum. Tab. — Tabacum. Tan. — Tanacetum vulgare. Tarax. — Taraxacum. Tart. — Tartarus emeticus. Tart, ac — Tartari acidum. Tax. — Taxus baccata. Tereb. — Terebinthina. Teucr. — Teucrium marum verum. The. — Thea csesarea. Ther. — Theridion curassavicum. Thuj. — Thuya occidentalis. Tong. — Tongo. Urt. — Urtica urens. Uva. — Uva Ursi. Valer. — Valeriana. Verat. — Veratrum album. Verb. — Verbascum thapsus. Vine — Vinca minor. Viol. od. — Viola odorata. Viol. tr. — Viola tricolor. Zinc — Zincum. Zinc. s. — Zincum smphuricum. Zing. — Zingiber.
201. Mgs. — Magnus artificialis.
202. M. arc. — Magnetis polus arcticus.
203. M. aus.— Magnetis polus australis.
lxxi
ERRATA.
41, line 21, for Connulsio cerealis read Convuisio eerealis. 114, — 14 from the foot, transfer the clause or section commencing with
" an abuse of coffee and tea," and terminating with " and will be
found useful," to the chapter on Headache. 155, — 10, for exterior read interior. 221, — 18 from the foot, after beyond, insert the words " the fact of their
occasional evacuation at stool." 233, — 11 from the foot, transfer the clause commencing with " Conium
maculatum," to after that terminating with " remain unmiti- gated." 306, — 4 from the foot, after Dose, erase the words which precede
" a dessert-spoonful every two to six hours." 351, — 2, for "and is so called from being nearly peculiar to drunkards,"
read and is nearly peculiar to drunkards, hence its name.
373, — 6 from the foot, after heart, insert " friction sounds."
374, — 3, for lung read sac.
— last line, after the, insert general.
376, line 8, erase the words " burning pain in the seat of the surface." 466, — 20, for urethretis read urethritis. 473, — 13, for humeralis read humoralis. 481, — 2, for (siphilida) read (siphilides). 484, — 11 from the foot,/or "Arsenicum or Carbo was," read "Arsenicum
and Carbo were." 526, — 20, for " we find swelling of the psoas muscle and in the region of
the groin," read " we find some degree of external swelling." 542, — 3, for Irichiasis read Trichiasis. 760, — 2, for ventricularum read ventriculorum.
Ixxii
The Medicines which the Author has been in the habit of using, in common with the principal homoeopathic practitioners in this country, are those prepared by Mr. Wm. Headland, Chemist, 15, Princes street, Hanover square, London, and Hanover street, Edinburgh, who has for years devoted himself exclusively to homoeopathic pharmacy. From, having tested their efficacy both in private and dispensary practice, the Author feels that he can with safety recommend them to the continued confidence of the public.
N.B. Mr. Headland's Homoeopathic Preparations may be had of the Publisher of this work.
HOM(EOPATHIC
PRACTICE OF PHYSIC.
It has been repeatedly found that some remedies act very bene- ficially when administered after the previous employment of certain others. The subjoined list affords a few such examples, and may prove useful in the treatment of particular cases : the remedy to be selected must be in accordance with the symptoms.
Acidum nitri. Cole., Petr., Puis., Sulph., are often used with success after Acidum nitri.
Acidum phos. China, Lack., Rhus, Verat., are sometimes suitable after Acidum phos.
Acidum sulph. Puis, is sometimes useful after Acid. sulph.
Aconite. Am., Ars., Bella., Bryon., Cann., Ipec, Spong., Sulph., &c, will frequently be found of use after Aconite.
Alumina. Bryon. is often of great use after Alumina, when it is indicated.
Ant. crudum. Puis, and Merc, sometimes answer well after
Arnica. Aeon., Ipec, Rhus, Sulph. ac, are sometimes suitable after
Arsenicum. China, Ipec., Nux vom., Sulph., Veratr., will sometimes be found beneficial after Arsenic.
Belladonna. China, Ipec, Bulc, Hepar, Bach., Rhus, Seneg., Stram., Valer., are sometimes the most appropriate medicines after Belladonna.
Bryonia. Alum, and Rhus will sometimes be found suitable after
Bryonia.
1
2 LIST OF MEDICINES.
Calcarea carbonica. Lycopodium, Nitr. ac, Phos., and Silicea, will be found most useful after Calcarea.
Carbo vegetabilis. Arsen., Kali., Merc, will often be found suitable after Carbo vegetabilis.
Cinchona. Arsen., Bella., Puis., Veratr., are sometimes suitable after Cinchona.
Cuprum. Calc. and Veratr. are sometimes of service after Cuprum.
Hepar sulph. Bella., Merc, Nitr. ac, Spong., Silicea, are some- times suitable after Hepar sulph.
Ipecacuanha. Am., Ars., Chin., Cocc, Ign., Nux, are sometimes suitable after Ipecacuanha.
Lachesis. Ahim., Ars., Bell., Carb. v., Con., Bulc, Merc, Nux vom., Pkos. acid., are sometimes useful after Lachesis.
Lycopodium. Graph., Ledum, Phos., Puls.9 SiUc, are sometimes serviceable after Lycopodium.
Mercurius. After Mercurius, Bell., Bulc, Hepar, Lach., Nitr. acid., Lep., Sulph., are sometimes suitable.
Nux vomica. Bryon., Puis., and Sulph., will frequently be found efficacious after Nux vomica.
Opium. After Opium, Calc, Petr., Puis., will sometimes be found of use.
Phosphorus. Petr. and Rhus will be found suitable after Phos- phorus.
Pulsatilla. Asa,, Bryon., Nitr. ac, and Sepia, are sometimes suitable after Pulsatilla.
Rhus toxicodendron. Am. c, Ars., Bryon., Calc, Con., Phos., Phos. ac, Puis., and Sulph., are sometimes useful after Rhus tow.
Sepia. After Sepia, — Carbo v., Puis, are sometimes suitable.
Silicea. After Silicea, — Hepar, Lach., Lyco., Sepia, are sometimes of service.
Spongia. Hepar sulph. is sometimes suitable after Spongia — for instance in croup.
Sulphur. Aeon., Bell., Calc, Cupr., Merc, Nitr. ac, Puis., Rhus, Sepia, Sil., are sometimes suitable after Sulphur.
Tartarus emeticus. After Tatar, emet., Bar. c,Ipec,Puls., Sep., are sometimes useful.
Veratrum. After Veratrum, Ars., Am., Chin., Cupr., Ipec, are sometimes suitable.
RULES FOR DIET.
SYNOPSIS OF THE RULES FOR DIET.
UNDER HOMOEOPATHIC TREATMENT.
ALIMENTS ALLOWED.
Soup or broth made from the lean of beef, veal, mutton, or chicken : to which may be added, well boiled sago, tapioca, vermicelli, rice, semolina, or maccaroni, young peas, carrots, pearl barley, or other farinaceous materials, seasoned merely with a little salt.
Meats. Beef, mutton, (poultry rarely,) pigeons, larks, rabbits, (venison, and game in general, may in most cases be partaken of in moderation, but never when high,) plainly cooked, and roasted, broiled, or stewed in its own juice, in preference to boiled. (Ham or neat's tongue rarely.)
Msh. Soles, whiting, smelts, trout, and flounders, perch, and such like, boiled in preference to fried ; when cooked in the latter manner, the white must alone be partaken q|, and the outer or fried portions rejected.
Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, artichokes, parsnips, carrots, turnips, French-beans, sea-cale,vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, or with milk, where required, instead of butter.
Eggs lightly dressed; all kinds of light bread, not new-baked; and biscuit, free from soda, potash, and the like ingredients.
Light puddings, such as those made from vermicelli, semolina, fecula of potato, sago, arrow-root, bread, rice ; simple cakes, composed of flour or meal, eggs, sugar, and a little good butter.
Fruit. Baked, stewed, or preserved apples and pears : also goose- berries, raspberries, grapes, or any other wholesome fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occa- sionally be partaken of.
Beverage. Water, milk, cocoa, chocolate (unspiced), arrow-root or gruel (made thin), toast- water, barley-water, milk and water, sugar and water, rice-water.
Salt should be used in moderation.
UTILES FOR DIET.
ALIMENTS PROHIBITED.
Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups.
Meats. Pork, bacon, calf's head, veal, turkey, duck, goose, sau- sages, kidney, liver, tripe, and every kind of fat and salted meat.
Fish. Crab, lobster, oysters, and shell-fish in general ; and almost all other fish not specified in Aliments allowed.
Vegetables. Cucumber, celery, onions, greens, cabbage, radishes, parsley, horseradish, leeks, thyme, garlic, asparagus ; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper.
Pastry of all kinds, whether boiled, baked, or fried.
Spices, Aromatics, and Artificial Sauces of all kinds ; as also the ordi- nary condiments, mustard and vinegar.
Cheese.
Chesnuts, filberts, wTalnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned in Aliments allowed, under Fruit. (See also article Regimen.)
The above regulations are subject to considerable modifications in particular cases, both*as regards the articles allowed, and those which are prohibited. Regularity in the hours of meals should be observed ; and too long fasting, as well as too great a quantity of food at one time should be avoided.
PART I.
ON THE SYMPTOMS, CHARACTER, DISTINCTION, AND TREATMENT OF DISEASES.
FEVERS. Febres.
GENERAL CONSIDERATION OF FEVER. CAUSES, TREATMENT, AND DIET TO BE OBSERVED.
Perhaps no form of disease has more occupied the attention of pathologists, or given rise to a greater number of theories than Fever. Many authors consider fever and inflammation as synony- mous terms, others as mere modifications of the same pathological state of the system. The investigation is certainly one possessing peculiar interest ; but, fortunately, in the homoeopathic system, no theory can in the slightest degree affect the practice, since, in the treatment of this class of disease, the external phenomena present sufficient indications for the selection of the proper remedies.
Acute diseases have always been considered as the true touchstone of every system of therapeutics. Homoeopathy has been submitted to the test, and the results have at once proved the bold assertion of its founder, that its principle is a law of Nature, — the minute doses act in these cases wdth a promptness and certainty scarcely to be credited, except by those who have either witnessed or experienced their power : under this system, the disease is brought to a salutary crisis, before any great expenditure of vital energy has taken place ; and, from this circumstance, combined wdth the absence of debili- tating measures, the period of convalescence is greatly shortened, and in many instances scarcely perceptible, the patient being, as it were, at once restored from a state of disease to one of perfect health.
Although I shall avoid entering into any of the theories respecting fever and inflammation, I cannot but render the tribute of my admi-
6 FEVERS.
ration to the gifted men who have devoted so much of their time and energies to the elucidation of this difficult pointy since every new pathological discovery serves to throw light upon the specific action of medicinal substances. Practically speaking, when we find a medi- cine produce a change of health resembling that present in fevers, we know that in such fevers it is curative ; still it would be a satis- faction to be enabled to trace the connexion more closely, and to show the perfect affinity between medicinal and morbid action. There is no doubt, that, if a perfect theory of fever be ever given to the world, it will be found in perfect accordance with the homoeopathic law.
In all forms of acute disease fever is present ; in fever, properly so called, there is generally functional disturbance, accelerated action of the vascular, with the participation of the nervous system, and a tendency to increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever also possesses the property of passing from one species into another. Thus inflammatory fever may, by severe antiphlogistic measures, be altered into a low typhus ; or, on the other hand, a simple fever, by injudicious treatment, may be changed into an inflammatory one ; and that again assume the intermittent form ; also, one attack may present all these different phases.
Fevers, terminating fortunately, and running a regular course, may be divided into five stages : the accession, increase, crisis, decrease, and convalescence. When the result is fatal, it may arise' from a metastasis, the exhaustion of the vital energy of the patient, or the disorganization of some important function.
The belief in critical days is of very ancient origin, though there is some difference in the calculations of physicians upon this point : some counting from the day the shiverings declare the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in quotidian and other forms of ague, such distinctions are of little value, inasmuch as the homoeopathic treatment is directed to forwarding the crisis, and thereby materially shortens the duration of the disease. Statistics prove that the average continuation of acute affections is much shorter under the homoeopathic system, than it is where they are treated allopathically, or left to nature ; consequently, any calculations based upon other modes of treatment are not to be depended upon, and the best plan for the physician to follow is to watch attentively the disease before him, and apply the remedies his
FEVERS. 7
knowledge and experience point out as best calculated to conduct it to a satisfactory issue.
A crisis may declare itself by diarrhoea, profuse perspiration, hemorrhage, or increase or alteration of other secretions, or by the appearance of an eruption, after which, if salutary, the skin becomes moist and resumes its functions, and the pulse returns to usual standard.
Fevers have been differently classified by various medical writers. The arrangement we shall adopt is as follows : simple irritative fever, inflammatory fever, typhus, putrid, and gastric or bilious fevers, intermittent fevers, and then eruptive fevers, such as scarlatina, measles, &c.
Although this mode of classification is adopted for the sake of convenience, the author has no intention of generalizing disease : every febrile attack presents peculiar features, and is to be treated as an individual affection, and according to the nature of the symptoms presenting themselves, not by a blind adherence to the nomenclature of disease.
Causes of Fever. It cannot be denied that there exists in cer- tain individuals, a particular predisposition to acute diseases, and, as before remarked in the Introduction, the sanguine, nervous, and bilious temperaments possess this susceptibility in a far more marked degree than the phlegmatic.
The exciting causes are numerous. Miasms, epidemic influences, contagion, powerful mental emotions, derangement of some important organ, external lesions, excess or errors in diet, heat or cold, or alte- rations of temperature, exposure to cold or damp, repercussed erup- tions— in fact, anything that causes derangement of the equilibrium of the system may produce fever.
GENERAL TREATMENT IN FEVER, AND DIET.
The great essentials in the treatment of fever are :
Perfect rest, mental and bodily.
Pure air and a cool apartment ; the temperature of the patient's room should never exceed 55 degrees.
Feather-beds should be discarded and mattresses substituted, when practicable, and the bed-clothes be light but sufficient.
Nature herself generally prescribes the regimen to be observed by taking away appetite, while the thirst present, as an eminent
b FEVERS.
medical writer lias well observed, may be considered as her voice calling for fluid. Water is the best diluent ; no solid food, broth, or even gruel and the like, should be permitted in cases where the in- flammation runs excessively high ; and the utmost caution is to be observed in allowing gruel or weak broths during the decrease : an error in this respect often causes irreparable mischief, and it is always safer to err a little on the side of abstinence than on that of in- dulgence.
Toast-water, or wreak barley- or rice-water, sweetened with a little sugar or raspberry or strawberry syrup, or orangeade, may be allowed when the fever is somewhat abated, though then we must still care- fully avoid incurring the risk of a relapse, by giving any aliment likely to tax, in however slight a degree, the digestive powers. Fruits, such as those which have been enumerated in the Rules for Diet (see Introduction), are very generally allowable in most forms of fever, unattended with diarrhoea. Drinks ought, for the most part, to be given, in preference, frequently, and in small quantities, than in large draughts.
SIMPLE OR EPHEMERAL FEVER.
Febris simplex.
The disease seldom presents any distinct character, and generally runs its course in twenty-four hours ; as, however, it frequently forms the initiative of other more serious disorders, it deserves attention. Before attacks of scarlatina, measles, smallpox, &c., it is generally present, although occasionally showing itself as a distinct affection.
Diagnosis. Shivering, followed by heat, restlessness, thirst, acce- lerated pulse, general uneasiness and lassitude, terminated by profuse perspiration.
In allopathic practice, unless the immediate cause of the affection can be traced, — for instance, indigestion, — the treatment is occasionally hazardous ; for, if the simple fever be merely the commencement of an attack of severe inffammation, the allopathic physician incurs either the risk of increasing it by using stimulants, under the idea of its being a precursor of typhus; or, acting upon the opinion of its being a forerunner of inflammation, of weakening the constitution by antiphlogistic methods, if it should unfortunately run on to the former. In this case, the safer plan was to wait quietly the development of the
INFLAMMATORY FEVER. V
affection, in order to see if it would terminate in a crisis, or take upon it a more virulent form, and then deal with it accordingly.
Treatment, Throughout this work the disease will be found treated of, both when arising from indigestion or cold, and when appearing as the precursor of other affections ; but when it is encoun- tered along with the symptoms already detailed, and cannot be traced to any particular exciting cause, and particularly when hot dry shin is present, Aconite should be prescribed, which, if it be simple fever properly so called, will speedily dissipate all the symptoms ; and, if it be the forerunner of any more severe disorder, either at once check its further progress or materially modify its malignancy. The former is more peculiarly the case with purely inflammatory attacks : the latter holds good as far as relates to typhus, exanthematic diseases, and some other affections, which run a regular course.
INFLAMMATORY FEVER. SYNOCHAL FEVER.
Febris inflammatoria simplex. Spwcha. Febris synochalis.
Diagnosis, Rigors (generally considerable), followed by burning heat; pulse strong, hard, and greatly accelerated; dryness of the skin, mouth, lips, and tongue ; the latter generally of a bright red, in some cases slightly coated with white ; thirst ; urine red and scanty ; constipation; respiration hurried, in accordance with the pulse; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regularity to a crisis, which shows itself in profuse perspirations, critical urine, diarrhoea or hemorhage, prin- cipally epistaxis. The period mentioned is its ordinary average of duration, but under homoeopathic treatment, the perfect crisis is con- siderably hastened without the long convalesence entailed by the usual antiphlogistic means.
It is peculiarly apt, if not carefully treated, to change into typhus, or, by metastasis, to fix upon some important organ.
Causes. Sudden chill, or check of perspiration, exposure to damp or wet, dry easterly winds, violent mental emotion, high living, ex- ternal injury or lesion, locai inflammation, and slight febrile attacks mismanaged.
Individuals, of what is denominated a plethoric habit, are particu-
10 FEVERS.
larly subject to this disease ; it generally attacks between the ages of i 5 and 30 years.
Under the diagnosis we have given the pathognomonic symptoms of synocha ; we, however, find it complicated, in the majority of cases with more or less cerebral disturbance, which we shall consider more in detail under Inflammation of the brain or its tissues.
Treatment. Although, throughout this work, the author pur- poses to confine himself to pointing out the remedies most valuable in disease, without entering into any disquisition upon their efficacy, or the principle of their employment, yet he cannot refrain, in this instance, from briefly noticing a medicament, which has so success- fully superseded all the antiphlogistic measures of the old school, subduing, as it does, the inflammation, without lowering the vital energy. No one, who compares the pathogenetic symptoms of Aco- nite given in the Materia Medica Bur a of Hahnemann, and carries in mind the principle of its application, can forbear being struck with the close resemblance which they present to those of pure inflamma- tory disease ; and by this powerful auxiliary, the author has no hesi- tation in declaring, that disease of the said description is brought so fully under the control of the physician, as to be in a great measure divested of its malignancy, and in no case is the superiority of Homoeopathy more strongly evidenced.
When, therefore, the symptoms above mentioned are present, we may at once prescribe Aconite as follows : —
R Tinct. Aeon. 3, gtt. iij. Aq. pur. Jiij. M.
Dose. |ss every three to six hours, according to the intensity of the fever. The pulse should be carefully watched, and also the appear- ance first of simple moisture of the skin, and subsequently of copious sweating, which generally takes place after the first or second dose of Aconite. The intervals between the doses must be lengthened as soon as this favorable crisis sets in.
A slight degree of delirium is frequently present in this affection, chiefly at night, which — unless it threatens to run on to inflammation of the brain, in which case Belladonna must be had recourse to — Aco- nite of itself is sufficient to subdue. When, however, during the course of the affection, other symptoms, besides those mentioned, develop themselves, we may find it necessary to have recourse to different remedies, such as Belladonna, Bryonia, &c.
Belladonna is especially useful after the previous employment
INFLAMMATORY FEVER. 11
of Aconitum ; but it may be prescribed at the commencement of the attack in all cases when the cerebral system seems prominently affected, and there is great heat in the head, with violent cephalagia, particu- larly in the forehead, and redness of the face; distension of the arteries of the neck and temples ; nocturnal sleeplessness, with furious delirium ; eyes red, shining and fiery ; general internal and external heat ; burn- ing thirst and agonizing restlessness.
R Tinct. Bellad. 6, gtt. ij. Aquse purae, ^ij*
Dose. Jss every four hours, until amelioration supervenes, or we observe unequivocal symptoms of medicinal aggravation ; in which latter case we must cease to prescribe altogether, until the reaction has taken place ; and in the former, lengthen the intervals of repeti- tion, as the improvement advances.*
Bryonia. When the orgasm is chiefly concentrated in the tho- racic viscera, or when there is gastric complication, and the fever inclines to degenerate into synochus. This medicament is accord- ingly indicated when, in addition to the usual symptoms of inflam- matory fever already given, Ave find a heavy stupefying headache, with a sensation as if the head would burst at the temples, much aggra- vated by movement, vertigo and giddiness on rising up or moving ; burn- ing heat of the head and face, with redness and swelling of the latter ; delirium ; oppression at the pit of the stomach ; excessive thirst, sometimes followed by vomiting; constipation; aching or shooting pains in the limbs, short cough, oppression at the chest, and laborious breathing.
R Tinct. Bryon. 3, gtt. iij. Aq. purse, Jiij.
Dose. Jss every six or eight hours ; few cases are so particularly urgent, as to require more frequent administration of this remedy ; indeed, when the virulence of the disease has been subdued, a single dose is generally found sufficient, and no further exhibitions should take place, as long as the patient manifestly continues improving.
Cantharis has been recommended in irritative fever bearing a close resemblance to pure synocha, and especially when the follow^- ing symptoms become developed : the fever is very intense during the night, and is accompanied by burning heat of skin, strong accelerated pulse, general redness of the surface, dryness of the mouth, and violent thirst. Further, when pains are complained of in the right side of * See remarks on medicinal aggravation, in the Introduction.
12 FEVERS.
the body, attended with great anxiety and raving. Chamomilla is useful in pseudo synochal fever, with burning heat and bright redness of the cheeks, tremulous, anxious, palpitation of the heart, extreme irritability of temper, and over sensibility of the senses, alternate heats and chills, and, sometimes, spasmodic attacks, &c. Chamo- milla is peculiarly applicable when the above symptoms have been excited by a fit of passion or vexation. A dose or two of Aconite is, however, generally requisite, in the first place, when the derange- ment has been excited by the aforesaid cause.
When inflammatory fever seems to arise from a primary inflamma- tion of some important organ, such as the Head, Lungs, Liver, or Stomach and Bowels, the treatment will be found under the head of Inflammation of the function most evidently the seat of the dis- order.
It is sometimes the result of severe lesion, in which case the patient is to be treated as prescribed under External Injuries.
NERVOUS FEVER. SLOW-FEVER.
Febris nervosa. Typhus.
It is sometimes extremely difficult, particularly when the disease arises from some local affection of the more important viscera, to dis- criminate, at the commencement, between a nervous and inflammatory attack, so as to give a decided diagnosis. However, in such cases the marked advantage of the homoeopathic system is again showTn ; for, by exhibiting medicines in accordance with the symptoms that declare themselves, we run no risk either of weakening the vital energies, should we err in our diagnosis, and treat it on its first appearance as an inflammatory attack, — or of stimulating the inflam- mation by what is commonly denominated an anti-nervous treatment, should the precursory symptoms lead us to consider it typhus, and it afterwards assume the inflammatory form.
Diagnosis. Typhus rarely sets' in with such marked symptoms as announce the approach of inflammatory fever ; instead of severe chills or shiverings, we first find a complaint of general uneasiness, a sensation of chilliness, occasionally followed by a greater or less de- gree of heat. The patient either complains but little, or of pains in his head, chest, and abdomen, and frequently an unusual degree of drowsiness is present, arising from a comatose state of the brain — - there is also occasionally a slight dyspnoea — after various alternations
NERVOUS FEVER. 13
of cold and heat, the former sensation predominates in the feelings of the patient, while to those around him he appears hot ; the extremities* however, on examination, are found cold. Different characters of pulse present themselves; sometimes it is full and soft, at others accelerated, frequently about the natural standard or below it, or quick and weak, but not strong and hard as in inflammatory fever : the fre- quent difference between the action of the pulse and heart is worthy of notice, the former may be so weak as scarcely to be perceptible, and the action of the latter strong ; the pulse also may be hurried and the respiration natural. As the disease progresses, the tongue, at first moist, becomes thickly coated, dry, glazed, and tremulous ; there is faintness, cephalalgia, giddiness, and vertigo : the delirium, at first slight, and manifesting itself only at night, becomes unintermitted, and is characterized rather by wandering and low muttering, than fury and violence : we may also meet wdth spasms and convulsions. All these symptoms, if the disease be allowed to gain ground, increase in malignancy, the evacuations become involuntary, the weakness and lassitude excessive, and the patient sinks down to the bottom of the bed — an evidence of complete prostration of strength, while all endea- vours to rouse him are fruitless, and he is perfectly blind to all around. Tenderness of the abdomen, or pain in the region of the caecum is also frequently met with.
Some only of the above symptoms may be present, or the fever may be complicated with others : when only a few of the less virulent symptoms declare themselves, it is called mild typhus ; when compli- cated with considerable disturbance of the vascular system, great heat, and quick hard pulse, inflammatory typhus : a distinction is also found in the type, as in continuous and intermittent typhus ; in the acci- dental circumstances or exciting causes present, as for instance in the gastric and catarrhal complications, which, although generally treated as gastric or catarrhal fevers, with typhoid symptoms, may be con- sidered as modifications of this affection; this difference in arrange- ment can, however, make none in practice, as we must be guided by the symptoms that present themselves in selecting our remedies.
The congestive fever of some authors may be considered as a variety of typhus, in w7hich from the balance of the circulation being destroyed, the blood is determined to some particular organ, the ex- ternal heat of the body diminished, and the pulse becomes slow and oppressed. The symptoms vary according to the organs attacked. It may be remarked that in most forms of this malady, the course is
14 FEVERS.
extremely irregular — the precursory symptoms may precede the dis- ease only a few days or several weeks, and its duration is also uncertain.
Death may take place from exhaustion of the vital energies, para- lysis of the whole system, or of the brain, apoplexy, disorganization of some of the nobler viscera, or a change to the putrid form.
Causes. Densely populated neighbourhoods, where a number of individuals are crowded into small apartments, and the air rendered impure by exhalations from decomposed animal and vegetable matter, stagnant water, and a want of circulation, are the very hotbeds of typhus ; a deficiency and improper quality of food are often added to the above, and are of themselves sufficient to produce it : other causes are, over- exertion, either of body or mind, or excesses of any kind, the prevalence of cold, damp weather, mental emotions, and contagion.
In fact, anything tending to depress the vital energies may be pro- ductive of typhus ; it may consequently arise after inflammatory fever treated by bloodletting or other severe antiphlogistic measures, or even by the reaction of the organism, or an imperfect crisis after the same affection.
The prognosis in typhus is to be formed by the type of the fever, the regularity of its course, the local complications, the greater or lesser intensity of the symptoms, and the tendency to a dissolved state of the fluids ; — continued delirium and stupor ; carpologia, sub- sultus tendinum, impeded speech and deglutition, tremulous or para- lytic state of the tongue ; a fetid exhalation from the body ; excessively offensive, dark, dysenteric stools ; effusions of blood under the skin, or the early appearance of miliary eruption ; involuntary evacuation of faeces and urine ; hemorrhages and hiccough are highly unfavor- able signs. On the other hand, the absence of stupor and delirium, or abatement of febrile heat and thirst, returning strength of pulse, a gentle transpiration over the wrhole body, loose bilious stools, gradual clearing of the previously turbid urine, or moderate cloudiness in place of the former clear or colourless urine, and deposition of a late- ritious sediment, are to be held as favorable indications. Typhus fever generally begins to subside in this and other temperate or cold climates about the fourteenth or sixteenth day, but is frequently pro- tracted to a much longer period. In warm climates, again, the fever commonly terminates in six or eight days.
The following remedies have been found the best adapted to the different forms of typhus:
Aeon., Bella., Bryon,., Rhus, Nwc, Acid, m., Lycop., Hyoscy., Slram.y
NERVOUS FEVER. 15
Cham., . Natrum m.—\VL nervous fever, characterized by erythismus (Febris nervosa versatilis.)
Bella., Rhus, Arsenic, Bryony Qp*, Hyosc,Stram., China, Cocc, Nux v., Veratr., Am., Nitr* sp. — in Febris nervosa stupida, or slow typhus.
Aeon., Bella., Hyoscy., Bry., Bach., Op., Straw., Rhus, Acid.phosp., Cupr. ac. — in Typhus cerebralis.
Bryon., Rhus, or Aeon., Merc.,. Cham., Nux, Feratr., Bella., Hyoscy., Arsenic, China, Sulph., and Senega,— in Pneumo-typhus, Typhus
PULMONALIS.
Ipecac, Puis., Cham., Bryon., Nux, Ignat., Cocc, Am., China, Digit., — • in Typhus bil,iosus s. Typhus gastricus.
Rhus, Bryon., or Arsenic, Merc, China, Carb. v., Phosph., Canth., Puis., Sulph., Calc, Acid, nitr., Nux mosch.—m Typhus abdominalis, Typhus gravior {malignant, putrid, or petechial fever.)
During the period of incubation the development of the disease may sometimes be prevented, or the attack rendered much milder by the employment of Bryonia or Rhus, or both of these remedies in alterna- tion (see the indications given further on). In the inflammatory period Bryonia is one of the most important remedies, but it will not unfre- quently be found necessary to select one or more of the following in this stage : Aeon., Bella., Cham., Hyoscy., Nux v., Bycopod., Stram.
In the period of debility, Rhus is almost always of a greater or less degree of utility, and is often alone sufficient to effect such a favorable change as to render it a comparatively easy task to conduct the fever to a successful issue. The other remedies, which are often required at the debile stage, are, Arsenicum, Carbo vegetabilis, Acidum muriatieum, Mercurius, and Ci,nchona ; or, Acid, phosph., Bach., Am., Nux mosch., and Sulph.
In ileo-typhus, with ulcerations, Carbo v., Rhus, Acid, nitr., Phosphor*, and Bycop. are the most deserving of attention.
Carb. v. is occasionally of service in cases which seem utterly hopeless; the pulse, from being almost imperceptible, becoming stronger, and the sinking energies rallying in such a manner, after the employment of this remedy, that the patient is readily placed out of danger by the aid of one or more of the medicaments above enumerated, and particularly such as Rfais, China, Arsenic*, &c
At the commencement of typhoid fever, where gastric symptoms set in, such as headache^ giddiness, nausea, vomiting, watery, yellow, or greenish, slimy evacuations ; particularly when attended with slight chills, alternately with heat, or considerable shivering with
16 FEVERS.
slight heat, or marked heat with but little shivering, we may admi- nister Ipecacuanha. Or Pulsatilla maybe selected at this stage of the disorder, when there is frequent shivering, bitter taste, whitish tongue,vloss of appetite, nausea, vomiting of mucus, slimy evacua- tions, febrile heat, intermingled with chills, and particularly when the above symptoms occur in mild, temperate, or phlegmatic subjects, with extreme depression of spirits, and tearfulness ; in a more advanced stage of the disease, with slight delirium, tears and lamen- tations, alternating with somnolency, Pulsatilla is still of consider- able service. (Acid, phosphoricum is sometimes required after Pul- satilla.)
Digitalis is indicated when febris nervosa, or rather typhus biliosus is ushered in by yellow, jaundiced hue of the skin; violent, bilious vomiting, spasmodic pains in the stomach ; sensibility of the left hypochondrium on pressure ; frequent desire to make water, par- ticularly at night, with scanty, bilious urine; burning heat of the head and face ; anxiety of mind, and dread of some imaginary impending misfortune; urination painful and difficult, or entirely suppressed.
Nux vomica. Gastric or bilious symptoms, constipation, with frequent inclination and ineffectual efforts to evacuate. Nux vomica , is further indicated when the spasms, which not unfrequently accom- pany this disease, are confined to the stomach and intestines, parti- cularly the rectum — a frequent cause of the above-mentioned constipation ; painful and difficult emission of urine ; painful pressure, and tension in the epigastrium and hypochondria; sensa- tion as if the limbs were bruised ; general nervous excitability, with great nocturnal restlessness and slight delirium ; weakness, and exacerbation of the symptoms in the morning. Temperament, san- guine or bilious ; disposition, irritable and impatient.
When the disorder assumes the asthenic form of abdominal typhus, or when the inflammatory diathesis is more lymphatic than arterial, from the occurrence of the disease in venous-lymphatic subjects, with pale or yellowish appearance of the face, severe headache, or sensation as if a tight band were across the forehead ; thickly-coated tongue; bitter or foul taste; little thirst; sensibility of the scrobi- culus or umbilical region to the touch, and distension of the abdo- men; evacuations copious, watery, flocculent, and even bloody, some- times attended with tenesmus ; at first, dry burning skin, followed by profuse debilitating sweats ; depressed pulse, and great prostration ;
NERVOUS FEVER. 17
extreme restlessness and anxiety with constant tossing about in bed; disturbed unrefreshing sleep, with anxious dreams— Mercurius will be found a most efficient medicine.
Cinchona. This remedy is frequently of service in the first stage, or when there is paleness of the face, lancinating, rending, aching, or pressive headache, cloudiness of vision, buzzing or roaring in the ears, dullness of hearing; yellow or white coating on the tongue, dryness of the mouth, insipid, clammy, or bitter taste ; inclination to vomit; sensibility and distension of the abdomen; thin, yellow, watery motions, occasionally intermixed with undigested substances ; urine scanty, pale or dark coloured, and cloudy ; oppression at the chest ; dragging shooting pains in the limbs ; anxiety, sleeplessness, and general coldness and shivering. In an advanced stage of the disease, moreover, China is occasionally of con- siderable value, especially when the attack has become lengthened and tedious, and the following symptoms have set in : nocturnal sweats, obstinate diarrhoea, but with clean tongue, and absence of abdominal pain,— followed by Sulphur should the sweats not yield ; or by Acidum sulph., if the sweating be very profuse when lying still, and diminished by movement.
When inflammatory symptoms declare themselves at the com- mencement, Aconite and Belladonna are the best remedies ; but when the disease becomes more developed, and still retains the inflamma- tory character, Bryonia and Rhus will generally be found more useful. For the employment of Aconite, we have given the characteristic indications under Inflammatory Fever, and in all cases where these decided symptoms are present, it is imperatively called for, and should be administered as there prescribed. The following symptoms indicate Belladonna:
Alternate heat and chills, or general heat externally and internally, with redness, burning heat, and bloated appearance of the face, or alternations of coldness and paleness, and heat and redness of the face, violent throbbing of the carotids ; redness, sparkling, and protrusion of the eyes, with dilatation of the pupils, extreme sensi- bility to light, and strabismus ; singing or noises in the ears to a greater or less degree; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run away ; violent shooting pains in the fore- head, or dull heavy pain, causing the patient to put his hand frequently to his head; sopor; furious delirium or loss of conscious-
2
18 FEVERS.
ness ; delirium and carpologia, or spasmodic or convulsive attacks ; parched lips, soreness of the corners of the mouth, redness and dryness of the tongue, which is also sometimes foul, and covered with yellow fur; skin hot and dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids, nausea, pressure at the pit of stomach ; meteorismus ; constipation, or watery motions ; scanty and red or amber-coloured urine ; rapid respiration ; pulse full and accelerated, or quick, hard, and wiry; parotid glands inflamed and tumid.
Stramonium may be given when, in addition to the above symptoms, we find twitching of the muscles of the face, subsultus, strabismus, trembling of the extremities, tremulous motion of the tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulations, and risus sardonicus.
Hyoscyamus, with similar symptoms, and moreover, twitching of the tendons, strong full pulse, fulness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium; frequent, but ineffectual urging to urinate.
We shall now proceed to the consideration of two medicines, R7ius and Bryonia, whose value in typhus, in the form in which it appeared in Germany in 1813, was proved by Hahnemann's treatment of 183 patients, not one of whom died, while thousands perished under the means employed by the professors of the old system of medicine. The two medicines above mentioned possess many striking points of similarity, but also many of difference; they may, on some occasions, be administered alternately, with great advantage. For their indi- vidual employment the indications are as follows :
Bryonia. More particularly when the disorder assumes the cha- racter of a Febris nervosa versatilis, or Typhus cerebralis, with violent stupefying headache, as from a blow, and pain across the forehead, and at the temples, as if the head w- ould burst ; frequent raising of the hands to the head. Aggravation of these sensations by movement — con- tinuous violent delirium with excessive febrile heats; foul, thickly* coated, yellowr tongue, or dry cracked tongue, with parched mouth, and great thirst, and vesicles on the mouth or tongue> furred lips ; nausea, inclination to vomit, or vomiting of mucous and bilious matter ; tenderness of the scrobiculus when touched ; general heat of the whole body, dryness of the skin, redness of the face, and profuse perspiration during the fever ; sensibility of the epigastric regions ; distended abdomen, oppression at the chest, and frequent sighing and
NERVOUS FEVER. 19
moaning, indicative of threatening miliaria (alba) ; constipation , or re- laxed stools ; urine of a deep orange colour or bright yellow, with yellow sediment ; sensation as of a plug in the throat ; stitches in the side ; drowsiness or disposition to sleep during the day ; sleeplessness, fugitive heat, and excessive restlessness, or continued drowsiness or coma, with startings and unpleasant dreams; painful shooting and aching in the limbs, aggravated by movement ; trembling of the hands ? pulse quick, soft, frequent, or irregular, small and intermitting ; miliaria, petechiae ; irritability, irascibility, despair of recovery. (Crocus has in some instances been found of unequivocal service in alternation with Bryonia.) In the period of incubation, Bryonia and Rhus are, as has already been remarked, frequently of great service, either in arresting the fever at its onset, or of giving it a milder character throughout its future course. The indications for Bryonia in this stage are chiefly as follows : after a slight cold the patient complains of aching pains over the whole body, which admit of no relief from a change of posture ; there is severe throbbing, bursting frontal headache, aggravated by opening or turning the eyes ; the scalp is tender to the touch, and the head burn- ing hot, yet the forehead is nevertheless frequently bathed with a cold sweat ; the sitting or the recumbent posture is rendered compulsory, by the prevalence of debility, languor, and heaviness of the limbs, and there is an aversion to cold air ; the nights are disturbed, more espe- cially in the fore part of the night, by ebullition or congestion of blood, heat and anxiety ; the patient sighs and moans during sleep, and is often aroused by agonizing or frightful dreams, which continue to haunt him even whilst awake. Symptoms of deranged digestion are also prominently developed, as bitter taste, yellow, furred, dry tongue, disgust at food, nausea and inclination to vorm% pressure or weight and pricking in the scrobiculus cordis, with sensation of dis- tension in the hypochondria, costiveness.*
Rhus toxicodendron. This medicine is more peculiarly suit- able to the debile form or stage, the Febris nervosa stupida,— Bryonia being more applicable to the inflammatory, — but will frequently be found serviceable in all the stages of the disease, particularly when there is diarrhcea, congestion to the head, oppression at the chest, and great weakness. The headache is generally of a stupefying nature, with a feeling as if from a bruise, but not so severe as that of Bryonia ; the tongue presents nearly the same character, less nausea and iriclina-
* Hartman's Therapie, Ister Bd., 2te Auflage, p. 219.
20 FEVERS.
tion to vomit exists ; violent pain is felt at the epigastrium, especially when touched. Constipation as in Bryonia, but more particularly, copious yellowish, ox loose, sanguineous evacuations, with severe cutting pains in the abdomen ; the symptoms of general heat, and those of the face resemble those given under Bryonia, but without the perspira- tion, or at most, a clammy feeling of the skin. The urine is hot, dark coloured, or at first clear, and afterwards turbid ; the symptoms of the ears the same ; sleep also the same ; difficult deglutition of solids, as if from contraction of the throat and oesophagus ; general trembling, debility and prostration, almost amounting to paralyticjwea&ness of the dif- ferent limbs ; shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected; pulse quick and small, or weak and slow; in the morale we may notice, excessive anguish, anxiety, extreme lowness of spirits, and disposition to weep.
In Typhus abdominalis, characterized by continued heat and dryness of the skin, violent delirium ^oppression at the heart, with sighing and moaning; pains in the limbs ; extreme debility; tongue and lips dry, or covered with a brown or blackish tenacious fur ; red, burning cheeks, subsultus tendinum ; carpologia ; coma somnolentum, with muttering and stertor; weak, accelerated pulse; anxious expression of countenance ; sleep disturbed, or prevented by the frequent recur- rence of sudden starts ; eyes inflamed, watery, and insensible; features collapsed ; breath highly offensive ; involuntary evacuation of faeces and urine ; coldness of the extremities ; sinking energies ; petechias ; miliaria — Rhus is, moreover, a most efficient medicament.
During the period of incubation, or the premonitory stage of typhus (particularly of Febris nervosa stupida), it is also of great value. Its employment is called for here when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with diarrhoea, accompanied by colic, and complains of chilliness even when seated close by the fire; further, when aching pains (or pains as if arising from the effects of contusions) are experienced in particular parts of the body, or when a painful sensation is experienced as if the flesh had been torn from the bones ; the tongue is furred white, and there is giddiness, inclination to vomit, or actual vomiting of mucus ; the patient is tormented by numbness, creeping and tingling in the parts of the body on which he lies, together with lancinations, draw- ing pains, and stiffness in the nape of the neck and in the back, rigi- dity and feeling of paralysis in the extremities ; all the symptoms are,
NERVOUS FEVER. 21
generally speaking, exacerbated during rest and at night. Again, in the period of convalescence, it is a remedy of considerable importance, especially when the progress towards recovery proceeds slowly, the pulse retaining a febrile character, the appetite, although improved, being capricious, the bowels prone to become relaxed, and the chest not yet exempt from feelings of oppression.*
In many cases it will be found useful to give Bryonia, and Rhus in alternation, at intervals of from three to six hours.
Camphora frequently proves useful after Rhus (according to the ex- perience of some of the Continental homoeopathists) ; it is indicated especially when the symptoms are chiefly as follows : heat of the head, with confusion of ideas ; or violent delirium ; giddiness ; throbbing headache ; burning heat in the forehead ; cold and clammy skin; con- tinuous coldness of the hands and feet ; debilitating and clammy sweat ; tendency to diarrhoea; scanty, cloudy urine, which deposits a thick sediment; great weakness, and feeble, scarcely perceptible pulse. Dose. A drop of the tincture every quarter of an hour until symptoms of amendment supervene, and a change of prescription is called for.
Cocculus is often serviceable after the previous employment of Rhus or Camphora, especially when the great debility continues, and the patient complains of giddiness and headache ; or when there is a tendency to syncope, or paralysis of the limbs, and when there are prominent symptoms of gastric disturbance. Arnica is also of some importance infebris nervosa stupida; with coma somnolentum, or deli- rium and carpologia; or when the patient lies in a state of uncon- sciousness, as if he had been stunned by a concussion of the brain.
Arsenicum. This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, some- times restoring the patient when almost beyond the reach of hope, aud renovating the vital spark. The chief indications for its employ- ment are: extreme prostration of 'strength, falling of the lower jaw, open mouth, dull and glassy eyes, bitter taste, inclination to vomit, pres- sure and aching at the scrobiculus cordis, pain in the caecal region, bursting headache, giddiness, violent or low7 muttering delirium, sopor, tympanitis, burning thirst, dry hot skin, giddiness, parched, cracked, sometimes blackish-looking, clammy tongue, and colliquative diar- rhoea, pulse scarcely perceptible and intermittent.
* Hartman's Therapie, 3te Auflage, p, 222.
22
FEVERS.
Feratrum is occasionally useful after or in alternation with Ars., when the inferior extremities become cold and covered with cold sweat.
Carbo vegetabilis is another remedy which often proves of utility in these desperate cases ; it is indicated where we find drow- siness with rattling respiration, face pinched, sunken, and deathlike, pupils insensible to light, pulse scarcely perceptible, and the vital power rapidly sinking, cold perspiration on the face and extremities, involuntary and offensive evacuations, deep red urine, with a cloud floating in it or rising towards the surface. In Ileo-typhus, with symptoms of incipient ulceration, or with signs of so-called putre- scency, and tendency to metastases, Carb. v. is, moreover, a most serviceable remedy ; and in the second stage of malignant typhus, or typhus abdominalis, it may be employed with decided advantage when the symptoms are as follows : Burning, lancinating pains in th e epigastrium and deep in the abdomen, which become renewed after partaking of nourishment of any kind, and are accompanied by great anguish, excessive flatulency, and the evacuation of burning, light-coloured, fetid, watery, sanguineous stools with tenesmus; desire for salt food, and for coffee, but aversion to meat, — the patient4 however, generally dreads to satisfy any inclination which he may have for food, on account of the above-mentioned sufferings which such indulgence entails ; — anxiety and burning heat of skin, arising from congestions to the head and chest ; agglutination of the eyelids during the night ; deafness and tinnitus aurium, as also bleeding from the nose and obstruction of the latter from the formation of incrustations ; eruption around the nose, and the brown or blackish- looking cracked lips ; the legs are drawn up during sleep, which is restless and disturbed by frequent waking.
Acidum phosphoricum. When at the very commencement of the disease, Ave find great exhaustion and prostration, with wandering even when awake ; or in almost hopeless cases, this medicine may be administered either alone, or still better, in alternation with B/ms, when the patient is always found lying on the back in a comatose state, and either gives no reply when talked to, or if he does, it is in an incoherent manner; constant loquacious delirium, or low mut- tering ; carpqlogia, fixed look ; seeming efforts to escape from some alarming object; black incrustations on the lips; dry, hot skin, continual copious ivatery diarrhoea ; the motions are generally passed involuntarily; sanguineous evacuations; frequent, weak, and occa-
NERVOUS FEVER. 23
sionally an intermitting pulse. Should the debilitating sanguineous evacuations continue, Acid, nitricum should be administered/ or Cantharides, if strangury also be present. Acidim nitricum, in addition to being useful against hemorrhage, is also efficacious where there is sensibility of the abdomen, with diarrhoea and slimy, acrid, greenish- coloured stools ; tenesmus, aphthae, intestinal ulcerations ; sensibility of certain parts of the abdomen on pressure ; shooting pains in the rectum; tenesmus, greenish slimy diarrhoea; scalding micturition; tendency to collapse.
Sulphur has been found useful when Bryonia, Rhus, or Acicfam johosphoricum have been fruitlessly administered ; f but particularly when the following symptoms were encountered : pale and collapsed countenance, burning, itching eruptions on the lips, dryness of the mouth ; foul, dry tongue ; bitter taste ; slimy or bilious vomiting ; tenderness of the epigastrium, and pain as from excoriation in the umbilical region, increased on pressure ; borborygmus ; frequent, watery, flocculent or yellow evacuations ; cloudy urine, depositing a reddish sediment ; miliaria, miliaria purulenta ; epistaxis ; stitches in the chest, oppressed breathing ; dry cough, worse towards evening and at night ; sleeplessness^ or whining during sleep ; dry heat during the day, with moderately quick pulse, and profuse sweating at night.
Opium. (Fe&ris nervosa stupida.) Great drowsiness, or coma with stertorous breathing, open mouth, half-closed eyes, or fixed look, slight delirium or muttering; carpolqgia; the patient is in a continual state of sopor, from which it is extremely difficult to rouse him, and is scarcely aroused, ere he relapses into his former state ; dry offensive stools, which, together with the urine, are passed involuntarily.
Nitri. spir. In desperate cases of febris nerv. stup., with com- plete apathy or insensibility, and fixed, expressionless, or haggard eyes; dry, brown, or blackish lips; sopor, with low muttering delirium. As soon as signs of improvement set in from the employ- ment of this remedy, it will in general be found requisite to follow up the treatment by prescribing some one or other of the remedies mentioned above, such as Rhus, Acid, phosph., Nux, Bella., etc. J
Calcarea c. may sometimes be administered advantageously, alternately with Belladonna, Arsenic, or Rhus, according to the symp-
* Gtt. iv — vi, in an enema, sometimes necessary. Baertl. Arch., XX Bd., 2tes Heft. f Baertl. Archives, XX Bd., 2tes Heft. % Hartman's Therapie.
24 FEVERS.
toms; it is further, occasionally a most efficient remedy in cases in which debilitating diarrhoea or epistaxis will not yield to such remedies as, Ac. phosph., Rhus, Cinchona, etc. ; * when the nasal hemorrhage fails to be arrested by Calcarea, Hepar sulphuris is gene- rally the most appropriate remedy to follow up with, provided all the symptoms of the disease are not better embraced by Pulsatilla, Belladonna, Rhus, or Sulphur : lastly, Calc. c. may be exhibited with advantage where there are symptoms of impending miliaria, jerkings, or twitchings in the limbs, particularly in children, tendency to meningitis, delirium, etc.
Lycopodium is often a valuable remedy after Calc. in the second stage of typhus, when miliaria is slowly and scantily developed, and there is sopor with muttering delirium ; confounding of words ; stammering ; subsultus tendinum ; carpologia ; meteorismus, with constipation ; affections of the bladder; or, when there are shiverings alternating wdth heat ; circumscribed redness of the cheeks ; debili- tating sweats; excessive debility; complete hanging of the lower jaw ; half-closed eyes ; slow respiration ; or, state of excitement without heat or congestion in the head or face ; redness of the tongue ; constipation ; burning urine ; tranquil and resigned state of mind, or surliness and malevolence, especially on waking.
Lachesis is spoken of as being likely to prove serviceable in typhoid fever, attended with vertigo on rising or sitting up ; muttering delirium; hanging of the lower jaw; vacant expression of counte- nance ; sunken features ; bitter taste ; yellowish tongue, with bright red margins; cracked tongue; smooth dry tongue; or furred, white slimy tongue; heaviness of the tongue, with difficulty of protruding it, and inarticulate speech ; seeming paralysis of the eyelids; lethargic sleep, and tendency to lie in the prone position : thirst, with disin- clination to drink ; browrnish-red, copious urine.
Sec ale cornutum is, in like manner with Natrum m. and Helle- bonis, recommended by many homoeopathists who have had frequent opportunities of treating nervous fevers, particularly in cases occurring in the wake of other diseases; but is more especially appropriate where the symptoms developed clearly proceed from irritation of the spinal nerves, with wandering, fugitive, spasmodic pains extending from the dorsum and sacrum into different parts of the body ; the spasms which affect the face, become subsequently
* Baert-L Archives, XX Bd., 2tes Heft.
NERVOUS FEVER. 25
chronic ; whilst those that have their seat in the hands and feet partake of a tonic character. This remedy is further indicated by dry heat of skin, insatiable thirst, accelerated pulse, great restlessness and sleeplessness ; excessive languor ; aversion to food. Should the spasmodic affections readily yield to the employment of secale, but the febrile symptoms continue, some other remedy appropriate thereto must be prescribed.
Phosphorus is of great service where we find great dryness of the tongue, heat of skin, small, hard, quick pulse, painless diarrhoea, with excessive borborygmus; or when the disease becomes, as it were, concentrated in the lungs, and there is consequently congestion, with extremely laborious breathing and excessive anxiety, dullness on per- cussion, mucous rale, stitches during respiration ; cough, with copious expectoration of mucus mixed with blood, or even offensive pus ; more benefit may be looked for from this than from any other remedy. Pkos- jphorus is also serviceable when, notwithstanding the pneumonic con- centration, there is, moreover, sensibility and rumbling in the cse.caj region, or when there is continued heat of skin, with small hard accelerated pulse, throbbing of the carotids, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sudden cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive heat, and aching of the whole body. In addition to these symptoms, there is burning sensation in the abdomen and anus, with frequent semifluid stools streaked with blood ; giddiness, confusion, and throbbing pains in the head ; deafness, frequent discharge of blood on blowing the nose, and heat in the face ; tongue and lips dry and cracked ; bitter taste ; copious evacuation of urine, which deposits a whitish or reddish sediment ; venereal orgasm ; delirium ; obstupefaction.
Acidum muriaticum. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness of the mouth.
Natrum muriaticum is recommended in nervous fevers with great debility, insatiable thirst, dryness of the tongue, and loss of consciousness, and particularly when they follow in the course of antecedent debilitated diseases.
Helleborus has also been found of very great utility in febris nervosa, occurring after other febrile affections, such as scarlatina, rubeola, febris gastrica, febris verminosa, and cholera, with pain as
26 FEVERS.
from contusion, combined with tumefaction, in the integuments of the head ; disposition to somnolency, with confusion of ideas and extreme restlessness ; dark, cloudy urine ; heaviness, or feeling of stiffness and powerlessness in the limbs ; depression of spirits, and obtuseness of faculties.
In prescribing the above remedies, it will generally be found neces- sary to order the dose to be repeated every three or four hours, but as soon as an amendment sets in, or even if the symptoms become stationary, the medicine should be discontinued for a time, and only resumed (or changed, if called for by the invasion of new symptoms requiring a different remedy) when the slightest signs of a relapse or an alteration for the worse can be detected.
Against the following sequela .-—Decubitus, compresses with diluted alcohol, or a very weak lotion of Arnica, may be employed at the commencement ; but when there is violent inflammation Bella- donna, sometimes in alternation with Sulphur, should be had recourse to : when sphacelus supervenes, Card, v. internally and externally, or Arsen. or Cinchona ; where the bones are implicated Silicea, and when granulation is retarded— Sulphur and Cinchona will generally prove the most useful medicaments. Metastatic Abscess, Bella., and Hepar sulph. Furunculi : Arnica, Bella., and Sulph., or Lycopod., or Silicea. Frequent tendency to Diarrhcea ; China. Obstinate nights-sweats, sometimes writh dry nocturnal cough, Sulph, CEdema of the feet: Bryonia, Lycopod., Puis., China, Sulph., according to the concomitant symptoms. Intestinal ulcerations : Acid, nitr., Arsenic, Phosph., Card, v., Sulph., Calc, Puis., Bella.
After severe cases of Typhus, a period of debility generally super- venes, of greater or less duration, according to the violence of the attack. In such instances the invigorating effects of pure air is for the most part preferable to all other roborants ; the patient ought, therefore, under favorable circumstances, to get out of doors as soon as possible. In some cases, however, a dose or two of Cinchona may prove serviceable, particularly if the patient has suffered much from diarrhoea during the course of the disease. In others, Valeriana, Cocculus, N^ux v., or Veratrum, may be better indicated. Ferrum c. in repeated doses, is often more efficacious than China, where the pulse continues very weak and frequent after the cessation of profuse hemorrhage, particularly in the case of chlorotic females, or those wTho have previously suffered from chlorosis. Again, when the fever has completely subsided, as also the diarrhoea, and there remains only
PUTRID FEVER. 27
great debility with slow, small, feeble pulse, with profuse sweating towards evening, Ruta and Sulph., in alternation, are of great utility. When debilitating sweats supervene, Cinchona should be administered, followed by Sulphur if required. Magnes. m~ is useful when, in nervous subjects, general aching pains remain behind, with great weariness and weakness of the limbs, and lowness of spirits ; disturbed nights ; giddiness ; feeling of weight and confusion in the head.
Should symptoms of deranged digestion, with headache, palpitation of the heart, Sec, remain after the fever has been subdued, Nux vomica, Pulsatilla, and Spigelia will be found most serviceable, accord- ing to the temperament of the individual, and the symptoms present. (See article Indigestion.) The other medicaments mentioned under the head referred to, may also be advantageously consulted.
Diet. In a disease that presents so many varieties, it is difficult to give any rules upon this head, applicable to all cases. When a marked inflammatory character is present, the same abstinence should be enjoined as already noted under Fevers ; and in all cases, either during the progress of the disease or the period of convalescence, the greatest possible care should be taken to avoid tasking the digestive functions ; the diet should be light and simple, and the patient never allowed to indulge the appetite to its full extent.
PUTRID FEVER, PESTILENTIAL FEVER, OR MALIGNANT TYPHUS.
Typhis putridus. Typhus abdominalis.
We have already alluded to this form of the disease under Typhus, particularly in the indications given for the employment of Arsenicum, Carlo vegetabilis, Rhus, Merc, &c, but consider it of sufficient impor- tance for separate remark. This fever sometimes rages as an epidemy, but it more frequently appears in the wake of nervous fever, or the latter degenerates into the malignant type in consequence of improper general treatment, uncleanliness, or the impurity of the air by which the unfortunate patient is surrounded. Indeed, almost any fever may terminate in malignant typhus under the favouring circumstances just quoted.
Diagnosis. The symptoms of Nervous Fever already given, running on to the colliquative state ; extreme debility, pulse exceed- ingly small and weak, so as to be scarcely perceptible ; a peculiar sensation of burning pungent heat, communicating itself to the hand^ when placed upon the body of the patient, heavy cadaverous smell of
28 FEVERS.
the whole body, putrid odour of the breath, perspiration, and secre- tions in general ; profuse oily and clammy sweats : involuntary evacua- tions ; colliquative or sanguineous diarrhoea ; dark or bloody urine, epistaxis, petechias, and other marked tendencies to organic dissolu- tion. The patient is always found lying on his back, and continually shrinks down to the foot of the bed, a siga of utter helplessness and prostration.
Treatment. In the premonitory stage of epidemic Typhus putridus, the most appropriate remedies are those which we have enumerated under Typhus gastricus et liliosus, and at the commence- ment of Nervous fever, (which see ;) but when the disease has reached the second stage, Arsenicum, Card, v., Merc,, Acid, phosph., Acid, mur., Cantharis, Rhus, &c. Arsenicum corresponds closely to the symp- toms, and is, therefore, our principal remedy when the disease assumes this malignant form, particularly when we find involuntary and sanguineous evacuations and tenesmus. Carlo vegetabilis may be advantageously alternated with it, when the symptoms^ already given under Typhus for the exhibition of that medicine, are present ; Mer- curius is called for where there is great tenesmus, and when the dis- charge of blood is principally alvine, followed by Acid, phosph., Acid. nitr., or Cantharis, should sanguineous diarrhoea continue. (See
NERVOUS FEVER.)
Cinchona will frequently be found useful, when the more dan- gerous symptoms have been in a great measure subjugated, but at the same time great weakness remains from the loss of humours; it is also useful, when the little nutriment the patient may have partaken of passes off undigested.
In those cases where Arsenicum and Carlo vegetalilis fail to produce any amendment, the employment of the Mother Tincture of Rhus [Bosis. Gtt. j, ter quateme, vel smpius quotidie,) has, in a number of instances, been found most efficacious.*
* Many of the remedies, along with the indications for their employment, which have been given in the preceding chapter, but more particularly the following: Ipecac. , Bella., Hyoscy., Op., Nuoc, Camph., etc., will also be found equally appropriate in particular cases, or in cer- tain stages of so-called putrid fever — the attention of the practitioner is therefore particu- larly called to them in such circumstances.
TYPHUS FEVER. 29
CONTAGIOUS TYPHUS, CAMI^ FEVER, JAIL FEVER, PETECHIAL FEVER.
Typhus Contagiosus.
Diagnosis. The symptoms of nervous or putrid fever caused by infection or contagion.
Treatment. The same as already given under Febris nervosa, but especially Bryon., Rhus, Ars., Secale, &c. We may here add another remedy of much value in this form of the disease, namely, Opium, in- dicated by coma, — coma somnolentum, especially, — stertorous breath- ing, mouth partly open, eyes open or partially closed, loss of speech, rigidity of the limbs, smallness or intermission of the pulse, meteo- rismus, involuntary evacuations, or constipation.
When, in addition to the above-mentioned paralytic affection, we find jerkings in individual limbs, we should have recourse Lo Hyoscyamus or Stramonium, choosing the remedy which more closely approximates to the symptoms we have given for their individual use, under Febris nervosa.
ACCESSORY TREATMENT. PROPHYLAXES, ETC.
We need hardly insist upon, what every practitioner knows to be an essential auxiliary in the treatment of this affection, a constant supply of fresh and continually renewed air.
Prophylaxes, during the prevalence of Typhus. Cool pure air, thorough ventilation, the avoidance of dark or dismal-looking apart- ments, into which the genial day-light does not freely penetrate ; and the removal of all causes generating the disease, such as stopped sewers, or collections of decaying vegetable and animal matter ; a plain wholesome diet, with moderation in the use of fermented liquors or wine, and total abstinence from spirits ; the refraining from late hours, intense study, and excessive mental or corporal exertion ; exercise in open situations, with proper precautions against exposure to cold or damp ; and finally, the preserving a healthy tone of mind and cheerful temper.
The absurd practice of keeping the bowels constantly open by means of aperient medicines, and the use of sudorifics, cannot be too strongly reprobated; both these practices weaken the system and predispose it to the disease.
Standing between a fire or open window and the bed of the patient is to be avoided, as unnecessarily increasing the risk of taking the infection.
30 FEVERS.
The safest plan for the physician to pursue, in epidemic or endemic typhus,* is to form an aggregate of the symptoms by carefully collat- ing those of individual sufferers, so as to present a perfect image of the existent malady, and to choose his remedies accordingly, which should be administered directly on the premonitory symptoms declar- ing themselves, without waiting for the further development of the disease.
It may be remarked that Bryonia and Rhus cover a great number of the symptoms of typhus, as met with in this country ; when, there- fore, the point just mentioned has been ascertained, they may be given alternately, and will often either check the malady at its outset, or materially modify its virulence — in some cases, one of these remedies is of itself sufficient^ according to the leading symptoms of the reign- ing epidemic; in a great variety of instances, Arsenicum may prove a valuable prophylaxis; but at the same time, the indications, we have already given of the several medicaments, should be carefully con- sulted, as the same rule holds good for them all.
Febris lenta nervosa.
Lingering nervous fever is characterized by a predominance of fever chills and coldness over heat, little or no sweats, or only fugitive sweats ; pulse variable, but generally small and quiet. The fever commonly becomes increased in the morning, or while the patient is fasting, and is attended with great depression of spirits. After a meal it generally subsides, and leaves the patient in a more cheerful mood. Head- ache, spasmodic sufferings, and general uneasiness are frequent attendants on this form of fever. The causes of the disease are gene- rally attributable to those influences which exercise a debilitating effect upon the nervous system, as over-indulgence in venery, or self- abuse ; the excessive loss of blood, either by artificial or natural means ; protracted blenorrhcea; the weakening effects of nervous and other fevers ; severe and prolonged mental and corporal exertion ; care ; grief, &c. The fever developes itself slowly and gradually, and con- tinues for months without giving rise to any inflammatory appearances. The treatment must be regulated by the cause, and the nature of the symptoms. When the former is unknown, we must direct our atten- tion carefully and minutely to the symptoms, and select a remedy in accordance therewith
* Or any other epiclemy, &c.
INTERMITTENT FEVER. 31
When vexation, care, or debility from venereal excess, has given rise to the disease, Acid. _phospk. will rarely fail to effect a greater or less degree of improvement. The alternate employment of Arsenicum and Acid, phosph. has proved useful in some cases. When deep and concealed grief has been the exciting cause, Ignatia will, if adminis- tered early, generally succeed in arresting the disease, and will be found more or less useful in cases of long standing proceeding from the aforesaid cause. Cinchona will prove very useful, when constitu- tional debility, arising from the excessive loss of blood, or from pro- longed self-abuse (onanism), has developed the fever. {Acid. phosph. Nux, Sulph., Calc may be required after China.) In cases resulting from debilitating acute diseases, Veratrum, China, Hepar, Silic, or Acid, phosph., Calc, Lachesis, and Natrum m., will usually answrer best. In other casesj Ipecac, Camph., Relied-, CoccuL, Merc, Plumb., Lycop., Can., Cupr., Stann*, may be called for.
INTERMITTENT FEVERS— AGUE,
Fehres Intermittentes*
We have now to enter upon a class of fevers, differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, and the uncertainty of their duration.
Diagnosis. A chill or cold fit, followed by heat, and terminating by perspiration, more or less profuse ; these three stages constitute a paroxysm; after which, for a certain period, (the Apyrexia,) the patient is generally free from suffering.
These periods are generally of definite duration ; — if the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian, — of forty-eight, a Tertian, — of seventy-two, a Quartan ; even longer intervals have been observed between the attacks, hence the Octanae of some writers, — if twro paroxysms take place within each pe- riod, the ague is said to be doubled, as a double Quotidian, or Tertian.
These fevers are sometimes found existing in the simple form above noted, and at others complicated with other forms of disease, as in intermittent catarrhal or gastric fevers.
They are exceedingly indefinite in duration, and frequently assume a chronic form. An individual, once attacked with ague, is fre- quently liable to a return in after-life, if the disease has not been
32 FEVERS.
radically cured at the commencement; nay more, any attacks of disease he may be hereafter subjected to, are peculiarly apt to assume the intermittent form.
Nervous or inflammatory fever may change into an intermittent, or the latter take upon itself, if it continue, the character of either of the two former, or become remittent ; this frequently happens in hot climates.
Ague is rarely dangerous in this country, except when of long continuance, by the weakness it occasions and the injury it inflicts upon the constitution; it may, however, lead to obstructions and indurations of the more important viscera, particularly of the liver and spleen, or induce dropsical affections.
But in hot climates, or in low marshy countries, this disease is exceedingly fatal ; and on dissection, the brain and its tissues, the mucous coat of the stomach and bowels, the lungs, and peritoneum have been found affected ; in such instances, when the disease gains ground, the patient loses strength and becomes emaciated, every fresh paroxysm entails an increase of suffering, and the perspiration fails to relieve ; he complains of a sense of weight in the hypochon- dria, particularly the right, with griping pain in the bowels, flatulent distension of the abdomen, diarrhoea, or constipation, and constant thirst ; or of headache, cough, and dyspnoea ; the tongue is furred, and dry at the tip ; the skin hot, harsh, and dry ; the urine scanty, the abdomen tumid, the extremities become dropsical, and sleep is restless or broken.
Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important function, such as the brain, lungs, spleen, or liver.
We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifications of the symptoms will be found, more in detail, under the medicaments, when we enter into the therapeutic treatment.
Premonitory symptoms. Sense of languor, or general uneasiness ; yawning, headache, stupor, pains in the limbs or dorsal region, the toes and fingers becoming numb, and the nails blue.
Cold Stage {Congestive Stage). Coldness of the extremities, with a feeling as of a stream of cold water running down the back, and extending itself to the chest and abdomen ; general prostration of strength, insupportable coldness, external and internal tremors,
INTERMITTENT FEVER. 33
chattering of the teeth, respiration laboured and hurried, with inability to draw a full inspiration, and oppression at the chest. The head is variously affected, sometimes with headache, at others with coma, stupor, or delirium ; the pains noticed in the premonitory symptoms are generally present, and, in some instances, the patient complains of pain all over : the tongue is moist, the eyes are heavy and sunken, the features pinched, and the lips and cheeks livid : the rigors sometimes run on to convulsions.
The pulse is weak and oppressed, sometimes slow, at others quick, and frequently intermitting, and often, from the severity of the rigors, scarcely perceptible.
The heat of the body, except at the extremities, is generally above the natural standard, while the patient complains of cold.
Sometimes the patient feels only a slight degree of cold, without tremors, but accompanied with symptoms of functional derange- ment, and in a few hours the hot fit declares itself. The duration of the cold stage is from an hour to four hours ; and it runs into the hot without any marked interval.
The Hot Stage presents all the characteristics of a modified inflam- matory attack, with hot, dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, region of the spleen, liver, &c; there is also occasionally a degree of cere- bral disturbance, or even delirium.
The general duration of the hot fit is from four to twelve hours, when it terminates in the sweating stage ; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent, —a not uncommon issue of this disease in warm climates.
Sweating Stage. After the hot fit has continued a longer or shorter period, profuse perspiration sets in, commencing in the forehead and extremities, and quickly diffusing itself over the whole body; as soon as it makes its appearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm.
Causes. Marshy districts are noted as being the hotbeds of this malady ; a continuance of fish or farinaceous diet is also apt to produce it ; it may, moreover, arise from taking cold, indigestion, internal obstructions, peculiar constitutional tendency, or local irritation.
3
34 FEVERS.
The medicines should generally be administered in the apyrexia or interval between the paroxysms, but when the intervals are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside.
In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. The following remedies have been found most appropriate in ordinary cases.
Against marsh fevers the principal remedies are, Cinchona, Arsenicum, and Ipecacuanha; but the following are also useful in particular cases : Carb. v., Rhus, Veratrum, Natr. m., Fer., Arnica, and in some severe and very obstinate cases, Cimex lectul.
Against intermittents which prevail in spring or summer, and in warm climates : Bella., Ipecac, Veratr., Caps., Am., Lach., Cole, Cine:, Sulph. ; Bryon., Carb. v. et a., Puis., Digit., &c.
Those in which cold predominates require chiefly the following remedies : Veratr., Ipecac, Puis., Diad., Sabad., JPhosph., Carlo v., Bry., Capsicum, Staph. ; those with prevailing heat : Nux, Cocc, Ign., ■Sulph., Ars., Aeon., Bella., Bry on., Ipecac, Sabad., Valer., Veratr., Silic ; and those in which sweating predominates : Cocc, Caps., China, Merc, Ars., Bry on., Nux, Samb.
Intermittents which consist in shiverings, heat, and sweat- ing, (or a cold, a hot, and a sweating stage), are most frequently to be cured by Ipecac, Nux v., Ars., China, Veratr., Bella., Bry on., Caps., Cham., Puis., Rhus, &c.
In those which consist in shiverings and heat, the principal medicines are, firstly, when the heat precedes : Nux, Caps., Calc ; secondly, when the shivering precedes : Aeon., Am., Bry on., Caps., Carb. v., Ign., Ipecac, Cine, Natrum m*, Nux v., Puis., Rhus, Sabad., Sulph., Veratr. ; thirdly, when the shivering and heat precede or follow in alternation : Bella., Calc, Lycopod., Merc, Natrum m., Nux v., Sabad., Sil., Spig*, Sulph., Veratr. ; and fourthly, when they occur simulta- neously : Aeon., Arsenic, Bella., Cham., Ignatia, Ipecac, Lye, Nux, Rheum, Rhus, Sabad., Sulph.
In those which consist of heat and sweating, the most im- portant medicaments are, when the heat is accompanied by sweating : Bella., Bryon., Caps., Cham*, Cin., Hep., Ign., Merc, Nux v., Op., Puis*, Rhus, Sabad. ; and when 'the sweating sets in after the heat : Ars., %, Cin., Hep., Ign., Ipec, Puis., Rhus, Veratr.
INTERMITTENT FEVER. 3 5
Fevers which consist only in rigors and sweating call for Lyco- podium, Pulsatilla, and Sulphur principally, if the shivering and sweat- ing are simultaneous ; and Caps., Carb. v., Lycop., Natr. m., Rhus, Sabad., Thuj., Veratr., if the sweating follows the shivering.
When there is thirst before the attack : China, Am., Puis.; — during the cold stage: Ipecac, Bella., China, Carbo, Phosph., Sabadilla, Pry on., Cham., Cina, Ign., Caps., Rhus, Ars., Veratr. ; — after the cold stage : Sabad., Puis., Ars., China; — after the hot stage, China; — during the hot stage, Cham., Puis., Rhus, Veratr., Nuxv.; and when there is adypsia during the hot stage : Puis., Ars., Veratr., China, Nux v'., Ipecac, Carb. v., Ignatia, Rhus, Sabad., are the principal remedies. In intermittent fevers, attended with somnolency during the paroxysms, Opium, Nux vomica, Tartarus stibiatus, and Cocculus; or, in some in- stances, Bella., Hyosc, and Stramon., are amongst the most important remedies. In those with apoplectic and paralytic symptoms during the paroxysm, Nux v., Cocculus, Opium, Aconitum, and, perhaps, also Arsenic or Coffea, are chiefly indicated.
Those with syncope during the paroxysms, Veratrum album, and possibly also, Ipecac, Puis., Sulph., Sep., Lye, Graph., Sec.
With respect to the type of the fever : Pulsatilla, Ipecacuanha, Nux vomica, Caps., Diadem., Calc, Sabad*, may be instanced as being parti- cularly useful in simple quotidian fevers. Ant., Calc, Caps,, Cham., Bros., Lye, Mez., Staph., in tertian ; and Arsen., Aeon., Lye, Nux m., Sabad., in those of a quartan type.
Against double quotidians : China, Bella., Graph., Stram., Puis. And against double tertians : Nux v., Arsenic, Rhus, have, princi- pally, been recommended.
Intermittent fevers which recur every year have, for the most part, been treated most successfully by means of Nux v., Arsenic, Rhus, Sulph., Lye, Calc, Sep., &c.
In reference to the period of the day at which the ague-fit generally comes on, Am., Cham., Sabad., Staph., Calc, have repeatedly cured those which appear in the morning {^matutinal fevers). Ign., Sabad., Staph., Carb. v., Am., Lye, Sep., Mere, against those which set in towards evening ; and Carb. v., Cham., Mere, those which make their appearance at night [nocturnal fevers).
But as has already been observed, the entire morbid picture must be taken into consideration in the selection of the remedies, and not merely a single peculiarity. Remedies which have proved useful in quartans or tertians, will, nevertheless, be found efficacious in other
36 FEVERS.
types, if they correspond accurately to the characteristic accompany- ing symptoms.
The following medicaments are especially useful in intermittents presenting the train of symptoms enumerated :
Cinchona, Arsenicum, Ipecacuanha, Nux vomica, Pulsatilla, Antimonium crudum, Bryonia, Veratrum album, Cocculus, Sabadilla, Ignatia, and Carlo vegetalilis, Ant. crud., Bella., Caps., Canth., Ign., Bach., Puis., Sep., Digit., Natr. m., Bye, &c.
Cinchona. This well-known, but too frequently abused remedy is undoubtedly of great efficacy in those fevers which owTe their origin to the influence of marsh miasm, and are peculiarly preva- lent, at particular seasons of the year. It may be given when the fever commences with a sense of languor or general uneasiness of the heart, anxiety, headache, sneezing, great thirst, bulimy, or nausea, and pain in the bowels. It is also indicated when the fever has set in by adypsia during the cold stage— but thirst is experienced after the heat and dtiring the sweating, or thirst between the hot and the cold stage. It is contra-indicated when thirst exists during the hot stage. Turgidity of the veins, with heat in the head, with natural wrarmth or increased heat of the body, wTith or without increased heat of the sur- face. Or, again, determination of blood to the head, commonly with redness and heat in the face, frequently with chilliness of all the other parts of the body, and even external coldness, or only a feeling of in- ternal heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indications for the employ- ment of this medicament. In many cases, Cinchona, although not capable of effecting a radical cure, is yet of great utility as a pallia- tive : it should, under such circumstances, be exhibited immediately before the cold stage. {Arsenicum Carlo v., Veratr., Arnica, Sulph., Pulsatilla, or Calcarea, are often required to complete the cure after the previous employment of Cinchona.)
Arsenicum is one of the most important remedies in intermittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously, —or when we find cold shuddering alternately with heat, or a sensation of cold internally with heat, or an imperfect development of the paroxysms; or burning heat, as if molten lead were coursing through the veins, communicating an unpleasant sensation of heat (color mordax) to the hand, when placed upon the body of the patient : great restlessness ; excessive, almost insatialle thirst, obliging the sufferer to drink con-
INTERMITTENT FEVEIt. 37
stantly, although but little at a time; depression, marked prostration of strength and anxiety ; nausea, desire to vomit, retching, and even vomit- ing ; severe and burning pains in the stomach, and insupportable pains all over the body, especially in the limbs.
One marked characteristic of Arsenicum is, that all the sufferings of the patient, pains in the limbs, &c, increase in intensity during the paroxysms, and others develop themselves; another is, its marked periodicity, usually either Tertian or Quartan, and the rigors generally setting in towards evening.
It is therefore called for in these cases, where wre meet with a well- marked periodicity of imperfectly developed paroxysms, with some or any of the symptoms above mentioned.
A few globules of this medicament, given during the apyrexia, will be generally found a sufficient dose; however, in some cases, when the vital energies of the patient seem too weak to rally, and the cold fit continues, two drops of the tincture may be added to an ounce of water, and a dessert- spoonful given every four or two hours, or every quarter of an hour, according to the exigency of the case. Such cases are happily rare in this country, but we have thought it advisable to touch upon the means to be employed when they do occur ; in such instances Veratrum (which see) is also occasionally useful.
Ipecacuanha. This remedy has been found more or less useful in most cases of marsh fever, and although not always competent to effect the entire removal of the complaint, yet, when administered at the commencement, it is often of considerable benefit, and in many instances, when judiciously selected, is alone sufficient to perform a cure. Striking benefit has frequently been derived from its employ- ment with Nux v., by giving three to four doses -of Ipecac, at equal intervals during the apyrexia ; then Nux v., one dose, in the succeed- ing apyrexia.
Either of these remedies is sometimes alone sufficient to shorten the duration of the disease; the indications for Ipecacuanha are as fol- lows : much shivering, with but little heat or vice versa ; increase of the shivering by external warmth ; oppression at the precordial region ; adyp- sia, or at least, little thirst ; dryness of the mouth, nausea, vomiting, and other symptoms of deranged digestion.
For Nux vomica : Excessive weakness at the commencement of the fever ; the horripilation mixed with or immediately followed by heat ; warmth of the cheeks, with internal chilliness ; feeling of heat in the face* with horripilation in the remaining parts of the body ; heat in the head with coldness of the body ; burning pain in the eyes; or,
38 FEVERS.
giddiness, with feeling in the head as if from intoxication, desire to lie< down, with trembling of the limbs, syncope, or a sensation of para- lytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet, difficulty of breathing, palpitation of the heart, anxiety, irascibility, fear of death, and even violent delirium. (Febris intermittens apqplectica so called) ; gastric derangements, such as anorexia; dislike to bread; bitter and sour eructations, tension of the abdomen, or spasm of the abdominal muscles, and constipation; burning itching miliary eruption, and burning itching sensations over the whole body. During the fever : coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration ; occasionally stitches in the side, shooting pains in the abdomen, aching in back and limbs, and dragging pain in abdomen during the rigors. During the hot fit particularly : — headache, buzzing in the ears, heat in the head, or face, with redness of the cheeks, and thirst. Bryonia, Verat., Puis., Cocc, Bella., also deserve attention in intermittent fevers accompanied by constipation.
Pulsatilla, like the two remedies last mentioned, and also Antimonium crudum, Bryonia, and Ignatia, is an excellent remedy in Agues complicated with gastric or bilious symptoms, whenever the slightest dyspeptic attack brings on a relapse. Its more peculiar indications are : vomiting of mucus at the commencement of the cold stage ; adypsia, all through the fever, — or thirst, only during the hot fit ; simultaneous heat and shivering — aggravated in the afternoon or towards evening ; shivering when uncovered ; anxiety and oppression of the chest during the shivering. During the hot stage: redness and swelling of the face, or redness of the cheeks only, and perspiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indications for its employment.
Antimonium crudum. The indications for this remedy closely resemble those of Pulsatilla, but it is particularly called for when the perspiration breaks out simultaneously with the accesses of heat, and then suddenly disappears, leaving the skin dry and hot. It may be exhibited in the same manner as Pulsatilla.
Cina is of great efficacy in quotidian agues, which are ushered in by vomiting of ingesta, followed by bulimy ; as also when the cold stage is attended with thirst.
Bryonia is indicated by headache and vertigo, with dry heat preceding the attacks of shivering ; by the predominance of cold or shivering, with redness of the cheeks, heat in the head, and headache ; or marked heat followed by shivering; by stitches in the side,
INTERMITTENT EEVER. 39
excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting, and constipation.
Veratrum album is indicated by the predominance of external coldness, with heat internally ', cold clammy perspiration, especially on the forehead, or general coldness of the body ; or by shivering, followed by heat and perspiration, and then relapsing into shivering ; coldness, great thirst, deep-coloured urine, diarrhoea with griping, or constipa- tion, sometimes nausea or vomiting and vertigo, and pains in the dorsal and lumbar regions. Tart. emet.> has also been recommended in such cases, and especially when the nervous system becomes pro- minently affected, as indicated by sopor, insensibility, with coldness of the extremities, rigidity of the whole body, or twitchings of the muscles of the face and limbs, and almost imperceptible pulse.
Belladonna. Severe headache, with giddiness, or heat and redness of the face, pulsation of the carotids, and excessive exacerba- tion of pain from meditation; partial shivering and shuddering, with heat in other parts; great heat, with slight shivering; or violent shivering with moderate heat ; adypsia, or, on the contrary, intense thirst; extreme susceptibility, tearfulness, or depression of spirits, and desire for death, particularly. when the sufferings are at their height.
Cocculus maybe employed when, in addition to the usual symp- toms of Ague, we find, during the apyrexia, symptoms of spasmodic affections, particularly of the stomach and abdomen, such as cramp- like pains at the epigastrium, or constrictive pinching, or tearing, burning, colic-like pains in the hypogastrium.
Sabadilla has been found useful in cases where the attacks return always at the same hour, with chills of short duration, then thirst followed by heat; also, where thirst is present just at the close of the cold stage, and in such affections as consist entirely of chills.
Ignatia is indicated when, with heat of some parts of the body, there is coldness, chill, and shuddering of others ; also where the heat is only external. Its best characteristic is, when the chills are easily relieved by external warmth, and attended with thirst.
Opium has chiefly been recommended mfebris intermittens sqporosa,. with stertor, convulsive movements in' the limbs and suppressed evacuations. Tartarus stibiatus may, however, be found more generally appropriate in cases of this description. Nux. v., Cocc, Bella., Hyosc, JStramon., and Cham., are likewise worthy of attention here.
40 FEVERS.
Natrum m. Ague fits commencing with headache, general aching pains ; predominant or prolonged shivering ; great thirst during the hot fit, and nearly to the same extent during the cold stage ; also dryness of the mouth and tongue; tenderness of the scrobiculus to the touch ; bitter taste and loss of appetite ; debility, sallow com- plexion ; soreness of the corners of the mouth ; (sequelae of the abuse of Cinchona hark, or of Quinine).
Carbo vegetabilis, is particularly indicated, when throbbing at the temples, aching in the- teeth and in the bones of the extre- mities, and the coldness of the feet precede the paroxysm ; when thirst is present only during the shivering ; and there are rheumatic pains in the teeth or limbs before or during the attack, or nausea, giddiness, and redness of the face during the hot fit ; further, when an intense burning pain, occupying the right frontal protuberance and the orbit, accompanies the fever.
Capsicum. Excessive thirst during the cold stage; predominating cold, followed by burning heat ; accumulation of mucus in the mouth and throat, or vomiting of mucus ; diarrhoea ; slimy and burning stools ; headache, restlessness, sensibility to noise ; ill-humour, anxiety, and giddiness, which increase during the cold stage ; aching pains in the back and limbs; painful swellings of the spleen (after the abuse of China).
When the hot-fit continues long without perspiration supervening, and the intermittent fever threatens to become remittent or inflam- matory, we must have immediate recourse to Aconite, of which wre may give two globules, and if no relief follows in three or four hours, add six globules to an ounce, of water, and administer a dessert- spoonful every hour until perspiration sets in, or the pulse is reduced.
In intermittent fevers of various types, which become developed after a thorough wetting, Rhus toxicodendron is of great use ; and in those which are accompanied by very copious and sour, or otherwise offensive-smelling sweat, with palpitation of the heart; mixed heat and shivering, anguish and thirst during the hot stage, Mercurius does good. Agues which have become altered in character, and rendered much complicated \>j the abuse of Cinchona in large and long- continued doses, are in general very difficult to cure. The following remedies have been employed with more or less success in such cases : Belladonna, Ipecac, Verair., Arsenic, Arnica, Bryonia, Caps., Pulsatilla, Natr. m., Sulph., Sep., Calc, Carb. v., Merc.
RAPHANIA. 43
Cina, Nux> Loch., Hell., Fer. Against oedema of the feet and hydrops abdominis, arising from a similar cause, Bry., Helleb., Arsen., Acid' hydr., may be found of great service.
Inveterate intermit tents, occurring in bad habits of body, are most likely to be relieved by such medicaments as the following : SulpJi^ Calc.y Lycopod., Sepia, Calc. sulph., Carlo v., Hepar s., Cimex lent., JVatr. m.y Mez., etc.
The preceding are the medicines that have been found useful in ordinary cases of this affection ; but, as it is frequently found com- plicated with other complaints, it has only been found practicable to give a general statement of the course to be pursued when the disease occurs in its more simple forms, and merely to allude to the others — there being scarcely a disease known, that may not assume the intermittent type, as there is scarcely a proved medicine that does not also partake of the same character. All the author has endeavoured to do, in the preceding pages, is to give a clear idea of the treatment of ague, commonly so called, as frequently met with ; as he feels it would be vain to attempt to enter upon the many various forms and appearances which this malady presents.
RAPHANIA.
Morbus cerealis, Cannulsio cerialis. Eclampsia typhoides.
The term Raphania has been given to this disease from its being saidto be produced by eating a species of radish. A residence in damp, ill- ventilated dwellings, combined with insufficient, indiges- tible, or otherwise unwholesome food, seems, however, to be the general predisposing cause. Most authors have divided it into two forms, the acute and chronic. The acute variety is of the severest and most dangerous character, and though not so frequently ushered in* by premonitory symptoms as the chronic form, is yet occasionally preceded by indications of considerable gastric and nervous disturb- ance, such as, moist, foul tongue, insipid nauseous taste, eructation, inclination to vomit, spasm of the stomach, vomiting of dark or blackish brown-coloured bile; confusion in the head, giddiness, tremor, and slight creeping sensations (formication) of the limbs, etc. The disease itself commences with cold chills and lassitude, head- ache, and praecordial anxiety. These symptoms are succeeded by burning heat, intense, almost insatiable thirst, violent fever, delirium,
43 FEVERS.
feeling of suffocation, frequently attended with spasmodic palpitation of the heart, convulsions of various kinds, which latterly terminate in frightful tonic spasms. The cutaneous transpiration is either suppressed or the skin is covered with a cold clammy sweat, and the countenance wears an expression somewhat similar to that in febris nervosa stupida. After a few days the nervous state assumes a putrid type, the vital powers begin to sink, the spirits become extremely depressed, the face pale, the features distorted, the hearing obtuse, and stupor with fits of fainting supervene.
At length the pujse becomes almost imperceptible, purple exan- themata break out, or rigidity of all the joints, or tabes, succeeds; and finally, dry gangrene sometimes sets in, affecting either the fingers and toes alone, or entire limbs. The chronic variety is chiefly distinguished from the acute, by its marked exacerbations, paroxysms, remissions, and longer duration. It is, moreover, oftener introduced by pre- monitory symptoms, which generally partake of the following character : general languor, a distressing feeling of chilliness in the abdomen, back, and extremities; anxiety, headache, disturbed sleep, frightful dreams, rending, aching pains in the joints, and sensation of crawling in the extremities. Along with these, there are various signs of gastric derangement, such as eructation, pyrosis, nausea, vomiting of viscous mucus, gastrodynia, etc. When the paroxysm itself comes on, the creeping and painful sensations in the extremities increase in severity. Spasmodic contractions in various parts take place at the same time, the fingers being bent backwards, the eyes convulsed, and the pupils contracted ; the patient is seized with tremor, contorts the limbs in different directions, stammers in his speech, and speaks feebly and incomprehensibly.
Constipation is an occasional concomitant symptom, as also colic, hiccough, asthmatic sufferings, and even epistaxis and hemoptysis. In other cases diarrhoea with discharge of worms, and vomiting take place. When the attack is of a protracted nature, the clonic become converted into tonic spasms. The duration of the paroxysm varies from one to several hours. The recurrences take place at least once a day, and commonly end in a fit of copious sweating followed by sleep, and subsequent insensibility of the affected limbs. The patients are not wholly exempt from abnormal conditions during the remissions, experiencing great languor, numbness of the extremities, especially of the fingers and toes. The skin becomes bluish, corru- gated, and deprived of its sensibility; or colliquative sweats, petechia,
RAPHANIA. 43
and the other morbid states enumerated under the acute variety, succeed and put a period to the mournful scene.
Therapeutics. Hahnemann was the first to recommend the em- ployment of Solanum nigrum in this serious malady, and the opinion which he formed of its specific property, both in the acute and chronic forms of the malady, was amply confirmed by the successful result of subsequent trials. Secale-cornutum has also been favorably spoken of by some writers. The following remedies have, moreover, been mentioned as likely to prove useful in particular cases : Belladonna, Rhus, Hyoscya- mus, Stramonium, Aconitum, Arsenicum, Ignatia, Cina, Cuprum aceticum, Cinchona.
Belladonna, when there is burning, heat of the skin, excessive thirst, trembling of the limbs, slight convulsions, contracted, im- movable pupils, muscse volitantes. Rhus, when the nervous appear- ances form a prominent feature of the disease, and the symptoms approximate to those of a febris nervosa stupida. Hyoscyamtis and Stramonium correspond better than the foregoing to the convulsions, the former particularly to those which come on in the earlier stage of the disorder, and the latter to those of a more violent character, such as occur at a later period, and in the severer forms of the affection.
Arsenicum may be of service in chronic cases attended with anxious and oppressive respiration, spasmodic palpitation of the heart, quick, nervous, small, and occasionally intermittent pulse, foul, brown- coated tongue, extreme prostration of strength. Ignatia amara is well adapted to, and has proved useful in some of the milder chronic forms of the complaint,* more especially when the convulsive movements resembled those which are met with in St. Vitus's dance. Cina,—> spasmodic sufferings chiefly confined to the abdomen, vomiting, with discharge of worms. Cuprum aceticum afforded signal service in a species of Raphania chronica, in which the convulsions increased in intensity at every succeeding paroxysm.t
* Hartman's Therapie, vol. ii, 2d edit. p. 67. f Ibid.
44 FEVERS.
THE PLAGUE.
Pestis. Pestis bubonico. Typhus pestilentialis.
The term Plague is employed to designate a malignant disease which frequently prevails on the coast of the Levant, and which appeared in this country about 200 years ago. It is characterized by highly contagious typhus fever, buboes and carbuncles which have a strong tendency to take on a gangreneous character, petechiae, hemor- rhage, colliquative diarrhoea, and prostration of strength. Most authors who have written on the subject consider the plague to be a pestilential contagion, which is propagated almost solely by contact either with a diseased person, or with porous substances, such as wool and woollen cloths, which have absorbed and retained the spe- cific poison ; but it would seem that it occasionally prevails also as an epidemic disease. No certain statements have yet been made as to howT long an individual who has been affected with the disease is capable of communicating it to others, nor how long the contagion may adhere to a non-susceptible person without developing the disease in the said party, and may yet be communicated, and the malady produced in habits more susceptible to its influence. It has, however, been observed, that the disease generally appears so soon as the fourth or fifth day after infection. Sometimes premonitory symptoms, in the form of slight headache, and some degree of languor, are ex- perienced by the patient, for many days previous to the outbreak of the disease; but it more frequently happens that great depression of strength, anxiety, palpitation of the heart, fainting, giddiness, violent headache, delirium, and stupor, together with a weak and irregular pulse, very soon supervene. Nausea, and vomiting of a dark bilious substance are shortly superadded ; and, as the disease proceeds on its course, buboes form in the axillary, parotid, cervical, maxillary, and inguinal glands; carbuncles also arise, or petechiae make their appear- ance ; or hemorrhages and a colliquative diarrhoea ensue.
The disease is always regarded as serious and pregnant with danger when it presents itself in a severe form.
Much appears to depend upon the particular character of the epi- demy. When accompanied by buboes, it is commonly less fatal than when unattended by these inflammations. The invasion of healthy sup- puration in the buboes is always held as critical, and conducive to reco- very. The breaking out of a gentle perspiration has also been known to prove critical. Petechiae, hemorrhages, colliquative diarrhoea, and
THE PLAGUE. 45
a tendency to gangrenous degeneration of the carbuncles or buboes, have hitherto been regarded as positive indications of a fatal termina- tion.
Therapeutics. We are not aware of any detailed homoeopathic writings on the treatment of plague, and presume that no homoeo- pathic practitioner has as yet had an opportunity of treating the disease. We have every reason to believe, however, that this frightful malady will in time be found perfectly tractable under homoeopathic treatment, and thereby bereft of much of the terror which its invasion inspires in those parts wThere it so frequently and so destructively rages. The following remedies may be named as likely to prove more or less useful : Arsenicum, Lachesis, Cinchona ; Carlo v. et a., Veratrum, Rhus toxicodendron, Merc, Acidum nitr., Kreosotum, and Silicea.
The leading indications for these remedies against the typhoid fever, will be found in the chapter on Nervous fever, to which, there- fore, we beg to refer our readers.
Arsenicum, in addition to being appropriate to the fever, is, more- over, either alone or in alternation with Veratrum, well adapted to the excessively irritable state of the stomach, with rejection of everything that is partaken of, or vomiting of blackish bilious matter, the great prostration, and the colliquative diarrhoea which so frequently accom- pany the disease. It is, further, well calculated to be of essential ser- vice in warding off a tendency to gangrenous degeneration when carbuncles arise, and may even prevent a fatal issue when gangrene has already commenced. In the latter case, Lachesis and Cinchona are also capable of being of some service, and may, perhaps, be advantageously given in rapid alternation with Arsenicum.
When buboes form, and threaten to become indurated, although they do not assume a livid appearance, after the employment of Arsenicum, Veratrum, or any of the other remedies which may have been called for by the typhoid fever, such as Rhus, Cinchona, or Lachesis, — Mercurius may be useful, particularly when the parotid glands are affected, and the region of the liver is much distended.
Acidum nitricum, Carlo v., or Silicea may be required after Merc.
When the integuments over the buboes present a purple or livid aspect, or when the buboes suppurate and discharge, but instead of showing a disposition to heal, exhibit a gangrenous tendency, — Silicea may possibly succeed in bringing about a healthy action ; but Lachesis, Arsenicum, and China may claim a preference even here, provided they are better indicated by the entire morbid picture.
46 FEVERS.
When petechias break out, Arsenicum and Rhus will deserve the most attention.
When there is colliquative diarrhoea, Arsen., Veratr., and China.
When debilitating, sanguineous, alvine evacuations take place Acid. nitr. , Rhus, Arsenicum, China, and Kreosotum.
And when excessive epistaxis results, Cinchona and Rhus ; or per- haps Sulph., Calc, or Hepar s.
It is probable that Add. hydrojod., Acid, phosph., Phosph., Bryon., Bella., Hyosc, Lycopod., Spirit, nitr., &c, may also be worthy of notice in the treatment of plague.
REMITTENT FEVER. YELLOW FEVER.
Febris flava. Typhus icterodes.
This fever is a disease of warm climates, and has obtained the name of yellow fever from the hue w7hich the skin of those affected by it very frequently acquires. The more constant symptoms of the dis- ease are : violent vomiting, first of bilious and subsequently of brown- ish black matter, which is also passed by stool ; great anxiety and prostration, intense fever. Remarkable remissions take place in the course of the fever, succeeded in a few hours by exacerbations. The outbreak of the malady is generally preceded by sudden debility and restlessness, which are soon followed by headache, giddiness, faint- ness, and slight chilliness, to which are added praecordial oppression, want of appetite, and deranged digestion. In other cases, the seizure is sudden and unattended with premonitory symptoms, and the course of the disease exceedingly rapid, and a fatal termination not unfre- quent within thirty-six hours from the accession of the attack. The more usual form which the disease takes is, however, as follows: Immediately after the fit of chilliness and horror, violent reaction sets in, announced by a high degree of fever, with great heat of skin, strong throbbing of all the arteries of the body, and determination of blood to the head. The respiration is hurried and often laborious, attended with deep sighing and gasping for air. The face is flushed, the eyes heavy, sensitive to light, and affected with burning pains ; the tongue white, furred, and sometimes red, but soon becomes parched and dark-coloured, and tinged with yellow after the vomitings come on ; the thirst is excessive. A burning pain is sometimes experienced in the scrobiculus; an excessive sensibility to the touch in the right hypochondrium ; and the stomach, irritable from the first,
REMITTENT FEVER. 47
is rendered so much so as the disease advances, that everything which is taken into it is almost immediately rejected, along with a quantity of bilious matter. Severe darting pains traverse the head, the small of the back, and even extend down the thighs. The pulse is subject to variations, being in some cases quick and strong, in others quick, low and irregular ; in plethoric individuals, who have not been long exposed to the relaxing effects of the warm climate, it is accelerated^ full, and bounding, for some hours after the development of the reaction ; the urine is suppressed, or scanty and offensive ; the stools have likewise a most disagreeable fetor ; the patient is excessively rest- less, tormented writh spasms in the abdomen and legs, and tosses about with anguish. These symptoms constitute the first or inflammatory stage of the fever, and may continue from twenty-four to sixty hours and upwards, according to the severity or mildness of the attack. The second stage commences with the abatement of several of the preceding symptoms, and the increase or substitution of others. The skin and eyes present a yellow tinge ; the head is confused, or deli- rium supervenes, and the eyes look glassy. The fits of vomiting are more violent, and the matter ejected becomes thicker and darker ; the patient occasionally drops asleep, but instantly awakes in a fright, and sometimes he springs out of bed in a state of furious delirium, but instantly sinks to the ground in a state of tremor and exhaustion; the pulse flags, but is sometimes soft, at others high ; the tongue is generally parched, harsh, and discoloured, but sometimes moist and covered with a dark fur ; there is frequent hiccough, and the skin is soft and clammy. The duration of this stage is also variable; rarely if ever longer than forty-eight hours, sometimes only twelve. The first and second stages terminate by a remission of the more alarming symptoms, and a hope of recovery is entertained, but it is too often doomed to disappointment by insidious degeneration of the disease into the third stage, in which the pulse sinks, becomes irregular and intermittent, yet sometimes increases in frequency ; the vomiting becomes incessant, and is attended with great straining and noise^ from the violent belching of flatus ; the matter vomited is grumous, resembling coffee-grounds, and is named the black vomit. The breathing becomes more laboured; the tongue black, or shrunk dry and red ; the eyes hollow and sunk, and the features shortened. A gradual aggravation of the symptoms then ensues, attended with startings or twitchings of the tendons, the limbs become deadly cold, and the hiccough distressingly constant. Hemorrhage, or oozing of blood takes
48 FEVERS.
place from different parts of the body ; the urine is deep-coloured, the stools black or sanguineous ; the abdomen often tense and tympanitic ; vibices make their appearance, and death slowly or suddenly termi- nates the scene.
Therapeutics. From the scantiness of the information which is at present to be gleaned from homoeopathic authors respect- ing the treatment of the disease, we are, in the absence of any personal experience, precluded from giving even a brief sketch of the characteristic indications for the employment of the appropriate remedies. Under such circumstances we can but simply offer a list of those medicaments which will, in all probability, be found of the greatest value in remittent fevers. They are chiefly as follows : Aconitum and Sella., (in the inflammatory stage,) Nux v., Bryonia, Pulsatilla, Digitalis, Crotalus, China, Lachesis, Rhus, Arsenicum, Veratmm, Carlo v. (the three last named particularly in the third stage, but also in the second, in malignant cases), and perhaps also Arnica, Amon. m., Sulph., &c. When the disease partakes of the character of a highly congestive or malignant typhus, which it would appear to be prone to do when it occurs in situations where the marsh miasm is unusually concentrated, or where its effects are aggravated by the depressing influences of unhealthy locality, damp, ill-ventilated, crowded dwellings, together with deficient or unwholesome nutriment, the same medicaments that we have given in the chapter on Nervous Fever (which see) may be resorted to. (See also art. Cholera, where, as well as in that on Nervous Fever, a few of the leading indications for Ars., Teratr., Card, v., in some of the forms of this disease will be met with.)
HECTIC FEVER.
Febris hectica.
Hectic fever, properly so called, may be defined to be febrile symptoms occurring in the course of, and depending on the existence of some internal or local chronic disease. It usually commences slowly and insidiously, the only symptoms which present themselves, for some months, being lassitude after a short walk, or any trivial cor- poreal exertion, failure of appetite, and emaciation. Subsequently, the debility becomes excessive ; the blood forsakes the skin, which accord- ingly looks pale, except the cheeks, which display what has been deno- minated the hectic flush ; the appetite, impaired from the first, grows more and more fastidious, and the stomach becomes extremely irri-
HECTIC FEVER. 49
table, frequently rejecting all the aliment introduced, the pulse quick and weak, the artery giving from ninety to a hundred and twenty strokes in a minute, even at the incipient stage of the fever, and sweating takes place spontaneously at night in bed, but is, moreover, at all times readily excited by any exertion. Diarrhoea sets in during the course of the disease in a large number of cases, and the dis- charge from the bowels is always exceedingly offensive. The breath- ing is anxious, the patient commonly very restless, and often com- plains of pains bearing a resemblance to those of rheumatism. The disease is subject to exacerbations, and from the circumstance that each paroxysm begins with chilliness, followed by reaction, which is soon succeeded in turn by copious perspirations, it has been mis- taken for intermittent fever ; but the history of the case, together with the appearance of the patient, the greater irregularity of the different stages, and the almost unremitting quickness of the pulse, sufficiently distinguish the hectic fever.
Therapeutics. As hectic fever rests upon a morbid state of some portion or structure of the body, the treatment must be directed to the cure, or, if incurable^ the removal, where practicable, of the part diseased. It frequently happens, however, that the source of all the mischief is involved in impenetrable obscurity, and we are compelled to attack the disorder solely as it is manifested by its symptoms. Here, as in many other similar instances, it is, that the homoeopathist possesses such unequivocal advantage over the allopathist ; for, by dint of a faithful collation of every symptom, from the most important to the apparently most trivial, he is generally enabled (where the affection is not already beyond the reach of art), by assiduously consulting his Materia Medica, and comparing the pathogenetic symptoms therein detailed with those of the disease, to select a remedy specific to the case.* It is of unquestionable advan- tage to the homoeopathist, however, to pay due regard to the actual cause of the disease where that is discoverable, as by so doing he will materially facilitate his search after the appropriate remedy.
* The present imperfect and incomplete condition, comparatively speaking, of our Materia Medica, renders it sometimes a difficult task to meet with the remedy purely homoeopathic to the case, or the stage of the case, under treatment ; but there is every reason to conclude that the labours of zealous and untiring homoeopathic practitioners will eventually surmount the aforesaid drawback.
4
50 FEVERS.
The following remedies have repeatedly proved efficacious/ and in other instances been strongly recommended in hectic fevers. First, in hectic fevers, with internal or local affections such as chronic inflam- mations,— particularly of the mucous membrane of the stomach and bowels, — extensive suppurations, etc. : Phosphorus, Acid, phosph., Sulphur, Calc, Acid, nitr., Lachesis, Merc, Arsenicum, China, Bella., Puis., Sanguin. canad., Cham., Ipecac, Colocynth, Secale c, Ant., Scilla, Nux v., Hepar s., Silicea, Lycopodium. Second, against those arising from excessive depletion from loss of blood, immoderate indulgence in venery, &c. : China, Acid, phosph., Nux v., Stdphur, Calc, Staph., Lachesis, Cin., Artemisia absinthium, Carl, v., Con., Arnica, Anacard., Natrum m., Cocculus, Merc, Sepia, Nux moschata. Third, those pro- ceeding from the effects of severe acute diseases, such as typhoid fevers, cholera, scarlatina, measles, &c. : Cocculus, Belladonna, Ilyoscyawiis, Helleborus n., and Acid, phosph.,; or, Pulsatilla, Sulphur, Arsenicum, Vera- trum, China, &c. Fourth, those which have been developed by depressing emotions : Acid, phosph., Staphysagria ; or, Ignatia, Lachesis, Merc, and Hyoscyamus, Arsenicum, or Graphites. In so-called nervous hectic fevers {slow nervous fevers) : Arsenicum, China, Merc, Coc- culus, Nux v., Phosph. ac, Staph., and Veratrum have chiefly been recommended. And in hectic fevers proceeding from dyscrasia, such as scrofula, &c, or from disease of the brain, liver, or lungs, or else from the suppression of habitual discharges, normal or morbid, see the treatment pointed out for these affections in their respective chapters. The following characteristic indications for a few of the leading remedies may here be given, but in all where the symptoms are multifarious, or where no real cause for the disease can be traced, reference must be made to the Materia Medica.
Phosphorus, when we encounter colliquative diarrhoea; colliqua- tive, clammy, nocturnal ; chilliness and shivering towards evening, suc- ceeded by dry heat ; emaciation /extreme lassitude ; shortness of and laborious respiration.
Silicea, which is often very efficacious after Phosphorus, and some- times in alternation with Phosphorus, Sulphur, and Calcarea, is especially called for where there is great weakness, particularly of the joints ; paleness of the surface, emaciation ; anorexia; short, anxious respira- tion, febrile heat towards evening, or in the morning.
Sulphur. Dryness and paleness of the skin during the day, when at rest, with night sweats or perspiration towards morning or after any exertion; hectic flushes on the cheeks (especially the left cheek)
HECTIC FEVER. 51
and feverish heat in the evening ; thirst ; dry, or relaxed and slimy mo- tions ; palpitation of the heart ; short, oppressed respiration.
Calcarea. Dryness and flabbiness of the skin ; great emaciation and debility ; constant heat of skin with little thirst ; or frequent flushes of heat, with anxiety and palpitation of the heart ; or continued chilliness, but particularly in the evening, with redness of the cheeks ; apathy ; extreme dejection after speaking ; perspiration after the slightest exertion, or spontaneously during the night ; anorexia, weak and sluggish digestion ; great anxiety and uneasiness respecting the state of the health,
Arsenicum. Excessive emaciation, with great debility ; dry, burn- ing heat of shin ; thirst, with inclination to drink frequently, but in small quantities at a time ; palpitation of the heart; restless, unrefreshing sleep, frequently disturbed by sudden jerks and starts ; constant de- sire for the reclining posture ; anorexia, with impaired digestion ; vomiting of all food ; irritability of temper, and fastidiousness.
Cinchona. Dryness and laxness of the cutaneous surface ; sunken cheeks ; paleness of the face ; dryness and looseness of the skin ; but tendency to perspire after the most trivial exertion, and spontaneous sweating at night ; anorexia, with desire for delicacies only, or excessive hunger and voracity, with weakness of digestion, indicated by uneasi- ness, distension of the abdomen, and other derangements after par- taking of food, diarrhoea, sometimes with ingesta; sleeplessness, or restless unrefreshing sleep,with anxious dreams; great apathy, ill-humour.
Cocculus. Great debility, with tendency to break out into per- spiration after the slightest exertion, attended by dejection and trem- bling; frequent flushes of heat, especially at the cheeks ; dryness of the mouth and tongue ; anorexia ; nausea after eating, and at other times; oppression at the chest, with ebullition of the blood, and anxious respiration ; sleep disturbed by disagreeable dreams and fre- quent sudden starts ; extreme depression of spirits ; mildness of temper. (^Pulsatilla, Sulphur, and Calcarea are sometimes required after, or in alternation with, Cocculus.)
Ipecacuanha is, occasionally, of considerable utility in alterna- tion with Arsenicum, or Nux v., or as an intermediate remedy during the employment of other remedies, when the following symptoms predominate: anorexia, with desire for dainties exclusively; nausea after every meal, and sometimes vomiting of the contents of the sto- mach; dry heat, particularly in the evening, accompanied with thirst; great restlessness, burning in the palms of the hands, and nocturnal
52 FEVERS.
sweats ; apathy ; indifference ; shortness of breath after the slightest exertion.
Nux vomica. Want of appetite, with bitter or sour eructations after a meal, or vomiting of ingesta ; great debility ; perspiration excited by any slight exertion, or coming on spontaneously early in the morning ; paleness or sallowness of the face ; partial heat ; coldness and shiver- ing, with pains in the back and loins ; constipation ; or constipation alternately with diarrhoea ; desire for the recumbent posture ; dread of the open air ; ill-humour.
The diet should be light and of easy digestion ; and regular hours, with gentle exercise, ought to be enjoined.
MUCOUS FEVER.
Fehris pituitosa. Febris mucosa.
This is a form of continued fever which chiefly attacks persons of lymphatic temperament ; is characterized by irritation of the gastro- enteric mucous membrane, with excessive secretion of mucus from this, and sometimes from the other mucous membranes. The premonitory symptoms, which, for the most part, precede the attack for a considerable period, consist in loss of appetite, insipid taste, or even complete loss oi taste, moist, slimy, white furred tongue, nausea, fulness in the epigastric region, irregular stools, paleness of face, languor, &c. These symptoms rarely create any serious feelings, uneasiness, or anxiety, particularly as the patient has occasional intermissions of somewhat improved health. As the disorder pro- gresses, vomiting of a tasteless white mucus supervenes, the stomach becomes deranged and distressingly distended after the smallest quantity of food ; the tongue which was previously uniformly white, and coated with mucus, is now free of mucus at the tip and margins, arid of a somewhat dark red colour, which indicates the tendency to typhoid degeneration- Sometimes, however, the tongue remains white though it becomes dry, throughout the entire course of the disease, especially towards evening: the taste is disagreeable, the mouth and fauces are besmeared with mucus, and in the morning the patient hawks up and even vomits a white tenacious mucus. Costiveness or constipation is generally present ; though when the affection extends, the bowels are opened several times a day, accom- panied with borborygmus and griping, the stools consisting of white,
MUCOUS FEVER. 53
bilious, stringy mucus mixed with ingesta, and sometimes fragments of worms ; the urine is straw-coloured and turbid, and deposits a mucous sediment. The fever is at first marked with remissions, but these subsequently become imperceptible; the pulse is rather soft and weak, seldom frequent; thirst and sweat generally moderate ; there is considerable prostration of strength ; drowsiness, pressive aching frontal pains, restless night?, dull lustreless eyes and an indifferent, indolent, morose disposition are almost always in existence.
The duration of the disease varies considerably. In favorable cases it runs its course in fourteen days.
Recovery is generally preceded by the breaking out of a gentle sweat ; or a profuse discharge of straw-coloured urine, which deposits a thick sediment ; or it is ushered in by a gentle sleep. When the disease terminates fatally, it is either from the formation of aphtha which extend over the mucous lining of the alimentary canal and bronchial tubes, and become gangrenous, or in consequence of the repercussion, or non-appearance of miliaria, or through paralysis of the abdominal nervous system, with meteorismus, invo- luntary putrid-smelling stools, and small, weak, and trembling pulse; or from superadded paralysis of the brain.
Therapeutics. — In the treatment of this disorder it is of great importance to check it by means of appropriate remedies at the commencement of the attack, before the complete development of the fever, as by so doing we are thereby frequently enabled to arrest it with facility; whereas, when the disease is allowed to attain a more advanced stage it assumes a most obstinate character, and is with difficulty conducted to a happy termination. The principal remedies which have been recommended in the first or premonitory stage (status pituitosus) are Pulsatilla, Nux vomica, Ipecacuanha (the leading indications for which, will be found under Derangement of the stomach and Dyspepsia, which see),— Ammonium mwria- ticum, Mercurius, Dulcamara, Ignatia, Staphysagria*
Ammonium m. is chiefly indicated by the following symptoms : tongue coated with whitish mucus, incessant clearing of the throat in order to rid it of an accumulation of tenacious mucus ; disagreeable taste, with flow of limpid fluid into the mouth, nausea, aversion to food, eructation, risings of a sourish-bitter watery fluid, sensation of vacuity and hunger in the stomach, uneasiness or qualmishness, and
54 FEVERS.
warmth or heat in the stomach, evacuation of tenacious slimy stools, &c.
Dulcamara is particularly recommended when the attack has been excited by exposure to cold, and the disorder is manifested by insipid or soapy taste, great thirst, dryness of the tongue, increased secretion of saliva, disinclination for food, dirty white coating on the tongue.
Ignatia frequently proves of much efficacy at the commencement of the disorder, when the feelings of the patient vary considerably ; when there is great disinclination to exertion and desire to retain the recumbent posture ; when there is headache, with a feeling of weight and pressure in the sinciput, pain in the scrobiculus, and alternate paleness and redness of the face ; dry, cracked, or chapped lips, white tongue, insipid or disagreeable taste, disgust at food and drink, and bitter regurgitations ; further, when there are frequent, white, slimy stools accompanied by sudden general flushes of heat, with small, accelerated pulse.
Merctjrius is one of the most important medicaments in the treat- ment of this disease, both in its incipient and in its more developed form. It corresponds especially when, along with increasing loss ot appetite, the tongue is coated with a white fur, and covered with mucus ; the act of swallowing is accompanied by a painful feeling ot dryness in the throat and gullet, the taste putrid, and the breath offensive ; further, when there is nausea, with tearing burning pains in the temples, pressive aching or weight and tension in the scro- biculus, stomach, and region of the liver; risings into the mouth consisting of an acrid fluid ; cloudy slimy urine, with deposition ot sediment ; irregular alvine evacuations, with frequent inclination for stool ; pale, earthy, yellow face ; great debility ; inanimate, indolent disposition.
The characteristic indications are, thick, dirty, slimy coating on the tongue ; insipid, pap-like, soapy taste; longing for highly seasoned food; sensation of dryness in the mouth and throat; aphthae, sluggish stools, or constipation ; or relaxed, slimy, very offensive alvine evacuations; extreme mental and physical depression.
Staphysagria. This remedy has been found of great utility in the height of disease ; but it may, like Ignatia^ also prove of service in the first stage, more particularly when mental emotion has given rise to disease. (See Ignatia and StapJiysagria under art. Mental Emo- tions.) As already remarked, however, it is chiefly in the advanced
MUCOUS FEVER. 55
stage of mucous fever, and even when it has degenerated into a nervous or putrid type, that this remedy is especially serviceable.
Senega has chiefly been recommended against the following symptoms : slight rigors and heat, accompanied by pulsating head- ache ; oppressed and anxious respiration, shooting panis in the chest, general aching of the body, and considerable thirst, with accelerated pulse ; accumulation of tenacious mucus in the throat, and constant efforts to expel it. Senega is like Pulsatilla and Capsicum, peculiarly adapted to persons of phlegmatic temperament and soft, flabby muscu- lar system. In fully-developed mucous fever Digitalis is a valuable remedy, especially with extreme depression of the vital powers, slow, languid pulse, great prostration of strength, pressure and fulness in the pit of the stomach, incessant nausea, and frequent fits of vomiting, thirst, diarrhoea, frontal headache, especially over the orbits, short, disturbed sleep. In cases which become protracted, but without assuming a serious character, with predominant plethora venosa abdominalis, Sepia is deserving of attention. Lycopod/bum, Natrum, Kali c, Magnesia c, and Calcarea are also well adapted to those cases which take an obstinate character. Arnica, Spigelia, Dulcamara, Cina, Valeriana, on the other hand, have been spoken of as most suitable to those forms of mucous fever, which, after a longer or shorter interval of improvement, relapse into their previous state. If signs of invermination accompany the disorder, the principal remedies to be had recourse to are, Merc, Cina, Cicuta, Spigelia, Sulph., Sil., Nux v., Digital., EJyos., Valerian, Stram., Stann., &c. When the fever assumes a torpid character, ana nervous symptoms make their appearance, Bryonia, Rhus, Belladonna, Veratrum, or Phosphorus are commonly the most appropriate remedies. Bryonia is indicated by violent congestion to the head, dry burning heat of skin, dry lips, dry red tongue, pressure in the scrobiculus, constipation, slight delirium, &c. Rhus is indicated by a similar train of symptoms, but with great depression and extreme feebleness of pulse.
Belladonna is to be preferred, if signs of cerebral irritation predominate, the pulse is quick and hard, the skin dry and hot, and the tongue parched. Phosphorus is called for when the increased secretion of mucus, extends over the bronchial tubes as wTell as the entire alimentary canal, and is accompanied by ex- pectoration of mucus, rattling in the chest, and diarrhoea ; further, when the patient lies motionless, with the mouth open, the lips and tongue being at the same time dry, cracked, and blackish ; lastly,
56 FEVERS.
when there is oppressed respiration, delirium, and carpologia, Veratrum will often be found useful in the torpid form of mucous fever, with tinnitus aurium, dullness of hearing, and delirium.
In the event of threatening miliaria, announced by a peculiar sighing respiration, Ipecacuanha is chiefly recommended. And when the miliary eruption has made its appearance, or has been driven in, Arsenicum is the remedy on which we must place our chief reliance ; the usual symptoms in such a case are, sopor, cold sweat, sordes on the lips and teeth, offensive breath, dry, tremulous tongue, insatiable thirst, meteorismus, involuntary stools and urine, oppressive respiration, stertorous breathing, small, tremulous, much accelerated pulse, nocturnal delirium. (Acid, phosph. and Carlo v. are also deserving of attention here.) Arsenicum is further indicated when aphthae form, and are either of a simple kind or disposed to become gangrenous, and extend throughout the entire alimentary tube. Mercurius, as has already been observed, is well adapted to cases attended with the development of aphthae, nocturnal exacer- bations of fever, offensive breath, and sometimes swelling of the parotis. Acid, nitricum may frequently be employed with advantage after Mercurius.
Acid, suljphuricum and Mezereum may also be found applicable to some cases with the formation of aphthae. When mortification seems in- evitable, China, Carho v., Baryta c> and Acid, muriaticum, are, in addition to Arsenicum, the remedies which are mainly to be depended on. (See Fehris nervosa.)
The diet must, both in the first stage of the fever, and in that of convalescence, be light and of easy digestion, chiefly fluid, and only in small (quantities at a time; plenty of cold water should be drank, or rice- or barley-water, to which, during the period of convalescence^ it has been found advantageous to add a little wine.
GASTRIC FEVER. BILIOUS FEVER.
Fehris gastrica biliosa.
This is a form of fever in which, as its name implies, the digestive organs are chiefly affected ; it has some degree of affinity with typhus, but is distinguished from the latter by the absence of nervous symp- toms, although, when it assumes a torpid character, these are occa- sionally developed, — by the absence of the pressive aching pains in
GASTRIC FEVER. 57
the occiput ; and by the absence of disturbance or derangement in the senses of sight and hearing ; further, that the pain in the caecum, which is so constant a symptom in typhus, is not a feature of this disease.
The following are the principal symptoms of gastric fever : sensa- tion of fulness and weight in the epigastrium ; flatulent distension of the epigastric region, with inclination to vomit ; eructations of offen- sive flatus, and sometimes vomiting of ingesta and tenacious mucus mixed with bile ; thickly furred, dirty yellow tongue; abdomen soft ; bowels costive ; but in the advanced stage of the disease the evacua- tions are often very offensive, and contain portions of undigested food; frontal headache; languor; sickly and distressed expression of coun- tenance, with yellow discoloration of the albuginea; more or less chilliness, succeeded by heat and dryness of skin ; pulse quick but soft, sometimes intermitting or irregular, particularly the latter ; urine thick, cloudy, and dark coloured.
When bilious symptoms are predominant (Febris biliosa), all the symptoms commonly appear in an aggravated form ; the heat of the skin is very considerable, the restlessness and thirst excessive (the patient expressing a constant desire for acid drinks). The epigas- trium is, as in gastric fever, much distended with flatus, but, in addi- tion to this symptom, the following are more or less marked : the tongue is coloured at first with a pale yellow fur, which gradually assumes a deeper or brownish colour; the taste and eructations are bitter, and the substance vomited consists of a greenish, bilious matter ; the bowels are either confined or relaxed, presenting in the latter case a yellow, green, or brown colour; the face exhibits an earthy, somewhat jaundiced aspect ; sometimes there is also a greater or less degree of sensibility, hardness, tension, burning in the hepatic region; the urine is dark brown, bilious ; the pulse full, accelerated, intermitting or double.
Therapeutics. The following remedies are those which are most required in simple gastric fever : Pulsatilla, Nuw vomica, Ipecacuanha j Antimon. c, Bryon., Cham., China, Cocc, Tart., Rhus, Sulph., Arsen., Ve- ratrum, Colocyn., Acid. j)hosph. The principal indications for the selec- tion of these will be found in the chapters on Derangement of Di- gestion and Dyspepsia, which see. When mental emotions have given rise to the disorder, Chamomilla, Bryonia, Colocynth, and Acid.phosph. are the most appropriate remedies. Chamomilla and Bryonia particu- larly, if in consequence of a fit of passion ; Colocynth, from indignation, or mortification. Stafthysagria is sometimes preferable to Colocynth3 when
58 ERUPTIVE FEVERS.
vexation is combined with indignation. Acid. phosph., if grief, care, or anxiety have been the chief exciting causes. (See Mental Emotions.) In Bilious fever the most important remedies are, Aeon., Cham., Puis., Nuxv., China, Cocculus, Digit., Bella. ; Arsenic, Colocynth, Mercurius, Staph., Colch,, Taraxac, Ignatia, Asar. (See Derangement of Diges- tion, Dyspepsia, Hepatitis, and also Mental Emotions, when the disorder has been developed by such influences.)
When gastric or bilious fevers partake of a somewhat inflammatory character, Bella., Bryon., or Cham, will generally be required sooner or later in the disease. When the fever degenerates into a nervous character,: Bryonia, Rhus, Cocculus, Veratrum, Bella., or Arsenic., Carbo v., China, Hyos., Ipecac, Puis., Nux v., &c, will especially be called for in the majority of cases* (See Nervous and Putrid Fevers.)
ERUPTIVE FEVERS.
Under this head we intend to treat of those diseases which possess the common property of febrile symptoms, preceding an eruption which is present during a part of their course, such erup- tion varying, in character, according to the nature of the affection.
In this class are comprised, scarlet fever, measles, smallpox, chickenpox, miliary fever, and nettle-rash.
SCARLET FEVER.
This disease, in its simple generic character, consists of a conta- gious fever, with swelling of the face and a scarlet appearance of the skin — (hence its name) — which is of a bright raspberry colour, or of a hue resembling a boiled lobster, smooth and glossy, upon which the finger, being pressed, leaves a white imprint which almost immediately disappears. In the present day we seldom meet with it in this simple form, but more frequently complicated with severe or ulcerated sore throat, delirium, congestive or violent inflammatory symptoms, and often with more or less deviation from the charac- teristic efflorescence above described.
Diagnosis. Fever, with extreme quickness of pulse; a feeling of soreness or pain in the throat ; and, in one, or more days, the appearance of an eruption, of the colour above mentioned, in large, indefinitely marked patches, gradually growing paler towards their
SCARLET FEVER. 59
margins, and often overspreading entire limbs with a uniform scarlet colour; the efflorescence disappears in five or six days, when the skin desquamates, and comes off in large pieces.
We, sometimes, find scarlet fever with scarcely any, or even no external redness, but, at the same time, marked angina and bright redness of the tongue ; in such cases, the disease, instead of showing itself on the skin, has fixed upon the mucous membrane ; and even the angina and redness of the tongue, present in most cases of this disease, may be considered indicative of an internal scarlatina.
Scarlatina was formerly confounded with measles, from the resem- blance which the two eruptions bear to each other, at their com- mencement ; but they are easily distinguishable, even without taking into consideration the peculiar appearance of the skin above men- tioned— characteristic of the disease, — by the eruption, in scarlet fever, generally developing itself in from twenty-four to forty- eight hours after the commencement of the fever, whereas that of measles rarely sets in before the third or fifth day ; the absence of catarrhal symptoms, such as cough, sneezing, lacrymation. the usual precursors of measles, constitutes another mark of differerice. The greatly accelerated pulse, which denotes the approach of * scarlatina, is also never met with, to the same extent, in any other disease.
Therapeutics. In those cases, in which this disease appears in its simple form, the skin presenting the characteristic hue, with a smooth and glossy surface, [Scarlatina levigata s. plana), Belladonna is a spe- cific remedy.
Even in the severer forms of scarlatina, when the throat is con- siderably affected (Scarlatina anginosa), and high fever or congestive symptoms set in, and which, if not properly treated, or if they occur in a bad habit of body, may assume the malignant type (Scarlatina maligna)^ attended with ulcerated sore throat, extension of the inflammation to the air-passages, delirium, spasm, &c, — Belladonna is a valuable remedy.
In scarlatina anginosa, the fever and sore throat increase with the eruption, in mild cases, and cease with its decline, but, in the more severe, continue ; it is when the disease appears principally to attack the head, throat, thoracic, or abdominal viscera, that it becomes dan- gerous.* The eruption frequently does not appear before the third day, and then only in isolated patches.
* When scarlatina anginosa is complicated with bronchitis, phrenitis, or enteritis, the remedies mentioned under these different heads must be had recourse to.
60 ERUPTIVE FEVERS.
Belladonna should be administered, as soon as the throat and tongue become affected with dryness and burning, and there is a desire, but complete inability, to swallow even drinks or saliva ; with sense of suffocation; further, when the throat is of a bright red colour, having its surface excoriated, or covered with white specks, or stringy mucus, or presenting the appearance of thrush; the tonsils swollen, and the tongue of a bright fiery reel hue, sometimes interspersed with dark red patches at a later period in the disease ; also when deli- rium exists.
If the disease have taken a favorable turn, we may allow the Belladonna to continue its action; but if, after the second or third repetition of Belladonna, the inflammation and swelling increase instead of diminish, as is frequently the case in strumous consti- tutions, or if we clearly perceive an appearance of ulceration com- mencing, with increase of mucus, we must have immediate recourse to Mercurius.# If, on the other hand, the ulcers present a livid appearance about the edges, and emit an offensive odour, or, when there is excessive thirst, with great dryness of the mouth, and extreme prostration of strength, we must have recourse to Arsenicum, in preference to Mercurius ; and if this medicine prove inadequate to complete the cure, we should follow it with Nux vomica. (Vide Ulcerated sore throat.) Nux v. is, moreover, of considerable efficacy, when a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the fauces, which adheres so tena- ciously, that it is with difficulty expelled, and, sometimes, even threatens suffocation. [Pulsatilla is also useful in such cases. See Sore throat.)
When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite, in the same manner as already given under Inflammatory fever, which see.
When the quickness of pulse and other inflammatory febrile symptoms are subdued, and the affection of the throat again appears
* The exudations of various colours, or aphthous crusts, as they have been termed, which appear on the tonsils, anterior pillars of the velum palati and the fauces, in scarlatina anginosa are often mistaken for ulcers and eschars. They are, however, readily discovered, on attentive examination, to consist of a thick viscid fluid, or floculi or concretions of gray, yellowish-white, or blackish-looking matter, differing from coagulable lymph by being softer. They are easily removed, and the parts which they covered present no trace of ulceration or loss of substance. Mercurius is the most useful remedy here, but Acid, nitricum, Lachesis, &c, are sometimes required. (See Sore Throat.)
SCARLET FEV&R. Ql
prominent, we may return to Belladonna, especially if the skin retain the peculiar scarlatina hue.
Opium may follow the administration of Belladonna, when there is burning heat of the skin, drowsiness, stupor, stertorous breathing, open mouth, eyes half closed, restlessness with vomiting, or convulsions.
We may here remark that Dr. Schmidt of Vienna states that he has found Cuprum aceticum particularly efficacious, in a peculiar affection to the brain, that frequently declares itself in cases of reper- cussed exanthemata, and which, if not speedily checked, may terminate in paralysis of that organ.
Dr. Schmidt is of opinion, that when the eruption, during efflo- rescence, is suddenly repercussed, the result of which is frequently fatal, Cwpmm aceticum may be almost considered specific ; or, at least, the medicament, which, with the greatest degree of certainty, can save the patient ; if, in this condition, death should happen, it is in conse- quence of paralysis of the brain.
Symptoms indicating its employment: "Quick, small, weak, irregular pulse ; temperature of the skin considerably reduced, in more severe cases, chilly, and covered with perspiration. Affections of the nervous system are never absent; to this belong convulsive movements of various parts of the body, distortion of the eyes, face, mouth, head, &c., spasmodic affection of the chest, sometimes even eclampsia ; as well as great restlessness, frequent change of position, sopor, delirium, &c."
It displays its efficacy in reproducing the eruption, when the cerebral affection disappears, and the disease runs its usual course.*
Pulsatilla is indicated, when derangement of the stomach and digestive organs is a prominent symptom, the face pale, red, or bloated; also constipation — or looseness, especially at night, — occa- sionally with pains in the bowels, and shivering ; disposition fretful and sensitive, or melancholy.
When the eruption is very intense, and extends over the entire
* The remarks made on this medicine are taken from the translation of Dr. Schmidt's paper on the subject, in the ' British Journal of Homoeopathy/ No. Ill, page 233, to which the reader desirous of further information is referred. The following is Dr. Schmidt's formula : one grain of the Cuprum aceticum triturated with one hundred, one hundred and fifty, or two hundred grains of sugar of milk, previously triturated so as to feel as fine as flour ; the process should occupy from twenty to thirty minutes. Of this preparation take from three to four grains, dissolve in a tumbler of pure water, and administer in tablespoon- fuls, every quarter of an hour, half hour, one, or two hours, according to the violence of the disease.
62 ERUPTIVE FEVERS.
frame, and particularly when the patient affected, is of the scrofulous diathesis, Sulphur, in repeated doses has been strongly recommended. Aconitum, as intermediate remedy after SulpL, when great restlessness and dry heat of skin prevail. After the employment of SulpL and Aconit. other remedies, such as Puis., Calc, Arsenic, &c, maybe called for.
We frequently find this affection, in a complicated form, distin- guishable from pure scarlet fever by the absence of the peculiar hue of the skin, of which We have spoken at the commencement, and by the pressure of the finger leaving no white imprint. This, so widely different type of the disorder, will be found treated of, in the succeeding chapter, under the denomination of Purpura miliaris or Scarlatina miliaris.
The accession of laryngitis is one of the most serious and fatal complications which is liable to be encountered in scarlet fever. The remedies on which we must place the greatest reliance as soon as we have detected this dangerous state of matters, are : Aconite ', Spongia, Hepar s., Lachesis, Merc, Ars., Carlo, &c. (See Laryngitis.)
In strumous habits, or in instances where the disease has been allopathically treated from the commencement, many troublesome sequelae are frequently left. And we may remark that, even after the desquamatory process is completed, the whole of the danger is not altogether passed, any exposure to cold, or infringement of dietetic rules, being likely to entail unpleasant and even dangerous conse- quences.
Chamomile a. may be employed with advantage, either alone, or alternately with Belladonna, against excoriation of the face, &c.
Aurum. Against the offensive and purulent discharge from the nose, with soreness and swelling of the interior.
Mercurius vivus is a good remedy against soreness of the nose and face, with swelling of the submaxillary glands ; followed by Hepar sulp/mris, SiUcea, Sulphur, and Calcarea, if necessary.
Against the following symptoms. Belladonna is extremely efficacious : puffiness of the face, swelling of the hands and feet, lingering fever in the evening, glandular enlargements, chaps about the mouth, severe headaches, stammering, &c. ; and may frequently be advantageously alternated with the medicines just mentioned.
Dropsical swelling of the whole body is not an unfrequent sequela, sometimes requiring a most careful and discriminating treatment. The following remedies will generally be found the best adapted to
SCARLET FEVEU. 68
the successful treatment of the same: Hellehoms, Arsenicum, Bryonia, Rhus ; of these Helieb. is, generally, the most appropriate when the whole body has become suddenly anasarcous : Rhus, when the .inferior extremities are more especially affected, and Arsenicum, when Hettehorus does not speedily produce a favorable impression. Bryonia has been recommended as the best remedy when the dropsical infiltration is detected early, and the effused fluid is small in quantity. In obstinate cases, Arnica, Bella., Phosphoric acid, Digitalis, Baryta m., ' Sulph., Lycopod. Against Otitis, or Otorrhcea: Belladonna, Hepar stdphuris, or Pulsatilla are the best remedies ; and in the case of Boils, Arnica, followed by Bryonia and Sulphur, when necessary; and for Deafness, Belladonna, Pulsatilla, Dulcamara, Sulphur, are to be chiefly recommended.
It may here be added, that Ammonium carbonicum, Arsenicum, Secale cornutum, and Acidum phosphoricum, have been found very useful in scarlatina, when it assumes the typhoid fornl; and Arsenicum in fre- quently repeated doses, — or Acidum nitrictim, Aconitum, Lycopodium, and Belladonna, alternately, a dose of each remedy being given every hour, or oftener if necessary, for several successive hours, to rouse the vital force to new efforts,— in the severe and dangerous sore throat which accompanies malignant scarlatina, the amygdalae being swollen into hard tumours, often as large as apples, attended with snorting and difficult breathing, enlargement of the neighbouring glands, re- mitting pulse, and sopor.* Against Parotitis : Mercurius, Carlo v., Calcarea c, and Kali c, will generally be found the most important remedies.
Belladonna is valuable as a preservative against pure scarlatina, when epidemic, and moreover^ greatly assists in modifying the character of the disease, in such individuals as do not wholly escape its attacks, f
* Brit. Jour, of Horn. No. xii. Vide also Ulcerated Sore Throat. f There are various methods of employing Belladonna as a prophylaxis. We have repeatedly used the following prescriptions with advantage : R Tinct. Bellad. 3, gtt. vj. Aq. destil. J vj. Dose, To robust children of ten years of age a dessert-spoonful twice a day ; to those of about five years of age a teaspoonful daily ; and to those of and below three years, a tea- spoonful every third day. Or, in the case of delicate children, or those who are very sensi- tive to the action of the homoeopathic medicines :
R Bellad. 30, glob. 3. Aq. destil. Jj. Dose. A teaspoonful every third, or only every fifth day, when there is inactivity of the skin, with great susceptibility to the medicinal effects. A little pure alcohol may be added to the
64 ERUPTIVE FEVERS.
Should the disease continue to rage, the treatment may, in some instances, be renewed. If, however, the ruling epidemic be scarla- tina in an unusual or complicated form, the remedies employed as preservatives must be such as possess pathogenetic properties, corre- sponding to the entire morbid picture of the disease. Aconitum and Belladonna in alternation, (allowing twelve to twenty-four hours to elapse after the administration of Aconitum before Belladonna is given, and from two to four days after Belladonna, before Aconitum is repeated, and so on,) have been employed successfully in epidemics not possessing the clear scarlatina hue, with a smooth and glossy surface. While taking Belladonna or Aconitum the patient must adhere strictly to the homoeopathic diet, particularly avoiding wine and acids. We must, in administering prophylaxes, carefully watch their effects and if a medicinal action set in discontinue immediately.
Diet. During the course of this malady, the greatest possible attention must be paid to this point. In the more severe accesses of fever, no other nourishment must be given than toast-water, or weak barley-water ; and even after the fever has abated, every care must be taken, and a return be gradually made to a more nourishing diet, as negligence in this respect may be productive of the most serious consequences. In mild attacks the patient may be allowed gruel or weak broths.
SCARLET RASH.
Purpura Rubra s. Miliaris Hahnemanni. Scarlatina miliaris, miliformis,
papulosa. Miliaria purpurea*
This affection is, by many authors, regarded as a mere modification of the exanthema we have treated of in the preceding chapter, {scarla- tina pur a, scarlatina levigata seu plana.)
It is easily distinguishable from pure scarlet fever, by the dark redness of the efflorescence, by the slight pressure of the finger leaving no white imprint, and by the small granular elevations, the cause of the dark red hue, which are felt, on passing the hand over the affected cutaneous surface. Some parts of the skin are perfectly free from the miliary papulae, and consequently present a brighter hue than those which are studded with
water when the weather is very warm, or when it is required to keep the prophylactic liquid for a longer period than usual. A fortnight to three weeks' use of the Belladonna is generally sufficient to obviate any risk of infection.
SCAULATINA MILIAEIS. 65
them. In confluent scarlatina miliaris, or that in which, on some parts of the cutaneous surface, several papulae run into one another, the affection has received, from the appearance which the eruption then assumes, the term of scarlatina _p7ilycttenosa, vesicularis jpustulosa.
This eruptive fever does not run a defined and regular course, like other exan thematic fevers. The efflorescence often disappears sud- denly, and is then productive of extreme danger, frequently termi- nating in a fatal result. The extent of the efflorescence does not necessarily add to the danger, as the latter is often greatest, when the efflorescence is scarcely perceptible.
Sweat is only met with on the surfaces affected with the eruption, and it is, consequently, only when the eruption covers the whole body, that the sweat is general.
Those who have been once affected with the disorder, are by no means exempt from future attacks. Soreness of the throat is chiefly encountered, when the eruption is altogether wanting, but it is also frequently met with before the outbreak of the rash, becoming trivial during the full bloom, and, again, very severe on the dis- appearance of the same.
This disease requires a totally different treatment from scarlatina levigata (scarlatina pur a, scarlatina simplex), and Belladonna, the spe- cific remedy in the latter, will, in this case, neither be found to be a preventive nor an indispensably curative medicine, but simply an auxiliary in some complicated cases.
Aconitum. When the disorder occurs in an idiopathic form, there are few exceptions, in which any other remedy than Aconite is required, for the entire removal of the disorder. Sometimes it is found necessary to administer a dose of Cqffea, a few hours after the first or second dose of Aconite, when the patient complains of severe pain in the head, trunk, or extremities, and is extremely restless, fretful, agitated, and disposed to shed tears, and then, again, to return to Aconite after a similar interval : and so on, alternately, until the cure is completed ; which, under favorable circumstances, is speedily accomplished by means of these remedies.*
When, however, this eruptive fever occurs in complication with smallpox, or measles, or, when it breaks out in unfavorable sea- sons, during the prevalence of one or more of the said exan- themata, it generally becomes a much more serious disorder, and requires the aid of other remedies, in addition to the above men-
* Sulphur may be substituted for Coffea, in cases where the fever continues to run high, notwithstanding the employment of Aconitum.
5
66 ERUPTIVE FEVERS.
tioned. Among these, Ipecacuanha, Pulsatilla, Bryonia, Dulcamara, Belladonna, Arsenicum, Phosphorus 9 and Rhus are the most important, preceded by, and, where necessary, alternated with Aconite, when signs of inflammatory fever, or the following symptoms present themselves: — Slight, general fever chills, with rapidly alternating redness and paleness of the face ; quick full pulse ; slight confusion of ideas, increasing to a mild degree of delirium at night, combined with dryness of the mouth and lips, and thirst; eyes somewhat inflamed ; oppression at the chest, short cough, sometimes attended with reddish sputa, and followed by a shooting pain under the ribs ; occasional vomiting ; angina pharyngea. In all such cases, a dose or two of Aconite, at intervals of four hours, will be found of consider- able service, if not sufficient to put a check to the further progress of the affection.
Ipecacuanha. In many instances, either at the commence- ment of the attack, before the appearance of the eruption, or during its full development, but particularly the former, this is a most efficient remedy. It is indicated when there is a sensation of dis- tressing tightness of the chest, with laborious breathing, and heightening of the febrile action towards evening ; with symptoms of nausea, or even vomiting; extreme restlessness and agitation : deep sighing or moaning; disposition to tearfulness, or whining in children ; diar- rhoea, or colic.
When the oppression of the chest, and excessive restlessness have been removed by Ipecacuanha, but considerable nausea or frequent fits of vomiting remain, these symptoms will, generally, soon yield to Pulsatilla.
Bryonia is frequently more efficacious than either Coffea or Ipeca- cuanha, in relieving the extreme anxiety, restlessness, deep sighing or moaning, which so generally attend this affection ; it should, there- fore be had recourse to in all cases in which these remedies fail to afford speedy relief. In some rare cases, even Bryonia is not suffi- cient, and it is then found necessary to administer Cinchona, followed by Phosphorus. Bryonia is further indicated, when the accompanying fever partakes of a nervous character, attended with delirium and other symptoms mentioned under Bryonia, in the article on Nervous fever — which see. The excessive and continual urging to urinate, which sometimes sets in, in the course of the disease, is often very readily subdued by Bryonia or by Conium.
Belladonna. When the disorder is met with during the preva-
SCARLATINA MILIARIS. 67
lence of Scarlatina pura> (as also when symptoms, more or less cha- racteristic of the latter affection, make their appearance in the course of scarlatina miliaris,) this remedy is a most efficient auxiliary ; it is, moreover, a most important remedy, when symptoms of cerebral disturbance exhibit themselves ; or when the patient complains of his throat, which, on being examined, is found to be in a state of phlegmonous inflammation. Mercurius may follow Belladonna, when the tonsils become much inflamed and tumefied, or ulceration super- venes ; in the latter instance, however, Arsenicum or Acid, nitricum may become necessary under particular circumstances. (Vide Scar- latina, Sore throat, and Scarlatina maligna.)
Phosphorus. This remedy is very useful in cases in which there are symptoms of congestion in the chest, with extreme anxiety and oppression, and also, when there is considerable cerebral irrita- bility, characterized by over-excitability of the senses ; further, when the patient appears extremely listless and apathetic, and complains of burning sensations in isolated parts, rendering a frequent change of posture necessary. Phosphorus is often of great utility after Bryonia or Belladonna.
Dulcamara. When severe aching or gnawing (rheumatic) pains are complained of in the back or extremities, either in the course of the disease, or at its termination, Dulcamara is useful.
Arsenicum, may be had recourse to in an advanced stage of the complaint, if the vital power seems rapidly sinking, and the organs, which perform the act of deglutition, are, as it were, paralysed, so that the patient is incapacited from swallowing ; or when, from a metastasis to the throat, the latter has become so rapidly and seriously affected, as to have assumed a gangrenous aspect.* (See Ulcerated sore, throat.)
When the disease, in cases of a bad type, puts on a nervous,f or
* Compare these symptoms with those described under Calcarea carbonica at the end of this chapter.
f Rhus and Sulphur may also be mentioned as having been found useful in this disorder; the former, when the exanthema had degenerated into a species of vesicular erysipelas, attended with lethargy, great thirst and strangury ; and the latter, in cases where Belladonna had failed to effect all that could be expected. Antimonium tartaricum may prove of con- siderable service in the vesicular or pustular form of the exanthema. Against the convulsions which precede the evolution of scarlet rash, or the efflorescence of scarlet fever, as well as confluent smallpox, Tart. emet. is also indicated. In the event of repercussion of the eruption, Bryonia, Phosphorus, Sulphur, and Cuprum aceticum have been recommended as the most useful. Opium proves very useful when the following symptoms present themselves: burning heat of skin, extreme agitation and anxiety, vomiting, diarrhoea, or obstinate con- stipation, convulsions, and excessive drowsiness.
68 ERUPTIVE FEVERS.
even a putrid character, with extreme offensiveness of all the excretions, and hemorrhage from the nose, mouth, &c,, the medicines, already mentioned under fevers of the said description, (which see p. 32,) must be employed. Owpmm aceticum and Kreosote have been found useful in some of these, almost hopeless, but fortunately somewhat rare cases ; the former particularly, when the efflorescence repeatedly appears and disappears suddenly in the course of the disease.
To show, however, how very essential it is to make a careful selec- tion of the remedy, in the strictest possible accordance with the law similia similibus, instead of blindly pursuing the path of routine, and prescribing remedies solely in consequence of their having been found useful in other epidemies of the same name, we add the following account of a severe epidemy which was described by Dr. Elbe, of Dresden, in the 'Allg. Horn. Zeitung/ No. 15, 21ster Band :
"The scarlet-fever epidemy of 1 845, which raged not only in Dresden and its environs, but also in many other remote parts of Germany, was unquestionably of a more violent character than has appeared for a long time. There were but few families that entirely escaped its ravages, and the number that fell victims to it was very large. It is well known, that in many families as many as from three to four children died of it ; in one case, indeed, seven children out of a family of eight ; and from this great mortality a conclusion may be drawn of the violence and malignity of the fever.
It will perhaps not be wholly superfluous to remark, that a rubeo- loid epidemy, but which wras not exactly of a malignant character, pre- vailed here in 1844. After it had passed over, the scarlet fever appeared in the spring of 1845, sporadic, but of slight character, and continued thus till August ; in the said month, however, the epidemy assumed a malignant . character, which may perhaps, in a great measure, be ascribed to the excessive heat we had in July (frequently 32° Reaum. in the shade). So much is certain, that a great number of children died from that time forward of scarlet fever, although there were also slight cases which occurred during the course of the epidemy, which were readily cured by Aeon, and Belladonna, or recovered by the un- aided efforts of nature. This, however, happens in all epidemies, and as nothing of interest is to be elicited from it, either as regards patho- logy or therapeutics, I shall pass these over, and confine myself to pointing out the characteristics of the more malignant cases, and to mentioning those remedies which proved specific thereto.
SCARLATINA MILIARIS. 69
The exanthema itself, appeared in many cases very suddenly, with- out any precursors ; in others, a fever preceded the eruption for several days, which possessed, however, in the absence of all local disturb- ance, no determined character. The only circumstance worthy of notice being, that the skin was usually more dry, and of higher tem- perature, than it commonly is in fevers, and that Aeon, had no effect. In some cases, headache, hemorrhage from the nose, sore throat, vomiting, and diarrhoea showed themselves as precursors. Neither the nature of the precursory symptoms, nor the character of the exan- thema justified the prognostication that the disease would take a malignant course ; cases turned out dangerous, with a scanty as well as with an abundant efflorescence, and vice versa. This alone I ob- served, that those cases wTere more dangerous, in which the single patches were confluent and more elevated than usual ; frequently also these larger patches had not the proper scarlet red, but more of violet colour. The violence of the angina wras, likewise, a certain criterion of a malignant case ; on the other hand, the intensity of the fever (although even some cases, wrhere almost no fever existed, suddenly terminated with death), with an asthenic character, which appeared usually with the first eruptions, sometimes also with the following, was an almost infallible prognostic ; the skin was at the same time burning hot, partly dry, partly covered with colliquative swTeat ; the pulse small, weak, and very quick (130 to above 160); the face bloated; the tongue mostly dry, at first furred yellow, afterwards brown ; the tip red, and the papillae swollen ; the lips dry, and browrn, as in typhus; the teeth often covered writh a viscid brown mucus; thirst, usually excessive ; the difficulty in the performance of the act of deglutition was not always uniformly great ; in some cases it pro- ceeded from the swelling of the tonsils, in others, the cause appeared to be an inflammation of the throat, and again, in others, it mani- fested itself only during the febrile exacerbations, which mostly took place in the evening; strangury was not unfrequently an unfavor- able symptom; the urine which was voided, often emitted an ammo- niacal or putrid smell, and was as clear as water. So far, the more malignant cases were analogous, but from here they can, as regards the affected organs, the brain or lungs, be divided into two classes. The affection of the brain was, as usual, accompanied by violent deli- rium, periodical or continuous unconsciousness, involuntary evacua- tions of the urine and fasces, which latter were mostly of a light colour ; the skin, which had previously been hot, became cool, the
70 ERUPTIVE FEVERS,
pulse thready, the efflorescence scanty and violet-coloured ; death followed from paralysis of the brain. The affection of the chest be- trayed itself not only by short, but also by difficult and laborious breathing, by mucous rattling in the bronchi, and sometimes also by an efflux of pus from the nostrils. In this variety, also, involuntary evacuations took place latterly ; the excretions were in almost all cases clayey, as in icterus in adults, but the urine clear, like water. Delirium was, moreover, not wholly absent, but certainly not so violent as in the affections of the brain ; the disease terminated with paralysis of the lungs.
I have drawn the distinction between the two forms thus promi- nently, from the circumstance, that it was of importance in conducting their respective treatment. In most cases, death ensued on the third, but often not before the fifth day, and in rarer instances, already on the first day of the disease. I may transitorily mention that many other symptoms, such as convulsions, &c, made their appearance towards the close of the disease, but all danger was usually over when once the period of desquamation had commenced. The epidemy continued with almost unabated intensity till February, 1846, when it suddenly assumed a milder character, and then gradually disap- peared.
The sequelae of the disease consisted chiefly in hydrops anasarca, ascites, hydrocephalus, glandular swellings, and abscesses, which always yielded readily to the usual remedies.
Before I enter upon the treatment, I must add, that I by no means found the prophylactic power of Belladonna so very generally con- firmed. I had, it is true, cases, where children, to whom I gave Bel- ladonna as a palliative, escaped the scarlet fever, even when it was in the family; but I as often found that others were attacked by the fever although they had taken Belladonna for many weeks, and that notwithstanding the long-continued use of the same, the subsequent disease was not in the least mitigated by it.*
Of the treatment of the milder cases I shall say nothing here, since, as mentioned above, Aconitum and Belladonna perfectly sufficed. That these remedies, however, had no effect, and could have none, in the
* Belladonna may only be expected to act as a preservative when it happens to be specific tothe prevailing epidemy. Had the remedies ( Calcarea and Zincum) which were subsequently employed with such striking success in the treatment of this epidemy, been used as prophylaxes, there is every reason to surmise that these remedies would not have failed to exert a preventive effect. — J. L.
SCARLATINA MILIAR1S. 71
more malignant cases, may be accounted for by the fact, that in these the fever was not sthenic., or similar to the inflammatory; that the tendency to paralysis was occasioned by pure nervous weakness, i. e., by prostration of the vital power ; that Aeon, and Belladonna, on the other hand, can only prove beneficial against erethic and inflam- matory fever, and although unquestionably also against paralysis, they are only so when the latter has originated in congestion ; consequently that their curative power in febrile, congestive, and inflammatory states, rests upon their capability of suppressing abnor- mally excited vital power, but which must, in cases of the description noticed here, by all means be avoided ; on the contrary, we must endeavour to invigorate the already but too much depressed vitality, the lowered condition of which presented so much difficulty in the treatment of the epidemy in question.
The remedies employed in typhus, viz., Bryon., Aeid. phosph., Phosphor., Card, veg., Acid, muriat., Arsen., Rims, and Amnion, carl., appeared to correspond to the indication just mentioned, as also to all the other symptoms, and yet none of them had any unequivocal beneficial effect, for although single cases took a favorable course, still, the fatal termination was unfortunately the more frequent : it was therefore much to be doubted whether the more rare favorable termination was to be ascribed to these remedies or to nature.
Amongst the remedies quoted, Rhus and Amnion, card, undoubtedly appear the best suited against scarlet fever. Still Rims has no specific relation to this disease, for, although we certainly know it to be appropriate in erysipelatous, phlyctaenous, pustular, scabby, and herpetic forms of eruptions, it is not so in any which are analogous to the efflorescence of scarlatina. The observation of Dr. Kreussler (Allg. Homoeopath. Zeitung, 29. 8), that Rhus proved a specific remedy against scarlatina, combined with an intense vascular fever, I did not see confirmed ; it is moreover well known that the intense vascular fever abates as soon as the eruption has fulfy taken place, and before this period it will hardly be possible to mitigate the fever. According to my opinion, a beneficial effect, and that with some cer- tainty, can only be expected from Rhus in scarlet fever, if the latter is complicated with a typhoid state. Ammon. carl., therefore, appeared to hold out the most favorable expectations, especially as it had been already successfully employed by many ; this year, however, no advantage followed its employment, and this no doubt arose from the circumstance that every epidemy possesses its peculiarities, as is
72 ERUPTIVE FEVERS.
shown in that described by Schron (Hyg. 21, 1), in which he prescribed Amnion, card, with great success ; for, in the first instance, the frequency of the pulse, in the cases described by Schron, was not above 130, whilst it rose here to 164, consequently a difference of more than 30 pulsations in the minute ; secondly, in Schron' s cases, danger was indicated by the intensity of the redness and the extent of the efflorescence, whilst in our cases this was not of any prognostic moment ; and lastly, in Schron's cases, paralysis of the brain usually took place after vomiting, and in cases where the eruption was scanty, whilst it was here mostly unpreceded by any perceptible precursory symptoms, and could only be recognized by its consequences, viz., by the diminished temperature of the skin, by the retrocession of the exanthema, and by involuntary evacuations. Schron makes no men- tion of cases in which the lungs were implicated. These may be considered as the principal distinguishing characteristics of the two epidemies, and may account for the circumstance, that remedies declared as curative by Schron, were of no avail in the epidemy which occurred in this place.
All the remedies mentioned having failed, I was compelled to search for others, and I found Calcarea carbonica, and Zincum to be the most suitable according to the entire morbid picture of the disease. We shall, however, proceed first to attempt to compose, from the pathogenetic symptoms which can be produced by Calc. carb., a form of disease which presents a strong resemblance to the state described above.
We find, as the effects of Calc, Carb.,*
With regard to the JExanthema : Symptoms.— 293, 394, 415. Red, hot, turgid countenance.
417. Small painless rash on the face.
418. Eruption on the face resembling miliaria.
443. A fine eruption about the neck and chin attended with itching.
1364. Red streaks on the shin-bone, which consist of miliary vesicles, with violent itching and burning after being rubbed.
1403. Burning in the palms of the hands and soles of the feet.
With regard to Fever. 1502. Difficulty in falling asleep in consequence of excessive heat, in a cold room.
* Materia Medica (Homoeop.,>
SCARLATINA MILIARIS. 73
1555. Restless dozing, during the night, with excessive heat and confusion in the head, as in fever. 1585. Accelerated pulse.
Concomitant Symptoms. a. Affections of the Throat. 5 1 2-52 1 . Difficulty of deglutition.
528-29-30. Swelling and inflammation of the palate and tonsils. 525-27. Indicate inflammatory action in the pharynx.
b. Trachea and Lungs. 1025. Loud rattling in the windpipe, during the act of expiration, as if from an accumulation of mucus in the chest. 1053. Hot breath, with heat in the mouth. 1069-76. Difficulty of breathing. 1109-10. Precordial anxiety. 1023. Mucus in the chest, without cough.
■ c. Cavity of the Mouth, and intestinal Tube. 531-33. Dry tongue. 564-70. Thirst. 517. The faeces perfectly white.
d. Urinary System.
871—74, 76, 78. Strangury.
877. Wetting the bed (involuntary emission of urine).
884. Copious emission of watery urine.
895. Offensive, acrid smell of the urine, which is very clear and pale.
e. Nervous Symptoms.
1505-8, 10, 12. Involuntary exuberance of ideas, with visions during sleep.
1544-46. Indications of delirium.
1561. Decided delirium in the case of a child.
1435-36-79. Weakness, debility.
If we take the sum of these symptoms, we shall find that it yields as distinct indications of the applicability of Calcarea c. to the treatment of scarlet fever,# as may be gleaned from the pathogeny of Belladonna
* Scarlatina miliaris. — J. L.
74 ERUPTIVE FEVERS.
and Ammon. carb.> and more so than can be met with in that of any of the other remedies ; the angina, the constant attendant on scar- let fever, is also clearly to be recognized. We certainly find here but a small number of febrile symptoms, only a few times iC heat during the night, restlessness, and quick pulse •" experience, however, has long proved that Calc. is of great use in rather violent fevers, e. g. in fever accompanying dentition,^ — the usus in morhis is, therefore, in its favour. It is moreover known that every febrile state will yield, if the rest of the morbid picture, the source of the fever, corresponds with the remedy employed. Thus far we might already expect a curative effect from Calcarea in scarlet fever ; but it is chiefly to be recommended in an epidemy of the character of that which is at present under our notice, by its so distinctly marked symptoms of paralysis of the lungs ; it possesses also the nervous . symptoms, which wrere never absent in the more malignant cases, "and even the faeces and the urine, with the peculiar smell of the latter, are of the same nature. There was, therefore, reason to conclude that a bene- ficial effect might be looked for from the employment of Calcarea; and my expectations were realized in the most striking manner, for of all those children, to whom I gave this remedy, I did not lose a single one. At the same time it wTill be seen from wrhat I have stated, that Calc. is only indicated in that form of the disease, where affections of the chest take place, and where paralysis of the lungs is to be feared. I gave it in the first instance, in these bad cases only, and invariably effected a speedy cure by means of it; afterwards, however, I employed it in all cases without exception, from the commencement of the attack, and the disease, under such circum- stances, always assumed a mild character, at least symptoms of threatening paralysis of the lungs never appeared after its use ; the fever, however violent it might be, diminished so rapidly, that on the third day it wras hardly perceptible; the development of cerebral symptoms, indicative of threatening paralysis alone, could not be prevented by it, and as soon as these appeared I discontinued the Calc. and proceeded as I shall hereafter describe.
I gave Calc. only once every twenty-four hours, and usually gr. j. of the third or fourth trituration. It may probably be asked, why I repeated the medicine so seldom in such precarious cases. But I must confess, that I have seen a decidedly better effect from these rare doses than from more frequent repetitions. Moreover, the curative effect of the Calc. develops itself with considerable quick-
SCARLATINA MILIARIS. 75
ness, as I often had occasion to observe ; for example, I have even succeeded in arresting incipient paralysis of the lungs (a state which decidedly requires the promptest assistance), by one dose of the third trituration ; and in a case, which occurred in a child of one year old, where difficulty of deglutition appeared in the evening, during the febrile exacerbation, to such a degree that suffocation was to be apprehended, relief was so far afforded in the space of a few minutes by Calc. 4, gr. j, that the child was enabled to drink with ease, although the symptoms had existed for upwards of an bour before my arrival. The attack returned for several evenings in succession with equal intensity, but as Calc. was then immediately administered, it never lasted above ten minutes. But great as was the curative power of Calc. in the above-mentioned form of this epidemy, it was inadequate to cope with the other variety, viz. that with threatening paralysis of the hrain ; here Zinctim was indicated, its pathogenetic properties bearing not only a similitude to scarlatina in general, but with the form in question in particular, as the following catalogue will render manifest.
The eruption is indicated by :
Symptoms : — 276. Efflorescence in the face. 297. Violent itching in the knee, and redness of the same. 921. Itching between the shoulder-blades, with extensive eruptions. 991. Miliaria at the bend of the left elbow. 1035. Red, small, round spots on the hands and fingers. 1231. Pricking itching of the skin with miliary eruption after rubbing. 1232. Itching miliary eruption in the popliteal space and the joint of the elbow. 1234-35. Small red efflorescence with itching, disappearing after scratching.
Fever. — 157. Sensation of heat in the head, and redness of the face. 158. Heat in the head, during the evening^ with increased temperature of the cheeks.
1266. Whilst in a sitting posture, almost burning heat is felt in single small spots. 1358-68. Fever consisting only of heat. 1357. Describes a febrile paroxysm with trembling of the limbs, which was characteristic in this variety of the epidemy. 1371. Quick pulse, sometimes with a sensation of increased temperature.
Angina. 370. Pressive pain in both tonsils during deglutition, in the evening and throughout the night. 373. Feeling of contraction in
76 ERUPTIVE FEVERS.
the throat whilst swallowing. 374. Pain in the throat, as if caused by internal swelling. 376. Pain in the throat whilst swallowing, with swelling of the external parts, and of the tonsils.
Lungs, — 807. Tightness of chest, two successive evenings, with small quick pulse.
Mouth, and intestinal canal. 352. Dryness of the tongue.
390-96. Much thirst. 391. Dry, cracked lips.
613. Viscid, light yellow stools.
622. Solid, light- coloured stools.
627. Thinner and easier stools than ordinary.
1288, In the morning on awaking involuntary discharge of liquid stools.
Urinary System.
673. Diminished emission of urine, of a pale colour.
666-68. Strangury.
675. Frequent and somewhat increased emission of urine, varying from the clearness of water to lemon colour.
677. Frequent but not copious emission of scanty, very light- coloured urine.
679. Involuntary emission of urine whilst blowing the nose.
Nervous Symptoms. a. Delirium. 11. Fear of thieves, or horrible visions whilst waking, as in febrile delirium.
48. Unconnected ideas.
1310-29. Restless sleep with anxious dreams, and delirium.
b. Indications of Paralysis of the Brain ;
49. Diminished faculty of comprehension, and difficulty of col- lecting the thoughts.
50. Absence of thoughts, and mental torpor.
51. Oblivion of what has transpired during the day.
52. Great forgetfulness.
55. Sensation of weakness in the head. 217. Transfixed, motionless eyes, with absence of mind. Further, with regard to the symptoms combined with suppressed activity of the brain : —
263-64. Pale countenance ; and 1029. Cold hands.
SCARLATINA MILIARIS, 77
Rademacher also mentions, as the primary effect of zinc, cc great disposition to sleep, and a state between dreaming and sleeping/5 and employs it for this reason in delirium ; he, at the same time, admits its usefulness against sleeplessness in acute diseases of the brain, and considers its principal effect to be on the brain. When we come to compare the ensemble of these symptoms with the first variety of scarlet fever above described, wTe find a reflection of the whole picture of the disease ; we see an eruption not dissimilar to that of scarlet fever, a febrile state, which consists only of dry heat, with a quick pulse and excessive thirst, as also the symptoms of difficult deglutition, (not merely those which are spasmodic, but likewise those which arise from swelling of me tonsils.) These are the reasons in general that are calculated to determine us to employ Zincum in scarlet fever ; but that which chiefly points out the sphere of its operation is its influence upon the brain, with incipient signs of paralysis of that organ, giving rise to the following concomitant phe- nomena: involuntary evacuations of faeces and urine, diminished temperature of the skin, accelerated pulse, trembling or paralytic state of the extremities. On the other hand, with the exception of the single symptom of oppression, we do not meet with any indications of a paralytic affection of the lungs. From what has been stated, it is sufficiently obvious that Zincum can only be beneficial in those cases which are complicated with affections of the brain ; the efficacy of Zinc, in analogous states, e. g., in paralytic states of the medulla spinalis, has been long known. I found it necessary to prescribe Zincum in large and frequently repeated doses (gr. /3. — gr. j of the first trituration, — at the commencement every hour, afterwards every two to three hours), from the circumstance that, in consequence of the prostration of activity in the central organ of the nervous system, the organism is neither readily nor lastingly acted upon by external agency.
As we have just seen, both forms of the disease possess exactly those symptoms in common, in which Calc. and Zinc, resemble one another, and both differ in those in" which Calc. and Zinc, do not coincide. But in order to substantiate theory by practical evidence, may I be allowed to communicate at least two cases of cure by means of these remedies.
Oskar Graf, 3 years old, scrofulous, but strong, formerly afflicted for a long time with hydrocephalus chronicus, had, on the 31st of December, been affected with general dry burning heat during the
78 ERUPTTVE FEVERS.
whole day. January 1st he complained, after a sleepless nighty of headache and colic,, and vomited once ; in the course of the morn- ing the scarlet efflorescence began to appear, and spread over the whole body before the close of the day ; the skin was burning hot, the pulse small, weak, and could not be counted ; there was also profuse sweat. The child, usually so cheerful, lay still and quiet, with closed eyes, and answered only reluctantly if spoken to ; the face was bloated, the thirst excessive, and the patient drank often, but little at a time ; in addition to these symptoms, grinding of the teeth and convulsions of the face took place almost every half hour (both symptoms in this case probably arising from the presence of ascarides) ; delirium subsequently supervened. I prescribed, in the forenoon, Calc. 3, gr. j. The child remained in much the same state throughout the day, only, in the afternoon, the heat became diminished, and the gnashing of the teeth less frequent; in the evening, however, both returned, with increased restlessness and delirium. In the night, between January 1 st and 2d, the patient slept little, and was very restless, particularly between 12—1, and in the morning he passed the faeces and urine involuntarily ; the paroxysms of teeth-gnashing had not returned so frequently, and the child appeared to be in a less soporous state, but was boring rather more with his head into the pillow; the heat was no longer so excessive ; the pulse, towards evening, could at least be counted 152, and was consequently also no longer so small; the efflorescence looked well, (another dose of Calc. had been given that morning.) On January 3d the child was no better, and had passed a rather sleep- less and restless night ; the gnashing of the teeth was more violent and more frequent ; the patient went on boring witli the occiput into the pillows ; and there was great anxiety, with oppressed respi- ration, and mucous rattling; the pulse as it was the day preceding. Calc. was repeated, whereupon the attacks ceased entirely during the day, the restlessness subsided, the respiration was no longer so difficult, and in the afternoon the child slept for a short time ; in the evening the fever had not increased. During the following night the restlessness was not great, and the sleep continued for half an hour at a time ; in the morning, an involuntary alvine evacuation occurred, but there was perfect consciousness, no sopor, no delirium, no difficult respiration, and no mucous rhonchus ; the exanthema still looked ' well. Calc* repeated. In the evening the fever did not increase, the temperature of the skin moderate, and the
SCARLATINA MILIARIS. 79
pulse no longer small, 142. January 5th, the child had passed a quiet night, sitting cheerfully on the bed ; no dangerous symptoms were present, the eruption was receding, the temperature of the skin little increased, the pulse 115, no involuntary evacuations, and the child responded perfectly sensibly to all inquiries; no febrile exacerbation ensued in the evening. 1 accordingly discontinued the medicine, and the disease proceeded on its course, as free from danger as usual under the employment of Calcarea.
Oskar Wagner, 4 years old, an uncommonly tall, stout, over-fed, flaccid, scrofulous boy, was attacked with several fits of vomiting in the night, between December 20-21. On the following morning the vomiting had ceased, the child was very restless, the surface of the body cool, and the exanthema made its appearance. Cede. card. 3, gr. j. During the evening much heat, in the night delirium, and two involuntary, but liquid alvine evacuations. On the morning of the 22d very violent fever, the exanthema fully developed and very much raised, the single points or elevations standing together in groups ; Calc. repeated. During the day, delirium, great thirst, dry brown lips ; the state of the tongue could not be discovered, as the child could not be induced, during its whole illness, to show it; periodical unconsciousness and delirium, the latter continuing during the night with restlessness. Calc. repeated. On the 23d, early in the morning, intense fever with delirium. Calc. repeated. In the evening the child was in a state of complete sopor, pulse collapsed, small, 152; extremities cool, — Zincum 1, gr. j, every 2 hours ; the night very restless, much delirium. After midnight the child appearing quiet, the parents discontinued the medicine.
This supposed quietude was, however, a bad symptom, for on the morning of the 24th I found the child lying perfectly motionless ; the pulse very small, and could not be counted; utter unconsciousness ; the extremities icy cold, the rest of the body cool, and the whole cutaneous surface blueish-red, except about the eyes, forehead, and chin, these parts being white ; the eruption remaining was but scanty. Zinc. 1, gr. j, every two hours. After the first dose, symptoms of returning consciousness were already perceptible ; in the evening the skin was warm, and its blueish-red colour had disappeared; the pulse was somewhat strengthened, 150, and there was some degree of sweat; the night passed over pretty favorably, now and then delirium, but also several hours5 sleep. On the 25th, the child appeared to have recovered more consciousness, he recognized his parents and asked
8 0 ERUPTIVE FEVERS *
for something to drink. The temperature of the skin was some- what higher, the pulse no longer weak, 140, and, for the first time, the urine was not emitted involuntarily. Zinc, continued every three hours. The following night he slept perfectly quiet, without deli- rium ; in the morning he was in full possession of his faculties, and wished to play ; the temperature of the skin was natural, the pulse strong, 128, and the skin had commenced to exfoliate. Zinc, three times a day. On the 27th, the child was well, as far as circumstances could admit, and recovered perfectly without taking any more medicine.
The difference between the effects of Calc. and Zinc, in this epidemy, not only as elucidated by the symptoms enumerated in the Materia Medica, but also as established by experience, consists accordingly in the following *. Calc. operates more upon the organs of the chest, Zinc, more upon the brain ; Calc. diminishes the immo- derate febrile heat and the frequency of the pulse ; Zinc, does not affect the frequency of the pulse which is associated with febrile heat, but removes the icy coldness of the skin, (the result of depressed vitality), strengthens the small, quick pulse, and reduces it to a normal state of frequency; Calc. is only useful in slight delirium, but very effective in violent angina ; Zinc, is as beneficial in violent delirium alternating with sopor, ajs in paralysis of the brain ; Calc. is, on the other hand, preferable in incipient paralysis of the lungs. I must guard myself here against the imputation of any intention to hold Zinc, and Calc. curative in all malignant cases of scarlet fever, by sta- ting, that it was only in this epidemy that I found them of such great efficacy, and it is only in similar instances that their beneficial effects may be looked for. I was induced to make these communications, chiefly from the circumstance that I consider it would be attended with great advantage if the different epidemies were carefully described and compared, their distinguishing characteristics pointed out, and the remedies mentioned which had proved most serviceable in each, — as it is mainly by such means that the selection of the specific remedy, at the first outbreak of the disorder, can in future be facilitated, and a number of sacrifices thereby avoided/5
The remedies required for the occasional sequelae of scarlatina miliaris are the same as those enumerated at the conclusion of the chapter on Scarlatina.
MEASLES. 81
MEASLES. Rubeola.
This disease generally reigns as an infectious epidemic, and, for the most part, confines its attack to children, in which cases it is seldom, when properly treated, either severe or dangerous ; wThen it occurs in adults, it generally assumes a more critical character, It rarely attacks an individual a second time.
Measles is not to be so much dreaded for itself, as for the dele- terious consequences it, under an improper mode of treatment, frequently entails, or to use the technical term, the dreg it leaves after it, which, in many constitutions, develop an inherent disposition to consumption.
Diagnosis. Catarrhal symptoms, such as short, dry cough, lachry- mation, with redness of the eyes, and a degree of fever, more or less marked, preceding the eruption from three to five days, and generally continuing as long after, or all through the disease.
Eruption of a number of small red spots (frequently papular), the skin, in thcintervals between them, generally preserving its natural colour, and sometimes exhibiting a faint reddish hue. We often find them in the shape of small irregular arcs. They, for the most part, make their first appearance on the face and neck, become confluent, and extend themselves gradually downwards over the rest of the frame. About the sixth or seventh day from the time of sickening, the eruption begins to turn pale on the face, and afterwards on the rest of the body, and, generally, entirely disappears about the ninth day, with a bran-like desquamation of the epidermis, a distinguishing sign of this disease.
Therapeutics. Aconite has been regarded, in some instances, as almost specific against measles, and in its mild form, will frequently be found sufficient, in a few doses, to conquer the disease, or at least mate- rially to shorten its duration. This remedy is particularly indicated, when the fever assumes an inflammatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration ; and is more or less useful, throughout the course of the malady, either alone or in alternation with Pulsatilla, or any of the other remedies which
6
82 ERUPTIVE FEVERS.
may be better indicated, whenever marked febrile or inflammatory action becomes prominent. [Coffea or Hepar are frequently useful after Aconite, when there is a distressing, dry cough.)
Pulsatil.l.a is also very efficacious, and even specific in this disease, and is frequently indicated at the commencement, from the strong resemblance which some of its pathogenetic properties bear to the catarrh attendant upon measles, together with the characteristic exacerbation of the symptoms towards evening, &c* This remedy is, moreover, of great utility in bringing out the eruption, when it is longer than usual in making its appearance; but, whilst the fever is high, Aconitum must be administered, and, if the febrile irritation does not diminish after a dose or two of Aconitum, Sulphur may be given, after which, if the fever return with increased force, Aconitum will rarely fail to answer our expectations.
When there is great oppression at the chest, before the eruption is evolved, a dose or two of Ipecacuanha is very useful.
Pulsatilla is also valuable w7hen any gastric derangement is present, or when the cough, which so generally accompanies the disease, is worse towards evening, or in the night, and is attended with consider- able mucous rhonchus, or copious, thick, yellowish or whitish expec- toration, sometimes followed by vomiting, or symptoms ofepproaching suffocation ; further, when there is coryza with a thick, yellowish or greenish nasal discharge. {Sulphur is frequently of considerable ser- vice after Pulsatilla, particularly in strumous subjects. Where there is dry nocturnal cough, Nux v. will be found useful, especially in dark-complexioned subjects.)
Belladonna. When the inflammation attacks the throat, pre- senting many of the throat symptoms we have given for this medicine under Scarlet Fever, attended with great thirst, which the patient is often prevented from indulging by the acute shooting or pricking pain in the throat produced by swallowing ; and further, when there is a hoarse, dry, barking, and somewhat spasmodic cough, worse at night, with mucous rhonchus, great restlessness, and high nervous excite- ment ; also, in those cases of measles, where no eruption declares itself, but simply headache arid catarrh, with severe inflammation of the eyes, which present a glassy appearance, are bloodshot, or streaked, and watery; finally, when evident signs of cerebral irritation set
* Pulsatilla and Bryonia are two of the most important remedies, when there is promi- nent bronchitic complication. (See also Bronchitis.)
MEASLES. 83
in. (Against ulcerations on the cornea, Merc, followed by Calc. or Separ s.)
Bryonia is an excellent remedy, when the eruption is faint, or imperfectly developed, and the respiration much oppressed and labo- rious, attended with aching in the limbs ; also, when there is dry cough, and the patient complains of shooting pains in the chest, increased by a full inspiration.
This disease has frequently terminated fatally, from the eruption being driven in by sudden exposure to cold or change of tempera- ture ; in such cases, Bryonia, administered as above, is generally found efficacious in re-evolving the eruption, and preventing this disaster ; if diarrhoea, with mucous discharge, follow the suppression, Pulsatilla is indicated ; if the vomiting, with great oppression at the chest, be the more prominent symptom, Ipecacuanha should be substituted, and followed in turn by Arsenicum, if symptoms of improvement do not speedily show themselves :. — In the case of chil- dren, Cliamomilla is to be preferred to Ipecacuanha, when there is dyspnoea and diarrhoea with colic and vomiting. When symptoms of cerebral disturbance supervene, Cuprum aceticum,* Belladonna, and Stramonium, or Sellelorus niger, Arsenicum, and Sulphur, have proved of the greatest utility ; — and in the case of pulmonic inflammation* Phosphorus, t Bryonia, or Sulphur, should Aconitum and Pulsatilla not suffice. In those comparatively rare cases in which typhoid symptoms manifest themselves, either during the course of the disease, or at its termination, Bryonia, Arsenicum, and Phosphorus will be found useful, where any chance of recovery remains. (Vide Typhus.)
For the treatment of coughs, which sometimes remain after measles, Sulphur, Sepia, Carlo v., Conium, Chamomilla, Drosera, Dulcamara, Syoscyamtis, Ignatia, Nux v., Belladonna, &c, are very serviceable. (See Coughs.) Against Laryngitis, Aconitum, Separ s., Spongia, Belladonna, Lachesis, Arsenicum, Mercurius, &c. (See Laryngitis.)
For the diarrhoea, which the disease sometimes leaves behind it, Cinchona, Pulsatilla, Mercurius, and Sulphur are in general the most appropriate remedies ; for their several indications, see Diarrhoea. For otitis or otorrhcea, Pulsatilla, Carlo v., Sulph., Merc, and Separ sulphuris (chiefly) ; for parotitis, Arnica, and Phos. ; for tenderness of the skin, Mercurius; for miliaria alba (chiefly), Nux v.; and for burn- ing, itching rash, which bleeds after scratching, Arsenicum and Sulphur are severally indicated.
* Vide Scarlatina, p. 64.
84 ERUPTIVE FEVERS.
As a precautionary measure agaist the attacks of this disease, when epidemic, we may prescribe a few globules of the third or sixth potency of Pulsatilla, in a little water, followed by Aconitum, at the same potency, three days after; allow the latter medicine to act for twenty-four hours, and continue the alternation for a fortnight, renewing it, when necessary, at the termination of a week or ten days. This treatment will, frequently, be found sufficient to ward off this disease, or if it be taken, will generally reduce it to an extremely mild form.
Diet. In this respect we may follow the rules given under Scarlet Fever.
SMALLPOX.
Variola.
This disease is, by pathologists of the present day, divided into two varieties — the distinct, when the pustules on the face are clearly defined, and do not run into one another ; and the confluent, when they coalesce and form one continuous whole.
When the symptoms are less severe than those properly character- istic of the disease, and the eruption on the face slight, it is called the modified smallpox. We generally find this description in such per- sons as have been properly vaccinated, a precaution which, although not always a preservative from the attacks of variola, greatly lessens its virulence, and gives a milder character to the complaint, when taken.
Diagnosis. The disease is frequently very sudden in its attacks, commencing with chilliness and shivering, followed by febrile symp- toms, headache, severe pains in the small of the back and loins, languor, weariness and faintness ; the patient also complains of oppres- sion of the chest, and acute pain in the pit of the stomach, increased hy pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Catarrhal symptoms, as sneezing, coughing, wheezing, and frequently difficulty of breathing, often accompany this disease.
SMALLPOX. 85
The eruption first displays itself in the shape of small, hard-pointed, red elevations, which, in about three days, present a vesicular appear- ance, surrounded by an inflamed circular margin, and become depressed in the centre as they enlarge. About the sixth or eighth day, the lymph in the pustule becomes converted into pus, and the depression in the centre disappears.
When the pustules are very numerous on the face, it generally becomes much swollen, and the eyelids are frequently closed up. On the first day, a small lump, like a millet-seed, may be felt in each of the elevations above noticed, distinguishing this eruption from all other exanthemata. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course ; thus, those which first appeared, are forming into scabs, or dying off, while the others are suppurating. The general desiccation commonly takes place on or about the eighth or fourteenth day, according as the pus- tules may happen to be distinct or confluent.
When the pustules have attained their full development, they gene- rally burst, in mild cases emitting an opaque lymph, which dries into a crust and falls off, whilst in severe ones, we find a discharge of puriform matter, forming scabs and sores, M7hich leave, on their heal- ing, permanent marks or pits. Red stains, caused by increased vascular action, always remain for a while after the eruption ; but if no ulceration has taken place, they disappear in process of time.
In Confluent Smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease ; the pain in the pit of the stomach, and difficulty of breathing, are more complained of, and, in children, the eruption is frequently preceded by convulsions and delirium ; the latter symptom, indeed, is frequently present with adults, during the suppurative or secondary fever, which frequently assumes a typhoid character, and sometimes carries off the patient on the eleventh day. All cases, in which we have generally a deep-rooted morbid constitu- tional taint to contend against, require the utmost skill of the expe- rienced practitioner to ward off a fatal result. An extensive erythe- matous efflorescence of the face or trunk almost invariably precedes the confluent variety of smallpox.
Salivation, with soreness of the throat and aphthae, or pustules on the tongue and pharynx, frequently declares itself in both forms of this disease, but more particularly in the confluent.
Before we come to the medicines to be administered in the different
86 ERUPTIVE EEVERS.
stages of the disease, we may say a few words upon the general treat- ment of the patient.
Cool' and fresh air are our best auxiliaries, the variolous virus being of a nature to react upon the organism, and warmth being calcu- lated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open windowT when attacked with convulsions, will generally be found to afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed.
When the vesicles declare themselves, and begin to form into pus- tules, the room ought to be kept as dark as possible, to aid in pre- venting the risk of disfigurement, a precaution deducible from common experience, since we find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease.
Therapeutics. In the first or febrile stage of the disorder, Co f- fea is valuable in allaying the nervous excitability generally present.
Aconite may either follow or precede this medicine when the fever runs high, and visceral congestion threatens.
Chamomilla is often of great service at this period, or during the course of the disease in children, when there are dyspnoea and diarrhoea, with colic and vomiting; or when starlings or convulsions set in, prior to the appearance of the eruption, and again, during the maturative stage, when the nights of the little patient are much disturbed by a troublesome cough. Should Chamomilla afford but slight relief, Belladonna may be administered.
When considerable tightness and oppression at the chest, some- times attended with nausea and vomiting, are experienced before the appearance of the eruption, the alternate use of Ipecacuanha and Antimonium tartaricum affords speedy relief. The latter remedy is, moreover, well indicated when convulsions precede the evolution of variola; and, from the close analogy which the eruption it is capable of producing bears to that of smallpox, may be administered with advantage during the eruptive and maturative stages also, unless some other remedies should be more urgently called for by the nature of the symptoms ; the existence of a hollow sounding cough, with loud mucous rhonchus, is an additional index for the employment of Antimonium tartaricum.
Bryonia is sometimes useful in assisting the natural course of
SMALLPOX. 87
the eruption ; it is also indicated when symptoms of considerable gastric derangement are present, such as bitter taste in the mouthy foulness of the tongue, headache, rheumatic pain in the limbs, increased by motion, constipation, and irritability of disposition; also, when there are occasional shooting pains in the chest, especially during inspiration.
Rhus is equally serviceable at this stage of the disease, and par- ticularly, when the acute pains in the head, back, and loins are aggravated during a state of rest, and temporarily relieved by move- ment.
Belladonna. This remedy may follow Aconite, when the latter has been indicated, should symptoms of cerebral disturbance have set in, characterized by flushed countenance, intolerance of the eyes to light, headache, and delirium, great thirst, nausea, and vomiting ; or, when there is redness of the tongue at the tip and margins ; abdomen tumid and painful, particularly at the" epigastrium, with sensibility on pressure ; prostration of strength, stupor, &c.
For additional indications for the employment of this remedy, see Inflammation of the Brain and its tissues.
Opium is useful when there are symptoms of stupor or strong inclination to somnolence.
If Antimonmm tartaricum and Ipecacuanha do not succeed in allaying the nausea and vomiting, and the patient complains of excessive thirst and dryness of the mouth, the tongue being at the same time very foul and dark, and the prostration of- strength excessive, we may prescribe Arsenicum — (the dose to be repeated every two or three hours, if required, but the remedy must be discontinued as soon as decided benefit has resulted from its action). The last symptom generally occurs after the maturation of the eruption and secondary fever.*
Pulsatilla is occasionally of considerable utility in confluent smallpox, when an efflorescence, similar to that of measles, precedes or accompanies the eruption, attended with nausea or vomiting, and aggravation of all the symptoms towards evening.
An occasional dose of Stramonium, two globules, is sometimes useful,
* In some cases, and especially those of a bad type, livid spots, or diffused ecchymoses are observed on the skin, prior to the evolution of the eruption {variola nigrce). Arsenicum is here also of considerable service, particularly when great weakness and languor, thirst, nausea, or vomiting, with pain in the epigastrium, are present. Acidum muriaticum, in re- peated doses, has been found of important service in cases of a similarly bad type, with typhoid fever, and constant tendency of the patient to sink downwards in the bed.
88 ERUPTIVE FEVERS.
when some pustules are already formed, in forwarding the eruption, and shortening its duration.
During the filling up of the pocks, a secondary or suppurative fever frequently sets in, particularly when the pustules are thick, and evince a disposition to run into the confluent form ; when, more- over, there is swelling of the head, inflammation of the eyes, throat, and nose, with salivation, hoarseness, and impeded deglutition; tenderness of the stomach ; diarrhoea, with tenesmus, and sometimes sanguineous stools. Having, if this remedy be called for, first attacked the more prominent febrile symptoms, with Aconite, we should have recourse to Mercurius, 3—6, a few hours afterwards, in repeated doses, until amelioration declares itself. When the fever runs high, in confluent smallpox, and threatens to continue so, as it often does throughout this form of the disease, Aconite must repeatedly be had recourse to, and given in alternation with Sulphur, when not sufficient of itself to mitigate the excessive febrile action.
While the disease is running its course, particularly during the distension of the pustules (should no other remedies be imperatively called for), and also towards the period of their bursting, we may safely administer an occasional dose of Mercurius as above, and in the latter case, follow this medicine with a dose or two of Sulphur, to assist in the desiccation.
When rheumatic pains, in the back and extremities, which become worse at night, and are somewhat relieved by movement, are com- plained of at this period, Rhus may be advantageously alternated with Sulphur. Rhus is moreover extremely serviceable in confluent smallpox, when the fever assumes a typhoid type, attended with the signs ^denominated putrescent ; Mercurius and Arsenicum are also occasionally useful in the latter case, when indicated by the character of the symptoms. (Vide Typhus.)*
During the period of desiccation, frequent laving of the pustules with tepid water and bran, and gently drying them afterwards, will be sufficient ; cleanliness being then the great requisite, combined writh a careful attention to diet.
Repercussion of the Eruption. When this has taken place,
*When Pleuritis or Pneumonia intervene during the progress of the disorder, the remedies mentioned under these different heads must be had recourse to. The invasion and progress of the latter disorder are sometimes so insidious, that, unless the aggregate signs of pneumonic inflammation be narrowly looked for, disorganization of the lung may take place before the existence of such a complication is detected.
SMALLPOX. 89
and symptoms of cerebral disturbance have set in, we may have immediate recourse to Cuprum aceticum, provided Belladonna, Sulphur, Bryonia, or some other remedy be not better indicated. Some physi- cians, in their treatment of the affection, divide it into two distinct stages; we have, however, contented ourselves, when necessary, with slightly referring to them. Should Laryngitis supervene during the course of smallpox, we must have immediate recourse to Aconite, Hepar s., Spongia, Belladonna, Lachesis, Arsenicum, or Mer- curius, &c. (See Laryngitis.) Against the cough, which some- times results from an attack of smallpox, Belladonna, Mercurius, and Arsenicum, are three of the most appropriate remedies in most cases, (the particular indications for which will be found in the article on Coughs, which see;) and against asthmatic symptoms, attended with mucous rattling in the chest, Tartarus emeticus should be em- ployed, and followed by Senega, if insufficient to effect a cure. When, in the suppurative stage of confluent smallpox, the pus becomes sanious, and sphacelus is apprehended, Arsenicum and Carlo v. may exert a beneficial effect.
Cinc/wna and Phosphorus have repeatedly been found specific against the Diarrhoea, which occasionally results : — and against the Ophthal- mia, Conium, Belladonna, Hepar sitlphuris, Euphrasia, Sulphur, Calcarea, Arsenicum, Pulsatilla, Mercurius, Nux vomica, and Rhus toxicodendron, have been found the most useful remedies.
Modified Smallpox is merely a mild description of the above, and, as we have before said, is the form the disease generally assumes, when it attacks those who have been properly vaccinated. We must regulate our treatment according to the symptoms, being guided in the selection of the remedies by the indications before given.*
Diet should be regulated by the virulence of the attack ; but, in all instances, the beverages should be cold, as a warm regimen, and neglect of the precautions before mentioned, may convert the mild into the malignant form. After recovery, it is necessary that the patient abstain, for a considerable time, from animal food.
* I have given in detail the treatment which has been generally adopted by Homoeopa- thists, and with great success. But it may here be added, that Vaccinine, given internally, has obtained much repute, as an important and eminently successful remedy, in the treat- ment of variola, the most virulent cases having been reported to have yielded to it, with a promptness and certainty, that would afford another great illustration, if such were needed, of the truth of the homoeopathic law.
90 ERUPTIVE FEVERS.
It may be remarked that, after an attack of malignant smallpox, the patient's constitution generally requires a thorough renova- tion,— he should, therefore, be put under a course of medicine best calculated to attain that result.
CHICKEN-POCK. Variola spuria, Varicella*
Diagnosis. A disease, bearing a considerable resemblance, in its external character, to smallpox, but differing in its duration, and symptomatically, being considerably milder, generally requiring no medical assistance, but merely attention to diet, and but rarely becom- ing dangerous, except when the lungs or brain become involved. The fever, however, occasionally runs high.
When this affection attacks an individual during the prevalence of smallpox, which is not unfrequently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with which the eruption declares itself; the pustules (in many instances closely resembling those of the smallpox), being generally fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark.
Therapeutics. When much fever is present, we should check it by the administration of Aconite, repeated from time to time as required, or Coffea, also occasionally repeated, if there be simply extreme restlessness and anxiety. When cerebral symptoms threaten, Belladonna must be given; for the employment of this medicine, see Inflammation of the Brain. When the complaint is attended with convulsions in children, particularly during dentition (see Con- vulsions), Antimonium tartaricum may be given to accelerate the eruption.
Mercurius, may be employed when the lymph of the pustules becomes converted into pus, as in the smallpox, and is also bene- ficial if strangury be present. For the course of treatment to be adopted when the eruption has been driven in, see Repercussion of the eruption' in Smallpox. In anomalous cases, where other symptoms supervene, more closely resembling Smallpox, we may refer to the remedies mentioned under that disease.
MILIARY EEVER. 93
MILIARY FEVER.
Miliaria. Miliaria alba. Miliaria sudatoria. Sudor miliaris.
Diagnosis. The primary feature of the disease consists of a great number of exceedingly small, round/ red pimples, which are soon converted into white vesicles, afterwards become opaque, and end in scurf; they are irregularly scattered, of the size of millet-seeds (hence the name of the complaint), and when the hand is passed over the cutaneous surface, a sensation is experienced as if caused by the pre- sence of small grains of sand beneath the cuticle.
This affection is sometimes idiopathic, but more frequently asso- ciated with fever, and even occasionally accompanies various chronic diseases, in which latter instance, it may generally be considered as an evidence of some internal constitutional taint : it is most frequently met with in women, particularly at the turn of life, and at the period of confinement (arising from the room being kept at too high a tem- perature—a frequent cause of this malady). This, like other cutaneous affections of the same nature, is generally preceded by febrile symp- toms, the eruption appearing on the fifth or sixth day ; from the com- mencement of the fever we frequently find profuse perspiration, with a putrid sour odour; previous to the vesicles evolving themselves, there is a tingling or itching of the skin, occasionally attended with a sen- sation of burning, together with a numbness of the extremities ; the patient complains of dyspnoea or a sense of oppression at the chest, sometimes with short dry cough, and stitches in the side, and not unfrequently, of creeping, tingling, numbness, weight and stiffness in the extremities, or severe or fugitive rheumatic pains in the limbs and teeth. Low spirits, excessive anxiety, extreme restlessness, sighing, tinnitus aurium, violent palpitation of the heart, irregular pulse, and the emission of clear, colourless urine, are also frequent premonitory indications of approaching Miliaria.
Prognosis. This must be regulated by the severity of the accom- panying symptoms. Death often takes place suddenly, particularly on the shrinking of the vesicles. When the morbid signs decline after the appearance of the eruption, the termination of the disease will commonly be favorable. In malignant forms of the complaint, a fatal issue sometimes takes place within twenty-four or forty-eight
92 ERUPTIVE EEVERS.
hours. The general course of the disease varies from four or five days, to three weeks. Convalescence, in severe cases, rarely sets in before the fourth week.
Therapeutics. In consequence of the numerous diseases with which miliary fever is complicated, it requires a variety of medicaments. When it appears in a simple and apparently idiopathic form, and is attended with anxiety and restlessness, which seem to depend upon an accelerated circulation of the blood, with great internal and external heat, Aconite is a specific remedy. When the above symptoms seem more particularly to arise from high nervous excitability, Cof- fea is indicated.
Belladonna should be administered when the accelerated circu- lation is attended with considerable determination of blood to the head, and delirium; but Arsenicum is the most appropriate remedy when the eruption is accompanied by excessive anxiety and oppression at the chest. (Veratrum is sometimes useful after, or in alternation with, Arsenicum,
When the disease is found conjoined with puerperal or other fevers, and is preceded by oppression, lassitude, anxiety, and a sense of weight about , the chest, restlessness, sighing, &c. ; it is generally speedily subdued by Ipecacuanha ; M'hen, however, the symptoms, which precede the eruption, are accompanied by constipation, or shoot- ing pains in the chest, Bryonia should be selected.
Nux vomica is useful when aching, gnawing pains are experienced in the epigastric region, attended with eructations, constipation^ and other signs of gastric derangement.
Calcarea carbonica is a most valuable medicament in critical miliary fever, especially against the extreme anxiety which is so fre- quently manifested, or against the convulsions which sometimes take place in the case of children, and finally as a general remedy to hasten the development of the eruption when it is tardy in making its appearance.
Chamomilla (followed, if no alteration takes place, by Tincture of Sulphur) is also useful when the disease occurs in children, brought about by excessive warmth, or even errors in diet, attended with a watery, greenish or yellowish diarrhoea.
Puis., Tart, stihiat., Straw., Acid, phosph., Led., Cocc, or Carl, v., may be required in certain cases.
When this disease is benign and appears in an idiopathic form, it
MILIARY FEVER. 93
is rarely so severe as to require a very frequent repetition of the medicines if the accessory treatment, about to be pointed out, be carefully attended to — in most cases, a globule or two, repeated in from four to twelve hours, according to the intensity of the disease, will be found sufficient, and, in some instances, a single dose will dissipate all the symptoms, or at least so modify them that we may safely trust to Nature to perfect the cure — but it is otherwise in the severer or more complicated forms of the malady. (See also Scarla- tina miliaris.)
Remarks. When it exhibits itself in complication with other affections, Miliaria may be either symptomatic or critical, and the physician should always bear in mind that an improper treatment of other affections may develop it. When symptomatic, it may be recog- nised by appearing either very early or late in the original affection, which, so far from being relieved by the eruption, is frequently exacer- bated by the excitement of the nervous system consequent on its appearance. Even when critical, — in which case, after the eruption has been fully developed, amelioration takes place, — it is still danger- ous from its liability to retrocede. When the disease is very prevalent, its outbreak amongst lying-in women may generally be prevented, if proper attention be paid to keeping the patient cool by light covering and the removal of feather beds, and allowing a free supply of pure air. When, however, it appears critical, we must be most careful not to check it, and a moderately warm temperature must be kept up.
Repercussion of the Eruption. When this has taken place we must carefully watch the result, as sometimes Nature herself provides for it by an increase of some other secretion, but when symptoms of cerebral disturbance, &c, present themselves, Cuprum aceticum, Calcarea <?., or Belladonna, &c, must be had recourse to, accord- ing to circumstances. (See articles Scarlet FEVER,and Scarlatina miliaris.)
Diet. Same as already given for Fever, modifying it according to the violence of the symptoms ; when repercussion threatens to take place, the patient's beverages should be given moderately warm.
94 ERUPTIVE FEVERS.
NETTLE-RASH.
Urticaria.
Diagnosis. Spots or wheals,, flat or prominent, and of a dull white colour, like the sting of a nettle, or redder than the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and reappearing when exposed to cold, evolved suddenly and con- tinually changing their situation.
This eruption is brought to the surface by various causes, not unfrequently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with restlessness, languor, oppression, and want of appetite, derangement of the digestive functions, and fever. When the erup- tion breaks out the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected. This disease, in almost all cases arising from a constitutional cause, requires for its total eradication a regular course of treatment.
Therapeutics. In acute cases, the remedies found most useful are Dulcamara, Aconite, Nux vomica, Pulsatilla, Antimonium crndum, Bella- donna, Hepar sulp/mris, Rhus toxicodendron, and Bryonia.
Dulcamara, when the exciting cause has been cold or damp, when the affection occurs in wet weather, or when we find con- siderable fever with bitter taste in the mouth, foul tongue, diarrhoea, pains in the limbs; and extreme itching, with a burning sensation after scratching.
Aconite, when the febrile symptoms are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present.
Nux vomica, when there is considerable gastric derangement, with constipation, more especially when arising from wine, stimulants, or indigestible substances ; it may, if necessary, follow Aconite in eight or twelve* hours after the febrile symptoms are somewhat modified.
Pulsatilla deserves a preference, under similar circumstances when the bowels are relaxed, and the patient is of a quiet disposition and lymphatic temperament, and the attack has apparently been excited by indigestible food.
NETTLE-RASH. 95
Antimonium crudum may follow Pulsatilla, should the latter have failed to relieve the affection.
Belladonna is indicated when the affection is attended with a severe throbbing headache, with redness of the face.
Hepar sulphuris has frequently been found useful in urticaria accompanied by cold in the head, and particularly when the coryza was confined to one nostril.
Hhus toxicodendron is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection has apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. (See Article on Diet in Introduction.)
Prescription. In ordinary cases, we may prescribe 6—12 globules of the sixth dilution in six dessert-spoonfuls of water, and order one to be taken morning and evening, except in the case of Aconite, which may be more frequently repeated, when the febrile symptoms seem to demand it.*
In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external applications or lotions ; a sudden retropulsion, as before noted under Scarlatina and Smallpox, being frequently attended with fatal consequences. When, however, from improper treatment, we have reason to dread this having taken place, we may generally succeed in re-establishing the eruption, and thereby averting any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symptoms declare themselves, the complaint should be treated as before described under Scarlatina, &c, — Repercussion of the eruption, which see.
Urtica urens has been found useful in some cases; and in those of a chronic or extremely obstinate character, Calcarea, Lycopodmm, Sul- phur, Card, veg., Causticum, Acid, nitric, Conium,Natr.mur.<i &c; the last two, particularly, when the eruption is liable to reappear after violent exercise or exertion of any kind ; Calcarea, when exposure to cold fresh air produces it ; and Acid, nitricum when it arises from the patient going into the open air, after having kept within doors for a day or two.
* See the directions for the repetition of the dose in the Introduction.
DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM.
TOOTHACHE.
Odontalgia.
When we find a constant disposition to this distressing nlalady, on the slightest exposure to cold, without any presumable cause, or what is generally called rheumatic toothache, we are warranted in concluding that some taint lurks in the constitution, and until proper measures are adopted for its eradication, even the remedies most clearly indi- cated under other circumstances, fail to relieve the patients, or at most but temporarily alleviate his sufferings. Another obstacle to the selection of the proper remedy is the difficulty we find in obtain- ing from the patient a perfectly clear description of his sensations. We shall, nevertheless, mention a few of the remedies which have proved most efficacious in the relief of toothache, and when the symptoms of the sufferer approximate closely to the indications given for the several medicines, they will, in very many cases, afford a prompt relief.
Therapeutics. Among these, Belladonna, Chamomilla, Mercurius, Nux vomica, Pulsatilla, Sulphur, Carlo vegetabilis, Hepar suVphuris, and Arsenicum, hold a high rank.
Administration. The medicine selected maybe taken dry, or dissolved in a little water ; and if an aggravation of pain is expe- rienced soon after taking the medicine, the dose must not be repeated, as this is generally succeeded by considerable relief; but when the pain threatens to get worse again, the same remedy may be repeated, provided the symptoms are of a similar description to what they were before taking the remedy ; if they have altered, select another medicine.
TOOTHACHE. 97
Belladonna is particularly indicated when the pains are very severe, of a drawing, tearing, or shooting nature, extending to the face and ears ; becoming aggravated in the evening, and especially at nighty with gnawing or boring pain in the carious teeth, swelling of the gums and cheeks, dryness of the mouth with excessive thirst, wTith or without salivation : renewal of the pains from intellectual labour, or after eating ; aggravation of suffering when masticating ; also in the open air ; congestion to the head, with heat and redness of the face, also pulsation in the head and cheeks.
Chamomilla, when there are severe drawing, jerking, pulsative or shooting pains ; heat and redness, especially of one of the cheeks ; the pain becomes almost insufferable, especially at night in the warmth of the bed; shooting and pulsative pains in the ear of the affected side ; the pains are aggravated by eating or drinking anything hot or cold, but espe- cially the former ; great agitation and loss of self-control from pain, or excessive weakness, sometimes amounting to fainting; great irascibility, and disposition to shed tears during the paroxysms, Chamomilla is useful When the toothache has arisen from an abuse of Coffee,* in which case Nux vomica and Pulsatilla are also valuable, when indicated by the sj'mptoms. Rhus and Dulcamara frequently answer best after Chamomilla in toothache from cold, when the last-mentioned remedy has not removed the attack. And when the toothache returns after every exposure to cold, Sulphur is, generally, the best remedy, but in some cases, Cinchona.
Mercurius is particularly indicated when the pains affect carious teeth, or exist in the roots of the teeth, and consist of tearing, shooting pains, occupying the whole side of the head and face of the part affected, and extending to the ears ; loosening of the teeth, and a feeling as if they were too long ; the pain becomes almost insup- portable towTards evening, and especially at night in the warmth of the bed, and is also aggravated by eating or drinking, particularly after anything cold has been partaken of, and likewise by exposure to cold or damp air ; swelling and inflammation of the gums ; nocturnal per- spiration, peevishness, and inclination to tears ; this medicine is especially useful in persons who are subject to glandular swellings.
* Those who are subject to toothache ought to abstain from coffee altogether ; as also from very hot or cold drinks, stimulants of every description, sweetmeats and acids ; they ought farther to refraki from using medicated tooth-powders, particularly if they wish to derive any benefit from homoeopathic treatment ; the toothpick ought to be cautiously used if required, and the mouth well rinsed with tepid water (or about the same tem- perature as that of the mouth), night and morning, and after each meal.
7
98 DIGESTIVE SYSTEM.
Nux vomica is useful For persons who are habituated to wine, coffee, or other stimulants, or addicted to a sedentary life, or to severe study ; of lively or irritable temperament, dark or florid complexion ; or whose sufferings are increased by intellectual labour. The pains generally occur in carious teeth, and are of a drawing and jerking or gnawing description, occasionally diffusing themselves to the head and ears, sometimes attended with painful enlargement of the sub- maxillary glands : gums swollen and painful, accompanied with throbbing and pulsation. The toothache is more liable to come at night or on awaking in the morning, sometimes also after dinner or in the open air.
Pulsatilla is peculiarly adapted to persons of a mild or phlegma- tic disposition. The pains are digging and gnawing, attended with pricking in the gums, and extending to the face, head, eye, and ear of the side affected ; this remedy is particularly efficacious in toothache, when accompanied with earache, or with paleness of the face, when the affection has been excited by taking cold, and when we find shortness and difficulty of breathing ; the pains are sometimes of a drawing, tearing, shooting, or jerking description, and occasionally produce a sensation as if the nerve were drawn tight, and then suddenly relaxed ; the pain is much aggravated in the evening or after midnight, generally increased by warmth and when the patient is at rest, and mitigated by cold air or cold applications to the mouth.
Spirit, sulphuris. This remedy is particularly valuable in strumous habits, with a tendency to constipation. It is indicated by pain, sometimes attended with swelling of the cheek, and shooting pains in the ears, congestion of the blood to the head, and pulsative head- ache ; the pain is of a tearing, jerking, pulsative description, affecting both carious and sound teeth ; aggravated in the evening and at night. or by exposure to the open air, also by the application of cold water or by mastication ; sensation as if the teeth were loosened, elon- gated, and set on edge ; the gums are swollen, affected with ptilsative pains, and bleed easily.
Bryonia is also a useful remedy in this affection, particularly with persons of a lively, choleric, and obstinate disposition. Its indications are loosening and sensation of elongation of the teeth, espe- cially during or after eating ; shooting in the ears, with inclination to lie down, pains aggravated by taking anything hot in the mouth, mitigated by lying on the affected side or exacerbated by the con- trary position.
TOOTHACHE. 99
Carbo vegetabilis is indicated by toothache, with dragging, tearing, or constrictive and throbbing pains, excited by anything hot, cold, or salt ; chronic looseness of the teeth ; receding, ulcerated, and suppurating gums (particularly after the abuse of mercurial preparations, such as calomel, etc.), bleeding of the teeth and gums, with tendency of the teeth to decay rapidly.
Hepar sulphuris is indicated by dragging, jerking toothache increased by approximating the teeth (clenching), by masticating, or from sitting in a warm room ; swelling of the gums, with tenderness on pressure, or abscess in the gums. This medicine is especially useful in cases where hurtful doses of Mercury have previously been taken under allopathic treatment.
Arsenicum, when there is nocturnal pain, which extends into the ear, cheek, bones of the face, and temple; aggravation of the pain by lying on the affected side ; amelioration from the warmth of the fire ; aching in the teeth so excessive as almost to drive the patient to madness or distraction ; sensation of elongation and looseness of the teeth ; grinding of the teeth, and bleeding of the gums.
Aconite, Belladonna, Chamomilla, Coffea, and Ignatia, are the most useful in affections of this nature with children.
Aconite, when the pains are difficult of description, or are de- scribed as being of a pulsative nature, attended with great agitation, feverish sensation, blood to the head, heat and redness of the face, and when the pains are described as of a pulsative, throbbing nature.
Coffea, against violent pains with great excitability and almost distraction in adults ; also when the patient is conscious that the excitement is disproportionate to the pain suffered.
For Chamomilla we have already given indications ; if it prove insufficient, and the toothache has been caused by a chill, and is attended with diarrhoea, we may substitute Dulcamara.
Ignatia is suitable for such cases as present similar indications to those of Nux vomica or Pulsatilla, but more particularly applicable to mild or sensitive dispositions, with alternation of high and low spirits.
Tartarus emeticus will often be found beneficial in toothache occurring during cold, wet weather, — particularly in women, — with nocturnal exacerbation, or aggravation of the pain when drinking any cold liquid.*
* In rheumatic or arthritic toothache with nocturnal aggravations, or increase of pain
100
DIGESTIVE SYSTEM.
Assafcetida may generally be prescribed with advantage when the pain is chiefly of a subdued description, and is intermittent ; also when it partakes of a burning or shooting character, and seems to proceed from within outwards.
SORE THROAT, or QUINSY. APHTHOUS SORE THROAT.
Angina faucmm, Tonsillitis p/ilegmonoides, Cynanche tonsillaris. — Angina apJithosa, etc,
Qcjinsy. — Diagnosis. Inflammation of the throat, denoted by swelling and red colour of the back part of the throat, accompanied with difficulty of swallowing, impeded respiration, alteration of the voice, and fever.
In the incipient stage of this affection, there is a sense of constric- tion about the throat, with a feeling of soreness, and sometimes of obstruction in the act of swallowing the saliva ; if it runs its course, the difficulty of swallowing and breathing increases, the tongue swells and becomes foul, the tonsils assume a redder hue, 'occasionally a number of small yellow eminences appear at the back of the throat, particularly on the tonsils ; the patient complains of thirst, and the pulse is high, strong, and frequent ; sometimes the cheeks swell and become florid, and the eyes inflamed, and in severe cases delirium is not an unfrequent occurrence. As the local affection progresses the majority of the foregoing symptoms become aggravated, and the ton- sils tumefied, and suppuration ensues if resolution be not speedily effected.
When suppuration takes places, the pain is instantly relieved on the bursting of the abscess; it sometimes happens, however, that scarcely has the patient been relieved from suffering by the latter event, before the state of the other tonsil gives indications that a similar train of symptoms are about to be encountered there. This affection, occasionally dangerous, if not" properly treated, even in its simple form, becomes particularly critical when it puts on the putrid
on partaking of cold or warm drinks, but with temporary relief on the external application of heat ; also in toothache which returns every spring or autumn during the prevalence of easterly winds, (and then continues sometimes for several weeks,) the pain being occasionally confined to one tooth, which is extremely sensitive to the slightest touch, and often accom- panied with acute shootings into the ear, Rhododendron Chrysanthum. is a useful remedy, in repeated doses.
101
type. In such instances, the attendant fever generally assumes a typhoid character; when this takes place, we may always infer a pe- culiar constitutional tendency.
Therapeutics. The following are the principal remedies used in the treatment of quinsy : Aconitum, Belladonna, Mercurius, Carlo v., Acidum nitricum, Lachesis, 'Pulsatilla, Nux v., Arsenicum, Chamomilla, Ignatia, Dulcamara, Hepar sulphuris, Silicea, Stil/phur.
When this disorder is, at the commencement, attended with consi- derable fever, thirst, and dry heat, deep redness of the parts affected, painful and difficult deglutition, pricking sensation in the throat, with aggravation of the symptoms when speaking, we should have recourse to Aconitum.
The next medicament we shall mention, Belladonna, as may have been observed in the treatment of Scarlatina, Measles, &c., is one of the best remedies we possess against phlegmonous inflammation of the throat, more especially when it occurs in plethoric or lymphatic subjects. The following are the symptoms by which it is particularly indicated :
Pain in the throat as if from excoriation, attended with scraping, and a sensation of enlargement, and burning or shooting pains, principally experienced during the act of swallowing ; these pains sometimes extend to the ears. Other characteristic indications for this remedy are — a sense of spasmodic constriction or contraction of the throat, with constant and almost uncontrollable desire to sivalloiv the saliva; occasionally there is violent thirst, with dryness of the throat, but a dread of chink from the suffering it occasions. Sometimes a complete inability to drink exists, and the liquid returns by the nostrils. On examination, the throat presents a bright red colour, with swelling of the palate, uvula, and tonsils ; there is also an accumulation of slimy whitish mucus in the throat and on the tongue, obliging the patient to spit frequently ; swelling of the muscles and glands of the neck, severe headache, chiefly confined to the forehead, sometimes determination of blood to the head, and delirium. (After Belladonna, — Mercurius, Lachesis, or Pul- satilla are often suitable.)
This remedy frequently succeeds in speedily removing the whole of the above group of symptoms, or, at least, so far subdues them as to enable Mercurhos to complete the cure.
Mercurius is frequently valuable at the commencement of the disease, and forms one of our best remedial agents; in some cases
102 DIGESTIVE SYSTEM.
advantage accrues from the employment of Belladonna in alternation with it. The indications for its selection are : violent shooting in the throat and tonsils, especially when swallowing, — these pains extend to the ears, and glands before the ears, and under the jaw ; inflammatory redness and swelling of the affected parts of the throat, burning in the throat, desire to swallow, attended with a sensation of an obstruc- tion existing in the passage ; accumulation of thick and tenacious mucus in the throat, difficult deglutition, especially of liquids, which sometimes escape through the nostrils ; swelling of the glands, and muscles of the neck, and of the posterior part of the tongue ; occa- sional swelling of the gums ; unpleasant taste in the mouth, which is filled with saliva more or less inspissated ; throbbing, and formation of matter in the tonsils ; (confluent, or small, isolated, round, white specks or vesicles on the tonsils ; indolent ulcers in the throat ;) (An- gina aphthosa) ; offensive odour from the mouth ;■ aggravation of the symptoms at night, from the act of speaking, and in the evening ; chills, and shivering, sometimes alternated with heat ; nocturnal sweat- ing. (Lachesis, Hepar sul/phuris, Carl, v., or Ac. nit. are often suitable after Merc.
Lachesis. One of the characteristic indications for this remedy is, aggravation of all the symptoms on awaking from sleep, or an in- crease of the pain in the throat from the slightest external pressure ; it is, moreover, an excellent remedy in cases of tonsillitis in which Bella- donna or Mercurms have afforded relief, but seem incapable of effecting resolution ; and also in aphthous sore throat with considerable ulcera- tion, when Mercurms has afforded only partial relief.
Carbo vegetabilis. This remedy may either follow, or be selected in preference to, Mercurius, — after a previous dose or two of Aconite when necessary,— in Aphthous sore throat characterized by the appearance of small white specks or pimples (which, if not checked, become confluent and spread beyond the throat) on the en- larged and protuberant tonsils, when the patient complains of severe burning and pricking pain, with great thirst.
Acidum nitricum is indicated when Aconite and Mercurius have been administered in Aphthous sore throat, characterized by superficial ulcerations in the throat, and the small white or grey ulcers refuse to put on a healing appearance a few hours after the use of the latter remedy.
Nux vomica. This remedy is especially useful when the sore throat appears to arise from, or to be accompanied by, symptoms of
SORE THROAT, OR QUINSY. 103
deranged digestion, and when a sense of scraping or excoriation exists in the throaty and also when a feeling of contraction is experienced in the upper part of the throat during empty deglutition ; secretion of viscid mucus, which can be expectorated only with great difficulty, and sometimes accumulates in such a quantity as to threaten suffo- cation ; or there is swelling and elongation of the uvula, producing a constant desire to swallow ; at times only a sensation of swelling, with aching pressive pains ; . or when cold has been the exciting cause, and the affection is attended with dry cough and headache, chiefly in the morning, and pains under the lower ribs during the cough. This remedy is likewise indicated when there are small offensive ulcers of the throat, or when considerable debility is present. (Vide Ulcerated Sore Throat. SulpJmr is frequently useful after Nux vomica?)
Pulsatilla is frequently serviceable after Belladonna when there is an undue secretion of viscid mucus in the fauces ; — but it is more particularly when the following symptoms are met with that this remedy is called for: gastric derangement, with dark livid redness of the throat and tonsils ; a sensation as if the parts affected were much swollen, or a feeling of enlargement in the upper part of the throat, as also of excoriation and scraping, with dryness of the throat without thirst; shooting pains in the throat when not swallowing; aggravation of the symptoms towards evening, attended with shivering ; also accu- mulation of adhesive mucus in the throat. This remedy is more parti- cularly suitable for females, or for individuals of a mild and phlegmatic temperament.
Chamomilla is a remedy particularly useful in sore throat when it occurs in children, or in nervous or sensitive females who suffer much from trivial ailments, and especially when the disease has been brought about by checked perspiration, — when there are shooting or burning pains, with a sensation of stvelling in the throat, deep redness of the parts affected, inability to swallow solid food, especially when lying down ; thirst, with dryness and heat of the mouth and throat, or secretion of frothy saliva with burning heat in the throat and gullet ; swelling of the tonsils and glands before the ear and under the jaw ; cough excited by constant tickling in the throat, attended with hoarseness ; fever towards evening ; alternate heat and shivering, redness of the face, hot especially of one cheek, great excitability and tossing about.
Ignatia is indicated when there is a sensation as of a plug in the
104 DIGESTIVE SYSTEM.
throat when not performing the act of deglutition, with red and inflam- matory swelling of the tonsils or palate ; burning pains during the act of deglutition, as if the substance being swallowed were passing over an excoriated surface, or partially obstructed by some foreign body in the throat. Liquids are more difficult to swallow than solids ; there are also shooting pains in the cheeks, thence extending to the ears, when not performing the act of deglutition j induration of the tonsils or evolution of small pustules upon them.
Dulcamara is generally a most useful remedy when sore throaty particularly in the form of tonsillitis, has arisen from exposure to tvet. It may be followed by Belladonna or Mercurius, should it not wholly remove the affection, and should any of the symptoms given under these medicines present themselves.
Coffea cruda. Sometimes useful as an intermediate remedy when many of the symptoms enumerated under Belladonna, with the exception of the external swelling of the throat, are present ; and also when there is a sensation as if the uvula were elongated or loaded with mucus, causing a constant inclination to swallow. One of the best indications for its employment in this, as in other diseases, is an over- excitability of the nervous system, characterized by sleeplessness, great restlessness, sensitiveness, disposition to weep, [and peculiar impressionability to external agents.
When the disease occurs in an aggravated form, or. when it has been neglected, and all the parts have become so excessively tumefied that the mouth can scarcely be opened, the breath being at the same time extremely offensive, the tongue foul, and the strength much exhausted, Arsenicum may be given with advantage. (See also the indications for the employment of this remedy in sore throat, which have been already given under Scarlet Fever, and will also be found under Malignant Sore Throat.)
Hepar sulphuris is valuable in bringing the matter to ahead, when resolution cannot be effected, and the quinsy has attained to such a height that its bursting is desirable from the painful sense of suffoca- tion, arising from the tumefied condition of the tonsils.
Silicea. This remedy is, in some instances, of greater efficacy than Hepar in rapidly fonoar ding the suppurative process, and causing the ripened abscess to burst. It generally promotes incarnation more effec- tually than Hepar.
Mercurius may follow either of the last-mentioned medicines,
SORE THItOAT, Oil QUINSY. 105
after an interval of a few hours, to facilitate the healing. Silicea and, in some cases, Sulphur may be called for after Mercurius. Bryonia and Rhus have been found useful in some forms of sore throat, the former especially when attended wTith considerable gastric disturbance, and where there was great dryness of the throat, with redness of the soft palate and tonsils, but no swelling ; — the latter where there was con- siderable fever towards evening, hot dry skin, aching and pricking pain during deglutition, lowness of spirits, and excessive anxiety. Bryonia is indicated by sore throat, with difficult deglutition and hoarseness ; pain in the throat as from excoriation ; excessive dryness of the throat, and pressure in the throat as if caused by a hard angular body ; pain and pricking in the throat, which is also experienced on external pressure or on moving the head ; accumulation of adhesive mucus in the trachea, temporarily removed by coughing. It is fur- ther called for when there is marked gastric disturbance, the tongue covered with a dirty yellow fur, the taste insipid, and the bowels confined ; when there was severe frontal headache and very disturbed sleep, with dryness of the throat, redness of the tonsils and palate {vekcmpalati), without swelling.^ Rhus toxicodendron, when the pains seem situated lower in the gullet, the disposition of the patient anxious, depressed, or disposed to tears ; and when Bryonia has not been suffi- cient to remove the complaint. Where there is difficulty of swal- lowing, and, at the same time a sensation as if a plug or some kind of foreign substance w7ere in the throat, — Lachesis, Nux v., and Arsenicum are useful when otherwise indicated. Stdph., Bella,, Baryta, Merc, Sep., Ign., Graph., Am. c. and Coccnlus are also indicated by this latter symptom. In obstinate cases, such as are occasionally met with in bad constitutions, the healing of the cavity, after the matter has been discharged, goes on very unfavorably, and even fresh abscesses form in succession : Sulphur, Ilepar s., and Bsoricum, repeated every eight or twelve hours, have chiefly been recommended to subdue these fortu- nately rare symptoms ;- — Sulphur in ordinary cases, Ilepar, when the patient has been previously subjected to an abuse of Mercury under allopathic treatment, and Psoricum when Sulphur has been taken in excess.*
Sepia is a useful remedy in obstinate cases of angina, with pain in the fauces as if the parts were excoriated, and prickings during the act of deglutition.
* Brit. Jour, of Homoeopathy, No. VII.
106 DIGESTIVE SYSTEM.
Relaxed sore throats generally require Nux, Puis., Capsic, Gentiana cruciana, or Stilph., &c. (See also the other remedies mentioned in the article on dyspepsia, as such sore throats are commonly connected with deranged digestion.)
The following remedies may also be mentioned as being useful in angina when the symptoms are as described : —
Vbratrum album is indicated by constrictive and suffocating pain in the throaty particularly during deglutition ; sensation of con- traction in the gullet ; sense of roughness and scrapings or of extreme dryness in the throat ; intumescence and burning in the gullet, some- times attended with danger of suffocation.
Cocculus, indicated by great dryness and sensibility of the gullet, causing everything partaken of to seem pungent, acid, or too salt ; by constriction or sensation of paralysis in the gullet, and noisy or clucking deglutition.
Capsicum is often useful in sore throat from cold, when Puis., Cham., Ign., Bry., or Nux v. afford little relief, particularly when a degree of fever continues, with shiverings and thirst, followed by heat; pressive aching pains, accompanied by a sensation of spasmodic con- striction in the throat ; distressing cough ; constant desire for the recumbent posture and for sleep, with dread of the slightest breath of cold air.
In gangrenous sore throat, or sphacelated quinsy : — Ars., Bach., Carlo v., Am. c, China, Conium, Rhus, or Baryta m. are the remedies which are chiefly to be relied on where there is any chance of recovery. (See Ulcerated Sore Throat.)
The diet of the patient must be regulated according to the degree of inflammation present.
If required, the throat may be gargled with a little warm water, and when much pain is present, inhalation of the vapour from boiling water will often afford considerable relief^ but at the same time it may be observed that all medicinal gargles, blisters, leeches, or other topical applications are rendered unnecessary by proper homoeopathic treatment. While we thus free the patient from a considerable degree of annoyance and needless suffering, we, at the same time, by a careful attention to the symptoms, and the exhibition of the proper remedy, effect a speedy cure. In overcoming the predisposition to sore throat, Mercurius, Sepia, Baryta m. and Graphytes have been found useful. The latter two particularly, when sore throat results after every exposure to cold, and is always prone to terminate in sup- puration.
ULCERATED SORE THROAT. 107
ULCERATED SORE THROAT.
Malignant Quinsy. Malignant, putrid, or gangrenous Sore Throat. — Angina Maligna, Tonsillitis Maligna, Cynanche Maligna.
This serious disease is also known by the name of Scarlatina Maligna, from the eruption with which it is frequently attended. It is usually epidemic, of a highly contagious nature, and generally occurs in damp and sultry autumnal seasons.
It sets in with coldness and shivering, succeeded by heat and ac- companied with great languor and oppression at the chest ; nausea, or vomiting, and sometimes purging ; eyes inflamed and watery ; deep red colour of the cheeks ; the nostrils are also more or less inflamed, and secrete a thin acrid discharge, frequently causing soreness or ex- coriation of the nose and lips ; pulse indistinct, or very weak, small, and irregular ; tongue white and moist.
The deglutition is painful and difficult, and the throat, on being examined early in the disease, is observed to be of a bright red colour, and much tumefied ; but this state is very soon altered, and nume- rous ulcers of various sizes will then show themselves interspersed over the parts, which become covered with a white, grayish brown, or' livid coat. In some cases, these ulcerations spread so widely as to extend over the whole fauces into the nostrils, or downwards even to the glottis and gullet, &c, and assume a sloughing appearance as they increase in magnitude. The prostration of strength, considerable from the first, is now excessive ; the tongue, lips, and teeth are covered with brown or blackish incrustations, and there is more or less deli- rium; the breath is extremely fetid, and the patient himself complains of a disagreeable odour. The neck appears swollen and of a livid colour, and an efflorescence of a faint scarlet hue, or blotches of a dark or livid red, sometimes intermixed with petechiae, break out on various parts of the body, and usually, though not necessarily, add to the danger, — as many are carried off, particularly children or per- sons of an advanced age, without any eruption, when the local symp- toms are severe and the fever high, — but the appearance of livid spots or petechiae, and other indications of so-called putrescency, with frequent shivering, weak fluttering or intermittent pulse, sunken coun- tenance, severe purging, extreme prostration, and bleedings from the nose, mouth, &c, must decidedly be regarded as symptoms of immi- nent danger.
108 DIGESTIVE SYSTEM.
When the local symptoms are mild, the danger is rarely great ; and even in the severe forms of the disease, when a gentle sweat breaks out about the third or fifth day, when the sloughs throw off in a fa- vorable manner, leaving a clean, florid, healthy-looking bottom, and the respiration becomes more gentle and free, the expression of the face more lively, and the pulse stronger and more equal, a salutary result may be held in expectation.
Therapeutics. The subjoined remedies will frequently be found adequate to subdue the various forms which the malady assumes, where any prospect of a cure may reasonably be entertained from the commencement : Aconitum, Belladonna, Mercurius, Acidum nitricum, Pulsatilla, Arsenicum, Lachesis, Nux v., Carlo vegetabilis, Sulphur, &c.
The accompanying fever being generally of a low typhoid character, Aconite is rarely necessary in this complaint; however, there are cases, particularly when the fever runs high from the commencement, in which advantage is found to result from a dose or two of this re- medy, followed by Belladonna as soon as the patient complains of dryness, with impeded deglutition and a sense of constriction or choking in the throat, which, on examination, is observed to be swollen and to present a florid red appearance.
Belladonna is additionally indicated when the fever continues to run high ; when the face is bloated and the eyes much inflamed ; when the patient is affected with considerable delirium, and is, occa- sionally, with difficulty to be restrained from leaving the bed, or com- mitting acts of violence ; or, further, when the rash, which sometimes breaks out in this disorder, about the third day, presents a scarlet hue, and is smooth and glossy.
In cases in which the symptoms are mild, or in which the above- mentioned symptoms have been reduced by means of the remedies quoted, and an increased secretion of mucus supplies the place of the previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting, — a dose or two of Pulsatilla may be administered with good effect. The progress of matters in the throat must, however, be carefully watched, and as soon as the presence of small ulcers, or still better, their incipient formation, can be detected, a dose of Mercurius should be prescribed, followed by Acidum nitric um, when, from the increasing size and painfulness of the ulcers, Mercurius does not promise to arrest their progress or cause them to assume a healthy aspect.
ULCERATED SORE THROAT. 109
In the milder forms of this disease, the two last-named remedies will frequently be found sufficient to conduct it to a speedy and suc- cessful termination ; but in those much more dangerous forms, which the complaint so readily assumes when it rages as an epidemy, and when the patient, at the commencement, is seized with vomiting and purging, attended with such prostration of strength as to render it impossible for him to leave the recumbent posture without feeling faint, and compelled to fall back exhausted by his efforts; when, moreover, the ulcerations spread with alarming rapidity, and early take on a sloughing character. — In such cases, the conducting of the disease to a happy issue becomes obviously a much more serious and difficult task. Here the symptoms must generally at once be at- tacked by administering Arsenicum, — sometimes, however, benefit will be found to result from a dose of Pulsatilla beforehand, when there is an excessive degree of bilious vomiting,-— but Arsenicum must unhesitatingly be had recourse to when there is that marked prostra- tion of strength so characteristic of this disease, accompanied with nausea or vomiting ; or when the ulcers present a livid hue. This important remedy is also indicated in a more advanced stage of the disease, when the ulcerations are covered with dark sloughs, sur- rounded by a livid margin ; the teeth and lips incrusted with sordes ; the tongue parched, cracked, blackish, and tremulous; the pulse small and irregular ; and there is delirium or constant muttering ; with frequent hanging of the lower jaw ; laborious respiration ; acrid discharge from the nostrils, causing excoriations ; the eyes dull and glassy ; the skin hot and dry, and the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglu- tition with great pain and difficulty ; finally, when the prostration of strength is so extreme that the patient seems rapidly sinking, and a rash of a livid colour breaks out in blotches, here and there intermingled with petechiae.
Lachesis will frequently be found very useful after, and in some cases alternately with, Arsenicum, should the patient complain of great pain in the throat, which is aggravated by the slightest external pres- sure ; or should the sloughs seem indisposed to cast off, and the neck become much swollen and discoloured. Conium has been recom- mended when the diseased parts assume an ash-gray colour and a dark brown or blackish aspect, paleness and puffiness of the face, swell- ing of the tongue, inarticulate speech, loose, sanguineous, involuntary stools, depression of strength and spirits, evolution of a whitish erup-
110 DIGESTIVE SYSTEM.
tion on various parts of the body. When the tendency to gangrene continues, and the patient is still affected with considerable prostra- tion of strength, accompanied with debilitating sweats, Cinchona will often be found of service. Nux vomica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous, small, foul, offensive ulcers are seen in the mouth and throat, — and may be succeeded by Carl, v., should a copious fetid ichor be discharged from the ulcers, attended with extreme exhaustion, and small, indis- tinct, or scarcely perceptible pulse. Secale cornutum may sometimes be administered with advantage in alternation with Ca/rb., when the latter appears to afford but temporary benefit. Rhus is occasionally useful in extreme cases, particularly if there be great muscular weak- ness, with trembling of the extremities, especially on movement ; sopor, and other symptoms described under this remedy in the chapter on Typhus.
When, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invi- gorated, the countenance more animated, and the sloughs are thrown off in a satisfactory manner, yet the ulcers threaten to become indo- lent ; these will, generally, very speedily acquire a clean and florid bottom, and begin to cicatrize, on the administration of Acid, ni- tricum. In other cases the aid of Sulphur and Silicea will be found necessary.
For further particulars in the treatment of malignant sore throat, the reader is referred to page 65 of this work.* In conducting the cure, the utmost cleanliness, combined with free ventilation, ought to be strictly observed, for the double purpose of removing all malignant excretions and effluvia, — and thereby putting a check to the ready extension of the contagion, — and providing for the comfort and well- being of the patient.
The diet should consist of semolina, sago, gruel, and similar articles of food.
Angina Pharyngea. Pharyngitis. Oynanche Pharingea.
Inflammation of the membrane which lines the pharynx is gene- rally an attendant on tonsillitis ; and, in like manner, when phlegmo- nous inflammation commences in the pharynx, it for the most part, extends to the tonsils. In pharyngitis simplex, although there is
* See also Sore Throat.
INFLAMMATION OF THE (ESOPHAGUS. Ill
usually some degree of inflammatory fever, it rarely attains a consi- derable height, and is, together with the local affection, with facility subdued by means of a dose or two of Aconite.
When the inflammation spreads to the tonsils and neighbouring parts, the same remedies must be employed which have been enume- rated under Tonsillitis, which see..
When the velum palati is particularly implicated, Coffea, Belladonna, Mercurius, or Nux vomica answer best, after Aconitum, where the latter has been called for, but found in adequate to complete the cure. If, on the other hand, the uvula participates chiefly in the pharyngeal inflammation, Nux v., Coffea, Bella., Merc, Sulphur or Calcarea are, in addition to Aconitum, the more important remedies.
When a spasmodic, almost suffocating, constriction of the gullet takes place in pharyngitis, and Belladonna, Mercurms, or Lachesis fail, Calcarea c. often affords rapid relief.
INFLAMMATION OF THE (ESOPHAGUS. (ESOPHAGITIS.
Inflammation of the gullet is more frequently met with as a symptomatic disease. It is, accordingly, sometimes encountered in strictures, measles, smallpox, and in the case of tumours in the neighbourhood of the oesophagus.
It does, however, occasionally occur in an idiopathic form, either in consequence of mechanical or chemical irritants, or otherwise. The disease is indicated by the following symptoms : a sense of burning heat is experienced in the oesophagus, either high or low in the tube, according to the seat of the disease, with painful and difficult deglutition. The patient can almost always point out the locality of these, generally circumscribed, sensations ; and consequently refers them either to the neck or to the back, between the shoulders^ and under the sternum.
In the treatment of symptomatic oesophagitis, our attention must be directed to the removal of the exciting cause, when this is practicable. In the idiopathic form again, we must be guided, in the selection of our remedies, by the law similia similibus. Amongst the medicines wThich are capable of producing symptoms, analogous to those which characterize the disease : Belladonna, Hyoscyarmis, Cantharis, Arsenicum, Mercurhis, Arnica, Carlo v., etc., are the most important. In some
112 DIGESTIVE SYSTEM.
instances it may be found requisite to commence with Aconitum, but generally speakings the attendant fever of the phlogistic character, will find a sufficient antidote in Belladonna, which remedy is, moreover, better adapted to the collective features of the complaint. Hyoscya- mus frequently succeeds in removing any signs of spasmodic con- traction in the gullet when Belladonna is insufficient to remove them ; but when the burning heat continues unabated, and deglutition is still performed with great pain, Cantharis should be resorted to. Mer- curius is especially useful when symptoms of incipient suppuration make their appearance ; Arsenicum when "great prostration of strength sets in, either in the course of the complaint, or at the com- mencement of the attack, accompanied by intense thirst and sleep- lessness. Should only partial relief result from Arsenicum, Carbo v. may be had recourse to. In other instances Veratrum may be required. In cases arising from mechanical lesion, the early employ- ment of Arnica has been favorably spoken of. The remedy selected in any case will rarely require to be repeated earlier than six to eight hours after the first dose : and subsequently at Ignger intervals, if the symptoms are found to yield. When the symptoms become more unfavorable after an interval of twenty-four hours from the taking of the first dose, another medicament must be prescribed.
MUMPS.
Parotitis, Angina Parotidea.
Diagnosis. Inflammation with swelling of the parotid and sub- maxillary glands, sometimes running high, and extending to the throat and tonsils, with danger of suffocation.
This complaint generally affects individuals under the age of puberty, and frequently declares itself as an epidemy, during the prevalence of cold damp weather. When properly treated, it is rarely dangerous, but particularly apt, if not carefully attended to, to attack some more important organs by metastasis, — for example, suddenly disappearing in the glands mentioned, and painfully affect- ing those of the breast, &c. : these metastases may occur either from fresh exposure to cold, or from the application of saturnine, campho- rated or other repellent lotions.
This complaint is generally ushered in by the ordinary symptoms of mild catarrhal fever, after which the swelling declares itself, some- times interfering with the motion of the jaw, and, by the extension
MUMPS. 113
of inflammation to the tonsils, affecting the hearing and impeding inspiration.
Therapeutics. Mercurius may almost be termed the specific remedy in the idiopathic form of this disease.
When Mercurius does not promise to produce much benefit, after a dose or two (which is frequently the case in those who have been formerly salivated by Mercury under allopathic treatment), Carlo vege- talilis should be administered, particularly if the affection be accom- panied by a considerable degree of hoarseness.
When, through any neglect in taking proper precautions against cold, a metastasis to the brain has taken place, characterized by a sudden disappearance of the swelling of the glands, followed by a loss of consciousness, delirium, or other symptoms of Inflammation of the Brain (which see), we should have immediate recourse to Belladonna, Hyoscyamus, or Cuprum aceticum, etc.
Belladonna, is moreover indicated when the swelling is red and presents an erysipelatous appearance. If the inflammatory symp- toms do not readily yield to Belladonna, Hyoscyamus may be given ; and after the latter Rhus, Bryonia, Sulph., Arsenicum, Lachesis, or Silicea, according to circumstances.
Should, however, the disease in the same manner be transferred to the stomach, Carbo vegetabilis is usually a most useful remedy; when it fails to afford all the desired relief, Cocculms may be had recourse to.
When the glandular enlargement occurs as a sequela of any of the following disorders, the remedies thereafter mentioned will ge- nerally be found the best adapted to effect resolution when prac- ticable : of Typhus, Bella, Stclph., Calc. c. ; of Measles, Arnica, Bry- onia, Rhus; of Scarlatina, Hepar s., Bulc, Baryta, Bella., Rims, and Arsenicum. — Carl, v., Silicea, Lycopodium, Hepar, Conium, Chamomilla, Aurum, Sulph., and Calc, in general cases, according to circum- stances.
During the treatment of this affection, every care should be taken that the patient be kept moderately warm, exposed neither to damp, cold draughts, or vicissitudes of temperature.
114 DIGESTIVE SYSTEM.
INDIGESTION, or DYSPEPSIA.
This disease appears in so many different phases, that we shall simply content ourselves with an enumeration of some of the principal exciting causes, and refer to the symptoms given under the different medicaments for its Diagnosis. The following may be considered the chief of these :--
Irregularities in diet — such as an over-indulgence in the pleasures of the table, partaking of rich and indigestible food and stimulating soups, excessive use of wine, malt and spirituous liquors, strong tea, coffee, and other stimulants; imperfect mastication of food; irregu- larity of, or too long fasting between meals ; indolent or sedentary habits ; exhaustion from intense study ; keeping late hours ; mental emotions, &c.
The foundation of this disorder is frequently laid in early life, by the baneful practice of administering large doses of calomel and other deleterious drugs, for the most trivial as well as the more serious derangements of the chylopoietic viscera ; and the evil is perpetuated in more mature age, by a continuance of the same absurd and injurious system.
Therapeutics. The principal homoeopathic remedies for the treatment of this affection are : Nux vomica, Sulphur, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha, Ignatia, Carlo vegetabilis, Cinchona, and Hepar sulphuris.
An abuse of coffee and tea is a frequent cause of many descriptions of sick and nervous headache, attended with excitement and dys- peptic symptoms, which will frequently disappear of themselves on the disuse of these beverages. If, however, this result should not speedily ensue, for the effects of coffee we may have recourse to Nux vomica, Pulsatilla, Chamomilla, or Ignatia, according to the character of the symptoms. Against the effects of tea, Cinchona will generally be found an antidote, followed by Ferrum if necessary ; in other cases, Ipecacuanha, Thuja, or Belgium will be found useful.
Nux vomica covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental ex- ertion, or long watching, or from the abuse of wine or ardent spirits : the head confused with occasionally a feeling as if resulting from intoxi- cation, and giddiness with sensation of turning and wavering of the
INDIGESTION OR DYSPEPSIA. 115
brain; headache, unfitting for, and increased by, mental exertion; tearing, drawing, or jerking pains in the head or cheeks, and pulsative pains, and a sensation as if a nail were driven into the brain ; congestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, fre- quently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower part of the white of the eyes, with a mist before them ; a sensation as if one were about to fall ; sparks, or small gray or black spots before the eyes ; short-sightedness ; pale or yellowish colour, or redness of the face, especially about the mouth and nose ; frequent headache, and impaired powers of digestion, with insi- pidity of food ; foul, fary, white or yellowish tongue ; thirst, with water- brash, particularly after acids or rich food ; accumulation of slimy mucus, or water in the mouth ; metallic, salt, sulphureous, herbaceous, mucous, bitter, sour, sweetish, or putrid taste, chiefly in the morning, or after meals; bitter eructations, or continued nausea, especially after meals, or even after drinking cold water or milk,- — or on going into the open air after a meal, or after partaking of acids ; heartburn, hiccough^ acidity, flatulence, frequent and violent vomiting of food, mucus, or bile, or ineffectual efforts to vomit ; distension and fulness in the epi- gastrium, with excessive tenderness to the touch; a feeling of tight- ness of the clothes round the upper part of the waist ; cramps in the stomach ; constipation ; reddish urine, with brick-dust coloured sedi- ment; sleep, unrefreshing and restless, either from suffering or other- wise, with disagreeable dreams, and drowsiness in the morning.
One of the most distinctive indications for the employment of this remedy in preference to the next mentioned, is the temperament, which is restless, irritable, lively, arid choleric. A disposition to Hemorrhoids is also a good indication \
For Pulsatilla we have nearly the same range of dyspeptic symptoms, with the distinction of its being particularly adapted for females^ children, individuals with light hair, and a marked predispo- sition to purulent exudations at the edge of the eyelids, or to styes, and for mild or phlegmatic dispositions. Amongst its characteristic indications, we more frequently find a want of thirst than thirst; a re- pugnance to fat and rich meat, and suffering, after taking pork or pastry ; general chilliness, or great difficulty in keeping the hands and feet sufficiently warm ; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils ; frequent and loose, or diffi- cult and loose, or sluggish evacuations ; hypochondriasis, hysteria.
116 DIGESTIVE SYSTEM.
Bryonia : Headache, burning or expansive, particularly after drinking, attended with bewilderment of the head and vertigo; tongue dry and red, or covered with a coated, whitish-yellow fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hunger ; craving for acid drinks ; great thirst ; insipid clammy, putrid, sweetish, or bitter taste in the mouth ; acidity and flatu- lence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, water-brash, vomiting of food or bile, particularly at night ; tenderness of epigastrium to the touch, sensation of swell- ing in the pit of the stomach ; especially after a meal, or on walking ; sensation of burning in the pit of the stomach, especially when moving. Constipation ; temper restless, irascible, and obstinate ; also when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the symptoms. The dys- pepsia is more apt to manifest itself in summer, or in damp weather, is frequently accompanied with chilliness. {Rhus is often of service when Bryonia produces little or no improvement.)
Chamomilla : Headache, with sometimes semi-lateral pulling, shooting, and beating in the head ; fulness, giddiness, and staggering in the morning when getting up, oppressive heaviness, vertigo, and sen- sation of a bruise ; headache, felt sometimes during sleep, with obscura- tion of the eyes ; and yellow colour of the white; tongue dry and cracked, with a thick and yellowish coating ; mouth dry, with the occasional presence of frothy mucus ; excessive thirst and desire for cold drink ; bitter taste in the mouth and of food; want of appetite and dislike to food. Acidity or sour risings, regurgitation of food, nausea, vo- miting of food, mucus, and bile j acute, oppressive pain in the region of the heart, distension at the epigastrium, pit of the stomach, and upper part of the waist, chiefly after eating, and at night attended with in- quietude and terror ; burning pain in the pit of the stomach, uneasi- ness and feeling of sinking in the stomach; cramps in the stomach, especially when traceable to coffee ; sometimes constipation, but ge- nerally relaxation of the bowels. This remedy is valuable in indigestion, brought on by aft of passion, or suppressed perspiration.
Ipecacuanha: Face pale and yellowish; tongue sometimes clean, at others coated white or yellow ; aversion to food, and parti- cularly to fat, or to rich indigestible food, such as pork, pastry, &c, or dyspeptic suffering on partaking of such ; vomiting of food, drink, mucus, or bile, sometimes after a meal ; retching or easy vomiting,
INDIGESTION Oil DYSPEPSIA. 117
generally attended with coldness of the face and extremities, and sometimes alternating with watery diarrhoea ; feeling of emptiness, and flaccidity, and sensation of sinking at the stomach. Headaches, attended with nausea and vomiting ; shooting pains, with heaviness and painful pressure on the forehead. Both this medicine and Pulsa- tilla are valuable remedies for indigestion in children, arising from imperfect mastication or improper food.
Ignatia may sometimes follow Pulsatilla to complete a cure, or even supersede it, when there is a tendency to constipation, and par- ticularly in persons who are subject to sudden alternations from high to low spirits, or vice versa ; it is especially indicated when grief has been the inducing cause of dyspepsia, hysteria, and hypochondriasis. In chronic cases, these remedies, as indicated, are chiefly valuable in the commencement of treatment, and may require to be followed by ether remedies to complete the cure. Sulphur, or Tincture of Sulphur, will be found especially useful after Pulsatilla and Nux vomica, in removing any symptoms that may remain. Hepar sul- phuris is a valuable remedy in some cases of dyspepsia, but particu- larly when the patient has previously been taking blue-pill, or any other mercurial preparation for a considerable time.
Acidum sulphuricum : Dyspepsia arising from excessive study, drinking, or other excesses, with the following symptoms : great weakness of digestion ; acrid, foul, putrid taste in the mouth, dry tongue, burning and smarting sensation in the throat, sometimes at- tended with pricking, especially at night, and so troublesome as to prevent sleep (Pyrosis) ; offensive breath, especially in the morning (aphtha) ; renewal or aggravation of the symptoms from drinking cold water; all cold drinks appear to disagree, unless a little brandy or some other ardent spirit is added to them; accumulation of water; saliva in the mouth ; flatulence ; bitter risings ; vomiting of a limpid fluid, or of food. It may be here remarked that, in cases where Nux vomica seems indicated, but the disposition is of a morose or hypo- chondriacal turn, Cocculus may be substituted with effect; when, however, the indications for temperament are not sufficiently distinc- tive, Coccculus, Nux vomica, and Pulsatilla may be advantageously alternated. Finally, Carbo vegetabilis will frequently remove an\ symptoms that may remain after Nux vomica.
Cinchona is a valuable auxiliary in the treatment of this derange- ment, when there is impaired appetite with great weakness of diges- tion, which is more liable to be experienced on partaking of supper ;
118 DIGESTIVE SYSTEM.
flatulence; bitter taste; languor; hypochondriacal disposition; and particularly when we can trace the affection to debilitating losses of fluids, such as the abstraction or loss of blood, too great a drain upon the resources during lactation, prolonged use of aperient medicines, &c. ; also in disorders arising from the abuse of tea, or from a resi- dence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter.
Natrum c. may follow Nux v., Bryonia, or Cinchona, with advan- tage, when a degree of weakness of digestion remains.
In chronic cases this disorder sometimes takes a critical turn, when vomiting becomes excessive, everything taken is returned from the stomach, the skin is hot and dry, the patient becomes emaciated, and the countenance cadaverous. In serious cases of this de- scription Arsenicum and Lachesis will tend much to invigorate the sinking energies, and even,— with the occasional aid of Bycopodium, Veratrum, Baryta, Phosphorus, Conium, or some one or other of the above-mentioned remedies, where necessary, — eventually effect a cure, provided the inroads of organic lesions have not already placed the unfortunate sufferer beyond the reach of art. (See also Chronic inflammation of the stomach. Cardialgia. Want of appetite. Flatulency, and Derangement of the stomach.)
The following are frequent additional pathognomonic signs of de- ranged digestion, and may, when taken in conjunction with others already described, facilitate the selection of the remedies placed in juxtaposition :
Tongue, swollen : Bach., Merc, Ars., Bella., Kali, Hell. ; Calc, China, Silic, Big., Plumb., Anac, Blect., Con., Thuj., Stram., Sec.
Tongue with a white fur: Puis., Sulph., Merc. Tart., Am. ;—N%ix v, Bry., Ant. c, Calc, Sep. Bism., Ign., Ipecac, Big., Baph., &c.
Tongue, with a yellow fur : Nux, Puis., China, Ipecac, Plumb. ; — ■ Cham., Bry., Cocc, Veratr., Bella., Alum., Coloc, China, Sulph., Blect., he.
Tongue, with a slimy fur : Puis., Sulph., Merc, Bella., Acid, phosph.; Bach., Chin., Sulph., Verb., Nux mosch., Cupr.
Tongue, with a brownish fur : Sulph., Bella., Phosph., Sil., Verb., Hyos., Sabin., &c.
Tongue, with & grayish fur: Tart., Amb., Cupr. acet., Puis.
Tongue with a grayish-brown fur (whity-brown) : Ambra,Puls., Nux, Bry on., Ipecac, &c.
Tongue with a greenish fur: Phmibum.
— with a blackish fur : Merc, Chin., Phosph., Bach.
INDIGESTION OR DYSPEPSIA. 119
Tongue : with a dirty fur: Bry., Bye, Glean., Anthraps.
— with a thick fur : Puts*, Merc, Bella. ; —Nux v., Cham., Sulph.
— vivid red at the margins : Bella., Nux v.
— with vivid redness of the papillae : Bella., Ammon.
— red at the tip : Elect.
— vivid redness of the whole tongue: Bella., Bry., Back., Hyos., Nux v., Cham., Ban. sc, Rhus, Ars., Sulph., Veratr., &c.
Tongue dry: Nux v., Sulph., Veratr., Bella., Merc, Nux mosch., Cham. ;^—Bach., Bry., Rhus, Sep., Carl, a., Baryt. m., Plumb., Sec.
Tongue glazed, shining: Bachesis ;;— - Bella., Sulph., Bry., Ars,, Veratr., Sec.
Tongue with elevated papilla : Elect., Crocus, Oleand., Bella., &c.
— cr ached, clefted, or split into furrows : Nux, Puis., Bach., Bella., China, Plumb., Cham., Veratr., Ars., Baryt., Cic, Ran. sc, Sulph.
Tongue tremulous : Bella., Ars., Bry., Merc, Big., Bulc, Nux, Coec, Ign., Veratr., Bach., Rhus.
Saliva/ acrid: Merc, Bulc, Veratr.
— alkaline : Galv.
— bitter : Ars., Sulph., Thuja.
— brownish: Bism.
— cool : Asar.
Saliva, frothy : Bry., Plumb., Ran. sc, Sulph., Spig., Eng,, Berb., Canth., Phell., Sab. Saliva, hot : Baph.
— of a mawkish, insipid taste : Bry., Puis., Ipec, Ign., Nux v., Cham., Bye, China, Caps., Sulph., Sec,
Saliva, of a metallic taste : Bism., Ran. hi, Zinc, Cocc,Hepar, Agn., Cup., Natr. m., Sec.
Saliva, of an offensive, fetid smell : Merc, Big., Hydrarg. subm.
— of a reddish colour : Sabin.
— of a saline taste : Sulph., Sep., Veratr., Euph., Merc sol., Hyosc, Phosph., Verb.
Saliva, of a sour taste : Ign., Sulph., Calc ; Gale phosph., Galv., Alum., Bad., Natr. s., &c.
Saliva, of a sourish-sweet taste : Zinc oxyd*
— of a sweetish taste: Puis., Plumb., Big., Sabad. ;- — Alum., Gran., Sec.
Saliva, thick : Nux mosch., Bism., Bella., Sec.
— thin, serous : Puis., Magn. m., Kreos., Mags, ans., Galv., Bobel., Asar., Thea., Sec.
120 DIGESTIVE SYSTEM.
Saliva, tenacious: Puis., Nux, Lack., Phosph., Staph., Ars., Zinc, Sec.
Saliva, of white colour: Ran. b., 01. an., Sabin., Spig., &c.
Gums, bleeding of the: Nux v., Carlo v., Stilph., Natr. m.,Acid. nitr., Mere., Phosph., Sil., Staph.; Cale., Graph., Baryt. c., Am. c, Alum., Magn. m., Acid, sulph., Sep., Kali c., etc.
Gums, redness of the: Card, v., Kreos., Nux v., Mere., Kali, Natr. m., Phell., Ran. sc, Hep., Aur.
Gums, spongy : Nux v., Caps., Natr. m., Carl. a. et v., Bry., Ars., Merc., Staph., Sulph., Kreos., China.
Gums, swollen : Nux v., Natr. m., Sulph., Merc, Caps., Staph., Sep., Baryt., Am. m. et c, China., Ac nitr., Lach., Lye, etc.
Gums, tender : Nux v., Lach., Natr. m., Caps. ; Staph., Cole, Agar., Amb., Acid, nitr., Carbo v., Hepar.
Gums, fetid : Carb. a. et v. ; Acid, n., Staph., Hepar, China, Natr. m., Merc, Graph.
Gums, shrinking, or separation of the gums from the teeth: Carb. v., Merc, Sulph., Par., Cist.
Gums, paleness of the : Staph., Phtmb., Acid, nitr., Zinc, Oleand., Merc
Teeth, discoloration, aching, decay of the : Nux v., Puis., Bryon., Cham., Merc, Staph., Lach., China, Sulph., Calc, Plumb., Ars., Natr,, Veratr., etc.
Lips, vivid redness and spongy state of the : Nux v., Bry., Carbo v. et a., Baryt. c, Bella., Hep., Lach., Caps., Merc, Sil., Staph., Sulph., Alum., China, Spig., etc.
Lips, blanched, yellowish, and somewhat indurated : Nux v., Sulph., Calc, Lycop., Ars., Lach., Can., Clem., Silic, Aur., Natr., Alum., Spig.
Throat, sensation of excoriation, roughness, and dryness : Nux v., Lach., Carb. v. et a., Sulph., Puis., Calc, Merc, Cham., Lgn., B?yon., Hep., Teuc, Scilla, Staph., etc.
Throat, redness of the, with swelling of the uvula, etc. : Nux v., Bryon., Ign., Cham., Caps., Puis., Lach., Sulph., Calc, Baryt., China, Sep., Veratr., Cocc.
Eyes, bleared and suffused : Nux v., Puis., Natr. m., Staph., Graph., Cham., Calc Lye, Bism., Ant., Agar., etc.
Eyes, muscae volitantes : Nux v., Puis., China, Lye, Sulph., Sep., Agar., Merc, Cocc, etc.
Eyes, appearance of vapour or mist before the : Puis., Plumb.,
INDIGESTION OR DYSPEPSIA. 121
Sulph., Calc,- Merc,- Bell., Cyc, Dig., Alum., Ign., JEnon., Am. m., Ambr., etc.
Eyes, sparks, flashes of flame : Nux v., Lack., Lycop., Dig*, Staph., Calc. c, Merc, Natr. m., etc.
Eyelids, thickened, gorged, and inflamed at the margins : Nux v., Puis., Cham., Merc, Hep., Bry., Sulph., Buph., Veratr., Lye, Ars., Baryt. c, Staph., Sep., Natr. m., etc.
Nose, dryness of the nostrils: Sulph., Calc, Sep., Graph.; Bryon., Bella., Ign., Mag. m., Phosph., Rhus, Kali, Sil., etc. , Nose, excessive secretion from the : Ars., Bach., Ign., Lye, Puis., Ipecac, Hep., Bry., Nux v., Sulph.; Cocc, Carbo v.,, Alum., Ammon. c, Calc, Merc, etc.
Nose, itching in the nostrils: Nux v., Puis., Carl, v., Ign., Am. c, Agar., Spig., Teuc, Cm., Sabad., Sulph., Calc, etc.
Nose, imaginary smells : Nux v., Puis., Sulph., Calc, Ars., Graph., Alum., etc.
Nose, deficient sense of smell: Puis., Sep., Sulph., Calc, Alum., Ipecac, Natr. m.
Nose, great acuteness of smell : Sulph., Lye, Hep., Colch., Nux v., Cham., Calc, Kali c, etc.
Ears, dryness of the (eustachian tube) : Graph., Lach., Ac nitr., Petr., Carb. v., Ars., etc.
Ears, acuteness of hearing : Lach., Ars.^ Lye, Bry., Cham., Veratr., Sep., Plumb., Magn., Chin., Sil., etc.
Ears, dullness of hearing : Nux, Puis., Sulph., Calc, Carb. v., Lach.,
Bell., Ars., Veratr., Ant., Anac, Asar., Kal., Hep., Staph., Bry., Lye, etc.
Head, frontal headache : Nux v., Puis., Bry., Ign., Natr. m., Chin.,
Plumb., Sep., Natr. m., Ant., Staph., Plat., Sulph., etc. (See also Art.
Cephalalgia.)
Face, flushes of heat in the : Lye, Graph., Cocc, Kali e, Alum., Ambr., Kali m., etc.
Face, pimples on the: Nux v., Carb. v. et a., Lach., Sulph., Sep., Acid, nitr., Acid, m., Ambr., Alum., Hepar., etc.
Face, eruptions various, on the : Nux v., Rhus, Sulph., Lach., Lye, Graph., Merc,Sep., Calc, Am. c, Big., etc., etc,
Face (earthy colour of the, and of the skin in general) : Nux v., Ars., Lach., Lye, Ign., Ipecac, China, Natr. m., Merc, Bry., Silic
Face, pale : Nux v., Puis., Carb. v., Lye, Sulph., Veratr., Magn. m., Plumb., China, Sep., Calc, Anac, Big., Graph., Ign., Am. c, Ambr., Olean., Merc, etc.
122 DIGESTIVE SYSTEM.
Face, red: Bry,, Nux, Cocc, Lye, Puis., Plat., Hep., Ign., Sulph., Calc, Lack., etc.
Face, yellowish : Nux v., Puis. , Lye. , Natr. m., Magn. m., Card, v., Graph., Calc, Merc, Pry., Sulph., Sep., etc.
Skin, like parchment: Arsenicum; Lye, Graph., China, Sep., Amir., Am. c, Calc, Kali, Natr. c.
Giddiness: Nux, Puis., Plumb., Natr. m., Op., Pry., Calc, Kali, Natr.m., Lach., etc. (See also Art. Vertigo?)
Head, confusion in the : Pry., Nux, Puis., Calc, Sepia, Plumb., Op., Rhod., Zinc, Natr., Plat., Staph., Caps., Graph., Magn. m., Calc ph., Nux mosch., Rhus, Ambr., Am., Sec.
Upper Extremities, tremulousness of the: Bry., Rhus, Veratr,, Phosph., Silic, &c.
Upper Extremities, numbness, (torpor); Nux v., Lye, Cham., Croc, Graph., Kali, Sep., Sulph, Verat., Silic, Magn. m., Ambr., Baryta, Sec.
Upper Extremities,/^^* or spasmodic movements of the : Puis., China, Ign., Lye, Pry., Cham., Plumb., Cic, Sabad., Bella., Op., &c.
Hands, tremulousness of the: Lach., Stilph., Calc; Phosph., Zinc, Agar., Cocc, Kali, Tart., Rhus, Sabad*, Bis., Sec.
Hands, numbness of the hands and fingers : Nux v., Lye, Puis., Croc, Carb. a., Cocc, Phosph., Lye, Veratr., Zinc, Calc, Am.e, Baryta c, Sep., Sil., Natr. m., Kali, Zinc, Cham., Sulph., Sec.
Hands, jerkings or spasmodic movements : Ign., Lye, Bry., Cham., Kali, Cic, Merc, Phosph., Sulph., Sec,
Upper Extremities, tingling, crawling, or creeping sensations in the: Nux v., Puis., Ign., Caps., Rhod,, Sulph., Am., Magn., Bella., Sabad., Mgs., Mags, ans., Sec.
Hands or Fin gers, tingling, Sec, of the: Veratr., Sulph., Rhod., Nat. m., Magn., Colch., Lam., Calc, Sil., Baryta c, Nux,, Bry,, Bella., Cocc, &c.
Fingers, paleness and torpor of the, as if dead : Sulph., Calc, Thuja., Chel.; Am. c, Am. m., Lye, Hep., Phosph., Acid, phosph., Merc, Acid, m., Acid, n., Hep., Cic, Sec.
Hands or Fingers, coldness of the : Nux v., Sulph., Puis,, Cocc, Ambr., Baryta c, Cham., Natr. m,, Phosph., Petr., Kali, Ac. nit., Ran. b., Scilla, Tart., Thuja*, Sec.
Hands or Fingers, burning heat in : Nux, Lach., Lye, Carlo, Staph., Phosph., Sec.
INDIGESTION . OB DYSPEPSIA. 123
Lower Extremities, tremulousness of the: Nux, Cocc, Puis., Bry., Lye.) Calc, Card, v., Cham., Natr., Sec.
Lower Extremities, numbness of the (torpor) : Nux v., Graph., Petr., Ant., Carb. v., Calc, Lye, Alum., Ambr., Cham., Platina, Plumb., Kali, Olean., Sulph., Sep., Silie, Verat., Led., Thuja, &c.
Lower Extremities, /^rife^s or spasmodic movements of the: Ign., Puis., Carb. v., Op., Lye., Kali, Ipecac., Scilla, Natr. m., Plat., Sep., Am. c., Baryta c., Silie., Sulph., Cie., Sec.
Lower Extremities, torpor and paleness (deadness) : Graph. chiefly.
Lower Extremities, creeping, crawling or tingling in the: Plat., Rhod., Sulph., Caps., Bor., Sabad., Guai.^ Raph., &c.
Feet, creeping, Sec, in the : Caps., Sulph., Sep., Am., Par., Zinc, ox., Croc., Ammomum, Calc, Sec, Am. m.
Feet, torpor and paleness (deadness) of the : Calc, Nux v., Rhus, Liic, Chel., Sec
Feet, feeling of numbness or torpor in the: Nux, Cocc, Lack, Plumb., Sep., Kal., Sil., Oland., Sec.
Feet, feeling of heat in the : Puis., Staph., Phosph., Elect., Petr., Led., Sec.
Feet, coldness of the: Sulph., Sep., Sil., Cocc, Carbo a., Graph., Kali c, Rhod., Colch., Con., Big., Lach., Lye, Plat., Plumb., Acid, mtr., Natr. m., Sec.
Lower Extremities, tottering, staggering, (trembling) or giving way of the legs or knees : Nux v., Puis., Bry., Plat., Lach., China, Ruta, Sulph., Sec.
Lower Extremities, cramps in the : Nux v., Sulph., Calc, Lye, Bry., Cham., Acid, nitr., Lach., Carb. v. et. a., Baryt. c, Am. c, An., Colocy., Can., Magn. m.y Sec.
Lower Extremities, cramps in the feet : Nux v., Sulph., Lye, Carb., Plumb., Staph., Silie, Rhus, Natr., Ran., Graph., Am. c, Pefr., Sec.
Drowsiness, tendency to : Puis., Nux v., Bry., Ant. ; Cocc, Carb. v., Plumb., Staph., Ign., Am., Cham., Coloc, Ars., Veratr., Zinc, Sec.
Emaciation : Nux v., Puis., Sulph., Calc, Ars., Veratr., Lye, China, Natr. m., Cham., Ant., Am. c; — -Cocc, Carb. v., Per., Plumb., Graph., Hep., Lach., Merc, Sec.
Obesity : Calc, Sulph., Baryt. c, Ant. c, Ars., chiefly.
Asthma: Nux v., Carb. v., Caps., Cham., China, Sulph., Zinc, Ars., Veratr., chiefly.
124 DIGESTIVE SYSTEM.
Moral Symptoms. Hypochondriasis: Nux, Puis., Sulph., Calc, China, Bella. ; — Cham., Cocc, Natr. m., Staph., Rhus, Zinc, Anac. , Ars., Aur., &c.
Ill-humour, irascibility : Nux v., Bryon., Cham., Carl, v., Ars.y Natr. m., Graph., Veratr., Kali, Sulph., Sep., Sil., Ac. nitr., Lye, &c.
Sadness, depression, dejection, gloominess : Ign., Puis., Coco., Bach., Bye, Natr. m., Sulph., Calc, Plat., Nux v., Veratr., Ars., Graph., Silic, Sep., Ac. sulph., Phimb., Am. m., Anac, &c.'.
Suspicion, mistrust : Puis., Nix v., Bach., Baryt. c, Merc, Ac. sulph., Cic, Bella., &c.
Anxiety, inquietude : Nux v., Puis., Bryon., Bach., Cham., China, Carb. v., Sulph., Calc, Bye, Merc, Plumb., Acid, nitr., Ars., Veratr., Am., Aur., Sabad., Cic ; — Alum., Amb., Am. m., Anac, Graph., Plat., Natr. m., Bhus, Sep., Staph., Acid, sulph., Cocc, Baryt, c, &c.
Fickleness : Ign., Plat., Natr. m.9 Zinc, Cm., Caps., Puis., Sulph,, Vol., Carb. a., Kali., Ars., Nux musch., &c.
Hysteria, tendency to: Ign., Puis., Plat., Sep., Nux, Sulph., Calc, &c.
Accessory Treatment and Diet. In no class of disorders is it more requisite to adhere strictly to dietetic regulations, than in those which consist of derangement in the digestive system, whether so called functional or organic : the patient should therefore, in such cases, regulate his regimen, as closely as possible, by the rules* laid down at the commencement of this treatise, carefully avoiding, more- over, all such articles as he may find disagree with him even if they appertain to the aliments allowed. He should generally abstain from soups, and everything that has a tendency to distend the
* As we have already observed at the conclusion of the said " Rules, " there are particular cases in which the regulations given are subject to considerable modifications. Thus, in some severe forms of dyspepsia, it is necessary to allow meat only every other, or every third day, or to prohibit it entirely for a time, and to substitute farinaceous food, or fish, or meat which is of a less stimulating quality, such as chicken. In other forms, particularly where the patient suffers much from flatulence, vegetables must be disallowed. Again, there are cases, but especially those with symptoms of biliousness, or rather excessive secre- tion of bile, in which milk, eggs, butter, and fat rich food are inapplicable. The use of unfer- mented bread will frequently be found of more easy digestion than that which is made by the ordinary process. There are instances, however, in which the former does not agree with dyspeptics. In such cases, bread made by means of the German yeast will often prove of easier digestion.
WANT OF APPETITE. 125
stomach, such as taking large quantities of warm liquids ; he should not indulge his appetite to its full extent, and carefully avoid late hours, unnecessary exposure, and severe mental exertion or anxiety ; he should also take sufficient exercise in the open air, and, as much as possible, keep his mind from dwelling upon his complaint, or on gloomy subjects.
WANT OF APPETITE.
Apepsia. Anorexia.
Want of appetite, being a concomitant symptom of many diseases, is treated accordingly in other parts of this work ; but we now propose to look upon it as one of the leading symptoms of indigestion, and in this character deserving a particular notice. In a great variety of cases, amongst others that of dyspepsia, it is usually attributable to an ill-regulated regimen, imperfect mastication of food, the abuse of tonics and other medicines in large doses, sedentary habits, and the neglect of sufficient exercise in the open air.
In many instances the removal of the exciting cause will cure this disorder. Sufferers from this inconvenience should carefully avoid creating an artificial appetite, and also partaking of the smallest quantity of food, until the previous meal has been assimilated ; the habit of taking tea, and even, as the expression is, cc making a meal of it," within a couple of hours after removing from the dinner-table, is a frequent cause of apepsia and dyspepsia.
Another source is the habit of drinking frequently, or very copiously during meals — thereby attenuating the saliva and gastric juice, and rendering them less fitted for the purpose of digestion.
Other causes are the custom of sleeping after dinner, partaking of heavy suppers, before retiring to rest, and the indulgence in fermented vinous or spirituous liquors, or in tea or coffee, particularly the latter.
An alteration in the hours of meals, and avoiding too long fasts between them, will frequently remove this affection.
In other cases, early rising, great attention to diet, abstinence from rich or highly-seasoned food, together with the .daily use of pure, cold water, — drinking a tumblerful an hour or so before break- fast, two to four hours after dinner, and again about the hour of
126 DIGESTIVE SYSTEM.
retiring to rest,-— will suffice to restore the weakened digestive func- tions to a normal condition.
When, however, we cannot trace this disorder to some of the above, or any other probable cause, when every attention to regimen, and even an alteration of diet, according to individual peculiarities or idiosyncrasy, has failed to produce any good effect, we generally find the want of appetite accompanied with other symptoms of derange- ment in the digestive functions, which may prove useful in aiding us to select a proper remedy to restore the natural tone of the stomach ; — this will be found among the medicines most useful in Dyspepsia and Cardialgia : namely, Nux vomica, Chamomilla, Pulsatilla, Cin- chona, Ipecacuanha, Antimonium crudum, Bryonia, Arnica, Hepar sul- phuris, Lachesis, Sulphur, and Calcarea, etc.
Nux vomica is the principal remedy when the want of appetite can be traced to late hours, the habitual use of wine and coffee, or to sedentary and studious habits, also when the following symptoms are present : dryness of mouth, tongue coated white, with cracks or slimy mucus in the mouth, agustia, pyrosis, or insipidity of aliments (particularly meat), accumulation of water in the mouth, aversion to food, costiveness or constipation, confusion in the head or giddiness (as if the results of intoxication), amnesia, and difficulty of fixing the mind to a train of application, weight in the occiput, tinnitus aurium, heaviness and aching in the limbs, uneasiness and a feeling of working or dragging of the tendons in the lower extremities, or cramps, restlessness, and irritability of temper, — symptoms aggra- vated in the morning.
Chamomilla is frequently found useful after Nux vomica, when, although considerable benefit has been derived, the whole train of symptoms are not removed. The following are its particular indica- tions : restless sleep, sensation of fulness and aching in the head, heat and redness of the face, a degree of fever, tongue thickly coated, yellowish, rough and cracked, (anorexia and greenish diar- rhoea,) and general sensibility of the nervous system. This remedy is especially called for, when a bitter taste in the mouth (or vomiting of bile, or of greenish mucus) ensues after eating.
Pulsatilla. This remedy is specific in the affections arising from partaking of over-rich or greasy food, for instance, pork or pastry ; or of aliments causing flatulence, such as vegetables ; or of food, in- the preparation of which rancid butter or lard has been used. The
WANT OF APPETITE. 127
more immediate indications are, whitish, cleft or fissured tongue, with bitter, salt, or foul taste in the mouth, sliminess of the mouth, scraping, roughness or acidity at the pharynx, bitter eructations, aversion to warm food or to meat, as .well as butter, and all rich food; loss of taste ; distension of the abdomen, and particularly a feeling of tension under the false ribs, borbory gmus, retarded or difficult defecation, or diarrhoea^ drawing^-in of the limbs (resembling that presentment in ague), exacerbation of symptoms in the evening, in contradistinction to Mux vomica, which is generally indicated by this occurrence in the morning. This remedy is well adapted to the mild lymphatic temperament, and also when there is a peculiar sen- sibility^ with a dislike to conversation ; it is likewise valuable when imperfect mastication is the cause of the aflfection, as well as in cases, where there is a marked aversion to tobacco,; even wrheii the patient is accustomed to its use. Moreover, this remedy will be frequently found of benefit in some cases where Chamomillahm only temporarily relieved ; but should a considerable degree of nervous- ness, or even irritability, remain after Pulsatilla, Nux vomieamaybe had recourse to.
Cinchona is highly efficacious in anorexia occurring during foggy weather, when the air is charged with unwholesome vapours, or in the vicinity of marshy lands. The following are its indications : a sen- sation of constant satiety, with general indifference to food, andadypsia ; tongue cracked, or loaded with yellow or white coating ; sensation of sinking and fluttering in the epigastrium (particularly when this symptom can be traced to the effects of tea) ; eructation after eating; desire for highly-seasoned food, acids, pepper, and other condiments ; general weakness^ with inclination to assume the recumbent posture, and inability tp remain long in one position ; uncomfortable feeling of dry heat, or shivering and sensitiveness in the open air ; retarded or interrupted sleep ; general feeling of uneasiness, with moroseness and peevishnesSi
Ipecacuanha is indicated by the following symptoms :■■ Nausea or vomitings without foulness of the tongue, with dislike to food. Tobacco— even to smokers— has a nauseous taste, and causes vomit- ing. This remedy is also useful when the impaired appetite has arisen from bolting the food, particularly in children, and may be followed by Pulsatilla, when only partial relief has been obtained.
Antimonium crudum will prove a good remedy in cases where a great disposition to nausea and vomiting with foul tongue exists ;
128 DIGESTIVE SYSTEM.
anorexia, dryness of the mouth with great thirst, particularly during the night ; accumulation of phlegm in the throat, with continual attempts to clear the throat ; frequent rising, soon after meals, of the food last partaken of; pain or disagreeable fulness at the epigas- trium, frequently with sensibility to external pressure. In cases of recent standing with the above symptoms it is very speedily effica- cious ; and when relief does not quickly follow, the next mentioned remedy should be had recourse to.
Bryonia in recent derangement of the stomach with anorexia; when we find thirst more during the day than through the night ; with a sensation of dryness in the throat, extending down the oesophagus ; chilliness ; yellow, dark brown, or white-coated, cracked tongue, with constipation.
Arnica. This remedy is valuable when the loss of appetite has arisen from sitting up at night ; watching at a sick bed ; from not having devoted a sufficient number of hours to the period of rest ; from intense mental exertion ; or from provocation or excitement. When from these causes the nervous system is powerfully affected ; tongue coated yellow; taste foul, bitter, or sour, or nauseous, or chalybeate, with offensive smell from the mouth ; rising of the food, or eructations of the taste or smell of rotten eggs ;* aversion to smoking and desire for acids ; sensation of fulness in the scrobiculus after meals, with inclination to vomit ; distension of the abdomen, with pinching colic, relieved by doubling up the body, and renewed by drinking the smallest quantity of wine, or passing off and then coming on with inclination to evacuate the bowels ; general irrita- bility and impossibility of fixing the mind upon any subject ; incli- nation to remain lying down, as this position relieves a heavy stupefying headache, which the least motion or even conversation increases.
Hepar sulphuris is useful in chronic cases of want of appetite, with indigestion from the slightest cause, notwithstanding the most careful observance of diet. It is indicated by desire for high- seasoned dishes, acids, and wine ; nausea, even inclination to vomit, particularly in the morning ; and constipation, frequently with colic. This remedy is one of our chief antidotes to Mercurius, and conse-
* (Tartarus emet., Sulphur, Valerian, Sepia, Stannum, also cover the latter symptom) : the practitioner will therefore do well to bear the said remedies in mind, when this particular symptom is a prominent one, and does not yield to Arnica,
DERANGEMENT OE THE STOMACH, ETC. 129
quently one best adapted to those affections of the stomach which have arisen from the long-continued use of calomel, or other mercurial preparations.
Laches is is a valuable remedy to follow Hepar sulphuris in ob- stinate cases, particularly when long-continued constipation is com- plained of, and the symptoms have always been aggravated by acid drinks^ &c; in the latter case Arsenicum is also useful, and may sometimes precede or follow Lachesis with advantage.
In addition to the two last-mentioned remedies, we may observe, that in the same class of cases, Belladonna, Mercurius, Sulphur, and Calcarea may be used with considerable advantage, when the former remedies have afforded only partial relief.
Acidum sulphuricum is a useful remedy in cases of impaired ap- petite, with weakness of digestion, arising from habitual excess in the use of ardent spirits, or from debilitating loss of fluids, such as blood, or in consequence of excessive study, — with the following symptoms : acrid or putrid taste, dry tongue, burning and smarting sensation in the gullet resembling heartburn ; offensive breath, especially in the morning ; aphthae ; disagreeable sensation of pricking in the throat, frequently occurring during the night, and disturbing sleep. In other cases the practitioner or student may consult the subjoined re- medies in the Materia Medica with advantage, either as applicable to the treatment of this affection, or to that of dyspepsia and cardialgia : Sepia, Colchicum, Femim, Silicea, Buta, Amnion c, Bhus, Aurum, Baryta c, Acid, nitr., Kali c, Natr. m. and c, Graphites, Hyoscyamus, Ignatia, Staphysagria, Kreosotum, Petroleum, Anacardium, Brosera, N. mosch. Cap- sicum. (See also Dyspepsia and Cardialgia.)
DERANGEMENT OF THE STOMACH, ERUCTATIONS, &c.
Under this head we intend treating of a disorder which may arise in individuals of a generally unimpaired digestion — the characteristics of eructations will assist to indicate the remedy for persons subject to this unpleasant affection.
The ordinary causes of this derangement are : hurried, imperfect mastication ; overloading the stomach ; fat, greasy, indigestible, or tainted food, flatulent vegetables, ices, stimulants, &c.
Therapeutics. When the symptoms of approaching stomachic
9
130 DIGESTIVE SYSTEM.
derangement declare themselves immediately, or a few hours after a repast, a little strong black coffee is frequently a sufficient re- storative.
Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist Nature by tickling the fauces with a feather, and giving tepid water to drink until the sto- mach has completely evacuated its contents. Should, however, on the following morning, symptoms of deranged digestion continue, such as nausea, inclination to vomit, or vomiting, and disagreeable or offensive eructations, we should administer Antimonium crudum, — one of our most useful remedies in this affection, and which rarely fails to afford at least some relief. It is also peculiarly indicated when the affection has arisen from drinking sour or impure wine; or, when, in addition to the symptoms of disordered stomach, a degree of 'fever returns every second day.
Ipecacuanha, When a rash has been throwTn out, from the effects of a disordered stomach, attended with anxiety, oppressed breathing, and sickness, this remedy will, in most cases, effect speedy relief; — but should the difficulty of breathing, or a degree of nausea, or other uneasiness continue, Bryonia should be employed. (Tar- tarus emeticus is sometimes more efficacious than either Ipecac, or Bryonia, when there is great drowsiness, with constant nausea and frequent vomiting : relaxed, brownish, yellow motions.)
Bryonia. In addition to the usefulness of this remedy in the foregoing instance, it is also very serviceable when the following symptoms are present: bitter eructations \ fever, alternately with cold- ness and shivering ; or redness of the face, heat in the head, and thirst with coldness and shivering ; also where diarrhoea or constipation and peevishness, or excessive irritability are present. (In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief.)
Arsenicum is appropriate when there are acrid and bitter eruc- tations with nausea and vomiting ; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the sto- mach, with diarrhoea or cholic, and griping in the hypogastrium, and particularly when these derangements have arisen from the effects of an ice which had been partaken of when warm, or from fruit, stale vegetables, or acids. It may, in many cases, be advantageously fol- lowed by Carlo vegetabilis, which see.
DERANGEMENT OF THE STOMACH, ETC. 131
Nux vomica is indicated by offensive or acrid eructations, consti- pation, and confused headache, particularly when arising from previous intoxication, or even slight over-indulgence in wine or other stimulants ; when possible, it should be taken the same night, as taken in the morning, although eventually relieving, it frequently causes an aggra- vation for a few hours. (In derangement of the stomach with heart- burn, flatulence, more or less nausea and headache, &c, in conse- quence of a chill or of indulging in mental or corporeal exertion im- mediately after a meal, this remedy commonly affords speedy amelioration.)
Arnica, deranged stomach, accompanied by eructations resembling rotten eggs.#
Pulsatilla is, next to Antimonium crudum, the most im- portant remedy in recent cases of deranged digestion, with eruc- tations of ingesta,' tongue foul and covered with mucus ; chilliness and lowness of spirits ; and also when a rash has been thrown out in consequence of the derangement. This remedy is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid wine, &c. ^Arsenicum may follow Pulsatilla, if the latter do not effectually relieve.)
Aconite. When the affection owes its origin to partaking of sour beer, vinegar, or other acids> particularly when we find oppressive pain in the stomach, great heat in the head, nausea, or actual vomit- ing of mucus, or even of blood.
He-far. sulfhuris. When the digestion is naturally weak, and sour vomiting, attended with burning in the throat, colic, and diarrhoea, is liable to ensue from the slightest error of diet, and particularly when anything of an acid quality has been partaken of. {Lachesisis often of great service here in alternation with Hepar sul- jphuris, at intervals of a week or so.)
When a fit of passion has produced an attack of indigestion, Chamomilla rarely fails to relieve. Bryonia is, however, to be preferred when chilliness and shivering accompany the symptoms of gastric derangement. (See Mental Emotions.)
Carbo vegetabilis, although last mentioned, is not one of the least valuable remedies in this affection, and is often found par- ticularly useful after Pulsatilla, Arsenicum, or Nux vomica, in removing any symptoms that may remain ; it is, moreover, particularly useful
* See also note, page 132.
132 DIGESTIVE SYSTEM.
where great susceptibility to the influence of the atmosphere, par- ticularly to cold, exists at the same time ; or in sufferings arising from abuse of wine, ices, or salt; further, in derangement of the stomach, arising from having partaken of game or fish which has been too long kept, or meat that has been recooked whilst in a state of fermentation, which is liable to occur in warm weather ; in the latter instances Carlo v. is to be preferred to any other medicine, and will rarely fail to afford relief; but if any disagreeable symptoms remain, Cinchona may be administered in a little water ; and followed, if required, by 'Pulsatilla in the same manner. Finally, this remedy {Carlo, v.) is peculiarly valuable in obstinate and chronic cases of deranged digestion when annoyance or inconvenience is felt after every meal, even amounting to nausea and vomiting, attended with excessive flatulency, and where the pit of the stomach is tender on pressure,*
FLATULENCY.
Flatulentia. Flatus. Tympanitis intestinalis.
This affection, together with the sufferings it entails, is generally found in individuals of weak digestion, and many also suffer from it immediately on taking cold in the abdomen or feet ; it is also, as well known, a common result of errors in diet, and the too frequent indulgence in vegetables and fruits. In corpulent individuals the sufferings arising from this complaint, such as difficulty of breathing, palpitation of the heart, trembling of the limbs, confusion of the head, and swelling of the face, especially in hypochondriacal subjects are most distressing. However, with proper attention to regimen, and suitable medical treatment, it is rarely very difficult to remove.
As an accompaniment .of deranged digestion, it has already been noticed under Dyspepsia.
The most useful preservatives against the complaint are avoiding cold, exposure in cold damp weather, very cold drinks, or distending the stomach with a large quantity of warm fluid, particularly strong tea or coffee ; each patient should also study his own digestion, and carefully refrain from partaking of any species of aliment which experience has proved to produce flatulency. Sedentary habits also
* A small quantity of finely-powdered charcoal, in a little good French brandy, will be found an equally efficacious mode of administering this remedy as a corrective against de- rangement of the stomach produced by having partaken of tainted meat or fish.
FLATULENCY. 133
should be avoided, and a proper portion of the day devoted to exercise in the open air.
Therapeutics. In the treatment of this affection the following medicines are most frequently called for : Cinchona, Arsenicum, Nux vomica, Pulsatilla, Carlo vegetalilis, Colchicum, Belladonna,' Colocynth, and Spirit sulphuris. Of these Nux vomica and Pulsatilla are perhaps the most frequently required.
Cinchona. When the affection can be traced to the effects of habitual indulgence in tea or warm drinks, an hour or two after a hearty meal, by which the process of digestion has been interrupted ; or to debility, loss of humours from venesection, or the continued use of purgatives ; or to deranged digestion arising from flatulent food, with painful tension and distension of the abdomen ; or when, on the occasional expulsion of flatus, a sensation of tension is felt in the umbilical region ; or, finally, where coldness or shuddering is experienced after drinking.
Arsenicum, where the last-mentioned symptom has not been relieved by the foregoing medicine.
Nux vomica. In cases where the flatulence is attended with sensation of pressure at the pit of the stomach, causing dyspnoea and a feeling as if the clothing were too tight, or a sensation of pressure as from a stone, and particularly when the affection arises from an habitual use of coffee, or from sedentary habits.
Pulsatilla, when the affection has arisen from having eaten of rich or greasy food, after which a copious draught of water has been partaken of, and the abdomen is tumid and accompanied by a pain as from a bruise, with borborygmus. Carlo vegetalilis is one of the most important remedies after the foregoing, in chronic cases, especially when the inconvenience arises after partaking of the smallest morsel of food.
Colchicum, when from a considerable accumulation of flatus the abdomen is extremely distended, or, as it might be expressed, inflated, and sounds like a drum on being struck with the hand [Tympanitis intestinalis) — without any marked pain, but with heat and difficulty of respiration. This remedy is generally peculiarly efficacious when the derangement is attributable to vegetable food ; or to the effects of exposure to a cold, damp atmosphere.
Belladonna. In cases of flatulent obstruction, in which the transverse section of the colon is the particular seat of the accumulated
134 DIGESTIVE SYSTEM.
flatus, and becomes protruded like a pad, this remedy should be employed ; it may be followed by Colocynth when the relief obtained is only temporary, or when, from the manner, in which the patient traces the course of his uncomfortable feelings, there is every reason to conclude that the flatulent distension and obstruction occupy the entire extent of the colon.
When the flatulence occurs very frequently, in fact, where a marked predisposition to it exists, we must have recourse to Spirit.
SULPHURIS.
Although we have pointed out the remedies best suited to the eases of this affection most ordinarily met with, and have also treated of the same subject under Dyspepsia and Colic, to which the reader is referred, we still think it advisable to add a few medicines which bear particularly upon this disorder, and are deserving of atten- tion. They are: Lycopodium, Cocculus, Natrum, Natnmi muriaticuwi, Zincum foliatum, Magnetis Polus Arctus, Agnus castus, Fermm, Graphites.
SPASM OF THE STOMACH.
Gast?:odynia, Cardialgia, Gastralgia.
Diagnosis. Contractive and spasmodic or gnawing pains at the epigastrium, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities: the patient is sometimes relieved by emission of ascending flatus, and when complicated with pyrosis, by a discharge of a quantity of limpid fluid ; occasionally headache and constipation are present. In some cases the pain is very slight, but there is always more or less, and a degree of anxiety, with nausea, often in- creased by taking food. The disease originates in an abnormal state of the nerves of the stomach, and is frequently accompanied by a disease of the liver, spleen, or pancreas, or even by scirrhus of the stomach or duodenum, in its advanced stages. It is a frequent attendant on gout ; and very rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time, according to the violence of the affection, and return in many instances periodically, and may be brought on by partaking of improper articles of diet, or in severe cases by any solid food whatever.
The chief articles to be avoided by an individual suffering from this
SPASM OF THE STOMACH. 135
malady are — crude, uncooked vegetable substances (such as salads), also cheese, new bread, sweetmeats, cherries, nuts, olives, and roasted chesnuts ; and stimulants of all kinds, whether strong tea, coffee, alcoholic or fermented drinks.
The exciting causes are : long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, worms, and in some instances, perhaps, exposure to cold or damp weather.
It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly discharge, or from any interruption of its usual course ; in such instances it is fre- quently accompanied with hysteria, syncope, and may pass on to vomiting of blood.
Notwithstanding the general intractable nature of this affection, it has been treated with marked success by the method about to be pointed out.
Therapeutics. Nux vomica is one of the principal, and, in a large number of cases, the most appropriate remedy against spasms of the stomach, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or an excessive indulgence in spirituous liquors ; it is, moreover, of essential service in many cases which have arisen after the suppression of chronic or hemorrhoidal discharges, or when the party affected is liable to fits of hysteria or hypochondriasis ; the following are the immediate symp- toms which call for the administration of this medicine : Constipation, pressure, squeezing, or spasm in the stomach, accompanied with a sensa- tion as if the clothes were too tight at the waist, or as if flatus were pent up in the hypochondria. This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addition to which, a feeling of depression or constriction is experienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Frequently, also, we find nausea, accumulation of clear water in the mouth, or risings of sour bitter fluids, attended with a sensation of burning in the throat and gullet (pyrosis) ; sour or putrid taste in the mouth, vomiting of ingesta, flatulent distension of the bowels, constipation, aching in the* forehead, palpitation of the heart, and anxiety. When these symp- toms are liable to be excited by a fit of passion, or become aggravated in the morning, or when the patient is occasionally awakened out of
136 DIGESTIVE SYSTEM.
his sleep by the spasmodic attack, this remedy is still more certainly indicated.
Should Nux vomica merely afford temporary benefit, followed by re- newed aggravation, and in cases where the disorder returns again after it has been for a time suppressed by Nux, we should first repeat that remedy; and if it then fail to afford relief, Carbo vegetabilis will generally be found to answer our purpose ; if not, Spirit, sulphuris may then be had recourse to, particularly where the affection is trace- able to the suppression of some chronic eruption. This last-named medicine, as well as Pulsatilla and Sepia, the value of which in such cases we shall notice under their several heads, is particularly useful in gastrodynia in females, arising from derangements of the menstrual functions.
In other cases, where no improvement results from the exhibition of Nux vomica, the following should be consulted : Chamomilla, Bella- donna, Cocculus, Ipecacuanha, Pulsatilla, Sepia, Ignatia amara, Cinchona, Staphysagria, Stannum, Bryonia, Platina, Senega, Batanhia, and Arnica montana. Should any one of these seem strongly indicated from the first, we must not hesitate to employ it in preference to those we have already noticed above.
Chamomilla. For the employment of this remedy the principal indications are : pressure as if from a stone in the pit of the stomach; or painful pressure at the precordial region, as if the heart would be crushed, flatulent distension at the same part, as also of the hypochon- dria and abdomen, with shortness of breath, anxiety, and throbbing headache ; mitigation of the above symptoms on partaking of coffee, — a distinguishing mark between the indications of this remedy and those of 'Nux vomica ; — on the other hand (as in the case of the latter), it is also indicated when the symptoms, as described, are liable to be brought on by a fit of passion.
Colocynth is sometimes more efficacious than Cham, in the latter case, and especially when the fit of passion is accompanied by indignation.
In obstinate cases, where Chamomilla fails, notwithstanding the apparent similarity of the symptoms, Belladonna ought to be sub- stituted for it ; also when we meet with gnawing pressure, or spas- modic tension in the pit of the stomach, relieved on lending backwards and holding in the breath ; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to de- prive the patient of consciousness. Carbo v. may, however, be preferred
SPASM OF THE STOMACH. 137
to Belladonna, when the most prominent symptom remaining consists of a sense of aching and pressure at the pit of the stomach and the praecordial region, causing a feeling as if the heart were about to be crushed. (See Chamomilla.)
Cocculus, in many cases of this complaint, is particularly indi- cated, when, in addition to the usual symptoms, there are constipation and constrictive pains over the entire abdomen, wdth flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms.
Ipecacuanha is useful m cases of this affection, when the pa- roxysms are accompanied by nausea, vomiting, dull darting pains in the pit of the stomach, and sensation of excessive uneasiness in the same region.
Pulsatilla. In cases with shooting pains in the stomach, which are aggravated by movement, and particularly by making a false step. Pulsatilla is also one of the most appropriate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeezing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposition thereto. Tendency to hysteria or hypo- chondriasis. This remedy, as wrell as Sulphur and Sepia, is called for in cases of this affection, arising from suppressed menstruation. When Pulsatilla does not afford much relief, the desired result is often attain- able through the agency oilgnatia.
Sepia is an efficacious medicine in gastrodynia arising from sup- pressed or difficult menstruation, and may in general cases advan- tageously follow Pulsatilla ; it is indicated when, as in the cases of Nux v. and Pulsatilla, most of the sufferings arise after a meal, when there is pressure in the stomach as from a stone, and a burning pain is experienced in the epigastrium and scrobiculus. By restoring singly, or in conjunction wdth Pulsatilla and Sulphur, the menstrual flux, it frequently removes the cardialgia and hysteria consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms.
Ign atia amara i3 indicated under nearly the same circumstances as Pulsatilla, with the exception of the state of the bowrels, Ignatia being more appropriate to cases attended with costiveness, and where the inclination to vomit is absent, or when the affection has
138 DIGESTIVE SYSTEM.
been caused by grief, anxiety, exhaustion by long abstinence, &c, or occurs in very hysterical or hypochondriacal individuals. (See also the remedies mentioned at the end of the chapter.)
Cinchona is of great service in most cases of spasms of the stomach with general weakness arising from loss of humours, the result of bloodletting, or repeated hemorrhages, abuse of emetics or aperients, too long -continued suckling, &c. ; and is further indicated by great weakness of digestion, distension and uncomfortable weight, pressure, or pains in the stomach after eating, so that the patient feels much easier when fasting ; these latter symptoms are the more immediate indications for the employment of this medicine. (Nux v. and Carlo v. may follow Cinchona, should the latter not remove all the symptoms.)
Staphysagria. This is useful in some cases of this complaint, and is particularly applicable when there is acute pressive tension and squeezing about the pit of the stomach, which sometimes ob- structs the breathing, but which is relieved by bending the body forward. When, however, the pain partakes of a marked tensive character, and extends to the region of the navel, accompanied by sensibility of the region of the stomach on external pressure, shortness of breath, anxiety, and nausea, St annum will be found more appropriate.
Bryonia. This medicine is more particularly adapted to the milder cases of cardialgia, with painful pressure, or a feeling of dis- agreeable fulness in the stomach after a meal, which occasionally becomes converted into a feeling of constriction,, cutting, or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more clearly indicated when the symptoms are gene- rally accompanied by severe headache or painful compression in various parts of the head, and particularly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree ; increase of the Sufferings by movement ; habitual costiveness.
PiiATiNA. Spasms of the stomach in females, occurring particularly at the monthly period, (Chamomilla, Pulsatilla, Nux v., and Cocculus are equally efficacious at such periods when the symptoms are as indi- cated under these remedies,) and especially when the menses are, at the same time, generally very copious, and of too long duration.
Senega will be found efficacious in cases characterized by painful pressure and burning in the stomach, especially at night.
Ratanhia. Spasm of the stomach, or painful constrictive pain,
SPASM OF THE STOMACH. 139
relieved by eructation, with loss of appetite, hiccough, distension of the abdomen, costiveness, and frequent micturition.
Arnica Montana, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a Mow, etc., will be found specific. It is, however, also an excellent remedy when there is a sense of pressure as from a stone, or of fulness in the stomach and scrobiculus, constrictive pain in the stomach and in the precordial region, shooting pain in the pit of the stomach, with painful pressure or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Bismuth, — Cardialgia, with tenderness on pressure at the pit of the stomach in hysterical females. This remedy is, further, often of great service in some of the most obstinate cases, particularly when there is a sensation of great weight or pressure, with indescribable pain and uneasiness in the stomach.
Arsenicum. Periodic pains in the stomach, chiefly consisting of a burning character, and attended with acrid, sour eructations, vomiting of ingesta, or of mucus, sometimes even of blood ; ano- rexia, extreme debility, emaciation.
Lycopodium. Squeezing or compressive pains proceeding from each extremity of the stomach, with flatulent distension; want of appetite, pains in the back and loins (constipation) ; exacerbation of the symptoms in the open air, after a meal, or in the morning ; car- dialgia in lymphatic females, with too copious catamenia.
Lachesis. Spasms of the stomach, particularly in persons addicted to excessive indulgence in wine or ardent spirits, relieved by partaking of food ; tongue covered with a dark brown fur, or glazed, red, and cracked, or swollen ; flatulence, constipation ; tremulousness, numbness, and paralytic weakness of the extremities.
Sulphur is frequently an indispensable remedy in chronic cases, attended with heartburn ; aggravation of the pains after a meal ; constipation, hemorrhoids.
Calcarea. In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, especially after the previous employment of Nux v., Lachesis, and Sulphur, It is further a valuable remedy in the cases of plethoric females subject to nasal hemorrhage, or to excessively copious menstruation ; and is generally indicated when the paroxysms of pain come on usually at night, or after a meal; in which latter instance, vomiting sometimes results, or nausea and
140 DIGESTIVE SYSTEM.
acidity, with painful sensibility on pressure at the epigastric region. Constipation, hemorrhoids, or chronic looseness of the bowels, are additional general indications for the employment of this remedy.
These are the principal remedies to be employed in ordinary cases of Cardialgia ; but, in some cases, one or more of the following medi- cines may be called for : Sanguinaria canadensis, Bismuth, Carlo v., Graph., Gratiola, Magn., Nitr. spir., Sil., Stann., Staph., Stront., Am. c, Cup., Daph., Kali, Euphorb., Kreos., Natr., Natr. m., Nux m., Assqfcctida, Digitalis. In Cardialgia occurring in hysterical or hypochondriacal subjects, Ign., Nux v., Calc, Grat., Cocc, Stann., Bism., Digitalis, etc., form the more important medicaments.
The diet ought to be extremely simple, and easy of digestion ; and everything which is known by experience to bring an attack should be eschewed. Fat, oil, butter, cheese, etc., are often hurtful, and should therefore be avoided. See also Dyspepsia, of which this malady is but a modification.
HEARTBURN.
Black water. Water-brash. Pyrosis.
This is not an affection of that organ which its name would imply, but a painful or uneasy sensation of heat or acrimony about the pit of the stomach, sometimes extending upwards. It is frequently accom- panied with anxiety, nausea, and vomiting ; or a violent gnawing spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. The remedies required for the treatment of the disorder are the same as those mentioned under Dyspepsia, Flatulence, and Spasm of the Stomach, according to the symptoms : of which Nux v., Puis., Sulphur, Acid, sulphuricum, Carbo v., Cinchona, or Calcarea, will be found the most appropriate in ordinary cases. (See the aforesaid derange- ments for particular indications.)
VOMITING OF BLOOD.
Hcematemesis.
Diagnosis. 'Blood evacuated by vomiting, sometimes pure (generally venous), of a dark colour, but sometimes of a bright red ;
VOMITING OF BLOOD. 141
it is occasionally mixed with bile, food, &c. ; the quantity varies ; blood is also not unfrequently discharged in coagula by stool.
Premonitory Symptoms. Weight, pressure, fulness or tensive pain or spasm in the hypogastric or hypochondriacal regions ; griping and colic ; burning heat in the region of the stomach ; anxiety, particu- larly on partaking of food or drink, or on pressure at the stomach . saltish taste in the mouth ; impaired appetite and nausea ; giddiness ; syncope, cold perspiration ; sometimes also an intermittent pulsation is perceptible at the scrobiculus.
Some only of the preceding symptoms may be present previous to the attack, and others, during its course when very severe, or fre- quently renewed. We often find wild delirium or wandering accom- panied with spasms, and a gradually increasing weakness and remis- sion of pulse with frequent syncope.
The most frequent causes of this affection are the sudden suppres- sion of any sanguineous discharge, and the consequent determination of blood to the stomach ; it is, therefore, agt to declare itself after a stoppage of the hemorrhoidal flux, and is a very common affection in females, from the suppression or cessation of the catamenia; in which case (as before remarked under that affection), it is frequently preceded by Cardialgia. Other causes are scirrhus of the stomach, internal lesions or injury of that organ from swallowing sharp sub- stances, or from worms; poisons, drastic purgatives, or emetic drugs, external contusion, obstruction of important viscera,' or a change in the constituent principles of the blood itself; the direct cause is the bursting of some of the vessels of the stomach.
The dangers arising from the use of powerful astringents are, inflam- mation or subsequent induration of the stomach, or putrid gastric fever.
When this affection occurs in females from non-appearance or suppression of the monthly discharge, or from its final cessation, see articles Chlorosis, Amenorrhcea, Cessatio mensium ; when it arises from worms, see Helminthiasis ; from poisonous substances, see Poisons ; and when it originates in diseases of the spleen, consult Splenitis.
We may now proceed to the consideration of the remedies above alluded to.
Aconitum. When the premonitory symptoms above given, declare themselves, and particularly when a considerable degree of fever pre- cedes the attack.
142 DIGESTIVE SYSTEM.
Ncjx vomica. In a decidedly plethoric constitution with a marked (venous) stomachic or abdominal congestion, and tendency to constipa- tion^ particularly when arising from suppression of hemorrhoids, or of the menstrual flux, or from indulgence in vinous, spirituous, or fermented liquors ; this remedy is still further indicated by irritability of temper.
Pulsatilla. The value of this remedy is noticed in the diseases of females above mentioned; it is also, in many cases, found more suitable than Nux vomica for males, when of lymphatic temperament and mild disposition. Some of the best indications for this medicine will be found under Dyspepsia, Cardialgia, and Derangement of the Stomach.
Cinchona. When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debilitating losses, is clearly indicated ; it should also be chosen when the patient has had a severe attack of haematemesis, which has ceased of itself, but stil] left great weakness.
Arnica. One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a sanguine temperament, and choleric disposition. It is further indicated, when the patient complains of pains resembling the results of a contusion, in all the extremities.
Spirit, sulphuris is useful in strumous habits, or when the affection has arisen from suppressed hemorrhoids ; its value also in cases of abnormal menstruation will be pointed out in the proper place.
The following remedies also deserve a careful study: Phosphorus, Belladonna, Arsenicum, Lycopodium, (which may be ranked next to Nux v. in cases arising from abdominal congestion^) Hyoscyamtis, (which, with Belladonna, is particularly useful in cases attended wTith Spasmodic action,) Lycopodium, Arsenicum, Phosphorus, and Secale cornutum (in Schirrus), together with Carlo vegetabilis, Millefolium, Cantharides, Cal- carea carbonica, Natrum muriaticum, and Zincum, under peculiar circum- stances, and as tending to eradicate the predisposition to such affections.
The application of dry cupping-glasses to the abdomen and under the ribs, or of a cloth which has been dipped in cold water, to the lower region of the abdomen, sometimes forms a useful auxiliary in arresting the hemorrhage. See also Hemorrhage from the Lungs, under Haemoptysis.
CONSTIPATION. 143
Diet. The rules already given under Cardialgia should be observed^ but with still greater strictness ; no solid food must be par- taken of; all drinks should be cold ; animal jellies^ preparations of milk; light puddings, and broths, merely tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose ; immediately after an attack, no food should be given for some hours, and then very cautiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite.
COSTIVENESS, CONSTIPATION, OBSTIPATION.
Constipatio, Obstipatio, Obstructio Alvi.
We have now to treat of an affection which so frequently baffles the skill of the practitioners of the old school ; their leading cause of failure being their ignorance of, or inattention to, the great curative principle, and consequent proceeding upon a system opposed to the operations of Nature. This complaint is generally sympathetic with some other derangement of the organism, and, consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the Constipation, most closely approaching to an idio- pathic form, is the practice of flying to aperient medicines on the slightest appearance of costiveness, under the absurd idea that keeping the bowels open is a species of panacea against disease of every descrip- tion. Many mothers are so possessed with this idea, that they con- tinually administer physic to their children, without the slightest apparent call for it, and thus lay the foundation of dyspepsia and other visceral derangements in after-life. Many a slight case of costiveness which, if left to nature, would have disappeared of itself, leaving no ill consequences, has, by an ill-judged administration of aperients, been converted into obstinate and habitual constipation, embittering existence, and predisposing the constitution to a variety of diseases in after-life. To prevent misconception upon this point, it should be clearly understood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, we happily possess remedies calculated to restore the general balance of the system; and, in obstinate cases, do not content ourselves with simply alleviating the
144 DIGESTIVE SYSTEM.
symptoms, but mainly direct our attention to the permanent removal of the affection.
Many of the principal causes of this disorder, besides that men- tioned, are the same as those particularised under Indigestion or Dyspepsia.
Therapeutics. In trivial cases it will be found sufficient to pay proper attention to diet, to avoid too dry or indigestible food, to masticate properly, to partake of meat only once a day, and to take sufficient exercise in the open air.* Should this course not have the desired effect, we must choose one or more of the following remedies: namely, Opium, Alumina, Bryonia, Nux vomica, Pulsatilla, Platina, Na- trnm muriaticum, Plumhim metallieum, et carbonicum, Sulphur, Calcarea c, Lachesis, Veratrum, Lycopodium, Sepia, Veratrum^ Silicea, Zineum, etc.
Opium is chiefly to be selected in recent cases, when constipation is not habitual ; but is also, like Nux v., and other remedies, service- able in cases of a more chronic character, occurring in vigorous, plethoric, well-nourished subjects, and arising from inactivity in the intestinal canal, or from sedentary habits. In old people, it is generally more useful than Bryonia and Lachesis, when diarrhoea alternates with the constipation, although these and other remedies, such as Antim., Phosph., and Ruta, must be borne in mind and administered when called for by the nature of the symptoms. The more immediate in- dications for Opium are ; want of power to relieve the bowels, with a feeling of constriction in ano ; pulsation and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, determination of blood to the head, with redness of the face, and headache.f
* See also the concluding remarks of this chapter.
f Opium is strongly recommended by Dr. Perry, as the best palliative remedy in consti- pation arising from pressure on the rectum, such as that which is occasioned by the gravid uterus, abdominal tumours, swelling of the ovarium, fibrous swelling of the uterus, and, in consequence of which, the faecal matter frequently accumulates in excessive quantities in the rectum, and can only be expelled after great effort, accompanied by severe pain. In weak, nervous, emaciated females, in whom the monthly discharge is always too copious, or in cases where the constipation has arisen from affections of the stomach or liver, Opium is contraindicated. M. Perry recommends the administration of Opium by olfaction, in pre- ference to the ordinary method, and that as follows. At the period of the day at which the patient used formerly to have the bowels relieved, or, otherwise, as soon as a slight ineffectual inclination for stool is experienced, he desires the patient to smell a solution of Opium (a few globules dissolved in a small phial containing a mixture of spiritus and aqu.
CONSTIPATION. 145
Alumina. Constipation from an apparent absence of peristaltic motion ; faeces hard, dry, broken, evacuated with considerable exer- tion of the abdominal muscles and forcing, and sometimes streaked with blood; constipation from travelling,
Bryonia is especially useful in constipation occurring in warm weather > and in persons of dark complexion and an irritable or obsti- nate disposition, with a tendency to be easily chilled, and subject to rheumatism; it is further indicated when constipation arises from disordered stomachy and is attended with determination of Hood to the head, and headache.
Nux vomica, This remedy is particularly useful when constipa- tion results from too heavy a meal, indigestible food, and stimulating liquids ; or when the confined state of the bowels has resulted from prolonged diarrhoea or frequent purgings. In the latter instances Opium may often be advantageously alternated with Nux v. In chronic cases arising from long-continued indulgence in vinous, fermented, or spirituous drinks, or coffee, or from sedentary habits or excessive study, Nux is one of the most effectual medicaments. It is peculiarly adapted to persons of irascible and lively temper, with determination of blood to the head, and headache* unfitness for exercise, disturbed sleep, and a feeling of general oppression or heaviness ; frequent and ineffectual efforts to relieve the bowels, attended with a sensation of stricture, and sometimes frequent, painful and difficult emission of urine. It is further, as remarked under Dyspepsia, particularly indicated for individuals subject to hemorrhoids.
Pulsatilla has nearly the same indications as Nux vomica, with the characteristic distinction of temp eram en t before notedunder Dyspepsia. In recent cases, it is particularly indicated when the obstruction has arisen from indigestion brought about by rich or greasy food, and when it is accompanied by moroseness and shivering.
Platina is a useful remedy when constipation has been brought about by travelling, when Opium has failed, or especially w7hen the act of expulsion is attended with great straining.
destill.) several times, and to repeat the process after an interval of half an hour, and again, as before, on the day following, if no satisfactory action result from the first trial. He fre- quently found, that on the first occasion, only a more decided inclination to go to stool was the sequel, whereupon, after a repetition of the olfactus, the desired effect took place. In some very obstinate cases, he ordered a simple enema to be employed, after several pre- vious trials of Opium, in the foregoing method, and succeeded in this manner in instances where neither Opium, nor the enema alone, was capable of affording the desired relief. — Journal de la Med. Homceop., torn, i, chap. 1.
10
146 DIGESTIVE SYSTEM.
Plumbum metallicum, or Carbonicum. Obstinate constipa- tion, with ineffectual efforts ; painful retraction and constipation of the anus ; or evacuation of tenacious, hard, bullet-shaped faeces. (See Obstipation.)
Natrum muriaticum. This remedy will sometimes be found efficacious when many others have failed to relieve, particularly in chronic and extremely obstinate cases.
Sulphur is one of the best remedies in the relief of habitual cos- tiveness, constipation, particularly when hemorrhoids are present, or a disposition to them exists; or frequent inclination to go to stool, but without the desired result.
Veratrum. Constipation, chiefly from inactivity of the rectum, with heat and dryness of skin, determination of blood to the head and lateral headache. (Alumina is also of great efficacy in consti- pation from torpidity of the rectum — -see Constipation from inertia recti.)
Lachesis. In obstinate constipation, this medicine may be given with effect after Nux v. to those wrho habitually take wine rather freely, or who experience flatulent distension after meals and ineffectual efforts to eructate.
Sepia may frequently be taken with advantage in chronic constipa- tion after Nux and Sulphur ; and is, moreover, particularly well adapted for females in whom there is an irregularity or obstruction of the menstrual flux ; it is also indicated by constipation in individuals sub- ject to rheumatism, as wTell as by hard, conglomerate bullet-shaped faeces. (See Obstipation.)
Silicea is often useful when constipation is accompanied with colic, impaired appetite and thirst; the stools hard, knotty, and passed with great difficulty; and the patient troubled with tenes- mus. (Conium is occasionally useful in completing the cure after Silicea.)
Lycopodium . Chronic constipation with ebullition and determination of blood to the head: colic, flatulence, sense of tveight in the lower part of the bowels.
In Obstipation with indurated faeces, formed into hard balls (scybald), Pkimb., Magn. m., Sep., Ruta, Verb., and sometimes Nux v., Op., Veratr., Sulph., &c, are useful ; but in obstinate and complicated forms of this affection, the treatment requires considerable experience, in addition to a thorough knowledge of the Materia Meclica. In all cases of con- stipation of an obstinate or chronic nature, recourse may occasionally
CONSTIPATION. 147
be had to an enema of tepid water, as a temporary mode of relief, until the medicine has effected the desired result. The drinking of a tumblerful or more of cold water, thrice a day, fasting, dashing cold water against the abdomen, and then applying brisk friction by means of a coarse towel, combined with early rising and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering, or defeat the object we have in view, by exhausting instead of giving tone to the energies of the patient,) will be found useful auxi- liaries in promoting a regular action of the bowels. The diet ought to be regulated according to the state of the primary digestive organs,* and highly-seasoned food, or that which contains much fibrous or ligneous matter, such as radishes, cabbages, turnips, green fruits, &c, avoided. When constipation occurs in alternation with diarrhoea, Nux v., Lachesis, Rhus, Antimonium, Ruta, Bryonia, Opium, and Phos- phorus have been found useful. In . constipation from inertia recti, or from atony of the intestinal canal, Sepia, Veratrum, Awrum mu~ riaticum, Alumina, Natrum m., and Padus avium have been recom- mended as the best general remedies ; but when the indications for the selection of any of the remedies we have given in the preceding part of this article manifest themselves, we must not hesitate to pre- scribe accordingly.
For constipation in aged persons, the following medicaments are generally the most efficacious : Opium, Aurum m., Natrum m., and Padus avium, {Padus prudus,) or Veratrum, Bryonia, Lachesis, Baryta c, Ruta, &c.
In that which is prone to occur when travelling : Platina, Opium or Alumina, Calcarea, Cocculus, Conium, Graphites, Gratiola, Arseni- cum, Kali, Baryta c, Agaricus m., or Ammon., &c, may also be called for in particular cases. When frequent purgings or protracted diar- rhoea have given rise to constipation, Nux v, and Opium sometimes in alternation, or China, Aurum m., Natr. m., Pad. prud>, Lachesis, Antim., Ruta, usually answer best.
Against constipation from exposure to the Vapoujr of Lead; Opium, Alumina, Platina, are, in general cases, the most important re- medies.
That from Congestion or fulness of the vessels of the head; Aconit., Belladonna, and, still better, Opium, Ntix v., Pulsatilla, Sulphur, Calcarea, Lycopodium, &c. (See Determination to the head.)
* See Dyspepsia, rules for diet in.
148 DIGESTIVE SYSTEM.
And against that from Duodenitis {chronic) : Nux v., Pulsatilla, Sul-> phur, Lachesis, Veratrum, and, sometimes, Mercurius, Digitalis, Kali> Sepia, Ars., Silicea, Amnion, c. (See also Hepatitis, Dyspepsia, and Spasmodic stricture of the rectum.)
PILES. HEMORRHOIDS.
Diagnosis. Varices, or effusion of blood in the cellular tissue of the rectum, either within or without the anus, (internal or external piles ;) or protrusion and filling of one or more of the inner folds of the same intestine, and with or without bleeding (open or blind piles), preceded or accompanied by pains in the back, sacrum, and abdomen ; sensation of itching, pricking, tickling, burning, or pressing at the rectum, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary functions.
The predisposing cause of the disease is a constitutional taint; whilst among the exciting causes are habitual costiveness, severe ex- ertion on horseback, prolapsus, use of drastic medicines, stimulating diet, the use of vinous, alcoholic, and fermented drinks, or coffee, the suppression of long continued discharges, sedentary habits, &c.
During the treatment of this affection it is of the utmost import- ance to attend strictly to the homoeopathic rules for diet. Strong or heating drinks, such as wines, coffee, strong tea, and stimulating ox highly - seasoned food of all kinds are particularly to be avoided. Sedentary habits and the use of soft cushions or chairs materially tend to aggra- vate the affection. The painful practice among surgeons of removing the hemorrhoidal excrescences by means of the knife or ligature is much to be deprecated ; for, independent of the danger not unfre- quently attending the operation, it may occasion serious consequences by metastasis of the congestion to some of the noble viscera ; in a great number of cases, moreover, it wholly fails, and the disease re- turns, sometimes even in an aggravated form.
Therapeutics. The medicines most used in this affection are
Aconitum, Nux vomica, Sulphur, Lycopodium, Arsenicum, Belladonna, Hepar sulphuris, Pulsatilla, Platina, Ignatia, Antimonium crudum, Colocynth, also Ipecacuanha, Calcarea, and Cinchona.
Aconite, although not specific in its curative action, is useful in
HEMORRHOIDS. 149
allaying pain, when considerable and distressing inflammation exists, and may in such cases precede the administration of each of the fol- lowing medicines, which are among the principal remedial agents in this disease.
Nux vomica, as wre have before had occasion to remark, is a most valuable remedy in this affection, and is equally efficacious against both descriptions of piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulating liquids, and also for females during pregnancy ; when the hemorrhoids are attended with shooting, burning or itching pains ; colic ; shooting and jerking pain, as if from bruises in the loins, rendering it difficult to rise or walk in an erect position ; and when they are accompanied by constipation and sometimes painful and difficult urination, and the other symptoms described under Indigestion or Dyspepsia.
Sulphur may follow the administration of Nux vomica ; and an alternation, at intervals of a week or ten days, of these remedies fre- quently effects a cure in cases of long standing.
Arsenicum. Hemorrhoids accompanied by burning and shooting pains, heat, and agitation, sometimes with prostration of strength.
Belladonna, moist hemorrhoids, with an insufferable pain in the sacral region, as if the back would break or be rent asunder ; difficulty in voiding urine,
Hepar sulphuris may follow Belladonna, should that medicine fail to, or only partially, i*elieve these symptoms.
Rhus toxicodendron, when the violent pain, mentioned under 'Belladonna still continues severe, this medicament may be selected in preference to Hepar, particularly if the pain be relieved by motion.
Capsicum, when a burning sensation exists, attended with consi- derable itching and diarrhoea.
Pulsatilla, discharge of blood and mucus during stool, some- times accompanied by painful smarting, and sensation of excoriation in the hemorrhoids, pains in the back, pallid countenance, and dispo- sition to fainting ; difficulty in passing water.
Platina, when there is frequent inclination to go to stool, followed by a very scanty and difficult evacuation, succeeded by general shudder- ing and a feeling of weakness in the abdomen / frequent creeping, itching, and piercing at the anus, particularly in the evening; griping in the lower intestine, discharge of blood during stool, and at other times.
Lycopodium is a most important remedy in chronic hemorrhoidal affections, particularly when there is congestion to the head, with
150 DIGESTIVE SYSTEM.
giddiness and headache, flatulent distension of the abdomen, constipa- tion, severe burning, itching, and pricking pains in ano, with painful protrusion of the hemorrhoids, and sometimes prolapsus ani after a motion ; acrid discharge from the hemorrhoids ; and prurient erup- tion round the anus.
Ignatia, is indicated by itching and creeping, and also sensation of constriction and excoriation in the anus, and pricking or darting pain extending deep into the lower intestine ; discharge of blood or of bloody mucus, rumbling noise in the abdomen, and protrusion of the lower intestine accompanied by acute pain.
Antimonium crudum, discharge of mucus and of blood at every stool, followed by severe coUcwxA pain in the hemorrhoids, with throbs bing, itching, and burning at the anus, and discharge of viscous acrid moisture, particularly at night ; frequent determination of blood to the head, with bleeding at the nose; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulence, and constipation.
Golocynth. In cases of hemorrhoids, attended with excessive almost insupportable colic, this is a most efficient remedy.
When the discharge of blood from piles amounts to hemorrhage, a dose or two of Aconitum may be given in the first place, followed by Ipecacuanha, if improvement do not speedily follow ; again, if Ipeca- cuanha does not arrest or diminish the discharge in a few minutes, Sulphur should be prescribed, and followed in turn by Aconitum : but if, notwithstanding the employment of these remedies, the hemor- rhage does not cease, Belladonna should be given, and then Calcarea.*
Cinchona is valuable either as an immediate remedy to support the patient, when there has been much loss of blood, or afterwards against prolonged debility.
These are the principal medicaments to be employed in the treat- ment of ordinary cases of hemorrhoids ; and when judiciously selected, will be certain to afford the desired relief, provided the patient is careful to adhere strictly to the rules laid down in the introductory remarks upon this affection. In severe cases of long standing, much patience and perseverance are required before the disease can be permanently removed.
Against hemorrhoids with mucous discharge (blennorrhea intesiini recti), Mercurius, Helleborus niger, Colchicum, and- Spigelia are valuable medicines.
* C. Hering's Hausartz.
STRICTURE OF THE RECTUM. 151
STRICTURE OF THE RECTUM.
Stricture of the rectum is divided, by some authors, into two kinds, viz. the spasmodic and permanent. The first appellation being given to that form of the complaint which sometimes arises in consequence of the existence of hemorrhoids, or from constipation, the prolonged use of drastic purges, etc., and in which the patient is affected with the following symptoms : costiveness, with consider- able pain in the anus, particularly after a stool ; the faeces are small in diameter, and present a twisted appearance. On passing the finger into the rectum, the lower sphincter is felt spasmodically con- stricted. The disease is, moreover, often complicated with a small but painfully sensitive ulcer of the mucous membrane, or with rha- gades, or irregular fissures or cracks. The second variety, the per- manent stricture, or stricture proper, consists in a thickening and induration of the mucous and muscular textures, and probably also of the interposing cellular tissue. In this form of the disease, the faeces are flattened and diminished in volume, and the patient en- counters much difficulty in expelling them ; the pain about the anus is distressingly severe, and does not remit, as in spasmodic stricture. When the finger is introduced into the rectum, the gut will, in most cases, be found contracted two or three inches from the anus ; but in some cases the seat of the stricture is considerably higher. As permanent stricture of the anus is by far the most serious and ob- stinate form of the complaint, we shall offer the following additional particulars connected with it. The disease comes on very insi- diously, and occurs in both sexes and at all ages, but in adults more frequently than in children. The patient, at the commencement, meets with some difficulty in evacuating the contents of the rectum, and is under the necessity of exerting considerable expulsive force. These symptoms gradually increase in severity, and are sometimes accompanied by others, which resemble those of ileus ; the pain becomes extremely violent, and the faeces are not only accompanied by a discharge of mucus, but also of blood and purulent matter, from the accession of inflammation in the contracted portion of the intestine. If the disease be not checked, the cellular tissue around the rectum becomes implicated in the inflammatory process, and putrid abscesses form which burst in various spots in the vicinity of
152 DIGESTIVE SYSTEM.
the anus, and the patient sinks. In some cases, the patient is carried off with symptoms resembling those of strangulated hernia, from the blocking up of the stricture by indurated faeces.
In the advanced stage of the disease, most patients become hectic, but frequently linger on for several years.
Therapeutics. In spasmodic stricture, or preternatural contrac- tion of the sphincter ani, the homoeopathic treatment is, in recent cases, at once gentle, simple, and peculiarly efficacious ; and even in long-standing, inveterate cases, their employment is generally attended with successful results, when the patient can be prevailed upon to pursue the treatment long enough.
The following are amongst the more frequently applicable reme- dies in ordinary cases of the disorder. Nux v., Opium,, Lachesis, Plumb. c, Sepia, Natrum m., Mang., Mags., Staph., Calc, Coloc, Aug., Thuja. Where the patient is habitually of a costiv.e habit, or the faeces are dry and hard, as is commonly the case in this affection, these remedies will prove equally opportune. And where hemor- rhoids appear to have given rise to, or at all events accompany and aggravate the disorder, the same medicines, together with Sulphur, Colocynth, Calcarea, etc., form the principal remedial agents.
In hysterical females, Lgnatia, Sepia, Nux v., Lachesis, and Natr. m., Calc., Staph., N moscL, deserve a preference. The indications which are given for the choosing the above-mentioned remedies under the chapters of Constipation, and Hemorrhoids, as also under that of Dyspepsia, when deranged digestion accompanies the complaint, will assist us in making a selection of the remedy or remedies best adapted to particular cases. Although we are opposed to the em- ployment of a bougie for the purpose of dilating the anus in spas- modic stricture, still we are willing to allow that there are some cases in which the introduction of a suppository of tallow, at night, (a por- tion of a mould candle for instance,) may prove serviceable. Cases that are complicated with rhagades require the employment of such remedies as Graphites, Agnus, Sulphur, Calcarea, Rhus, or, Hepar, Mezereon, Alumina, Merctirius, Lycopodmm, Sarsaparilla ; but one or more of the medicaments enumerated, at the commencement of this article, will commonly be called for in the course of treatment.
When the complication of a small, and excessively painful ulcer exists : Lachesis, Arsenicum, Lycopod. And, sometimes, Sulphur, Silicea, and Calcarea are chiefly requisite. The homoeopathic treatment of
STRICTURE OE THE RECTUM. 153
permanent stricture likewise possesses many advantages over that of the ordinary method, particularly when, in the latter, the employ- ment of bougies is rendered unsafe or inapplicable by the distance of the obstruction from the anus, or by an insuperable degree of irri- tability of the bowel.
At the commencement of the disease, when the patient expe- riences much difficulty in expelling the faeces, and almost constantly complains of more or less pain about the anus, the same remedies are required as those we have mentioned as appropriate in recent cases of spasmodic stricture. In the majority of instances, and especially in the male subject, Mix v. answers best to begin with, the more so, if the patient has been addicted to a rather free mode of living, or been given to sedentary habits and suffers from constipation, hemorrhoids, &c. in consequence. After the employment of Nux v., we shall generally find it requisite to have recourse to Sepia, Sulphur, and Calcarea at proper intervals.* At a more advanced stage of the complaint, where inflammation has taken place in the constricted portion of the bowel, and the pain has become intense, and is attended with a discharge of blood and even of purulent-looking matter, we have often obtained very satisfactory results from the use of a dose or two of Aconitum followed by Sulphur in repeated doses. After deriving all the apparent benefit from Sulph. which it seemed capable of accomplishing, we have prescribed Nux v., Ignatia, or Xachesis, according to circumstances, with decided benefit ; the former was selected in preference where the indications or peculiarities were present which we have already given above, — Ignatia where the patient was affected with shuddering after each evacuation, and the last-named remedy, where the pain in the anus was accompanied by throbbing. Pulsatilla we have substituted with advantage for Nux v., as an intermediate remedy, in individuals of phlegmatic tempera- ment ; but have always found it necessary to follow up the adminis- tration of this, or any of the three preceding remedies, with Sep., Sulph., Calc, Silex, &c. There are a variety of other medicines which may be required in preference, or subsequent to any of the foregoing, in particular cases, and in different stages of the disease. Amongst these, we may quote the following, as deserving of especial attention : Staphys., Graph., Zycop., Clem., Magn. n., Natr. m., Plumb, c, Alum., Merc., Mez., Dulc, Coloc, Plat., Rhod., Hep. s., Phosph., Thuj., etc. In cases where the bougie may be thought necessary, but * See rules for the repetition of the dose, etc., in the Introduction.
154 DIGESTIVE SYSTEM.
where great pain is produced by its introduction, the alternate use of Aconitum and Arnica may remove the irritation. When the faeces accumulate above the obstruction and give rise to additional irritation by over-distending the rectum, Opium should be prescribed, and succeeded by Nux v., if no effect take place after an interval of a few hours. * But when symptoms resembling strangulated hernia have made their appearance, in consequence of a blocking up of the stricture by a collection of hardened faeces, it may be advisable to attempt to introduce an elastic gum catheter through the stricture, for the purpose of throwing up an injection of tepid soap and water, and then tepid water and a couple or so of tablespoonfuls of sweet oil, previously to having recourse to aforesaid medicines ; and if the enema fail to empty the bowel of its contents, we must avail our- selves of the remedies mentioned, or any of the others for which we have given special indications in the article on Hernia.
In advanced cases of stricture, with ulceration of the mucous membrane, and the formation of abscesses, a cure may yet be attain- able through the instrumentality of Silicea, P7wsp/iorus, Sulpk., Calc, Lycop.) Merc, or Hepar s., etc.
ABSCESSES IN ANO. FISTULA IN ANO.
The formation of matter in the vicinity of the anus, is often pre- ceded by a shivering fit. In some cases, the first marked symptom of derangement consists in a swelling of a part of the buttocks in the vicinity of the anus, which presents a somewhat extensive circum- scribed hardness, and soon becomes very red in the centre, or assumes the form of phlegmonous inflammation, accompanied by a quick, full rpulse, with great dryness and heat of skin. In other instances, the suppurative process is ushered in by ah attack of widely ramified ery- sipelatous inflammation, unattended by any circumscribed hardness, and exhibiting the disease in a more superficial character ; the quan- tity of matter secreted being at the same time small, but the cellular tissue sloughy to a greater or less degree. On some occasions, the affection commences somewhat in the appearance of a carbuncle ; the skin displays a livid or dusky red aspect, the matter is unhealthy and small in quantity, and the cellular membrane is in a gangrenous state. Finally, it may be observed, that the abscess sometimes begins as a hardening of the cutaneous surface, near the anus, exempt from pain
* Plumbum c. may, perhaps, be better indicated than Nux v. in certain cases.
ABSCESS IN ANO. 155
and discoloration; the induration softening and suppurating very gradually. The pulse is, incipiently, full, and hard ; but as the dis- ease progresses, it speedily becomes low, or feeble, unequal and irre- gular ; the strength sinks rapidly ; and the spirits are excessively dejected.
The abscess may point in the buttock, either remote from the anus or in its immediate vicinity; or in the perineum. The matter may make its exit from one orifice or from several. Most frequently there is either only an external opening, or both an external and an internal one, which communicates with the exterior of the rectum; but in other instances there is merely an internal aperture. Hence, abscess, or rather fistula in ano, has been divided into three kinds: viz. the blind external; the complete; and the blind internal. When a fistula in ano, or sinus by the side of the rectum, is fairly established, the following symptoms present themselves: The patient experiences pain in expelling the faeces, and is not unfrequently affected with strangury, prolapsus ani, tenesmus, hemorrhoids, diarrhoea, or obsti- nate costiveness; there is a discharge of thin sanies from the anus, or from a small fistulous opening in its immediate vicinity, according to the variety of the fistula; and the surrounding integuments are gene- rally red and indurated.
Therapeutics* The homoeopathic treatment of fistula in ano is, in many instances, eminently preferable to the surgical. It is the duty of a surgeon, however expert he may be as an operator, to spare the knife on every occasion, and in every disease, when he can do so without detriment to the case, and especially when there are other, and equally efficacious means either of terminating or of materially alleviating the sufferings of his patient. The disease in question, in addition to being frequently capable of a cure through the instrumentality of medicine, is, moreover, in some cases, so com- plicated, that the performance of the surgical operation for laying open the fistula, will fail in effecting a cure, or if it succeed, the affec- tion will either return again at some future period, or its healing up will be followed by a more rapid advance and unequivocal develop- ment of the existing collateral disease. We particularly allude to complications with disorders of the liver, lungs, or with stricture of the rectum, scirrhus, &c, or to cases where the complaint occurs in persons of a very bad habit of body, and whose organism is in a greater or less degree of general derangement.
156 DIGESTIVE SYSTEM.
In the early stage of abscess about the anus/ if the patient be of a full, plethoric habit, the pain violent, and the inflammation of a phleg- monous character, a few doses of Aconitum are requisite. A simple emollient poultice may then be applied to the part, and the suppura- tive process forwarded by repeated doses of the third trituration of Silicea, or of Hepar s. and Silicea in alternation. Should the abscess not burst, during the employment of one or both of these remedies, which will rarely be the case, however, it may be opened mecha- nically, when the skin has become much attenuated. When the inflammation is erysipelatous, and spreads extensively, Bella, and Rhus may be prescribed alternately in the first instance, but as soon as a degree of fluctuation, however trivial, can be felt, or when shiv- ering sets in, . Silicea, which is one of the most important remedies in established fistula in ario, must be given in repeated doses. Should an opening not form, soon after the exhibition of Silicea, and the cel- lular membrane be found in a sloughy state, an aperture should be made for the discharge of the matter. If the skin presents a livid appearance, and the fistula commences with the features of a car- buncle, Lachesis and Silicea must be exhibited in alternation at the commencement ; but if a healthy action do not early display itself, a free incision may be made in the part, and Arsenicum and Cinchona had recourse to, in alternation, if the patient's strength and spirits become much depressed. A little wine may also be allowed, where required, as is sometimes the case, even under the invigorating or tonic action of the homoeopathic remedies, and that particularly in elderly subjects, or in those who have been long habituated to the use of stimulants, or have had their constitutions impaired by intemper- ance. After the bursting of the abscess and discharge of its contents, the approximation and union of the sides of the cavity may be left to Nature; but when incarnation appears to proceed slowly or imper- fectly, her efforts must be assisted by the internal exhibition of Mer- curius, Sulphury and Silex, or of Merc, Hepar, and Cole.
When the rectum has become involved or a true fistula has resulted, either through neglect or otherwise, our first object ought to be ta attempt to heal it by the employment of medicine. Even in cases of long standing, and particularly, as already stated, where any other disease is found to exist, or where the general health is in a much impaired state, the employment of appropriate homoeopathic medicines must be resorted to before the surgical operation is thought of. In recent cases where the fistula has not
PROCTALGIA. 157
been under homoeopathic treatment from the beginning of the attack, a dose or two of Mercurms may be given, and then Silicea and Sulphur to forward granulation. Should these not be sufficient to effect a cure, or should the case have been under homoeopathic treatment from the commencement, and Silicea have been employed to promote the ripening and bursting of the abscess, we may have recourse to Pulsatilla, Sulphur, and Calcarea, in alternation, if the employment of only one of these be found inadequate to effect a cure or surmount the complicated features of the case. Hepar may sometimes be required after Mercurius where the fistula is extensive, and Phosphoms after Silicea where there is considerable constitutional disturbance, or where there is complication with disease of the lungs. In cases which have been maltreated, or which have been long in existence and utterly neglected, the medicines with which the cure may be attempted are the same as we have already mentioned ; but Silex, Sulphur, and Calcarea may be named as those on which we may chiefly rely, where any chance of success remains. It may be added that, when the liver is implicated, or the digestion much impaired, either through habits of intemperance or otherwise, JVuw'v., Pulsatilla, Mercurius, and Lachesis will form valuable intermediate remedies, provided Sulphur, Silicea, and Calcarea prove insufficient to overcome that additional derange- ment. (See Hepatitis and Dyspepsia.) Where hemorrhoids exist, ■Sulphur is almost indispensable (see also art. Hemorrhoids); and where the disease is associated with scirrhus or carcinoma, Silicea, Sulphur, or Merc, Lack., Con., Arsenicum, and Lycopoclium, are the reme- dies that are most likely to afford any chance of a cure. In compli- cations with stricture Nux, Sulph., Calc, &c., claim attention. (See Stricture.)
PROCTALGIA.
Proctalgia, or severe pain in the anus, is liable to attack certain individuals after every exposure to cold ; but it more commonly occurs as symptomatic of some other affection, such as piles, prurigo, scirrhus, or the existence of a small ulcer, which often forms on the posterior wall of the rectum, opposite to the extremity of the os coccygis. The suffering in the latter, or symptomatic forms of the complaint, is solely experienced, or is at all events materially. aggra-
158 DIGESTIVE SYSTEM.
vated during and after the expulsion of faeces ; and the act of defecation is frequently attended with copious hemorrhage.
Therapeutics. When the disorder takes place in consequence of exposure to cold, or occurs apparently as a purely idiopathic affection, it will often yield to the employment of Kali c. In other cases, especially when the pain is excessively acute, a dose of Aconitum will be found useful, followed, if required, by the continuation of the pain in an undiminished ratio, after an interval of a few hours, by Nux v., or by Ignatia if the pain is increased after a stool, or is attended with shivering or shuddering. The following medica- ments may be named as likely to prove efficacious in some instances : Conium, Natrum m., Snlph., Sepia, or Carl. v., &c. In the symptomatic forms of the disease, the remedies must be selected according to the nature of the primary complaint. Thus, in the case of hemorrhoids, Aconitum, Belladonna, Nux v., Puis., Sulph., Sec, are principally re- quired. (See Hemorrhoids.) In that of prurigo, Sulph., Sep., Ac. nitr., Merc, Thuja, Calc., &c. In scirrhus or cancer, Con., Arsenic., Lachesis, Merc, Sulph., SiUcea. And in that arising from the formation of a small, excessively sensitive, ulcer in the lower and posterior part of the rectum, Lachesis, Lycopod., Sulphw, especially when there is obstinate constipation ; and Arsenicum, SiUcea, or Calcarea, when the bowels are in a normal state, or the former remedies are insuf- ficient to effect a cure.
PROTRUSION OF THE INTESTINE.
Prolapsus Ani.
By this term is understood the protrusion of a portion of the mucous membrane of the lower intestine ; it is of much more fre- quent occurrence in children than adults, and takes place during straining when at stool, or when urinating. The reduction of the protruded portion of intestine is easily effected by gentle pressure with the thumb, or thumb and fore-finger, which have previously been dipped in oil.
Therapeutics. The principal remedies for removing the ten- dency to this affection are, Ignatia, Nux vomica, Mercnrius, and Sulphur.
colic. 159
Ignatia is particularly efficacious when the disorder occurs in persons of mild and sensitive temperament, and is attended with constipation.
Nux vomica is indicated for persons of irritable or lively disposi- tion, and addicted to high and stimulating diet, with a tendency to hemorrhoids and constipation.
Mercurius is particularly suited for children, in whom the disease is attended with hardness and swelling of the abdomen, and great tenesmus.
Sulphur is one of the best remedies for the permanent removal of the disease. Calcarea, Jjt/cqpoa%um and Sepia may be found neces- sary in some obstinate cases, after SuVpli. In other cases : Plumbum, Arsenicum, Mezereum, Natrum m., Colchicum, Ruta, Tkericlion, and Mag- nes artificialis have been found efficacious.
COLIC.
Enteralgia.
Diagnosis. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with painful distension of the abdomen, spasmodic contraction, and sometimes vomiting and costiveness, or diarrhoea.
The general exciting causes of this complaint are, acid fruits and indigestible substances; cold from wet feet, drinking cold beverages when heated, constipation, worms, &c. It is frequently also a conco- mitant symptom of some other derangement, but occurs equally often as a primary disease. We shall here content ourselves with giving the symptoms under the medicines, without entering upon the differ- ent varieties of this affection. One of the ^distinctive characteristics between this malady and internal inflammation, is the pain being somewhat relieved by pressure.
Therapeutics. In general cases the selection of the remedy is considerably facilitated by directing our attention to the cause of the affection. Thus, when the pain is evidently induced by a morbid accumulation of flatus {flatulent colic) one or more of the following remedies will be required: Nux v., Puis. , CMn., Cocc, Card, v., Cham., Bella., Sulp/mr ; or, Lycop., ColcL, Natr. m., Coloc*, Grapk., Fer., Veratr., Acid, nitr., Mags, arct., N. moscli., Agn., Pkbsph., Zincum. When
160 DIGESTIVE SYSTEM.
the attack proceeds from a spasmodic contraction in a portion of the intestinal tube (Ileus) : Opmm, Plumbum ; or, when inflammation has supervened, or given rise to this form of the complaint : Nux v.j Bella., Lachesis, Merc. (See Enteritis.)
For colic resulting from hemorrhoids {Hemorrhoidal colic); Nux v.* Puis., Lack,, Coloc, Carl, v., Sulphur. (See Hemorrhoids.)
For that arising from the presence of worms in the alimentary canal: Cina, Cicuta, Spigelia, Merc; or, Per., Ruta, Salad., Nux mosch, etc. (See Invermination.)
For spasmodic colic : Bella., Hyosc, Cham., Coloc, Cocc, Nux v., Puis., Cupr., Laclu, Sttlph., etc.
For that wThich has been occasioned by indigestible food: Puis., Antim. c, Nux v., Bella. : or, Bryon., Carlo v., Arsenic, China, Coffea, Hepar, Sulph.
For colic which has been excited by a moral cause, such as a fit' of passion, or indignation : Chamomilla, Colocynth, and, sometimes, Sulphur.
When external violence, such as a blow, strain in the abdomen, or in the loins, has given rise to the attack : Rhus, Bryonia, Am., or, Carlo, v., Cole, Bach.
Against Lead colic, Devonshire colic, Pry bellyache (colica pictonum), Opium, Belladonna, and, secondly, Alumina or Platina, are the most efficacious remedies. (See also Lead paralysis, Art. Palsy.)
For colic arising from a chill, Nux v., Cham., Merc, Coloc, China, are the most serviceable.
For that from exposure to cold, damp weather, Pulsatilla; and that from a thorough wetting, Rhus.
In hysterical coUc : Ignatia, Cocculus, Mosch., Magn. m.yNux v., Puis., Ipecac, Bella., Bryon., Stramon., are the most useful.
And in that which occurs in females during the catamenia, (menstrual colic) : Cocculus, Nux vomica, Belladonna, Pulsatilla, Coffea ; and Carlo, v., Secale, Sulphur, Zincum, etc. (See Dysmenorrhea.)
Nux vomica is especially indicated, either in flatulent or hemor- rhoidal colic, or colic arising from a chill, when there is a sensation of fulness and tightness at the upper part of the abdomen; deep- seated or cutting pains in the abdomen, with acute, pressive, and forcing-down sensation, compelling the sufferer to bend double ; violent cutting pains in the hypogastrium ; confused headache, with occasional loss of consciousness ; short and difficult respiration ; flatulence, aggravation of the pains on the slightest motion, generally
COLIC. 161
disappearing when at rest; violent pains in the loins, and sensation of internal heat and obstruction ; constipation, coldness and numbness in the hands and feet during the paroxysm. It is a very useful remedy at the monthly period in females, when we find weight or violent deep-seated aching pain in the abdomen, and aching in the sacral region ; dragging pains extending to the thigh ; aching and creeping sensation in the same part when sitting ; painful pressure towards the rectum.
Pulsatilla is often of peculiar efficacy in colic occurring in females, either during the catamenia or at other times, when coming on periodically in the evening during cold, damp weather, and accom- panied by tightness and distension of the abdomen and epigastrium; pulsation in the pit of the stomach, aggravation of the suffering when at rest or in the evening, attended with shivering, which increases with the pains, and is mitigated by motion ; severe bruising pains in the loins, especially when rising up ; also when the affection has arisen from overloading the stomach, or from rich greasy food, with incli- nation to vomit, flatulence, diarrhoea, paleness of the face, livid circle round the eyes, and headache ; or in hemorrhoidal colic, with fulness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness.
Chamomilla, — bilious colic ; colic in females during the men- strual flux. The following are the principal indications : sensation as if the intestines were gathered into a ball, and as if the abdomen were empty, with tearing and drawing pains, attended with excessive anxiety and restlessness; distension under the lower ribs and in the pit of the stomach ; incarcerated flatus, sometimes nausea, or vomiting of a bitter or bilious fluid, bitter vomiting, followed by desire to relieve the bowels, and bilious diarrhoea ; livid circles round the eyes, alternate paleness and redness of the face ; the pains come on particularly at night, at other times early in the morning, or after a meal. This remedy, as before stated, is particularly adapted for children of irritable temperaments, and is extremely serviceable in all cases, in which a fit of passion has been the exciting cause of the sufferings. It is also useful when colic has arisen from cold in the feet or checked perspiration. Although hr instances quoted, Chamomilla is of itself, generally sufficient, it has been sometimes found useful to precede it by a dose oi Aconite. [Colocynth is often useful after Cha- momilla, when the latter has produced only partial relief.)
Belladonna, — flatulent colic, when there is distension of the
11
162 DIGESTIVE SYSTEM.
transverse section of the great intestine, attended with colic-like pain which is relieved by pressure on the part ; also severe dragging pains, from above downwards, as if the whole of the intestines would be forced downwards from their containing cavity ; menstrual colic, with spasmodic constriction in the abdomen, and a burning pain lower down or in the small of the back ; violent griping in the hypogas- trium. The symptoms are frequently attended with a liquid or puriform species of diarrhoea, and swelling of the veins of the head ; and the pains are aggravated by movement, or are sometimes so violent as almost to deprive the patient of reason.
Cocculus is indicated (especially in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains in the lower part of the abdomen ; great flatulence, fulness, and distension of the entire abdomen, with nausea and difficulty of breathing ; also when there are a sensation of emptiness, tearing and burning pains in the intestines, sometimes with squeezing, tearing and dragging pains, excessive anguish and nervous excitement, and constipation.
Colocynth. In the majority of violent and obstinate cases, we find this a valuable remedy ; it is* indicated when the pains are exces- sively violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives ; sometimes there is a sensation of clawing and pinching, and tenderness of the abdomen, with a pain as from a blow ; or distension of the abdomen ; at other times a sense of emptiness is experienced, with cramps and shivering, or tearing pains in the legs ; during the continuance of the attack, we find excessive restlessness, agitation, and tossing about from the violence of the pain : when the pains come on^ they continue with- out any apparent intermission ; after their disappearance, a bruised sensation remains, and the sufferer feels as if the intestines were held together by thin threads, likely to break from the slightest motion. Both this remedy and Chamomilla are particularly effica- cious in the so-called bilious colic, being indicated by the diarrhoea and bilious vomiting attending it, and also in cases where passion has been the exciting cause. Colocynth is more particularly useful in the case of adults, or where the fit of anger is attended with indig- nation.
Sulphur may follow either Chamomilla or Colocynth in cases of bilious colic, where only partial relief has been obtained ; or, in flatulent colic, may be taken after Nux v., Carbo v.y Cocculus, or Cha- momilla ; and in hemorrhoidal colic after Nux v.* or Carbo v.
DETERMINATION OE BLOOD TO THE ABDOMEN. 163
Arsenicum in colic, arising from disordered stomach, with nau- sea, vomiting ; diarrhoea, with green or yellow evacuations, violent gripings, headache, paleness of the face, and blue marks round the eyes ; accession of the pains particularly during the night, or after eating or drinking.
Coffea is valuable when we have to prescribe for colic with excessive pains, attended with great agitation^ anxiety, and tossing about, grinding of the teeth, convulsions, threatening suffocation, oppressive despair, acidity, and coldness of the body and extremities. It is also useful in some kinds of menstrual colic, denoted by a sensation as if the abdomen were being rent asunder ; or by fulness and pressure in the abdomen, and violent spasms, which extend to the chest. It is also indicated by cutting pains in the intestines as if divided by a knife, and when the pains are so violent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs.
Bryonia, colic with constipation, tension in the abdomen, and flow of saliva like salivation. In cases of colic, arising suddenly from indigestible food, a cup of black coffee, without milk or sugar, will frequently afford relief, by causing the stomach to free itself from the cause of annoyance ; i. e. in patients, who have not used that article as an ordinary beverage. When the complaint arises from Constipation, Silicea is sometimes called for, at others Conmm. See Constipation. (See also articles Dyspepsia, Gastro- dynia, Flatulency, Hepatitis, JVep/iritis.)
DETERMINATION OF BLOOD TO THE ABDOMEN.
Congestio viscemm abdominis. Conc/estio ad abdomen.
This derangement is characterized by a disagreeable or painful sensation of wTeight, heat, and burning, with hardness and tension in the lower portion of the abdomen.
Nux vomica is one of the most frequent sources of relief in those who lead a sedentary life, or are much addicted to over- indulgence in the pleasures of the table, and particularly when the following symptoms are complained of: hardness, tension, and fixed pain in the abdomen, sense of great weakness or prostration, ren- dering it difficult or almost impossible to' walk about ; constipation, with pain in the loins, spirits oppressed and irritable.
164 DIGESTIVE SYSTEM.
Sulphur will frequently be found serviceable in completing the cure after the above, or it may be selected in preference in cases of long standing, when we meet with the following indications : dull pains, and disagreeable sensation of distension in the abdomen, con- stipation, tendency to obstinate hemorrhoidal attacks, extreme dejection.
Carbo vegetabilis, may be selected when the symptoms are accompanied with excessive flatulency, and will frequently be found of great service in some obstinate cases when alternated with the two preceding remedies.
Arsenicum will also be found useful, especially when there is a disposition to diarrhoea with extreme weakness : or —
Capsicum, when these symptoms occur in individuals of a lymph- atic temperament.
Sepia* is often of much utility in the case of females, particularly when the symptoms are analogous to those described under Sulphur.
In particular cases the following will also be found useful : Pulsa- tilla, Belladonna, Mercurius, Bryonia, Zycqpodium, C/iamomilla, Rims, Veratrum, Toxicodendron. (See also Dyspepsia and Hemorrhoids.)
Daily exercise in the open air, together with a careful attention to regimen, must be observed by those who are afflicted with this affection.
LOOSENESS OF THE BOWELS. Diarr/ioea.
Diagnosis. Fluid discharge from the intestines in increased quantity.
This affection is simply an increase of the peristaltic action of the intestinal canal, and is so well known under its different forms, that I shall simply allude to the principal exciting causes, and then pro- ceed to the treatment.
The exciting causes are acid indigestible food, a check of perspira- tion, sudden changes of temperature, the prolonged use of powerful purgatives, which, although still more frequently the cause of consti- pation, nevertheless, by producing irritation of the intestinal canal, also predispose to attacks of this derangement, worms, &c.
Sometimes diarrhoea is a 'salutary crisis, as remarked under Fevers ; here again the homoeopathic treatment assists Nature, and, while it
LOOSENESS OF THE BOWELS. 165
abridges the duration of the affection, — and thereby obviates future debility, — does not rashly check its course.
Therapeutics. We shall, in the first place, give a synopsis of the medicaments, and the different forms of diarrhoea in which they are especially applicable, and then proceed to describe the leading indications for those remedies which are most frequently required in general cases. In Diarrhoea biliosa, — Pulsatilla, Nux v., Bryon., Cham., Ipecac, Antim. c, chiefly ; or, Arsenic, Coloc, China, Veratr., Aeon., Bella., Digitalis, Tarax., Asar., Colch^ Ign.9 Acid, phosph. In Diarrhoea mucosa s. pituitosa : Puis., Coloc^ Merc, chiefly; and Petrol., Acid, phosph., or Phosph. in inveterate cases. Or again, Nuxv., Secale c, Dulc, Ammon. m., Ignat., Staph., Senega, Bry., Rheum, Cham.y Digit., Cina, Bella., Acid, sulph., Arsenic, Sep., China, Rhus, Spig., Mez> In Diarrhoea stercoralis: Puis., Ipecac, Ant. c, Nux, Bry., Cham., Tart., Arsenic, Ac. phosph., Sulph., chiefly ; or Coloc, Coccul., China, Merc, Dig., Bella., Veratr., &c. Diarrhoea serosa : Arsenic, Cham., China, Puis., Nux, Rhus, Lach., Calc, Sec, Per., Hyosc, chiefly; or \ Phosph., Petr., Sulph., &c. Lienteria : Cinchona, Ferrum ; or Arsenic, Bry., Nux v., Phosph., Acid, phosph., Lach., &c.
When an attack of diarrhoea has been occasioned by a Chill : Cham., Dulc, Bry., Bella., Merc, Veratr., or Nux mosch. j in some cases, Puis., China, Natr., Nux, Sulph., are the most appropriate remedies. When arising from a chill, during spring, summer, or autumn : Ars., Dulc, Bry., ox Merc When from cold drinks : Ars., Bry., Puis., Card, v., Nux mosch. If a sudden mental emotion has given rise to the attack, — Coffea, Opium, Veratr., Antim., Aeon., or Puis., are the most useful when it has consisted of a sudden fright or an unexpected joy, — Ignatia or Acid, phosph. when of a depressing cha- racter, such as grief; and Cham., Coloc, or Bry., when a fit of passion or the effects of contradiction have brought on the complaint.
For diarrhoea arising from excessive indulgence in intoxi- cating liquors, Nux v. and Carlo v. are commonly, the most useful. That which is liable to ensue after partaking of milk, Bry., Sulph., Lycop., Sep., Natr. And that which takes place after eating fruit, or after the use of acids, Ars., Lach., or Puis., chiefly.
Against the diarrhoea which sometimes occurs as a sequela of Measles, Scarlatina, Smallpox, &c, Arsenic, Puis., Merc, Ac phosph., or Sulph., are commonly of the greatest efficacy. That which is encountered in strumous habits, Calc, Sulph,, Silic, Lye, Sep.,
166 DIGESTIVE SYSTEM.
Bulc ; or Arsenic, China, and Baryta c That in Phthisical, per- sons : Fer., China, Phosph., Calc That in individuals of Debili^ tated or exhausted constitutions : Secale c, China, Fer., Acid, phosph., Phosph., Nux mosch. And that in the aged, Antim., Secale, Bry., Phosph,
When diarrhoea is unattended with pain, Ferrum is the most useful remedy in general cases, but China and Secale c. are often useful ; the latter especially when the tongue is coated with mucus, the taste clammy or pap-like, and there is much borborygmus. When accompanied by colic (Diarrhoea torminosa) : Cole, Ars., Merc, Cham., Puis., Bry., Rhus, Rheum, Sulph., Acid, nitr., Hepar s., &c. When attended with tenesmus, Merc, Bach., Hepar, Rhus, Nux v. ; or Arsenic, Rheum, Caps., Sulph., Sec. With vomiting : Ars., Ipecac, Veratr. ; or Cham., Coloc, Dulc, Fer. (See also Cholera.)
With prostration of strength {colliquative diarrhoea) : Arsenic, Veratr., dn., Ipecac. ; or Secale c, Phosph., Acid, phosph., Nux v., Sep.
In chronic or inveterate diarrhoea, Phosph., Acid, phosph., Petrol., Sulph., Calc, China, Fer., Acid, nitr., Graph., Hepar, Rhus, Bach,, Acid, sulph., are the most important medicaments. And in cases in which there is constantly a relaxed state of the bowels or tendency to have several stools daily, Phosph., Sulph., Calc, Acid, nitr., Sep., Kreos., Graph., or Natr, m.
The principal remedies in ordinary cases are, Bulcamara, Bryonia, Cinchona, Ferrum aceticum, Chamomilla, Rheum, Mercurius, Pulsatilla, Nux vomica, Ipecacuanha, Arsenicum, Antimonium crudum, Rhus toxico^ denckon, Opium, Sulphur, Calcarea, Acidum phosphoricum, Phosphorus, &c.
Dulcamara is often the most appropriate remedy in diarrhoea, occurring in summer from cold, especially from wet feet or exposure to rain. Particular indications for its exhibition are the diarrhoea being attended with colic, or cutting pain, chiefly in the region of the navel; the evacuations being liquid, slimy and yellow, or greenish, generally coming on at night, and sometimes attended with nausea, or even vomiting; want of appetite and great thirst, paleness of the countenance, and lassitude.
Bryonia should be given in cases of diarrhoea arising from the before-mentioned causes, and attended with many of the symptoms noted under Bulcamara, when that medicine has failed to afford the required relief in six or eight hours, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and the stools
* Sec Synopsis.
LOOSENESS OF THE BOWELS. 167
are passed almost involuntarily, and certain portions undigested ; also when looseness is experienced after partaking of milk?* In diarrhwa occurring during hot iveatKer, when we cannot trace the causes to any errors of diet, requiring other remedies, this medicine is further indi- cated, and particularly so in the following instances : diarrhoea from checked perspiration, or being overheated — cold drinks — a chill from remaining in any cold exposed situation, or in draughts — or from biting, easterly winds. When this affection has been produced by passion, particularly in individuals of a bilious temperament, Bryonia is again a most useful remedy. (Chamomilla is equally efficacious here, and deserves a preference in the case of children.) % It may also be remarked, that the diarrhoea, arising from drinking impure water when heated, has frequently found relief in this medicine. When the water is strongly impregnated with vegetable substances, it may be advantageously followed by Cinchona, Pulsatilla, or by Arsenicum, according to the symptoms, (see these remedies.) (Antimonium is sometimes required to complete the cure after the previous employ- ment of Bryonia.)
Cinchona : — Looseness, in consequence of indigestion, particularly if occasioned by partaking of fruit or flatulent food, such as vegetables; stools very profuse, sometimes attended with but little pain, fre-^ quently occurring immediately Sifter partaking of food, or especially dur- ing the night, watery, and brownish, and sometimes containing portions of undigested food. Cinchona is, in some instances, further indicated when considerable spasmodic or griping pain is present, accompanied by flatulence, want of appetite, thirst, and great weakness ; and is also valuable after improper treatment or protracted cases of this affection, when considerable debility remains.
Ferbum aceticum may be advantageously given in alternation with Cinchona at intervals of twelve hours, when the evacuations are partly composed of undigested food* and pass without pain; or this remedy may be administered alone, w7hen the diarrhoea is unattended with pain, and there are paleness of the face, weakness of the eyes, pains in the back and anus, with great weakness of digestion.
Chamomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration ; it is further particularly indicated when the evacuations are watery, biliots, green, yellow, or slimy, or of a fetor resembling rotten eggs, and accompanied by fulness at the pit of the stomach, severe * See also Arsen.^ Merc.f Bryonia, Phosph., Lachesis.
168 DIGESTIVE SYSTEM.
colic or spasm, pain in the abdomen, distension arid hardness of the abdomen, bitter taste in the mouth, foul tongue, thirst, want of appe- tite, bilious vomiting, and flatulence (in infants), with restlessness, screaming, and drawing up of the limbs towards the stomach. Sulphur is frequently useful in completing the cure when the pains have been removed by Chamomilla.
Rheum, when the symptoms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a very sour smell; paleness of the face is also an indication for this medicine. (See Diarrhoea in Children.)
Mercurius, when the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated ; also when there is painful tenesmus before, during, and after stool, fre- quently followed by protrusion of the lower intestine ; severe cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, shuddering, great lassitude, and disposition to syncope ; sour smelling stools ; diarrhoea with ingesta.
Pulsatilla, is one of the best remedies in simple looseness, or diarrhoea, arising from errors of diet, such as indulgence in acids, fruits, or rich indigestible food, attended with foul tongue and other dyspeptic symptoms. (See Indigestion.) Another remarkable indication for this remedy is one evacuation differing from another in colour.
Ipecacuanha: — Looseness arising from indigestion, particularly if caused b,y imperfect mastication, attended with nausea and vomiting; paleness of the face (see also Arsen.), weakness, and desire to retain the recumbent posture (in the case of children). When Ipecacuanha does not appear to afford much relief, Pulsatilla ought to be had recourse to, in the space of from twelve to twenty-four hours, after the last dose of Ipecacuanha.
Nux vomica: — Scanty stools, consisting of slime and blood, attended with straining and great weakness, flatulency, and violent cutting pains in the region of the navel. For some of the occasional accompanying symptoms the reader is referred to the indications given under this remedy, in Indigestion.
Arsenicum : — Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, &c. the characte- ristic symptoms for its employment are, watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, emaciation, and great weakness ; and when the affection is more liable to come on at night, or after eating or drinking.— -{Vide the further indi-
LOOSENESS OE THE BOWELS. ] 69
cations for this important remedy in Part III, under Bowel Com- plaints in Children.)*
Antimonium crudum is a good remedy in cases arising from disordered stomach, with white tongue, loss of appetite, eructations and nausea ; also when the symptoms given under Bryonia (which see) continue after the administration of that medicine.
Rhus toxicodendron: — Lumpy or pap-like diarrhoea, coming on only at night, and preceded by colic, which disappears after each evacuation.
Opium is efficacious in diarrhoea arising from fright, or from cold, and may be followed, if required, by Dulcamara in the latter case. For other indications, vide Mental Emotions.
Lachesis : — Diarrhoea from acid drinks, or sour unripe fruits, with severe griping ; diarrhoea with ingesta ; diarrhoea during damp weather.
Sulphur is a most valuable remedy in diarrhoea, particularly when the affection is worst during the night, or when it occurs in strumous habits. In adults predisposed to hemorrhoids, or in chil- dren, when the diarrhoea is attended with excoriation and papular eruptions, it is particularly efficacious ; also in very obstinate cases, and where the slightest cold brings on a relapse or an attack ; or when milk disagrees and causes a looseness.
Calcarea may be had recourse to after Sulphur.
Acidum phosphoricum : — In obstinate cases, with portions of undigested food in the evacuations; or occasional involuntary evacuations.
Phosphorus : — In chronic, painless diarrhoea, with gradual prostra- tion of strenth ; diarrhoea with ingesta.
When diarrhoea occurs only or chiefly during the night, Arsenicum, Cham., China, Puis., Merc, Rhus, Sulph., Dulc, or Bryonia, are the most appropriate remedies ; and when it occurs alternately with constipa- tion, Nux v., Bach., Antim. c, Rhus, Ruta, or Tartarus.
Lastly, when diarrhoea has been produced by the abuse of medi- cinal agents in allopathic practice, the following are the most service- able : Hepar s., or Acid, nitr., China, or Carlo, when from the abuse of Mercurial preparations. Puis., or Rheum, when from the employment of Magnesia. And Puis., Cham., Merc. ; or Coloc, and 'Nux n., when from Rhus.
* When Arsenicum does not answer our expectations, Veratrum should be substituted ; the latter remedy is, moreover, for the most part to be preferred, when the disease appears to have arisen from atmospheric causes.
170 DIGESTIVE SYSTEM.
Diet. Acids or acidulous wines/ beer, coffee, strong tea, and fruits, whether raw or cooked, should be carefully avoided. Solid food should likewise be proscribed, as tending to keep up the intes- tinal irritation ; and gruel, fresh milk, broths, and light mucilaginous food substituted.
In protracted cases, attended with debility, but no symptoms of inflammation or ulceration, generous, easily digestible food, and sometimes a little wine, or wine and water, must not be withheld.
DYSENTERY.
Dgsenteria. Fehris Bgsenterica.
Diagnosis. Constant urgency to evacuate the bowels, tenesmus, violent pains in the abdomen, a greater or less degree of fever, parti- cularly towards evening, and stools of mucus or blood, or both.
It may appear suddenly, but is frequently preceded some time by loss of appetite, costiveness, flatulency, nausea or slight vomiting, with chills followed by heat of skin and accelerated pulse, then dull abdominal pains and increased evacuations ; after a time no faeces are discharged, but white mucus {dgsenteria alba) which may after- wards change to blood {dgsenteria rubra) ; stools, particularly when fever is present, very frequent and fetid. If not checked in time, the disease may terminate in ulceration or gangrene, or the patient may sink from exhaustion.
The prognosis becomes very unfavorable when the pains, which have previously been extremely severe, suddenly cease, the extremities become cold, the pulse small and intermittent, the stools putrid and involuntary.
This affection is very frequently complicated with pains resembling those of rheumatism {Dgsenteria r/ieumatieo-catarr/ialis), which will be noticed under the different remedies, as an additional indication for their employment. The exciting causes are, checked perspiration, particularly in warm weather, or an exposure to the cool atmosphere of an autumnal evening after the pores have been opened by active exercise, or exertion during the day ; low or marslf^ situations, local irritations, such as worms, scybala, &c, and suppression of hemor- rhoids, metastases, and sometimes, in infants, difficult dentition.
Therapeutics. The principal remedies in dysentery are Aconitum, Belladonna, Chamomilla, Pulsatilla, Ipecacuanha, Colocgntk, Mercurius corrosivus, Merc, vivus, Arsenicum album, Carbo vegetabilis, Nux vomica,
DYSENTERY. 171
Capsicum, Cinchona, Kreos., Aloe., Rhus, Sulphur, Staph., Tart., Sep., &c. Of these Aeon., Bella., and Nux or Merc, are the most appro- priate in Dysenteria inflammatoria. Aeon., Cham., Rhus or Puis, in Dysenteria riieumatico-catarrhalis. Aconitum, Mere, corros., Colocynth, Colch., Puis., or Veratrum in Dysenteria biliosa. Puis., Ipecac. 9 Merc, Dulc, but more especially Colchicum and Merc. corros. ; and, in some cases, Acid, sulph., Hepar s., Aloe., Canth., Caps., Carlo v., Rhus, Staphys., Acid, nitr., Plumb., in Dysenteria pittji- tosa s. alba. Arsenic., Nux, Carlo v., Petrol,, Kreosot., Acid, sulph. et nitr., in Dysenteria putrida. On consulting the chapters on Enteritis, Febris gastrica, biliosa, et mucosa, Diarrhoea, Cholera, and Dys- pepsia, many of the general indications for the most of these remedies will be found detailed, and considerable assistance in the selection of the remedies thereby afforded. The following are, however, some of the characteristic indications for so*ne of those medicaments which are most frequently called for in dysentery :
Aconitum. This remedy is peculiarly adapted to cases attended with synochal fever, and in young and plethoric patients is generally required at the commencement or in the course of the disease. It is indicated by full and hard pulse ; severe pains, generally in one spot 5 abdomen tense and painful when touched, denoting the commence- ment of inflammation [dysenteria inflammatoria) ; and is also valuable when we find pains resembling rheumatism in different parts of the body, with shivering, or excessive heat and thirst.
Prescription as in Inflammatory Fever, which see.
Chamomilla should be prescribed if, after the administration of Aconite, we still find violent heat and thirst, rheumatic pains in the head, and constant agitation and tossing. This remedy is also useful when the disease seems to have taken for its proximate cause the formation of gastric impurities in the primae viae ; or when it has arisen from exposure to a cool atmosphere when in a state of perspira- tion. When we find foul tongue, with clammy, bitter taste in the mouth, and bilious stools, before tenesmus declare itself. This remedy is evidently indicated as most useful in the first or diarrhoeal stage of the complaint; it may be followed by Pulsatilla, when the symptoms given under that remedy present themselves.
R Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. 3 ij.
M. Dose. Jss every six hours, until improvement takes place, or indica- tions for some other remedy present themselves.
172 DIGESTIVE SYSTEM.
Pulsatilla, when the gastric symptoms noted under Chamomilla are present, but the stools consist entirely of mums, striated with blood. {Bysenteria pituitosa.)
R Tinct. Puis. 6, gtt. iij. Aq. pur. §ij.
M. Dose, jss every six hours.*
The three remedies, above-mentioned, are also valuable in dysen- tery, arising from cold, or what is commonly denominated rheumatic catarrhal dysentery.
Ipecacuanha. This remedy is serviceable, when the dysenteric affection seems fairly established 5 when the stools consist of slimy matter containing white flocks, followed by evacuations of sangui- iiolent mucus.
R Ipecac. 3, gtt. iij. Aq. pur. 3 ij.
M. Dose. As above.
Colocynth. In cases attended with violent colic and excessive distension of the abdomen ; shivering with chills, apparently ex- tending from the abdomen over the whole body ; excessive agitation and restlessness ; tongue coated white ; slimy, and sometimes bloody evacuations ; it is sometimes found useful after Ipecacuanha or Mer~ curius.
R Tinct. Coloc. 6, gtt. viij. Aq. pur. giv.
M. Dose. 3SS every hour, or every three to six hours, according to the severity of the symptoms, until amendment supervenes, when the intervals between the doses may be lengthened.
Mercurius corrosivus, may be considered to be one of the most important of all the homoeopathic remedies in dysentery ; but it is more especially in cases with the following train of symptoms that it is characteristically indicated : in the red dysentery or bloody flux, when we find severe tenesmtis or straining, with evacuation merely of a little mucus, sometimes succeeded or accompanied by the protrusion of a portion of the intestine, and increased discharge of pure blood, or of putrid, corrosive, greenish, yellowish, or frothy mucus, intermixed with blood, and sometimes followed by the evacua-
* See " Rules for the repetition of the dose." — Introduction.
DYSENTERY, 173
tion of small hard substances (scybala) after much straining ; burn- ing in ano; severe griping and lancinating pain before, during, and even after the motions; increased desire to go to stool after each evacuation.
R Merc, corros. 3, gr.ij. Pulv. sacch. lact. gr. viij. Misce intime, et in chart, sequales viij distribue, quarum sumat imam tertiis vel quartis horis, p. r. n.*
In cases with the above symptoms, Mereurius corrosivus may be considered a specific : it will, at all events, prove so efficacious a remedy, that any remaining symptoms can, in general/ be removed with facility, either by means of Colocynth, Acidum phosphoricum, or Acidum nitricum (the two latter* especially, in the event of a conti- nuance of the sanguineous stools), or any of the other remedies, which may seem more appropriate, according to the indications for their employment, as given in this chapter,
(The directions for the dose are already given above.)
Bryonia is frequently called for in those cases in which it has been found necessary to administer Aconite, at the commencement of the disease ; but is more particularly indicated, when the attack has occurred, during the heat of summer, from the effects of a chill, and is attended with typhoid fever of the inflammatory form ; with loose evacuations of a brownish colour and putrid odour, occasionally containing lumps of coagulated mucus, resembling undigested sub- stances, or small hard lumps or balls (scybalous faecal matter), with griping during, and burning in ano after, the act of evacuating, and aching pains in the limbs, aggravated by movement. When the disease has attained an advanced stage, and the accompanying fever is of a low typhoid type, the patient being much exhausted and distressed with severe rheumatic or aching pains in the loins and extremities, when reclining or sitting still, and the stools of a slimy, frothy, white, gelatinous, or sanguineous nature, passed involuntarily at night in bed, Rhus not unfrequently gives a favorable turn to the disorder.
Dose of Bryonia or Rhus. Three drops of the third dilution to two ounces of water, a dessert-spoonful every two to four hours, until a favorable alteration is effected.
Arsenicum.— Dysentery of epidemic or contagious origin, wdth fever of a typhoid or putrid type (Dysenteria putrida) ; dysentery
* See " Rules for the repetition of the dose." — Introduction.
174 DIGESTIVE SYSTEM.
arising from exposure to noxious exhalations in marshy situa- tions, &c.
This remedy may, however, be selected in all cases, from whatever cause arising, when great weakness and even prostration exists from the commencement, with burning pain in relieving the bowels, thirst and aggravations of the sufferings after drinking, or, on the contrary, adipsia ; — also when the disease threatens to assume the ulcerative or gan- grenous form — characterized by previous severe pains, particularly burning, which suddenly cease ; hypocratic expression of counte- nance; rapid sinking of the vital energies; pulse small and inter- mittent ; coldness of the extremities ; highly offensive, putrid, and cadaverous-smelling evacuations, both of faeces and urine ; uncon- scious passing of stools ; offensive breath, and petechia in different parts of the body.
Be Tinct. Arsen. alb. 6, gtt. iv. Aq. pur. Jiij.
Dose. A dessert-spoonful every two, three, or six hours, according to the urgency of the case, carefully watching the effects, and shortening or lengthening the intervals accordingly.
Carbo vegetabilis is a most useful remedy in those desperate cases, where the breath is cold, the pulse almost imperceptible, and the patient complains of severe burning pains. Its indications closely resemble those of Arsenicum, with the exception of the thirst, and the aggravation caused by drinking. It may be given with benefit when that remedy has failed^, or only partially relieved, and in this, as in other affections, many instances might be cited, where a judicious alternation of these two remedies has effected benefit — -neither of them having been, singly, adequate to the exigency of the case.
Form of prescription, same as Arsenicum.
Nux vomica. When Arsenictim has diminished the severity of the symptoms and warded off the impending danger, but we find that the faeces still retain a highly putrid odour; also at any period during the course of the disease, when the following symptoms are present : — Frequent and scanty evacuations of mucus or sanguineous mucus, and occasionally small, compact, hard faeces (scybala), attended with violent cutting or griping pains in the region of the navels borborygmus, pains in the loins, tenesmus, burning or sensa-
DYSENTERY. 175
tion of excoriation in the anus, and sometimes protrusion of the intestine ; great heat and excessive thirst. ,
Cinchona is a good medicine when the disease has an endemic character, occurring in marshy countries, and in many cases where a state of putridity remains in the faeces, after the administration of the remedies above mentioned.
Form of prescription for Nux and China, same as that given for Pulsatilla.
Cantharides : Sanguineous stools, mixed with whitish mucus or solid substances like false membranes ; strangury.*
R Tinct. Canth. 6. gtt. iv. Aq. pur. ^iij. M. Dose. Jss every four or six hours.
Sulphur : — When the more marked symptoms are ameliorated by the use of the foregoing remedies, but the dysentery still con- tinues obstinate, and especially when the disease occurs in subjects, who have previously been long affected with hemorrhoids ; or when it has from time to time been subdued, and afterwards returned with greater or less violence ; or even when the apparently best selected remedial agents have failed to check its course. It will frequently be found most efficacious in all these cases, since, whenever they occur, we may suspect some latent constitutional cause is baffling our efforts. In the first instance, denoted by the removal of the more prominent symptoms, the affection is terminated ; in the second^ the predisposition to a return of the attack is obviated ; and in the third, the constitutional taint alluded to being controlled, the organ- ism becomes susceptible to the specific action of the other medi- caments.
R Tinct. Suiph. 6, gtt. iij. Aq. pur. Jij.
M. Dose. 2SS at first every twelve hours, until an effect is produced, then discontinued for a time and allowed to act.
In conclusion, we must not omit to add that, when the disease is of long standing, and has become (so to speak) habitual, a cure is often effected by means of Phosphorus.
* ColcMcum autumnale is preferable to Cantharides when the symptoms are as described, but more particularly when the stools consist almost exclusively of mucus, unmixed with blood (dysenteria alba,pituitosa), and when pain is experienced in the sigmoid flexure of the colon, and the disorder rages as an epidemy during the autumnal season.
176 DIGESTIVE SYSTEM.
Rules of Conduct and Diet. In this affection, it is of great import- ance to keep up a moderate degree of warmth around the abdomen, which is best obtained by flannel, worn outside the linen.
During the course of treatment barely sufficient nutriment to keep up the strength of the patient should be allowed ; and the more severe the inflammatory symptoms, the more strict must be the abstinence. No solids should on any account be given ; but the diet should consist principally of mucilaginous or demulcent fluids, such as thin barley-water, and gruel ; in comparatively mild cases, white of egg in sugar and water, weak chicken-broth or beef-tea, may be allowed. Even after convalescence, this course of diet should be for a short time observed, fruit and vegetables eschewed (especially when the disease is raging in an epidemic form), and a return to the usual diet gradually brought about. Wine and alcohol are absolute poisons in this affection.
Having thus given the general mode of treatment for this disease, which is ordinarily so fatal, we may remark that, in a great majority of cases, the homoeopathic method checks it at its commencement, without allowing it to assume the more serious forms portrayed in the instructions for its treatment, but, on the contrary, causing it to pass off, leaving the patient in sound health ; whilst in the most violent cases, where it has already made head, and seems approaching a fatal termination, this may almost be said to be the only system which offers a chance of salvation to the sufferer ; and in strumous constitutions, (where, under the old mode of procedure, the results were commonly so unfortunate,) it gently mitigates the violence of the symptoms, and safely conducts the patient through his perils.
Suppressed Dysentery. When the dysenteric evacuations have been suddenly checked by allopathic means, and a violent inflammatory or spasmodic action declares itself, distinguished by severe pains, anxiety, dyspnoea, nausea, and empty retchings, or distension and tenderness of the abdomen ; suppression both of faeces and urine ; coldness of the face, tongue, and extremities ; breath also cold ; with spasms, of various kinds in different parts of the body, which are renewed by any exertion, either of speech or movement, — the follow- ing remedies will be found useful.
AcoNiTUM. Against a,ny inflammatory symptoms that may pre- sent themselves.
Cuprum aceticum, when spasms or cold sweats predominate.
CHOLERA. 177
Belladonna, against inflammatory colic, or if symptoms of abdominal inflammation set in, (see article Enteritis, and also Colic,) aqd administer accordingly.
Colocynth, violent colic and distension of the abdomen, (see Colic.)
Veratrum album, coldness of the body and extremities, and retelling.
Carbo vegetabilis, in extreme cases, with scarcely perceptible pulse, and cold breath.
The use of clysters of warm water has, in many instances, been found serviceable, in promoting an evacuation of the bowTels, and bringing back the suppressed discharge.
When the patient has escaped the serious consequences above noticed, chronic complaints are often the result of Suppressed Dysen- tery : the most frequent being Dropsy, Paralysis, and Rheumatism.
cholera.
By the term Cholera Morbus was formerly understood a disease attended with nausea, griping, purging, and vomiting, generally pre- valent towards our summer months, and at the season when fruit abounds. But it has now become a generic term, under which are included two varieties — the Cholera Morbus, properly so called, and the Asiatic Cholera.
Diagnosis. The first-named, sometimes called the Sporadic Cholera, generally commences with a sudden feeling of nausea and griping, followed by purging and vomiting ; in severe cases, accom- panied with coldness of the body, particularly the extremities, anxious and hurried breathings, excessive thirst, a feeling of cramp in the legs, sometimes in the arms, with spasmodic contractions of the abdo- minal muscles, shrinking of the features, and a hollow expression about the eyes ; pulse weak, sometimes scarcely perceptible ; thin, watery, and fetid, or bilious evacuations, sometimes with dark bilious vomiting, anxiety, and tenesmus.
Causes. The most frequent are worms, gall-stones, unwholesome indigestible food ; fruits, or crude vegetables, alterations in tempera- ture, moist or marshy situations, damp weather, wet feet, suppressed perspiration from sudden exposure to cold, cold drinks when over- heated, dentition, or parturition.
12
178 DIGESTIVE SYSTEM,
Therapeutics. In the treatment of Cholera, in its sporadic form, (i. e. when the disease arises from occasional causes, such as cold, fatigue, &c.) the following remedies will be found the most efficacious : Chamomilla, Ipecacuanha, Veratmm album, Arsenicum album, Cinchona, and Pulsatilla.
Chamomilla is almost specific in the premonitory stage, particu- larly when the complaint has been excited by a chill, or a fit of passion, or great dread of being attacked during the prevalence of the disease.
The following are the symptoms which particularly indicate its employment : acute colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish ; bilious diarrhoea, cramps in the calves of the legs; yellow furred tongue, and sometimes vomiting of acid matter. {Pulsatilla is preferable to Chamomilla, when the attack has been brought on by partaking of rich, indigestible food, and when the stools are more of a mucous character. Colocynth, again, is more appropriate in some cases arising from a moral cause, more especially a fit of anger or mortification, attended with indignation.) Chamomilla, etc., may be prescribed as follows :
R Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. Jij. M. Dosis. Coch. maj. j, tertia vel sexta quaq. hor. pro re nata. *
Ipecacuanha may be administered after the above, should the attacks of vomiting become more prominent ; or it may be selected from the commencement, should vomiting predominate, or at least assume as marked a character in the complaint as the diarrhoea. Other indi- cations are — sensation of weakness, or softness (flaccidity) in the epigastrium, coldness in the face and limbs, sense of shivering in the abdomen; slight cramps in the calves of the legs, and in the fingers and toes. {JSux v. has been found of great value after Ipecac, when the vomiting yielded to the employment of that remedy, but symp- toms of Cardialgia remained, such as wTeight in the epigastric region, anxiety, pain in the abdominal viscera, frequent small evacuations, and tenesmus, frontal headaches, horripilation with predominating internal chills.)
Form of prescription, same as Chamomilla.
* Vide Rules for the repetition of the dose, in the Introduction.
CHOLERA. 179
Veratrum album, should the disease increase notwithstanding the employment of the preceding remedy, and assume the following characteristics : violent vomiting with severe diarrhoea, excessive weakness?, and cramps in the calves of the legs ; eyes hollow or sunken, countenance pale, and expressive of acute suffering and intense anguish ; coldness of the breath and tongue ; excruciating pain in the region of the navel, ten- derness of the abdomen when touched; dragging pains and cramps in the fingers, shrivelled appearance of the skin on the palms of the hands. (This is one of the best remedies in both varieties of this disease.)
R Tinct. Veratr. 6, gtt. iij. Aq. pur. Jiij.
Dosis. Coch. medioc. j. omni bihorio, omni hor., omn. quadr. hor., vel ssepius p. r. n.*
Arsenicum is useful, when this malady assumes a severe cha- racter from the beginning, but is more particularly indicated when the disease is attended with rapid prostration of strength, insatiable thirst, excessive anxiety, loss of articulation, with fear of approaching death, burning sensation in the region of the stomach, almost constant discharge from the bowels, or renewal of the discharge, as often as the desire for drink is gratified ; suppression of urine or scanty micturition, followed by a burning sensation; violent and painful vomiting, tongue and lips dry, cracked, blueish or black; hollow cheeks, pointed nose ; pulse almost imperceptible, or small, weak, intermittent, and trembling ; severe spasms in the fingers and toes; clammy per- spiration.
Form of prescription the same as that given for Veratr. The dose to be repeated every half hour, every hour or every two hours, ac- cording to the severity of the symptoms; the intervals to be lengthened as soon as signs of amendment set in.
Cinchona is chiefly most useful against the weakness which remains after cholera, but is also serviceable, occasionally, during the course of the disease, particularly when there are vomiting of ingesta, and frequent watery and brownish evacuations, containing particles of undigested food ; also when there is oppression at the chest, with eructations, which afford temporary relief; severe pressure in the abdomen, especially after partaking of the smallest portion of food ;
* See Rules for the repetition of the dose, in the Introduction.
180 DIGESTIVE SYSTEM.
great exhaustion sometimes amounting to fainting. This remedy is, moreover, indicated when the disease has been excited by indigestible substances, such as unripe fruit, &c, or by inhabiting a marshy situation :
R Tinct. Cinch. 3, gtt. §iij. Aq. pur. §ij. M. Dose, ^ss every six or twelve hours, according to circumstances, until amelioration results.*
Pulsatilla, in mild cases, with mucous diarrhoea and dyspeptic symptoms. It is also useful when the disease has been excited by the use of indigestible articles of diet. (Vide Diarrhcea and Indi- gestion.)
R Tinct Puis. 6, gtt.ij. Aq. pur. gij- M. Dose. A dessert-spoonful every six or eight hours, until amend- ment takes place.
Asiatic Cholera. Malignant Cholera. {Cholera asiatica, epidemica, spasmodical) This disease generally commences with vertigo, headache and singing in the ears, a sensation of flatulence in the stomach, or griping pains, and a feeling of weight and oppression in the region of the heart.
In some though not all cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue colour, but, in almost every instance, the frame loses its power of generating heat, the pulse and pulsation of the heart are almost unfelt, and the circulation of the blood becomes stagnant.
Patients, who have escaped through the second stage, are fre- quently carried off by a typhoid fever in the third.
We quote the following accounts of malignant cholera, as it has appeared in India, in the north of Europe,* and in this country,t as giving a sufficiently full and vivid description of the symptoms of the malady in its different stages.
"The attack of the disease in extreme cases is so sudden, that, from a state of apparent good health, or with the feeling only of trifling ailment, an. individual sustains as rapid a loss of bodily power as if he were suddenly struck down, or placed under the immediate effects of some poison;'* the countenance assuming a death-like appearance, the skin becoming cold, and giving to the
* Hoopers Med. Diet., page 380.
f Mackintosh's Practice of Physic, p. 337.
CHOLERA. 181
hand (as expressed by some observers) the sensation of coldness and moisture which is perceived on touching a frog ; by others repre- sented as the coldness of the skin of a person already dead. The pulse is either feeble, intermitting, fluttering, or lost; a livid circle is observed round the eyelids ; the eyes are sunk in their sockets ; . the tongue is cold, and either clean or covered with a slight white fur ; and, in many instances, even the breath is cold. In cases of this severity, the vomiting and purging characteristic of the disease do not commonly take place so early as in milder attacks, but seem to be delayed until the almost overpowered functions of the body make a slight effort at reaction. It is worthy of remark, that, unless death takes place in these extreme cases within a few hours, some effort of the animal power is made to rally the constitution ; and this point is insisted upon here, because it will direct the mind of practitioners to the particular moment when bleeding, and certain other parts of practice, recommended in the Indian Reports, can be enforced in this country with probable success. Vomiting soon succeeds; first of some of the usual contents of the stomach, next of a turbid fluid, like whey, white of egg, water-gruel, or rice-water ; described, perhaps, more accurately as a serous fluid, containing flocculi of coagulated albumen. The lower bowels seem to let go their contents; what happens to be lodged in the rectum is passed more or less in its natural state ; the next discharges are similar to those thrown up from the stomach, and are passed with violence, as if squirted with a syringe. The same similitude may be applied to the vomiting. Spasms, beginning at the toes and fingers, soon follow, and extend, by degrees, to the larger muscles of the legs and arms, and to those of the abdomen. These vary in intensity, but are sometimes so violent as to put on the appearance of tetanus.
ci In some severe cases the vomiting is slight, in others consider- able; and the purging and vomiting precede each other without any known rule ; but whichever may be the precursor, a severe burning heat is early felt at the praecordia ; there is an invincible desire A)r cold liquids, particularly water ; and, although the skin and tongue are cold to the touch, and the pulse nearly lost, or altogether imper- ceptible, the patient complains of intense heat, and has an almost insuperable aversion to any application of it to the skin. The spasms increase, sometimes spreading gradually, sometimes suddenly, to the abdomen, as high as the scrobiculus cordis. The next severe symp- toms are, an intolerable sense of weight and constriction felt upon
182 DIGESTIVE SYSTEM.
the chest, accompanied with anxious breathing, the spasms con- tinuing at the same time; a leaden or blueish appearance of the coun- tenance, the tongue, fingers, and toes assuming the same colour ; the palms of the hands and soles of the feet becoming shrivelled ; the fingers and toes giving the appearance of having been corrugated by long immersion in hot water. There is, throughout, a suppression of the secretion of urine, of the secretions of the mouth and nose: no bile is seen in the evacuations ; and it may be generally observed, that all the functions employed in carrying on life are suspended, or alarmingly weakened, except that of the brain,— which appears, in these extreme cases, to suffer little, the intellectual powers usually remaining perfect to the last moment of existence. At length a calm succeeds, — and death. The last period is commonly marked by a subsidence of the severe symptoms, without improvement of the pulse or return of natural heat ; but, occasionally, it terminates in convulsive spasm. Within an hour or two from the commencement of such a seizure, and sometimes sooner, the pulse may be imper- ceptible at the wrist, or in the temporal arteries. If it be discover- able, it will usually be found beating from eighty to a hundred strokes in a minute ; this, however, is not invariable, the pulse being not unfrequently quicker. The powTers of the constitution often yield to such an attack at the end of four hours ; and seldom sustain it longer than eight.
" In the less rapid and more ordinary form, sickness at the sto- mach, slight vomiting, or perhaps two or three loose evacuations of , the bowels, which do not attract much attention, mark the commence- ment of the attack ; a sense of burning heat soon felt at the praecordia excites suspicion of the disease ; an increased purging and vomiting of the peculiar liquid gives certain indication of its presence if this has not been previously declared by the prostration of strength, and an expression of the countenance not often exhibited, except when death is to be expected within a few hours. The symptoms before described follow each other in similar but slower succession ; the spasms of the extremities increase with the vomiting and purg- ing, and particularly in proportion to the constriction of the thorax ; and this form of the disease, which creeps on at first insidiously, and is in its progress more slow, by giving a greater opportunity for assistance, is, if treated early, more tractable; but if neglected, equally fatal with the more sudden seizures. Such cases last from twelve to thirty-six hours.
CHOLERA. 183
" The principal difference consists in the diffusion of the symptoms through a greater space of time ; a misfortune, it is true, to the patient, if the disease prove ultimately fatal, but advantageous, by affording an interval for the natural powers of the constitution to rally themselves, and for the employment of the resources of medical art. But there is another remarkable distinction well worthy of attention. It has been observed before, that in the more rapid cases> the intellectual faculties suffer but little ; and it may be added here, that the disturbance of them is not delirium, but rather a confusion and hesitation of mind resembling slight intoxication. In those of longer duration, if the individuals, either by the natural vigour of their constitution or medical assistance, sustain the shock beyond the period of twenty-four hours, suffusion of the tunica conjunctiva often takes place, not unfrequently delirium, and even coma.
" It is remarked, that those who survive seventy-two hours, gene- rally recover — but there are exceptions to this ; for although, accord- ing to the Reports of the Medical Practitioners in the Presidencies of Bombay and Madras, the recovery from this seizure commonly terminates the disease ; or, as is stated in the latter, the sequelae are those dependent upon some previous ailment of the individual ; yet the Bengal Report details a series of subsequent symptoms resem- bling those of low nervous fever, which, w*hen they proved fatal, usually terminated within eleven days from the commencement of the seizure called Cholera. To complete the outline, an account of these symptoms, extracted from the Bengal Report, will be presently given ; and we may observe, that they correspond accurately with the description given by Dr. Keir of the second stage of the disease, as it appeared at Moscow from the beginning of the month of October to the earlier part of the month of March. But we wall previously point out the manner in which the recovery from this seizure commoniy takes place. The first symptoms are, the abate- ment of the spasms and difficulty of breathing, a return of heat to the surface of the body, and a restoration of the pulse ; these^ how- ever, are equivocal, from being often only temporary ; and the prog- nostic from them is very uncertain unless they follow a progressive march of amendment : sleep and warm perspiration attending it are of more importance and more certain signs of recovery. The return of the secretion and evacuation of urine is reckoned one of the most favorable signs ; the next is, the passage of bile by the bowels ; and if this be freely established, and accompanied with an improvement
184 DIGESTIVE SYSTEM.
of the pulse and of the temperature of the skin, the patient is soon placed in a state of security from the attack : but it will appear, from the following extract from the Bengal Report, that upon this recovery he has often a serious stage of disease to encounter ; the description of which is given in the words of the author. Before, however, we proceed to this, we must remark, that the seizure, when not fatal, has three modes of termination : one in immediate convalescence, accom- panied only with great weakness ; — a second, in which large evacua- tions of vitiated bile are passed for several days, sometimes attended with blood, and with peculiar pains in the, bowels, particularly in the rectum. The third is of a febrile nature, of which the following account is supplied from the information given in the Bengal Re- port, viz, : —
" c The fever, which almost invariably attended this second stage of the disease, . . . partook much of the nature of the common bilious attacks of these latitudes. There was a hot, dry skin, a foul, deeply-furred tongue, parched mouth, thirst, sick stomach, restless- ness, watchfulness, and quick variable pulse, sometimes with delirium and stupor, and other marked affections of the brain. Generally, when the disorder proved fatal in this stage, the tongue, from being cream-coloured, became brown, and sometimes black, hard, and more deeply furred ; the teeth and lips were covered with sordes, the state of the skin varied, chills alternating with heats, the pulse became extremely quick, weak, and tremulous, hiccough, catching of the breath, great restlessness and deep moaning succeeded, and the patient soon sunk incoherent and insensible under the debilitating effects of low nervous fever, and frequent dark, tarry alvine dis- charges/ It is to be observed, that the able author of the Bengal Report doubts whether these symptoms can be considered as e form- ing any integrant or necessary part of the disorder itself/ or whether they belonged to the bilious seizures of the climate. Subsequent experience of the disease has removed this doubt by showing that the febrile stage of cholera has been much more frequent in other climates than in India.
"The cholera morbus of the north of Europe, to which the Russian peasants have given the name of 6 chornaia bolezn/ or black illness, like most other diseases, is accompanied by a set of symptoms which maybe termed preliminary; by another set which strongly mark the disease in its first, cold, or collapsed stage ; and by a third set, which characterize the second stage, that of reaction, heat, and fever.
CHOLERA. 185
" Preliminary Symptoms. — We have had but few opportunities of witnessing the presence of all these symptoms, some of which pre- cede the complete seizure by so short an interval, that the utmost diligence is scarcely sufficient to bring the patient and the physician together, after their occurrence, before the disease is fully formed. Diarrhoea, at first feculent, with slight cramps in the legs, nausea, pain or heat about the pit of the stomach, malaise, give the longest warning. Indeed, purging, or ordinary diarrhoea, has been frequently known to continue for one, two, or more days, unaccompanied by any other remarkable symptom, until the patient is suddenly struck blue, and nearly lifeless. Often the symptoms just mentioned are arrested by timely judicious treatment, and the disease completely averted. When violent vertigo, sick stomach, nervous agitation, intermittent, slow, or small pulse, cramps beginning at the tips of the fingers and toes, and rapidly approaching the trunk, give the first warning, then there is scarcely an interval.
" First stage. — Vomiting or purging, or both these evacuations, of a liquid like rice-water, or whey, or barley-water, come on ; the fea- tures become sharp and contracted; the eye sinks; the look is expressive of terror, wildness, and, as it were, a consciousness on the part of the sufferer, that the hand of death is upon him. The lips, the face, the neck, the hands, feet, and even the thighs, arms, and whole surface assume a leaden, blue, purple, black, or deep brown tint, according to the complexion of the individual, varying in shade with the intensity of the attack. The fingers and toes are reduced at least a third in thickness; the skin and soft parts covering them are wrinkled, shrivelled, and folded ; the nails put on a blueish pearl wThite. The larger superficial veins are marked by flat lines of a deeper black ; the pulse is either small as a thread, and scarcely vibrating, or else totally extinct. The skin is deadly cold, and often damp, the tongue always moist, often white and loaded, but flabby and chilled like a bit of dead flesh. The voice is gone ; the respira- tion quick, irregular, and imperfectly performed. Inspiration appears to be effected by an immense effort of the chest, whilst the aim nasi (in the most hopeless cases and towards the close), instead of expanding, collapse, and stop the ingress of the air. Expiration is quick and convulsive. The patient asks only for water, speaks in a plaintive whisper (the 'vox cholerica/) and only by a word at a time^ from not being able to retain air enough in his lungs for a sentence. He tosses incessantly from side to side, and complains of intolerable
186 DIGESTIVE SYSTEM.
weight and anguish around his heart. He struggles for breath ; and often lays his hand on his stomach and chesty to point out the seat of his agony. The integuments of the belly are sometimes raised into high irregular folds, whilst the belly itself is violently drawn in, the diaphragm upwards, and inwards towards the chest. Sometimes there are tetanic spasms of the legs, thighs, and loins ; but we have not seen general tetanus, nor even trismus. There is occasionally a low suffering whine. The secretion of urine is always totally sus- pended ; nor have we observed tears shed under these circumstances. Vomiting and purging, which are far from being the most important or dangerous symptoms, and which in a very great number of cases of the present epidemic have not been profuse, generally cease, or are arrested by medicine early in the attack. Frictions remove the blue colour for a time from the part rubbed, but in other parts, par- ticularly the face, the livor becomes every moment more intense and more general. The lips and cheeks sometimes puff out and flap in expiration, with white froth between them, as in apoplexy. If blood be obtained in this state, it is black, flows by drops, is thick, and feels to the finger colder than natural. Towards the close of this scene the respiration becomes very slow ; there is a quivering among the tendons of the wrist. The mind remains entire. The patient is first unable to swallow, then becomes insensible ; there never is, however, any rattle in the throat, and he dies quietly, after a long convulsive sob or two.
"The above is a faint description of the very worst kind of case dying in the cold stage, in from six to twenty-four hours after the setting in of the bad symptoms. We have seen many such cases just carried to the hospital from their homes or their barracks. In by far the greater number vomiting had ceased ; in some, however, it was still going, and invariably of the true, serous kind. Many con- fessed that they had concealed a diarrhoea for a day or two. Others had been suddenly seized, generally very early in the morning.
"From the aggravated state which we have just described, but very few indeed recover ; particularly if that state have been present even for four hours before treatment has commenced. A thread of pulse, however small, is almost always felt at the wrist, where recovery from the blue or cold stage is to be expected. Singular enough to say, hiccough, coming on in the intermediate moments be- tween the threatening of death and the beginning of reaction, is a favorable sign ; and generally announces the return of the circulation.
CHOLERA. 187
" In less severe cases, the pulse is not wholly extinguished, though much reduced in volume; the respiration is less embarrassed; the oppression and anguish at the chest are not so overwhelming, although the vomiting, the purging, and the cramps, may have been more intense. The coldness and change of colour of the surface ; the peculiar alteration of the voice ; a greater or less degree of cold- ness of the tongue ; the character of the liquids evacuated, have been invariably well marked in all the degrees of violence of attack which wTe have hitherto witnessed, in this epidemic. In no case or stage of this disease have we observed shivering, nor have we heard, after inquiry, of more than one case in which this febrile symptom took place.
" Fever y or hot stage. — After the blue, cold period has lasted from twelve to twenty-four, seldom to forty-eight hours or upwards, the pulse and external heat begin gradually to return ; headache is com- plained of, with noise in the ears ; the tongue becomes more loaded, redder at the top and edges, and also dryer. High-coloured urine is passed with pain, and in small quantities ; the pupil is often dilated ; soreness is felt on pressure over the liver, stomach, and belly ; bleed- ing by the lancet or leeches is required ; ice to the head gives great relief. In short, the patient is now labouring under a continued fever, not to be distinguished from ordinary fever. A profuse, criti- cal perspiration may come on, from the second or third day, and leave the sufferer convalescent, but much more frequently the quick- ness of pulse and heat of skin continue ; the tongue becomes brown and parched ; the eyes are suffused and drowsy ; there is a dull flush, with stupor and heaviness, about the countenance much resembling typhus ; dark sordes collect about the lips and teeth ; sometimes the patient is pale, squalid, and low, with the pulse and heat below natural : but with the typhous stupor, delirium supervenes ; and death takes place from the fourth to the eighth day, or even later, in the very individual, too, whom the most assiduous attention had barely saved in the first or cold stage. To give a notion of the importance and danger of the cholera fever, a most intelligent physician, Dr. Reimer, of the Merchant's Hospital, informs us, that of twenty cases treated under his own eye, who fell victims to the disease, seven died in the cold stage, and thirteen in the consecutive fever.
" This singular malady is only cognizable, with certainty, during its blue or cold period. After reaction has been established, it cannot be distinguished from an ordinary continued fever, except by the
188 DIGESTIVE SYSTEM.
shortness and fatality of its course. The greenish, or dark, and highly bilious discharges, produced in the hot stage, by calomel, are not sufficiently diagnostic ; and it is curious, that the persons em- ployed about these typhoid cases, when they are attacked, are never seized with ordinary fever, but with the genuine, cold, blue, cholera. Nothing therefore, is more certain, than that persons may come to the coast of England, apparently labouring under common, feverish indisposition, who really and truly are cases of cholera in the second stage."
" Phenomena of Asiatic Cholera as it appeared in this country.
" The disease consists of three stages. The first stage may be called premonitory; the second, the stage of collapse; the third, that of consecutive fever.
" The jkst stage is characterized by symptoms of indigestion, flatu- lent disturbance in the abdomen, precordial weight or oppression, slight nausea, acidity, griping pains, diarrhoea, vertigo, some degree of headache, or tinnitus. These symptoms, even when accompanied by spasms, are too often either disregarded or concealed, till the second stage is far advanced. It is most unfortunate, that this reluc- tance to confess the early part of the indisposition should so fre- quently exist in all classes of society, but particularly among the poor, because few of the more severe maladies to which flesh is heir are so remediable as cholera in the first stage, and not one more hopeless after the lapse of a few short hours.
" It is stated by the Russian physicians, that at Orenberg, Moscow, and other places, scarcely a person escaped, during the season when cholera prevailed, without some disorder of the stomach and bowels, — indicated by nausea, vomiting, .and oppression at prsecordia, indigestion, pain in the belly, and looseness of bowels. Many instances of dis- order of the stomach and bowels prevailed during the epidemic season, and for some weeks before there was a well -marked case of cholera in Edinburgh.
" Second stage. — The duration of the premonitory or first stage is various ; sometimes the unpleasant symptoms suddenly cease, and the patients recover quickly ; but this happy issue is comparatively rare, when proper remedies are not used ; and in some few cases, from the peculiarity of constitution of the patient, remedies seem to have little effect in arresting the progress of the disease, even
CHOLERA. 189
when applied in this early stage. The stools, which were at first feculent and bilious, now become characteristic of the true Asiatic cholera. They have the appearance of very thin gruel, or rice- water ; sometimes they are watery, limpid, with small flakes of curdy- looking matter intermixed ; at other times, they present an appearance of water in which fresh beef had been macerated. The usual feculent smell has vanished, instead of which the stools have a peculiar odour, which struck me to resemble that produced by macerating fish in water ; a similar odour is generally observed from the surface of the body. More rarely, the stools look like the lees of port wine ; and it was remarked, that almost none recovered who passed cc port-wine stools ;" I recollect at present one recovery only in which there was this appearance. The desire to go to stool is irresistible and instantaneous ; tenesmus is great in some cases, sometimes pre- ceded or accompanied by a sense of heat or griping. The stools are generally very copious, — sometimes, however, scanty ; often accom- panied by loud discharges of flatus from the bowels. Along with the bowel- complaint, there are burning heat in the region of the stomach, and vomiting of large quantities of a similar fluid from the stomach. The abdomen feels doughy. The thirst is intense, and there exists an urgent desire to drink cold water. The mind, for the most part, remains comparatively entire, but the vertigo and tinnitus increase. Cramps are general attendants, — sometimes confined to the fingers and toes ; at other times they affect the muscles of the extremities, and often those of the trunk of the body, more particularly of the abdomen. The urine is generally suppressed early in the disease. The voice is whis- pering, the person being unable to speak in any other tone. The respiration, although weak, is often nearly natural in other respects, even at times when the pulse is scarcely perceptible at the wrist; occasionally, however, the breathing is hurried and oppressed, some- times laborious. The pulse becomes weak and rapid early in the disease, even when the action of the heart is comparatively strong and tumultuous; but frequently both the pulse and action of the heart are feeble. As the disease goes on, both become more and more wreak ; the pulse is only now and then felt like a ' flutter/ and often ceases to be perceptible at the wrist for some hours before death. The tongue is cold and shrunk. It is quite painful to a bystander to watch the restlessness and impatience of the sufferers, who are con- stantly in a state of jactitation, more particularly when restrained, arid when heat is applied. Tndeed, they seem to have a horror at, and
190 DIGESTIVE SYSTEM.
to suffer pain from, warm applications. The temperature of the body, but more particularly of the extremities, diminishes early in the disease, and goes on sinking. It is often impossible to raise the temperature of the body during life, but the moment death takes place, and for two or three hours afterwards, the body becomes warm, — even the icy coldness of the extremities gives place to a genial warmth. The colour of the hands and feet become changed, more particularly the nails assume a blue appearance ; the face often is similarly affected ; occasionally the whole surface presents a blue colour, and, conse- quently, the second stage has sometimes been termed ' the blue stage ;9 but it is an error to suppose that the blueness is invariable, or that it is an attendant only on the worst forms of the complaint, — the patient who had this appearance more strongly marked than any other, was the one who made the most rapid and the most complete recovery. Blood, drawn from an artery or vein during this stage, flows with difficulty, is of a dark colour, does not coagulate, or sepa- rate any serum. It remains in a semi-fluid state, and has the appearance which the ancients called 'dissolved Mood,9 The surface of the body is covered, for the most part, with a cold exudation, the features and eyeballs shrink, and death closes the scene, — sometimes very unexpectedly, at others the body seems to be long dead, while the functions of the brain are still going on and comparatively entire.
" Sometimes the prostration of strength is extreme ; but it is my belief, that muscular debility is no part of the disease, till far advanced in the second, or collapsed stage. I have been surprised at the efforts made by patients when they were thought to be near death. . . . The appearance of muscular debility is occasioned by the vertigo, wrhich renders the gait unsteady and tottering, as well as by the dread of motion producing cramps.
" Many exceptions might be made to this account of the symptoms in these two stages. Sometimes no premonitory symptoms can be traced. I know of one case where the person appeared to have died under the effects of the first attack of cramps ; he was known to have laboured under slight bowel complaint for several days, but he did not confine himself, and was lying without any complaint on a sofa ; he was dressed, and engaged reading. A noise was heard, and he was soon after found on the floor on his face, dead, with the book clenched in his hand, and his muscles rigid. I have seen several cases where the urine was not entirely suppressed, and others in which the stools
CHOLERA. 191
were feculent and bilious up to the moment of death. But those cases are to be regarded as exceptions to the rule, which they do not con- travene. The symptoms in this disease, as in all others, must suffer modifications from peculiarity of constitution, previous condition of health, and habits of the patient affected.
"The symptoms which present the most unerring characteristics of Asiatic cholera are diarrhoea, and other symptoms of disordered stomach and bowels, in the first or premonitory stage. I believe pre- vious diarrhoea may be discovered in at least four out of six cases, and probably exists in all, if the history of each were perfect. Thus, in the city of Albany, U.S., diarrhoea occurred in 282 out of '336 cases ; in the remaining 54, it could not be ascertained whether this symptom had or had not existed. In the stage of collapse, there are the whispering voice, great restlessness, characteristic discharge upwards and downwards, cramps, suppression of urine, excessive thirst, weak faltering pulse, weak respiration, coldness of extremities, shrivelled hands and feet, bedewed with a cold exudation. The general blueness, when it exists, is also quite peculiar to cholera. It is re- markable how quickly an extremely collapsed state of the features takes place. The patients appear to dread hot applications. The blood-vessels, on such parts of the body as the temples, where they are comparatively superficial and easily seen, are observed to be full of blood of a very dark colour ,• even the serpentine branches of the temporal artery can be traced in this manner, and the motion of the blood is very slow.
" Third stage, — A large proportion of patients died in the second stage; there were few immediate recoveries from collapse, without undergoing the danger and miseries of a consecutive fever, which is now to be described. I shall never forget the joy expressed by all' who were watching the first case of cholera in which death did not take place in the stage of collapse. This feeling was increased as the watery diarrhoea, vomiting, and cramps diminished, and at last ceased, and as reaction became more evident and permanent. Nor shall I attempt to describe the subsequent disappointment, as bad. symptoms arose one after another, to convince us that the patient, although he had made an escape from one set of dangers, was still surrounded by another, which experience speedily proved to us were extremely formidable.
"The symptoms that denoted an escape from the horrors of the second stage, were, diminution in the number and quantity of the
192 DIGESTIVE SYSTEM.
evacuations, both from the bowels and stomach ; cessation of restless- ness, thirst, and cramps ; increase of the temperature of the body, and strength of the pulse ; an expression of animation in the countenance ; and a disposition to sleep. Sometimes the stools' speedily lost the characteristic watery appearance, and became feculent; but this change was generally gradual. Sometimes the secretion of urine took place early after the reaction was established, but this favorable circumstance rarely occurred so soon. In some cases, after every- thing appeared to be going on well, the vomiting and purging suddenly returned, the pulse became weak and quick, and the patient rapidly died.
" The phenomena of the third stage presented every appearance of fever ; sometimes of that form denominated in this country ( Typhus,5 and in several cases a similitude was easily traced to the last stage of Yellow Fever. In fact, the general opinion that was, and still is maintained, that cholera is nothing but a fever, with violent irrita- bility of stomach and bowels, suppression of the secretions of bile and urine, with a cold stage, appeared to derive support from the resem- blance to the phenomena of intermittent fever. But it will soon be in my power to show how erroneous this opinion really is, when the pathology of cholera falls to be considered,
" After the complete development of reaction, patients for a time appear to be doing very well, not teased with violent tenesmus and vomiting, nor disturbed with intense thirst and violent cramps. The restlessness has ceased, and they seem to be enjoying tranquillity. But this state is generally to be regarded as a calm which is too soon to be followed by a storm. The subequent symptoms vary much in different cases, depending on the previous state of health and habits of the patient, and his peculiarities of constitution, as well as on the phenomena of the previous stage, and the treatment pursued.
cc These symptoms were, lethargy or coma, which were frequent ; delirium ; convulsions ; paralysis ; rigidity of the flexor muscles of the extremities; distressing nausea; bilious vomiting, and thirst; dyspnoea, or hurried respiration ; cough, expectoration ; palpitation and irregular action of the heart, and more or less heat of skin ; bilious diarrhoea; port-wine stools; tenesmus; and pain or tender- ness, increased on pressure, in some part of the abdomen. Of all these symptoms, convulsions were the most rare. The others existed variously combined and modified.
"Cames of Cholera, — The undivided opinion of medical men who saw
CHOLERA. 193
the disease in India is, that in the East it is not contagious. After the appearance of cholera in Russia and Poland, however, a belief became prevalent that the disease had been modified by climate, and the habits of the people in Europe; that it had more resemblance to a fever, and was highly contagious. There were few medical men who were not influenced by this specious statement ; and I confess that my mind was at one time so strongly impressed with the belief in the contagious nature of the disease, that for the first five or six wreeks after its appearance in Edinburgh, when I retired to bed at night I scarcely expected to find myself alive in the morning. But my fears were at last dispelled, and my opinion is, that if it be contagious, it is not so in any very great degree. The following are the grounds on which this opinion is formed. It was intimated to me, by authority* that as the disease was so contagious, every possible precaution must be taken to prevent its extension, and that few bodies could be allowed to be opened^ as the contagion was more virulent and searching after than before death. But from the moment my mind was made up to accept the appointment, I resolved that fear should not be allowed either to interfere with my attendance on the sick, or to hinder my investiga- tions after death. Accordingly, in attending the first case of cholera in the hospital, I remained in the ward all night, and became so much exhausted, that I fell fast asleep in the bed next the dying person, and slept for above an hour, at a time when my animal spirits were low, and my physical strength diminished by the fatigues of the previous day. Subsequently, I have more than once accidentally fallen asleep on abed on which some unfortunate had died, and in a ward in which there were several dying persons at the^time. None of the house surgeons, the number being between 20 and 30, who were seldom out of the wards, had the disease, although their bodies must have been ready to receive the contagion, if fatigue of body, anxiety of mind, and want of sleep ever predisposed any person to take a disease. Two male nurses had cholera. One was a sober man, and although he had the warning diarrhoea, he neglected himself, but had the disease slightly. The other was a complete tippler ; he had a slight bowel complaint, which he concealed, and by way of curing, obtained leave to go home to see his family ; he got drunk, and was brought to the hospital with cholera, but never became collapsed. Several female nurses were also attacked ; but that is no wonder, for, independent of the fatigue they underwent, they were drunkards, and bad characters in other respects . and were actually in the habit of drinking the spirits and wine served
13
194 DIGESTIVE SYSTEM.
out to their patients. Two of these characters, after much fatigue and a hard course of drinking, went to bed one night quite drunk; they were both speedily seized with cholera — one died. But there is no proof of the influence of contagion in these cases. In truth, no case has ever been advanced in proof of the contagious nature of cholera, that cannot be explained on other and more satisfactory principles. Is it because four children, with father and mother, in one family, have had cholera, and because communication can be proved between them and an infected house, by means of a bundle of dirty clothes, or a web of linen, or actual personal contact, that we are rashly to attri- bute the whole to contagion ? The same story may perhaps be told in a different way. The father is a dissipated good-for-nothing man, who spends almost all his wages on whiskey ; he deprives his family of the means of procuring suitable nourishment ; the poor mother has pawned her last blanket, to purchase a few potatoes for her starving children, who have all had loose bowels for several days or weeks. The explanation is easy to show the strong predisposing cause — in- sufficient clothing, deficiency of food, &c. What answer can be made to this fact, that I have seen several mothers suckle their children when they themselves were dying of cholera, and in one instance I found an infant sucking its dead mother's breast,- — and yet not one of them had a symptom of cholera, at least for months afterwards ? . ♦ . • From the economical arrangements of the Board of Health, and the difficulty of procuring a proper apartment, the dead-room, where these examinations were conducted, wTas a miserable place about eight feet square ; generally six or eight persons were present, sometimes more ; and in an inner apartment, about ten feet square, there some- times lay six dead bodies. Not one of those who frequented this den of death, and w7ho had their hands imbrued in the secretions of the dead for six hours out of the twenty-four, were affected with cholera, although their hands were irritated and punctured daily !
" It cannot be denied that some mysterious influence was operating at the period cholera prevailed, by whatever name it may be called, — that it selected its own victims — exercised its poisonous qualities in one district, town, or hamlet, more than in another— changed the scene of its ravages suddenly and capriciously, and made its progress from place to place, by strange detours, avoiding many populous situations, in the direct tract of human intercourse. ....
"Were any persons more prone to contract cholera than others? This is an important question, and it is rare that a point in medical
CHOLERA. 195
investigation can be so satisfactorily answered. All who had any im- portant visceral disease, or tendency to bowrel complaint from slight causes, and drunkards, were the persons generally attacked. It is no doubt certain, that in each locality where cholera prevailed, some instances may be quoted to the contrary ; but these are very few indeed, and are to be regarded as exceptions to the general rule. Nothing could be more unsatisfactory than the accounts we received of the previous health and habits of patients; very frequently wTe found them to be quite the opposite of what had been stated ; but when we opened the bodies, in the careful and minute manner in which the dissections were conducted, we had the best evidence that few subjects were even tolerably sound.
€C Persons advanced in age had, in the epidemic that I saw, a bad chance of recovery. Females seemed to be more liable to the disease than males. Almost every woman we opened, under a certain age, had the catamenia; and we found a great number of diseases, of various kinds, of the uterus, ovaries, tubes, and broad ligaments."
Therapeutics. We now proceed to mention theremedies, which have been successfully prescribed by those homceopathists Vho have treated the disease in all its forms.
When the premonitory symptoms of this disease, as above noted, exhibit themselves, its complete development is frequently prevented, by the administration of the saturated solution of camphor.
Dose. One or two drops of the above, every five minutes, in a teaspoonful of cold water, until a cessation or amelioration of the symptoms takes place, when the intervals between the doses may be lengthened at first to every two, and then to every four or six hours.
In many cases also, we may succeed in checking the disease at its commencement, by the remedies already mentioned under Spo- radic Cholera. But when Cholera sets in in all its frightful forms, we should have immediate recourse to Veratrum, a remedy which all who have had an opportunity of trying have eulogized.
R Tinct. Veratr. 3, gtt. viij. Aq. pur. 3 iv. Dose, A dessert-spoonful every hour, every half hour, or even every quarter of an hour, according to the severity of the symptoms.
But should no improvement set in after several doses, and the cramps change to spasms and convulsions, with spasmodic constriction of the chest, which obstructs respiration, — Cuprum (third trituration, or
196 DIGESTIVE SYSTEM.
sixth dilution) must be had recourse to, in the manner as prescribed for Veratrum : and if Cuprum be productive of only partial melioration, Veratrum may be administered in alternation with it. When symp- toms of trismus and tetanus supervene, Camphora has been recom- mended as preferable to Cuprum. Arsenicum should be selected in preference to, or given alternately with, Veratrum, when an intense burning sensation is experienced in the stomach and bowels, with extreme prostration of strength, great thirst, &c. (Vide the indica- tions for both these remedies, page 179.)
Carbo vegetabilis (sixth dilution), may often be given with advantage when the patient is reduced to a state of almost complete asphyxia, with scarcely perceptible pulse ; or when, on the cessation of vomiting, diarrhoea, and cramps or convulsions, congestion to the head and chest ensues, with oppressed breathing, coldness of the breath, redness or lividity of the face (which is covered with clammy sweat), and . lethargy. It has been found useful in some instances to exhibit a dose or two of Acid, hi/drocyanicum, about an hour before the employment of Carlo v. Should the pulse become stronger under the action of Carbo v., but the pain, vomiting, cramps, &c, return, Veratrum must again be had recourse to. [Carbo v., like Cicuta, and perhaps Stramon., is, properly speaking, not so appropriate during the disease itself, as against the sequelae, especially those of a nervous type.)
Ipecacuanha and Nux v. have been found efficacious before or after Veratrum, or any of the other medicaments, when the symp- toms assumed the character mentioned at page 178. (The Russian homoeopathic practitioners found Ipecac, of peculiar efficacy.)
Phosphorus (followed by Acid um phosphoricum, should great clamminess of the tongue supervene) is particularly useful in cases of diarrhoea, which are so liable to occur during the prevalence of cholera, and which, if neglected, are but too prone to pass on rapidly to con- firmed cholera. [Camphora, Secale com., and Mercurius may also be required in cholerine. The Russian practitioners found Mercurius often useful in cholera proper. See also art. Diarrhcea, as any of the remedies mentioned there may be resorted to in preference to the medicaments just named, if better indicated.)
Dosis. Tinct. Phosph. 3 gtt. j, quarta vel sexta quaque hora.*
Phosphorus is also useful in the event of congestion in the chest
* Vide Rules for the repetition of the dose in the Introduction.
€H0LE11A.
197
during the course of the disease; and is, moreover, one of the most serviceable remedies against the obstinate diarrhoea, which sometimes remains after an attack.
Tartarus emeticus. Amongst the physiological effects of this medicament we find, those spasmodic movements, or jerking and twitching of the muscles ; the trembling of the limbs, prostration of strength, or weakness to fainting ; tremulous or imperceptible pulse ; peculiar paleness of the face ; hoarseness ; cramps in the calves of the legs ; and especially the symptoms of gastric derangement that are so frequently met with in some forms of the disease. When the stools still consist of feculent matter, as is the case in cholera biliosa, or at the commencement of cholera indica, or also at the termination of the same, where the functions of the abdominal viscera are not yet restored to a normal state, Tartarus is, at all events, well deserving of attention.*
Cicuta virosa is considered an appropriate remedy, when there are spasms in the pectoral muscles, continuous vomiting, and little diarrhoea; when the eyes are turned upwards, and the patient is in a soporific state. It is particularly in neglected cases, and conse- quently more in the sequelae of cholera, than in the disease itself, that this remedy is more generally indicated. Stramonium may like- wise be useful in similar cases.
In conclusion it may be added, that a few doses of Cantharis will be found useful, when there is great irritation and pain in the bladder ; Rhus, Bryonia, Acid, phosphor., Bella., Hyoscy., Stram., Carl, v., Op., Sec, when Typhus Fever results (vide Typhus) ; Belladonna (followed, if required, by Opium and Lachesis), wThen there is Con- gestion of the Brain ; Aconite, Phosphorus, Bryonia, Belladonna, Sec, in addition to Phosphorus, should Congestion in the Chest super- vene ; and Aconite, followed by Nux v., Bryonia, or Mercnrius, Sec, when the stomach and intestines become the seat of congestion. (Vide Con- gestion to the Abdomen.) Secale cornutum is very useful in cases of colourless diarrhoea, with pains in the extremities remaining on the cessation of the vomiting, but is also valuable after Veratrum and Cuprum, when the cramps or convulsions do not yield to these remedies. Cinchona is useful against the general debility, and Sulphur and Phosphorus are two of the most important remedies against irri- tation or weakness in the alimentary canal, characterized by frequent attacks of or nearly continual looseness occurring after cholera. The * Hartmann's Therapie, 3te Auflage, p. 188.
198 DIGESTIVE SYSTEM.
foregoing, then, are the principal remedies employed by homoeo- pathists in cholera, and when the treatment is had recourse to from the commencement, the disease generally yields without difficulty, rarely passing even into the second stage, and scarcely ever into the third. When patients affected with cholera sought the aid of a homoeo- pathic practitioner, after having been previously treated allopathically, it was found essential to give Camphora in repeated doses, in the first place, partly for the purpose of rousing the reactive power, and partly to neutralize the effects of the allopathic medicines.
The best preservatives against infection are Veratrum, Ctcprum, and Camphor ; an occasional dose of the preparation mentioned under the latter medicine, at page 195, has frequently been found sufficient to ward off an attack : it is, however, more particularly during the first stage of the disease itself, under whatever form it sets in, that the greatest reliance is to be placed on this remedy. Veratrum and Cu- prum are the prophylaxes which have been employed with the greatest success. Many homoeopathic practitioners recommend Veratrum alone, but the alternate prescription has perhaps been more generally pre- ferred. They may be prescribed as follows :
R Veratr. alb. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q. s, Misce intime, et divide in partes sequales quatuor. Sign 1, 3, 5, 7.
R Cupr. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q.s. Misce intime et divide ut supra. Sign 2, 4, 6, 8. N.B. — A powder to be taken in numerical order, every fourth day.
Some practitioners, again, would prefer prescribing as follows :
R Veratr.- alb. 6, gtt. iij. Spirit, vin. rectif. 3j. Aq. distil. Jiij.
R Cupr. 6, gtt. iij. Spirit, v. rectif. 3j- Aq. destil. Jiij. N.B. — The mixtures to be taken alternately; the dose to consist of a table-spoonful night and morning, every third day. Or thus :
R Veratr. alb. 3, gtt. j. Pulv. sacch. lact. q.s. F. pulv. tales sex. Sign 1, 3, 5, 7. R Cupr. 3, gr. vj. Divide in chart, aequales sex. Sign 2, 4, 6, 8. N.B. — A powder to be taken in the order numbered every third day.
CHOLERA. 199
The same rules should be observed, whilst these preservatives are being taken, as those we have notified in the article on Scarlatina- The patient at the same time avoiding excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all strongly predisposing causes to attacks of this malady. When the disease happens to break out, notwithstanding these precautions, it is almost invariably in a mild form.
During the prevalence of cholera the clothing should be sufficient to preserve the body at an equable temperature, and care should be taken to avoid chills or checked perspiration, or cold and wet feet : those who have habitually considerable perspiration in the feet, should change their stockings at least once daily ; a flannel bandage worn round the abdomen, is also a useful precaution, and should not be hastily laid aside, even when the danger seems to have passed away ; constant exercise should likewise be taken, during the day, in the open air. Adherence to the homoeopathic rules is a sufficient dietetic guide, but too sudden a change of diet is not advisable ; raw vege- tables and cold fruits, for example melons, should be carefully ab- stained from, and even the more wholesome varieties and all cooked vegetables, should be used in extreme moderation ; pure beer and non-acid wines are unobjectionable for individuals not attacked, and accustomed to their daily use, with the same limitation. It may appear almost supererogatory to observe that purity of air and thorough ventilation are highly necessary.
Accessory Treatment. The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means, and bottles of hot water applied to the feet, if necessary. The ob- servance of this rule greatly facilitates the action of the medicine employed: anything which might disturb the equanimity of the sufferer, such as noise or contradiction, should be carefully avoided, and his spirits should be sustained as much as possible. Cold water is the- best drink, but the patient should not be allowed to take too much at a time ; the occasional administration of a small piece of ice, if possible, or of iced water in teaspoonfuls, is often attended with benefit ; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestimes. During the convalescence following this disease, we must be careful not to in- dulge the patient to the full extent of his appetite. But if the appe- tite remain for a long time afterwards, in an impaired state, the
1200 DIGESTIVE SYSTEM.
employment of such remedies as Arsenic, Nux v., Puis., Rfais, Veratr., Cyclamen, or Acid, nitr., will, according to the peculiarities of the individual cases, prove of considerable service.
Remarks. When this disease is raging as an epidemy, we not un frequently find individuals suffering under many symptoms bearing a marked resemblance to those of cholera, but with constipation instead of diarrhoea, and retching in place of vomiting ; this affection being closely analogous to Suppressed Dysentery, the reader will find its appropriate treatment under that head, article Dysentery.
CHOLERINE.
This affection being merely diarrhoea, occurring during the preva- lence of Cholera, without any of the more severe symptoms of that disease, the reader is referred to that article for its treatment.
LIVER COMPLAINT.
This disease is divided into the Acute and Chronic : the latter generally goes by the name of Liver Complaint, although a careful diagnosis will often discover, that the real disease is in the stomach and intestines ; however, in many cases the liver itself becomes materially implicated, and in itself deserves considerable attention.
When the disease has been for a long time unchecked, and the inflammation becomes deeply seated in the substance of the liver, an abscess frequently forms, bursting either externally or internally; in the latter case often proving critical, or bringing on hectic fever.
ACUTE INFLAMMATION OF THE LIVER. Hepatitis.
This disease is much more common in tropical climes than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the powerful rays of the sun by day, are among its principal exciting causes; but it may also arise from violent mental emotions, the use of stimulating or alpoholic drinks, suddenly
HEPATITIS. 201
suppressed evacuations, strong emetics or purgatives, the abuse of mercury, gall-stones, external lesions, or injury of the brain.
Diagnosis. This differs according to the seat of the inflamma- tion. When it occurs on the outer surface or convex side, the symptoms closely resemble those of pleuritis ; there is generally a violent pain in the right hypochondrium, sometimes resembling stitches, at others burning — shooting to the sternum, the right scapula and point of the shoulder, and even affecting the right foot, — sensation of numbness or tingling in the arm of the same side, the pain increased by inspiration ; a short dry cough, and the symp- toms of inflammatory fever • bowels irregular, generally constipated, and stools, in the majority of cases, of an unnatural colour.
In this form the patient can only lie on the left side.
When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient complains rather of a sensation of pressure than actual pain, but the whole biliary sys- tem is much more affected. The eyes and countenance become yellow, and sometimes complete jaundice declares itself; the urine is orange coloured, the evacuations mostly hard, and generally of a whitish or gray colour. We also find bitter taste in the mouth, vomiting, and considerable distress. The patient can only lie on the right side. Inflammatory fever is met with in this variety likewise.
In both forms, the right hypochondrium, on examination, will usually be found hot, tumefied, and painful on pressure.
Inflammation of the liver, unless properly treated, is apt to assume the chronic form ; it may also end in suppuration externally, or internally by a communication either with the lungs or intestinal canal, or by a vomica in the substance of the organ itself, or it may terminate in indurations or other alterations of structure, in gan- grene, or in the formation of adhesions.
The disease may terminate by resolution, critical metastases, hemorrhoids, diarrhoea, epistaxis, or cutaneous, particularly erysipe- latous, eruptions.
Therapeutics. The following remedies are those which are most frequently required in the generality of cases: —
Aconitum, Belladonna, Mercurius, Lachesis, Bryonia alba, Chamomilla, Nux vomica, Pulsatilla, and Sulphur.
Aconite is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is
202 DIGESTIVE SYSTEM.
violent inflammatory fever, attended with insupportable shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish.
Belladonna* may be advantageously employed after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present themselves : oppressive pains in the region of the liver, which extend to the chest and shoulders, dis- tension of the pit of the stomach, sometimes extending across the epigastrium, producing a sensation of tension, with difficult and anxious respiration; determination of blood to the head, with cloudi- ness and giddiness, sometimes causing faintness ; great thirst, tossing about at night and sleeplessness. (Temperament, sanguine lymph- atic.)
When Belladonna fails to remove the whole of these symptoms, we frequently find that Mercurius will have the desired effect; this medicament is too well known as an allopathic remedy in the cure of this disease, and the consequences produced by its abuse are frequently so great, as to render the disease almost incurable. It is generally administered by allopathic practitioners, even when not indicated, until its marked pathogenetic symptoms declare them- selves, and consequently the patient, in addition to the original malady, has frequently to contend with a medicinal disease. The following are some of the principal indications for ifes employment .
Considerable fulness or tumefaction in the region of the liver, with, pricking, burning, or oppressive pains, not allowing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected ; pains in the shoulders ; bitter taste in the mouth, want of appetite, thirst, and protracted shivering, sometimes followed by sweating, but without relief, with pale yellow colour of the skin and eyes ; also in more advanced stages of the complaint when there is induration of the liver, or when we have reason to suspect the formation of matter. (Arsenicum, Hepar s., or Silicea, are equally, if not more, deserving of attention in the latter case.) If
* Dr. Bosch found the alternate employment of Belladonna and Bryonia very efficacious in acute inflammation of the liver ; when the liver remained tumid and painful after the removal of the fever, Phosphorus and Bryonia; and when fulness, weight, dull pain, with dyspepsia and icterus, Carlo v. and Bryon. ; or, when the said fulness and weight were unaccompanied by pain, but the patient complained of a feeling of weight in the scrobiculus, with frequent eructation, constipation, clayey stools, extreme languor, and jaundice, Carbo v. and Nux in alternation.— Hygea, XX Bd, 5 Heft.
HEPATITIS. 203
the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there will be additional reason for selecting Mercurius.
Lachesis. In subacute cases, or in those in which Belladonna or Mercurius have merely afforded partial relief, Lachesis is often of great service. It may also be administered with advantage, alternately with the said remedies, in obstinate cases occurring in drunkards.
Bryonia, when the pains in the region of the liver are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing, or respiration, and especially during inspiration ; or much exacerbated by movement ; also when the symptoms are attended with violent spasmodic oppression of the chest; rapid and anxious respiration; bitter taste in the mouth, tongue coated yellow ; and constipation. Bryonia, like Chamomilla, is particularly useful in cases which have been excited by mental emotion, such as a violent paroxysm of anger, and is well adapted to persons of nervous or bilious temperament, and of choleric dis- position,
Chamomilla, in slight cases, or simple irritability of the liver with pressive, aching pains, pressure in the stomach, oppression of the chest, and a Sensation of tightness under the ribs ; yellow colour of the shiny pains not aggravated by motion, &c. ; tongue foul and yellowr, bitter taste in the mouth ; paroxysms of great anxiety* Chamo- milla is almost a specific, when the above symptoms have been brought on by a fit. of passion.
Nux vomica is particularly indicated, when the pains are shoot- ing and pulsative, and attended with excessive tenderness, at the region of the liver, to the touch, pressure in the epigastrium and under the ribs, with shortness of breath, and constipation : also when enlargement and induration occur ; and, in the chronic form, when there are marked symptoms of gastric derangement. (Temperament sanguine or bilious ; disposition choleric.) (Vide Nux vomica, art. Indigestion.)
Arsenicum : — Distension of the right hypochondrium, with severe burning pains and sensibility to the touch, burning heat of skin, accelerated pulse, intense thirst, anxiety, vomiting of a dark- coloured, grumous fluid.
Pulsatilla. Sensation of tension in the region of the liver, and pressure or dull pain in the epigastric region ; oppression at the chest, bitter taste, yellow tongue, nausea ; loose, greenish, and slimy
204 DIGESTIVE SYSTEM.
stools; excessive anxiety, especially towards evening or during the night. (Temperament lymphatic ; disposition mild.)
Sulphur is valuable to follow Nux v. or Pulsatilla when either the one or the other, although apparently indicated, does not speedily declare a decided action, or when the disease continues, although in a diminished degree ; it is particularly efficacious after Nux vomica, to combat the sequelae of the disease. Rhus, Lycopodium, and Kali c. may be required in some forms of Hepatitis. The two latter have, together with Sulphur, Silicea, and Hepar, been especially recom- mended in abscess of the liver.
Diet. The same as under Fevers, modified according to the violence of the disease.
LIVER COMPLAINT, or CHRONIC INFLAMMATION OF THE LIVER.
Hepatitis Chronica.
In this form of the disease we find many of the symptoms which attend the acute variety, but in a modified degree ; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh, and loses strength ; and there is, not unfrequently, an occasional cough with expectoration ; sometimes considerable perceptible enlargement of the liver, either continuous or returning periodically, with a number of dyspeptic symptoms ; high-coloured or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms ; the pulse, except during these attacks, generally quick but regular.
Nux vomica, Bryonia, Arsenicum, and Sulphur are reme- dies of great value in this as well as the acute form of liver com- plaint. It frequently, however, requires a careful discriminative treatment, and all the acumen of the experienced practitioner to conduct the affection to a happy issue.
For the indications for the above medicaments, see Acute inflam- mation OF THE LIVER.
Carduus marianus. This remedy is indicated by most of the- symptoms which have been described under Bryonia and Nux v. in the preceding chapter, but it is more particularly called for, when there is bitter taste, wdth dull pain or occasional shooting or pricking in the right hypochondrium, increased by inspiration ; yellow hue of
ICTERUS. 205
the skin; short dry cough, or cough with expectoration of mucus streaked with blood ; and slight feverishness.
Aurum, Hepar s., Lycopodium, Magn. m., Natrum, Silex, Cinchona, Alumina, Calcarea, Digitalis, Laurocerasus, Berheris vulgaris, Sepia, Carlo v., Natrum m., Kali <?., Plumbum c, Acid, nitr., Magnesia, Cuprum m,, etc., have also been found useful in chronic disease of the liver.
JAUNDICE.
Icterus.
Diagnosis. Yellow colour, varying in shade from a pale saffron to a dark brown yellow, appearing first in the eyes, then extending over the surface of the whole body ; hard whitish faeces ; orange- coloured urine ; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver.
In severe cases, even the perspiration will impart a yellow hue to the patient's linen.
The disease frequently declares itself without being plainly refer- able to any exciting cause ; the principal causes, however, are affec- tions of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics, or drastic purgatives, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct.
Among the predisposing causes may be enumerated a too seden- tary or irregular mode of life, indulgence in spirituous liquors, and the frequent use of aperients.
It may be remarked that the malady frequently assumes the inter- mittent type.
Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences, for example, dropsy, hectic fever, or general atrophy.
Therapeutics. Mercurius and Cinchona are two of the best remedies in the treatment of the disorder, particularly the former ; but, in cases where the patient has suffered from the abuse of that mineral, a preference may, in most cases, be given to Cinchona, espe- cially when the disease appears to have arisen from partaking of indigestible substances, or where it assumes an intermittent form.
206 DIGESTIVE SYSTEM.
In cases which have been excited by a fit of passion, — as we have before noted, no unfrequent cause — we should have recourse to Cha- momilla; but Nux vomica is to be preferred, w7hen, in addition to this, the bowels are confined, or alternately confined and relaxed. Nux vomica is also indicated, when sedentary habits, over-study, or indulgence in spirituous liquors, appear to be the predisposing, or partly the exciting causes.
Pulsatilla : Lassitude, great weakness and anxiety, especially towards evening ; obtuse pressure, but sometimes also pricking or shooting pain, in the region of the liver, extending occasionally upwards, towards the right shoulder ; whitish stools.
Digitalis, is a most important remedy in many cases of this disease ; the following are the principal indications for its employ- ment : nausea, retching, or vomiting, tongue clean or coated white ; pressure at the pit of the stomach and region of the liver ; sluggish state of the bowels, with white, gray, or clay-coloured evacuations ; alternate heats and chills. (Icterus Spasmod. s. Spast.)
Aurum is frequently an excellent remedy in obstinate cases, after Pulsatilla, when the disorder occurs in young females.
Should the Jaundice be accompanied with symptoms of inflamma- tion, and pain and pressure in the hepatic region, see Acute inflammation of the liver ; it may, however, be again ob- served in this place, that in the majority of such cases, Aconite, fol- lowed if needful, by Belladonna, Mercurius, or Chamomilla, as best indicated, will be found of essential service.
In inveterate icterus, the alternation of Sulphur, Ilepar sulphuris, Lachesis, and Acid, nitricum has been found successful ; but as these cases frequently arise from obstructions, atony, or a spasmodic or irritable state of the liver and duodenum, they require considerable skill and discrimination in their treatment.
The diet should be light and unstimulating ; veal or chicken broth, with bread (unfermented) ; roast apples, also mild vegetables, such as vegetable marrow, stewed lettuce, and French beans. Bacons butter, eggs, milk, wine, spirits, and malt liquors in general must be strictly avoided. The drink should chiefly be confined to water.
INFLAMMATION OF THE SPLEEN.
207
INFLAMMATION OF THE SPLEEN. Splenitis.
Diagnosis. Sharp pressing or shooting pains in the region of the spleen, with, in most cases, a high degree of fever, general derangement, and sometimes enlargement and tumefaction; and, when very severe, hematemesis.
It is a rare disease in this country, but sometimes declaims itself in hot seasons, when it is not unfrequently mistaken for other affections. It may, however, arise in individuals of delicate con- stitutions, or in children, when exposed to the influence of marsh miasms, particularly when to that cause has been added insufficient clothing, want of exercise or proper nutriment, and long-continued mental disquietude.
The value of Cinchona in this malady, and the power it displays of developing an affection closely similar to it affords one of many exemplifications of the truth of the homoeopathic law.
From our very imperfect knowledge of the physiology of this viscus and its relation to the other organs, this disease, except when it presents itself in the tangible form above mentioned, is extremely difficult to diagnose. Its best characteristics are tenderness or sensibility on pressure in the splenic region, with general debility, paleness of the complexion, bloodless appearance of the conjunctiva, languid circulation, and tendency of the extremities to become cold.
Therapeutics. The chief remedies in this affection are Cinchona and Arsenicum, which are useful not only in its treatment, but against the tendency to dropsy, which not unfrequently develops itself in connexion with this complaint ; an aggravation, however, which can but rarely occur, where the proceedings of the practitioner are guided by the homoeopathic law, inasmuch as the very remedies employed to combat the disease itself are the surest preventives against such a result.
The other medicines most frequently required are Aconitum, Arnica Montana, Nux vomica, and Bryonia alba.
Aconitum. Against the fever generally present, if the disease be severe.
Cinchona, when the inflammatory symptoms have abated, or if no fever of any moment exists at the commencement, particularly if the disease owes its origin to marsh miasm, or if the accompanying fever presents an intermittent type, in which case it should be ad-
208 DIGESTIVE SYSTEM.
ministered during the Apyrexia; moreover, if impaired appetite and general derangement be present; — see this medicine under Apepsia. Also, if the patient have been weakened by hematemesis or diarrhoea ; — see these articles. When the abuse of this medicine has given rise to disease of the spleen, benefit will often be derived from the employ- ment of Arsenic., Carlo v., Puis., Veratr., and Stdjph.
Arsenicum is useful where the disease resembles or is complicated with ague (see Cinchona and this remedy under art. Intermittent Fever) ; and further, when the patient complains of a violent burning pain in the region of the spleen, and a constant pulsation at the scrobiculus, attended with great anxiety; also vomiting of a dark grumous, fluid, watery, or sanguineous diarrhoea, and burning at the anus; excessive weakness, and oedema of the feet. In some cases it has been found advantageous to alternate these two remedies, by giving a dose of Cinchona morning and evening, allowing an action of one, two, or three days, , according to circumstances, and then exhibiting the other in the same manner.
Arnica is indicated by pressive pain in the left hypochondrium, causing dyspnoea, and when the vomiting of blood is excessive. (When external violence has given rise to the disorder, Arnica is especially called for. Rhus may also be useful under similar circum- stances, particularly when severe corporal exertion has produced the disease.)
Nux vomica is chiefly indicated by the symptoms of deranged digestion, constipation, &c, which remain after the more threatening symptoms are removed.
Bryonia is found useful in milder cases, where an aching, shoot- ing pain is felt in the region of the spleen, which is much aggravated by the slightest movement; or when the patient complains of a constant stitch in the side, or the left hypochondriac region, and general gastric derangement, with constipation.
The preceding are the remedies, which have been found most useful in the treatment of the disease, in the acute form. Chronic enlargement and indurations of the spleen require a long and judicious course of treatment for removal, or even amelioration. We shall, therefore, simply direct the attention of the reader to those remedies, which have proved most successful in these instances — namely, Sulphur, Calcarea carbonica, and Baryta carbonica (particularly when the mesenteric glands have become affected), and further, Lycopodium, Carlo vegetalilis, Plumbum, Ferrmn, Mezereum, Platina, and Stannum.
INFLAMMATION OF THE STOMACH. 209
INFLAMMATION OF THE STOMACH.
Gastritis.
As some difference of opinion exists among medical authors, as to the application of this term, it may be as well to state clearly the disease intended to be treated of in this place.
By gastritis is here meant, inflammation of the mucous membrane of the stomach/ which frequently involves the submucous tissue, and sometimes the muscular coat.
Diagnosis. Burning, pricking, or shooting pain in the gastric region, increased by pressure, inspiration, or the passage of food ; swelling, considerable heat, and tension over the whole stomachic region, sometimes with pulsation ; great thirst, nausea, and vomiting, increased or brought on by the smallest quantity of food or drink ; sometimes with hydrophobic symptoms {Jvyd/rophobia symptomatica) ; soreness of the throat, with inflammation of the fauces ; hiccough, sobbing, great restlessness, anxiety, and prostration of strength; coldness of the extremities; tongue generally red at the tip and round the edges, foul, rough at the centre and round the root ; frequently also syncope, violent spasms, convulsions, even tetanus ; small, some- times scarcely perceptible, and remittent pulse; sunken features, with expression of anxiety; and, generally, constipation, but fre- quently diarrhoea, or alternations of these two states.
Death may ensue — either from gangrene, in which case the pains suddenly cease, the coldness of the extremities increases, and the pulse becomes scarcely perceptible, and remittent ; or from paralysis of the nervous system, during the attacks of the spasms or syncope. When this disease has been neglected or improperly treated, and the patient has the good fortune to escape with life, it may pass into chronic inflammation, scirrhus, or ulceration of the stomach.
Causes. The most frequent are partaking of cold drinks or iced water when heated or during hot weather ; the admission of acid or poisonous substances into the stomach ; lesion from having swallowed any rough-pointed body, external mjury, ardent spirits, suddenly checked secretions or evacuations, abuse of emetics, and, finally, metastases.
14
210 DIGESTIVE SYSTEM.
Therapeutics. The remedies which have been found the most useful in the homoeopathic treatment of Gastritis, are Aconitum napel- lus, Belladonna, Ipecacuanha, Nux vomica, Antimonium crudum, Pulsatilla, Bryonia, Ranunculus bulbosus, JEuphorbium, Cantharis, Hyoscyamus, Arsenicum.
Aconite is requisite in those cases, in which synochal fever is developed, — and must be repeated until relief is obtained, or an alteration in the symptoms calls for the selection of another remedy.
Belladonna may follow Aconite, if the active febrile symptoms become relieved, but do not wholly subside under the employment of Aconite, and when there is vivid redness of the tongue at the tip and margins, inflammation of the fauces, and hydrophobia symp- tomatica.
Ipecacuanha is useful, when the vomiting is excessive, the epigastric region considerably distended, and the patient affected with great anxiety, restlessness, and difficulty of breathing. Anti- monium crudum may follow7 this remedy, or be given in preference thereto, if the tongue be much loaded. Bryonia may be adminis- tered after any of the foregoing remedies, should they have afforded only partial relief, and particularly, if the disorder has been excited by a chill from having partaken of cold drinks when overheated.
Nux vomica is one of the most important remedies in the gastritis mucosa of drunkards, with low fever, nausea, and vomiting, in the morning or after the simplest food ; weight, fulness, and pain in the epigastric region, and tremulousness of the hands. It is, moreover, one of the most useful medicaments, when this disease occurs, as a metastasis from suppressed hemorrhoids, and has also been found efficacious after the previous administration pf Aconitum^ Bryonia, Ipe- cacuanha, and Arsenicum, when the disorder has been caused by a chill from drinking iced water when overheated. Lachesis and Arsenicum may, in some instances, be advantageously administered in alternation with Nux v., in the idiopathic gastritis mucosa of drunkards.*
Pulsatilla has been recommended in the subacute form of gastritis, arising from the sudden suppression of some secretion, such as the menstrual flux, &c. ; and also in cases proceeding from a chill in the stomach from ice, particularly after the previous employment of Ipecacuanha or Arsenicum. Banunculus bulbosus, Euphorbium, and Cantharis have been recommended in the more violent forms of the disease, especially when the burning pain, so commonly attendant on
* Opium may also be included with advantage here.
INFLAMMATION OF THE STOMACH. 211
this disease, is well marked. When, however, in addition to the last- mentioned symptom, there is excessive prostration of strength ; thirst, with violent vomiting immediately after drinking ; small, quick, and occasionally intermittent pulse ; anxiety, restlessness, and apparent sinking of the vital energies — Arsenicum must at once be had recourse to, whether the disease has arisen from a chill in the stomach or any other cause,— excepting, of course, poisoning by that mineral, in which case the treatment to be followed will be found under the head of Poisons. The alternate administration of Aconitum with Arsenicum has been found useful in some cases, — in others, Veratrum and Arsenicum : the former, at an earlier stage of the disorder, with accompanying inflammatory fever ; and the latter, where the extremi- ties have become cold, the puTse small, features sunk and expressive of great anxiety ; with hiccough, thirst, vomiting on partaking of the smallest morsel of food, solid or liquid, extreme debility, and other symptoms mentioned in the diagnosis. When the pain suddenly ceases, or when the burning pain continues, and the tongue becomes covered with a thick yellow coating, the pulse weak, irregular, or intermitting, and purulent matter is occasionally ejected, — Arsenicum is again one of the few- remedies by means of which we may yet hope to arrest the progress of the disease. Sulphur, Cocculus, and Card. v. have also been recommended in the last stage of gastritis. In certain cases the attention of the practitioner may be directed to the follow- ing remedies. Hyoscyamus, — Stupor, or confusion of ideas with incoherent speech ; convulsions, hydrophobia symptomatica. Lachesis, Stramonium, and Cantharis may likewise prove useful in cases in which the latter symptom is present, — see Hydrophobia. Finally, Colo- cynth, Mercurius vivus, Sulphur, and Chamomilla may be mentioned, as likely to prove serviceable auxiliary remedies in some instances; and Arnica should be resorted to, if the attack can be traced to lesion of the stomach from any rough or pointed substance having been swal- lowed, or if it has arisen from external injury.
When the disease has passed into the chronic form, Natrum m., Lachesis, and Nux v. may be administered in alternation wTith great advantage ; and followed, if required, by Lycopodium, Colchicum, Sul- phur, and Phosphoms, &c. Arsenic, Sep., Plumb., Platina, Kali c, Natrum m., Calc. c, Magn. c, and Rhus may also be named as likely to be required in some old standing cases.* Vide also Cardialgia (which chronic gastritis nearly resembles), and Dyspepsia.
* The alternate employment of Sulphur and Carbo v. has been recommended in chronic inflammation of the stomach with the following symptoms: Burning constrictive pains, with
212 DIGESTIVE ST STEM.
INFLAMMATION OF THE BOWELS.
Enteritis.
Diagnosis. This disease is comparatively of rare occurrence in the idiopathic form, and appears much more frequently as a symp- tomatic affection, particularly in the course of certain fevers — such as low Nervous or Typhoid Fever, Scarlet Fever, Measles, &c. ; and also in all diseases attended with hectic fever.
It much more frequently occurs in the subacute or chronic, than in the acute form. In the acute form of the disease, involving the sub- mucous tissue and peritoneal coat, as well as the mucous membrane, the symptoms are usually as follows : intense burning or pungent pain, generally in one spot of the abdomen, especially in the region of the navel, increased by the slightest pressure and by movement, with tightness, heat, and tympanitic distension of the abdomen ; sobbing, anxiety, and violent thirst, with aggravation of suffering from cold drinks ; obstinate constipation ; violent vomiting, first of slime and bile, and sometimes even of excrements {Ileus miserere) ; small and contracted pulse, inflammatory fever, flatulence, and fre- quently obstruction of urine.
In the subacute form of the disease, or in simple enteritis mucosa, the pain is often very slightly felt, in comparison with that which accompanies inflammation of the peritoneal coat, and generally con- sists of a diffused soreness over the abdomen, which is commonly, though not always, increased on pressure ; but indigestible food or cold drinks almost invariably cause an aggravation of pain. The tongue is often very red, smooth, and glossy ; and, generally speak- ing, there is more or less redness at the tip and margins, however foul the centre may be. We also find loss of appetite, and indigestion with nausea and vomiting, more or less prominent, according to the portion of the intestinal tube affected ; being greater the nearer the seat of the inflammation is to the*stomach. When the inferior parts are implicated (indicated by pain or soreness in the iliac regions and
sensibility to the touch, fulness and tension of the epigastric region, acidity, and frequent vomiting of watery fluid, or even of ingesta, great debility and sensation of paralysis in the extremities ; should indurations (not scirrhous) have formed, (symptoms — periodic, pressive aching pains, extending from the stomach to the spine, commonly increased after partaking of the most simple food, and accompanied by anxiety, oppressed breathing and obstinate constipation, and sometimes vomiting of mucus), which are often to be felt at the region of the pylorus, Sepia and Aurum should be given in alternation. — Hygea, Zeitschrift besonders fiir rationell-specifische Heilkunst, XX Band, 1 Heft.
INFLAMMATION OF THE BOWELS. 213
in the course of the colon); there is usually diarrhoea, the stools being frequently slimy and mixed with blood, in severe cases consisting of pure blood, particularly when the rectum is involved, in which case there is, moreover, considerable straining. The pulse is quick, the thirst sometimes excessive, with a greater or less degree of fever and extreme languor.
Unless resolution take place, it may terminate in induration of the intestines — laying the foundation of chronic constipation, hydrops, suppuration, or gangrene.
The signs of approaching gangrene, or of its having set in, are the same as in gastritis, with the difference of situation.
Among its exciting causes are, cold in the feet and abdomen, sup- pressed discharges, cathartics, worms, metastases, parturition, indi- gestible or highly stimulating food, prolonged use of acids, sour wine, or beer, &c. The state of the atmosphere appears to have some share in producing it, from the circumstance that the disorder sometimes prevails almost as an epidemy.
Therapeutics. Arsenicum and, where required, Veratrum are the principal remedies in the first-described variety of this disease, as well as in the severest forms of gastritis, to which, indeed, it bears a strong resemblance; but the treatment must necessarily be com- menced with Aconite when the accompanying fever is intense, and the skin hot and parched. For the selection and administration of the two former remedies, see Gastritis. Opium and Plumbum are the principle remedies against Ileus miserere, when that derange- ment arises from spasmodic congestion or strangulation of the intes- tines; but when it is connected with inflammatory action, or has resulted therefrom, Aconitmn and Sulphur are more appropriate. Lachesis, Mere, Bella., Sec, may, however, be better indicated, by the existing symptoms, in some cases. (See also Hernia.)
In the subacute form of the complaint, a few doses of Aconite are often serviceable ; — but as soon as the marked inflammatory symp- toms have been subdued, one or more of the following remedies must be selected to complete the cure : Belladonna, Mercurius, Acid, nitricum, Bryonia, Colocynth, Cliamomilla, Nux v., Pulsatilla, China, Opium, Can- tharis, Colchicum, Rhus, Phosphorus, Stilph., Silex.
Belladonna : — Tongue red and smooth, or coated while, or yellowish brown in the centre with intense redness of the Up and margins, and inflammatory redness of the papillae ; skin hot and dry, intense thirst, hot, flushed face, giddiness with occasional delirium, especially at
214 DIGESTIVE SYSTEM.
night ; sensation of soreness or of excoriation either in the umbilical and ccecal regions or over the entire abdomen , with tenderness on pressure, and sometimes considerable distension, particularly in the region of the arch or transverse section of the colon. {Lachesis is sometimes of great service after Belladonna.)
Lachesis is a most important remedy in enteritis, with burnings aching, cutting pain, oppressed respiration, tense, distended abdomen, with sensibility on pressure over the affected part, and obstinate constipation. [Belladonna may sometimes be returned to with ad- vantage after Lachesis ; but if any of the other remedies, such as Bryonia, Nttx, or Sulphur, &c, seem better indicated, they should unhesitatingly be had recourse to.)
Nux vomica : — Redness of the margins of the tongue, with yellow or whitish coating in the centre ; sensation of soreness, with burning heat in the abdomen ; loss of appetite ; indigestion, with vomiting after partaking of food, and aggravation of the abdominal pain after drinking ; flatulence, constipation, or constipation and looseness alternately ; scanty watery stools, or stools consisting of a small quantity of mucus, sometimes tinged with blood, and attended with straining. This remedy is especially useful when the above symp- toms have been caused by the sudden suppression of a hemorrhoidal flux, or from indigestible food, &c. Sulphur is frequently of great service after the previous employment of Nux.
Mercurius is a most important remedy in this disease, even in the most serious cases, and especially after Aconite, and Belladonna, or even Arsenicum, should that remedy have been called for. The following are its principal indications : tongue very foul, coated white or dark brown, sometimes dry, but more frequently covered with thick mucus; excessive thirst; abdomen hard, tense, distended, and very tender to the touch ; copious, watery, bilious, and highly offensive stools, but more frequently there is constant urging to stool, followed, after severe straining, by the evacuation of a small quantity of mucus tinged with blood ; or at other times, of pure blood in considerable quantity; extreme prostration of strength, chilliness and shivering, with tendency to sweating at night, which, however, brings little or no relief, {Mercurius may sometimes be beneficially alternated with Belladonna, or with Lachesis in more advanced cases.)
Acidum nitricum. The indications for this remedy are much the same as those described under the foregoing; it is, therefore, sometimes of great service in completing the cure, when Mercurius has effected considerable improvement, but seems inadequate to give
INFLAMMATION OF THE BOWELS. 215
further relief. It is an invaluable medicine, in chronic cases, attended with abdominal tenderness and tenesmus, and especially when the disorder occurs in individuals who have been previously subjected to an abuse of Mercury under allopathic treatment.
Bryonia. After the previous employment of Aconite, Bryonia is occasionally a very useful remedy here, particularly when the patient complains of severe headache, with constipation, and acute pain in the abdomen, aggravated by movement, and after meals ; it is also indicated when, after Aconite, there remain dark redness of the tongue, or whitish or yellow coated tongue, with parched mouth, and con- siderable thirst; loose, offensive evacuations, particularly after par- taking of food or drink ; nausea and vomiting after eating.
Pulsatilla : — When the acute inflammatory symptoms of ente- ritis, arising from the sudden suppression of some habitual discharge, such as the catamenia, or the hemorrhoidal flux, or occurring as a sequela of measles, have been subdued by Aconite, and the following symptoms remain : tongue loaded with a thick white, grayish, or yellow coating ; adipsia, or, on the contrary^ excessive thirst, deranged digestion, loss of appetite, with nausea and vomiting after partaking of a little nutriment ; sensibility of the abdomen on pressure, or on every movement ; flatulence.
Colocynth : — In cases where the large intestines are the seat of inflammation, attended with tympanitic distension of the abdomen, and soreness and sensibility to the touch ; tormina and diarrhoea, with increase of pain, followed by urgent desire to go to stool, after eating or drinking ; nausea, or vomiting of bilious matter ; frequent dis- charge of flatus.
Chamomill a is peculiarly well adapted to the treatment of the disorder in the form it is sometimes met with in children, or in highly nervous and excitable females, who are extremely sensitive to pain and complain loudly from trivial suffering ; it is indicated, moreover, by a sensation of soreness in the abdomen, as if arising from internal excoriation or ulceration, accompanied with painful tenderness on slight pressure, and slimy, whitish, watery, or greenish, or yellowish diarrhoea^ of an offensive odour.
Cinchona is frequently useful after Aconite or any of the foregoing remedies, when there is a tympanitic distension of the abdomen ; diarrhoea, aggravated after a meal, with portions of undigested food in the evacuations ; thirst, extreme weakness of digestion, and great debility.
Cantharis: — In very serious cases, with discharge of pure blood
216 DIGESTIVE SYSTEM.
at stool, and strangury ; or in an advanced stage of the disorder, with evacuations of mucus and solid substances, like shreds of membrane, this remedy will frequently be found of considerable service.
Colchicum will also be found useful, occasionally, in advanced stages of the disorder, with tympanitic distension of the abdomen, diar- rhoea, the stools consisting of white or transparent gelatinous mucus, or of blood mixed with substances resembling false membrane.
Rhus : — When eruptions break out about the mouth, and there is redness of the tongue, with pain as if from soreness or ulceration in the abdomen, and tenderness on pressure ; watery, slimy, frothy, or sanguineous stools ; low fever, with nocturnal delirium. Rhus is chiefly useful in symptomatic enteritis, such as frequently occurs in low Nervous Fever, which see. When ulceration, with purulent evacua- tions and nocturnal sweats, sets in, Arsenicum, Nux v., Sulph., PhospL, Acid, nitr., or Card, v., rarely fail to relieve, and may even effect a cure when the mischief is not too extensive.
The chronic stage of the complaint, which is chiefly characterized by fixed pain, fulness, or uneasines and oppression in the lower part of the abdomen, increased after meals or after cold drinks; appetite impaired or capricious; thirst, particularly after dinner or at night; bowels constantly relaxed, or affected by constipation alternately with diarrhoea ; fetid and discoloured evacuations ; skin hot, harsh, and of an unhealthy hue ; pulse rather quick ; tongue loaded, but red at the tip and margins, — or redness of the entire tongue, with large and elevated papillae, especially at the root ; emaciation, weakness, and languor. Here the foregoing remedies required the acute and sub- acute varieties, but more particularly Belladonna, Nux v., Bryonia, and Rhus, together with Acidttm nitricum, Phosphorus, Sulphur, SiUcea, Arsenicum, &c, will in most instances be found the most serviceable.
Acidum nitricum is particularly indicated when there is thirst, attended with pains in the bowels or other uneasiness after drinking ; impaired appetite, tenderness of the abdomen, fetid diarrhoea and tenesmus; greenish stools, with ingesta, skin dry and harsh during the day, sometimes with nocturnal sweats.
Phosphorus: — Soreness in the abdomen, with tenderness on pressure, and distressing distension after meals ; obstinate diarrhoea, or constipation and diarrhoea alternately ; stools containing ingesta ; pulse rather quick and hard ; weakness and emaciation.
Sulphur. This remedy is one of the most useful in enteritis, arising from the suppression of some accustomed discharge, such as the hemorrhoidal, &c. ; as also in cases arising from the driving
INFLAMMATION OF THE BOWELS. fe]7
inward of a tetter, or sudden healing up of an ulcer. It is also indicated when we find the tongue red or loaded ; thirst ; pain, as from excoriation, in the abdomen, with tenderness on pressure ; or fulness and uneasiness in the abdomen, increased by cold drinks or after meals ; diminished or fastidious appetite, with aversion to meat ; fetid diarrhoea, frequently containing ingesta ; constipation, or con- stipation alternately with diarrhoea, flatulence ; skin yellow, or other- wise unhealthy looking, or dry and peeling, but often covered with perspiration at night, or towards morning ; pulse quick and hard ; emaciation, with considerable debility.
Silicea. When the disorder has been excited by the sudden suppression of the perspiration of the feet, or the sudden healing up of a chronic ulcer, Silicea is one of the most important remedies. The following symptoms are some of the more immediate indications for its selection : dryness of the mouth, loaded tongue, great thirst, with diminished appetite, and sometimes disgust at meat, or cooked and hot food, with desire for cold food and drinks ; abdomen hard, hot and tense, and painful to the touch ; constipation, or extremely fetid watery stools ; borborygmus, especially on movement ; skin dry and parched during the day, and covered with sweat towards morn- ing ; pulse quick and hard.
Arsenicum, has already been noticed as the principal remedy in acute cases of a violent character ; it is, moreover, a remedy of con- siderable service in some of the chronic varieties of enteritis, charac- terized by a feeling of soreness or of burning heat in the abdomen, attended with nausea, want of appetite, and great thirst ; increase of pain after cold drink; borborygmus; diarrhoea^ sometimes with ingesta ; fetid, discoloured stools ; skin parched, hard, and of a yellowish, unhealthy-looking hue ; emaciation, with extreme debility.
Lachesis, Lycopodinm, Kali nitricum, Natrum mtoriaticum, Secale cornu- tum, Hepar sulphuris, Sepia, Calcarea, Graphites, arid Carbo vegetabilis, may also be of considerable service in some cases. When we have reason to suspect worms as the cause of this affection, the patient must be treated accordingly. See Invermination.
Diet. In acute cases of inflammation, either of the stomach or bowels, the regimen must be placed under the same restrictions as described at page 7 {Fever) ; and in subacute and chronic cases the food should be very light, and given in small quantities ; raw fruit, green vegetables, and sometimes potatoes, must be strictly prohi- bited ; and the drink should consist solely of toast-water, barley- water, or the like.
218 DIGESTIVE SYSTEM.
INFLAMMATION OF THE PERITONEUM.
Peritonitis.
Diagnosis. Painful tension and tumefaction of the abdomen, with a sensibility to the touch even more acute than in Enteritis, so much so, that the patient cannot bear the pressure even of a sheet upon the abdomen ; frequently constipation or ischuria, and the symptoms of enteritis.
Causes. General causes of inflammation, and, moreover, external injury, parturition, chill of the abdomen, and metastases.
Therapeutics. In the first place it will generally be found bene- ficial to administer three or four doses of A^onitum, exhibited at intervals of time varying according to the exigency of the case, until the fever and inflammation lower : this remedy has been found, in many cases, sufficient of itself to remove the affection, and in all it materially modifies its violence.
When the cause is external lesion, we should prescribe Arnica, and at the same time apply bandages wetted with a diluted tincture of the medicine, as recommended under External injuries in cases of contusion. {Aeon, followed, if requisite, by Belladonna, is, nevertheless, indispensable, as soon as inflammatory fever, with ex- cessive local tenderness, supervenes.)
Sometimes vomiting and other symptoms, closely resembling those of 'enteritis, are present ; at other times, merely the marked sensi- bility of the abdomen and tumefaction with gastric derangement ; but as, physiologically considered, these symptoms arise from the intensity and extent of the inflammation, and the sympathy of the other organs, our chief care must be to lower the inflammation, which having been in a great measure effected by the first-mentioned remedy, we shall find considerable benefit from the employment of Nux vomica and Mercurins in combating any remaining symptoms : —
Nux vomica, where there is painful sensibility, and distension of the abdomen, with a tendency to the predominance of gastric symp- toms and ischuria.
Mercurius is more particularly suited to the advanced stages of the disease, with weak, quick pulse, nocturnal sweats, and great weakness.
When the inflammation extends to the pleura, and the breathing
IN VERMIN ATION. 219
becomes affected, with acute shooting pain, we should have recourse to Bryonia, in the same manner as directed for Aconite. (See also Pleuritis.)
When the peritoneal coat of the upper portion of the alimentary tube or of the stomach itself becomes affected, evinced by an increase in the intensity of the disease, the pain extending higher — vomiting, generally a rare symptom, becoming severe and continual —collapse of the features, small pulse, and a rapid sinking of the vital energies, we should have recourse to Arsenicum.
In cases where there are evidences of the brain being affected, Belladonna may be had recourse to. (See Phrenitis.) in other instances Cantharides, ZacL, Chamomilla, Bryonia, Rhus, Lycopodium, Colocynth, etc. may be found necessary.* (See also Gastritis and Enteritis, as the indications for many of the remedies mentioned under that head will, in many instances, prove useful in the selection of the appropriate medicament in inflammation of the peritoneal coat.)
INVERMINATION. WORMS, Helminthiasis. Fehris helminthiaca*
The existence of worms in the intestinal canal, in the majority of cases, evidently arises from a peculiar constitutional taint, inducing a certain diseased statcof the mucous or lining membrane, and thereby giving rise to the formation of these parasites ; and, although no period of life is wholly exempt from their presence, infants and chil- dren appear to be much more subject to the affection than adults, on account of the predominance of nutrition in early youth. Weak- ness of the digestive functions, accumulation of mucus in the intes- tines, an ill-regulated diet, and a degree of moisture in the atmos- phere, favour their generation.
The three species most generally met with in the human subject are, the thread-, or maw-worm {Ascaris vermicularis, Oxynris), the long round worm {Lumbricus, Ascaris lumbicoides) , and the taenia or tape- worm ; of the latter there are two varieties, — -the solitary tape-worm (Tmnia solium, Tama osculis marginalihus), composed of long and slen- der articulations, which has been known to exceed the length of thirty
* In Peritonitis puerperalis: Aconitum, Ipecacuanha, Bryonia, Arsenicum, Veratrum, Chamomilla, and Pulsatilla are the remedies which have chiefly been used ; but some of the others which have been mentioned in the treatment of Enteritis may be found serviceable in particular cases.
220 DIGESTIVE SYSTEM.
feet; and the broad tape-worm (Taenia osculis stiperftcialiStis, Bothrio- cephalus latus), which varies from three to ten feet, seldom comes away entire, but in joints, which are considerably broader and thicker than those of the variety first mentioned.
The presence of worms, unless when passed, is not always easy of detection, since subacute inflammation of the mucous membrane from other causes wrill frequently present nearly the same range of symptoms ; but here (as in the treatment of most diseases) Homoe- opathy presents two manifest advantages over the old system. In the first place, if acting upon the certainty of the existence of worms, we administer a remedy specific to the affection ; in the next, when wre are uncertain as to the true character of the complaint, and select a medicament distinctly indicated by the united symptoms, this medica- ment will be found applicable to the affection, from whatever cause it arises; whilst a careful observance of the known pathogenetic powers of the remedies selected, will materially assist us in tracing the disease to its proper source.
Diagnosis. Worms, and especially ascarides, frequently exist in the intestines without occasioning any disturbance, and their pre- sence is only known by their being observed in the evacuated faeces ; but when the alimentary tube becomes irritated by them, a number of symptoms are developed, of which the following are the principal ; Pallor and sickly appearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils; headache or vertigo ; irregularity of appetite, or great voracity ; fetidity of breath ; acrid eructations ; occasional nausea and vomiting ; foul tongue ; tensive fulness of abdomen, with a sensation of gnawing and burning at particular parts of -the intestines; hard and tumid belly; great thirst ; discharge of mucus from the rectum, bladder, (and- vagina) ; heat and itching at the anus ; slight febrile symptoms, or remittent fever, and nocturnal wakefulness, with low spirits or irritability of temper, and gradual emaciation ; we also usually notice an inflamma- tory redness of the nostrils, with great disposition to picking or boring at the nose, especially in children, with sudden screaming when waking, and grinding of teeth. In addition to the above gene- ral symptoms of this affection, we frequently meet with severe colic- like pains, with tenesmus and slimy and bloody evacuations ; clysury ; strangury ; involuntary flow of saliva, especially when asleep ; con- vulsions in children, and epileptic attacks, combined with cerebral
INVERMINAT10N. 221
affections, in adults; inflammation of the bowels. The pain is periodic, and occurs particularly in the morning, and whilst fasting ; melioration generally after eating. The quality of the food exercises considerable influence over the pains ; milk, sugar, and other sweets, pungent, salted food, ham, cheese, raw fruit, etc., often produce aggravation.
In tania, in addition to the above, we find a crawling, scraping or groping, and twisting sensation, extending from the left side of the abdomen towards the epigastrium, and even as far up as the oeso- phagus ; or a sensation as of something rising into the left side of the throat, and then falling back ; the feeling of a cold ball on either side, with an undulatory motion ; a sense of sugillation in the abdo- men ; creeping torpor and numbness in the fingers and toes.
The principal exciting causes of worms are, insufficient and unwholesome food, (excess of vegetable, and deficiency of animal diet,) uncleanliness, impure air, with residence in a damp, dark, ill- ventilated dwelling.
The leu co-phlegmatic habit appears to engender a predisposition to their formation ; and females are oftener affected than males.
As already observed, the alimentary tube may be infested with worms, without any other indication of their existence being developed beyond.
But the reverse is more frequently the case, and in addition to the anxiety and alarm which are so often created in the minds of parents by the distressing nature of many of the symptoms, in severe cases a further and more serious cause for apprehension is given rise to, when other diseases above noticed, such as chronic inflammation of the mucous membrane (sometimes followed by perforation), mucous fever, epilepsy, or hectic fever, become associated with invermination.
The progress of the disease is generally slow, and there is a constant proneness to relapses. The prognosis is generally favorable, par- ticularly in the case of ascarides. It is less so in that of tape-worm, chiefly on account of the greater duration of the disease, and its more uncertain cure. When the colon and rectum are the seat of the disorder, the cure is more easily accomplished than when the stomach and small intestines are affected. When the nervous symptoms so- called, such as sopor, spasms, dilated pupils, vomiting, are present^ the case is liable to be confounded with hydrocephalus ; but in the latter the abdomen is flat or retracted, whereas in helminthiasis it is
222 DIGESTIVE SYSTEM.
soft and distended; the head in hydrocephalus is hot, and the symp- toms succeed each other in a regular course, whereas here they are very changeable, periodic, and inconstant.*
Therapeutics. Aconitum, Ignatia amara, Sulphur, Calcarea carbonic a, China, Ferrum metallicum, Ma/rum ver., Cina, Nux vomica, Merctirius, Valeriana, Spigelia, Belladonna, Sabadilla, Silicea, Cicuta virosa, Filix mas, &e. Of these, Aconitum, Ferrum, Ignatia, Merc, Nux v., Valer., Marum ver., Cina, and Sulph. Unci., are generally the most appropriate against Ascarides. Cina, Nux v., China, Bella,, Merc, Spigelia, &c, against LumbricL And Graph., Calc, Sabad., and Fragaria vesca, (Dr. Gross); or Sulph., Merc, and Calc, (Dr. C. Hering) ; as also Carbo a. et v., Kali c, Magn. m., Natr., Phosph., Petrol., Plat., Tereb., Filix mas, Punica granat., Stannum, against tape-worm.
Aconitum : — When considerable febrile irritation exists, with rest- lessness at night, fever and irritability of temper, continual itching and burning at the anus, and at times a sense of crawling in the throat.
In many cases Ignatia amaba will be found the most appro- priate medicine after Aconite, particularly if spasmodic twitchings take place in one of the extremities or in individual muscles, in- tolerable itching, and pain as from excoriation in the anus and rectum. (See Cina.)
Valeriana maybe substituted when the insupportable nocturnal itching causes spasmodic muscular twitching, and sleeplessness.
Ferrum metallicum is of much service when there is frequent vomiting and accumulation of watery fluid in the mouth.
Mercurius : — When, in addition to many of the ordinary symp- toms of worms, there is especially a constant inclination to go to stool, and diarrhoea with tenesmus ; distension and hardness of the abdomen (umbilical region) ; increased secretion of saliva.
Sulphur, in case the annoyance still continues after the lapse of two or three days. This remedy is, however, sometimes indicated from the commencement, and is in some cases alone sufficient to effect a radical cure. It is especially called for in lymphatic, leuco-phleg- matic habits, with tendency to frequent attacks of coryza and other mucous discharges; bitter, slimy taste, aversion to meat ; irresistible longing for sugar ; alternations of loss of appetite and voracity ; frequent regurgitation of ingesta, together with pyrosis, hiccough,
* Hartmann's Therapie, p. 163.
INVERMlNATION. 223
retching, vomiting, and borborygmus ; also when the before-men- tioned itching and feeling of soreness in the anus and rectum are extremely distressing.
Calcarea is, if anything, still better calculated than Sulphur to eradicate the tendency to worms* It is peculiarly well adapted to children of lymphatic constitution, with disposition to blenorrhoea ; cold in the head and diarrhoea; feeble debilitated frame ; defective nutrition ; face pale and hollow, or puny, and of diminished tempera- ture ; weakness of the ankles ; complications with scrofula and rickets ; chronic derangement of the digestive functions.
Silicea is often of essential service after Sulphur or Calcarea, when the symptoms are generally much exacerbated at the first quarter, or at the period of full moon, as is very frequently the case in helminthiasis. Some of the other medicaments, such as Mercurius, Nux v., or Pulsatilla, Ipecacuanha, Antimonium, may be required after a few doses of Sulphur or Calcarea, when indicated by the turn the symptoms may take; moreover the beneficial action of Sulphur or Calcarea, is often materially assisted by the intermediate use of one or more of the aforesaid remedies. An interval of from six to ten days and sometimes upwards, must generally be allowed to elapse between the different remedies, in chronic cases.
This course of treatment, persevered in for a short time, has often proved successful in most obstinate cases, by purifying the consti- tution, and restoring the mucous membrane to a healthy state. When excessive irritation is present, and does not appear to diminish readily under the action of the preceding remedies, we may give a drop of the tincture of Urtica urens, in a little water, or on a piece of loaf sugar, every night or morning for several successive days, and should this not relieve the annoyance, we may administer an enema of a dessert-spoonful of salt to a pint of water, of which from two to six fluid ounces, according to age, may be injected ; if this produces a relaxed state of the bowels a mixture of vinegar and water, in the proportion of one fourth part of the former, may be used.* After this palliative course of treatment, the course above mentioned may again be adopted, should it appear necessary.
Cina. This is an eminently useful medicine in the case of worms, and is generally indicated where the following symptoms are met with: frequent boring at the nose, obstruction of the nose, great perverseness of temper, bashfulness, heat and irritation, constant
* Hering's Hausartz.
224 DIGESTIVE SYSTEM.
inquietude and restlessness, -with, in children, a desire for things which are rejected when offered ; fits of crying when touched, pale- ness of face, with livid circle round the eyes ; constant craving for food, even after a meal ; griping, distension, heat, and hardness in the abdomen, with discharge of thread- and round-worms, costiveness, constipation, or loose evacuations ; fever chills towards evening, hard, quick pulse ; little sleep, or restlessness, tossing about, startings, talking or calling out suddenly during sleep ; transitory paroxysms of delirium; heaviness of the limbs; changing of colour, the face being at one time pale and cold, at another red and hot; pupils dilated, tongue covered with tenacious mucus ; disagreeable eructations, vomiting; itching in the anus, and crawling out of thread- worms, involuntary micturition, and white, turbid urine ; occa- sional convulsive movements in the limbs ; weakness and lassi- tude. This medicine is particularly indicated in Colic produced by worms.
Nux vomica is a valuable adjunct in cases of worms, with con- siderable derangement of the digestive functions, irritability of temper, and constipation ; or excessive distension and sensibility of the abdomen and epigastric region ; feeling of heat in the abdomen ; inclination to vomit ; exacerbation of symptoms early in the morning. (See also Dyspepsia, Gastric or Mucous Fever.)
Mercurius. When we find diarrhoea, distension of the abdomen, and hardness in the umbilical region, with increased secretion of saliva.
China is appropriate when the symptoms are generally exacerbated at night, particularly the abdominal sufferings; or, when pressive aching pains are experienced below the umbilical region after every meal, and are attended with distension of the abdomen, pyrosis, pains in the epigastrium, and retching ; also, when in addition to the fore- going, there is an over-excitability of the nervous system, with spasmodic twitchings of the muscles in various parts, tremulousness and debility. {Valeriana and Veratmm are also deserving of attention here.)
Spigelia in cases, with colic, voracity, diarrhoea, and chilliness; or nausea in the morning, accompanied by a sensation as if some- thing were ascending from the stomach into the throat; smarting in the nostrils, paleness of face, palpitation and anxiety ; exacerbation of symptoms particularly after dinner.
Belladonna is best adapted to cases with cerebral disturbance, great nervous excitement; nocturnal delirium, with startings during
INVERMINATION. 235
sleep ; tendency to be startled or frightened by the most trivial cause ; also colic, headache, thirst, quick pulse, hot, dry skin. Should these symptoms not yield to Belladonna, recourse must be had to Lachesis, or to Silicea, if the febrile symptoms continue, and the patient be of a scrofulous diathesis.
Cicuta virosa. Severe worm-colic with febrile irritation and convulsions. (Bella., Ignatia, Hyoscyamus, are also valuable in the event of convulsions. See that article.)
The treatment of taenia, although similar to the above, has some modifications. In most cases Aconitum may be prescribed, followed by Cina, after which considerable relief is often experienced ; subse- quently Filix mas, a drop of the concentrated tincture, night and morning for four or five days.*
Punica granatum has been employed with much success by Drs. Lobethal and T. O. Miiller. The latter gives the following symptoms as the principal indications for this remedy : convulsive movements, catalepsy and epilepsy, syncope, emaciation with vora- cious appetite, sudden starting from sleep, hallucinations, hypo- chondriasis, vertigo, confusion in the head, dilated pupils, yellow colour of the face, grinding of the teeth, accumulation of water in the mouth, capricious appetite, eructations of watery fluid, vomiting, sensation as if something were rising up in the stomach, distended abdomen, colic, palpitation of the heart, &c. (Hyg., Bd. x, pp. 137-93.)
In chronic cases, the following treatment has proved successful : Nux vomica, Mercurius, Sulphur, and Calcarea. Dose, four globules of each remedy in rotation in two doses, two globules at night and two in the morning, — an interval of from six to ten days to be observed between the different remedies. When any improvement takes place after the administration of any one of these remedies in particular, it will be well to repeat that medicine at the stated intervals, as" long as it appears to do good, instead of going on to the next remedy in rotation* In addition to these medicines, the following,
* Dr. Wahle, of Rome, considers the Filix mas a specific remedy in tcenia, when anything sweet invariably disagrees with the patient, or rather with the worm. He has repeatedly found only a few doses of this medicine sufficient to remove all the symptoms and sufferings arising from tape-worm, when the aforesaid peculiarity formed a marked symptom; and that every trace of the worm disappeared after the employment of the remedy, if the patient paid strict attention to diet— carefully avoiding indigestible food for the space of a few months. (Neues Arch., Dritter Band, Erstes Heft, p. 3.)
15
226 DIGESTIVE SYSTEM.
as already observed, are more or less useful in taenia : Carlo a* et v., Kali, Magnes. m,., Petrol., Plat., Tereb.,. Natrum muriaticum, Lycopoclium, Sabadilla, Fragaria, Graphites, Baryta, Stanmcm, Phosphorus, as the one or the other may appear the best suited to the case.
In the selection of these or other remedies, we must be guided by the entire group of symptoms. In many cases of tape-worm, a cure has been performed, and the parasite discharged, when the slightest suspicion had not been entertained that the sufferings of the patient arose from such a source, — by administering a remedy in strict accordance with the symptoms complained of by the patient. When the symptoms are few, or not well marked, we may derive con- siderable assistance by paying attention to such particulars as — the disposition and temperament of the patient; the periods of the day when the sufferings make their appearance or become exacerbated ; the part of the body affected (right or left side) ; the partialities, or peculiar dislikes of the patient; the agreeing pr disagreeing of different kinds of food or drinks, &c.
Regimen. The food ought to be wholesome and nutritious ; and consist chiefly of meat, such as roast or boiled beef, or mutton, some- times chicken, and occasionally a light pudding ; fruits or vegetables must be prohibited, as also milk, pastry, and sweetmeats : and the utmost care should be taken to prevent children from eating raw herbs, roots, &c., which they are so prone to pick up in their rambles, when not looked after. Plenty of exercise in the open air is of essential service, and must on no account be neglected.
BLENORRHCEA.
This epithet i$ given to an increased secretion or discharge from any of the mucous surfaces. We purpose to restrict ourselves here to the consideration of the affection as it occurs in the stomach and bowels.
Blenorrhoea ventriculi. This form of the complaint is chiefly cha- racterised by loss of appetite, insipid, clammy, nauseating, sweetish taste in the~mouth, furred, or white and thickly- coated tongue and fauces, flatulence, absence of thirst, constipation, or slimy stools, pale, cloudy and slimy urine. In addition to these symptoms, a sen- sation of coldness, with pressure and aching, or gnawing, throbbing, and spasmodic tension is experienced in the epigastrium, frequently
BLENORRHCEA. 227
attended with an oppressive feeling of sinking and emptiness in the stomach while fasting, and distressing fulness or weight after meals, the sleep is restless or disturbed by frightful dreams, or nig^t-mare ; the natural temperature of the body diminished, the countenance pale, and the physical powers much depressed. Accumulation of fluid in the mouth, nausea, and vomiting frequently take place early in the morning or after dinner, and occasionally at other times. Sometimes there is merely an adhesive, tasteless, rarely acidulous, inodorous mu- cus ejected by the act of vomiting. The prolonged use of imperfectly azotized and indigestible food, sedentary habits, the presence of worms in the alimentary canal, damp, ill-ventilated dwellings, or other debili- tating influences — such as excessive evacuations of blood, immoderate excess in the use of ardent liquors, depressing passions, and a lymph- atic temperament are the general predisposing or exciting causes of blenorrhcea in general. A moist, relaxing, and changeable state of the atmosphere, errors in diet, mental emotions of all kinds, mate- rially aggravate the symptoms, and are readily productive of pituitous fever (fehis j?ituitosa,feh?is mucosa).
Therapeutics. Ipecacuanha is one of the- most important remedies in the early stage of the disorder, and is in most instances the best with which to commence the treatment. It must be given in repeated doses, until it has produced all the amendment that it seems capable of producing, after which another remedy must be selected in accordance with the remaining symptoms. Against these, we shall generally find either Nux vomica, Arsenicum alburn^ Pulsatilla, Veratrum album, Tartarus emeticus, or BJieum patmalmm, etc., the most appropriate.
Nux v. is particularly indicated when spasmodic sufferings in the stomach with accumulation of watery fluid in the mouth, acid taste, vomiting of sour-smelling and tasting mucus, and constipation, sometimes in alternation with slimy stools, form the most prominent features of the case ; and especially when these symptoms occur in individuals given to sedentary habits, or to habitual over-indulgence in spirituous, vinous, or malt liquors. Arsenicum may be frequently prescribed with advantage after, or alternately with, Nux v. where there is an extreme degree of debility, and burning heat in the throat, or stomach, etc. When the last-named symptoms occur in lymphatic subjects, and especially females, Capsicum may be pre- ferred to Arsenicum.
228 DIGESTIVE SYSTEM.
Pulsatilla is productive of considerable alleviation where the pitui- tous state is accompanied by continued shivering, frequent slimy eva- cuations, and vomiting of mucus, and occurs in debilitated, irritable, and relaxed constitutions, but more particularly in chlorotic females. Sulphur may follow Pulsatilla with advantage when the latter is insufficient to remedy the state of matters. (See Chlqrosis.)
In cases of an inveterate character, attended with repeated and painful attacks of vomiting not only of mucus, but also of bile, from the violence of the act of vomiting, Veratrum rarely fails to afford prompt relief.
Tartarus emeticus is sometimes useful after, or alternately with Ipecacuanha, when in addition to the frequent recurrences of vomiting, there is also a constant tendency to slimy diarrhoea. Rheum may be given with advantage where there is much abdominal flatulence, ten- sion at the pit of the stomach and epigastrium, insipid, slimy taste, disposition to diarrhoea ; with brown-coloured stools mixed with mucus.
Gratiola has been chiefly recommended as being of considerable efficacy in rebellious or chronic cases where the foregoing remedies have only effected a degree of melioration. Along with Gratiola, the following may be mentioned as being useful in the treatment of inveterate cases : Sulphur, Carlo vegetabilis, Veratrum album, Calcarea mrbonica, Hepar sulphuris, Lachesis, Lycopodium, Natrum muriaticum, Stannum, Acidum nitricum, Plumbum, Magnes,, Assafoetida, Bovista, and occasionally Squilla, Cinchona, Ferrum, etc. When the affection arises from worms, Cina, Spigelia, Ferrum, Valerian, and Mercurius, etc. are the principal remedies. (See Invermination.)
Blenorrhoea intestinorum, is chiefly characterised by a distressing tension and constrictive sensations in the abdomen, accompanied with flatulent distension, spasms, and obtuse griping pains. Some- times the bowels are sluggish, or there is obstinate constipation com- plained of ; and the motions that are passed are either intermixed with more or less mucus, or are formed exclusively of masses of thick, tenacious mucus. At other times the bowels are relaxed, the evacuations consisting of large quantities of watery or bilious-look- ing mucus, passed in rapid succession, and preceded by griping pains. The remedies required here are nearly the same as those given in the foregoing variety of the disorder. When diarrhoea is present, Pulsatilla, Rheum, Arse?iicmm, Phosphorus, Mercurius, Cinchona, or
BLENORRHCEA. 229
Ferrum will commonly be found the most appropriate, the latter two particularly when the prolonged use of laxatives, or other debilitating losses have been the predisposing cause of the malady. When the bowels are inactive, but the motions coated or mixed with consider- able quantities of mucus^ or consist entirely of slimy substances,— Nux vomica, Sulphur, Sepia, Stannum, Alumina, Lachesis, etc , are usually the most suitable.
Blenorrhoza recti. (Hcemorrhoides mucosa.) This variety of the dis- order is most frequently met with in the male subject, and particularly in those of a debilitated habit. It may occur in the idiopathic form, but is often purely hemorrhoidal, and in such cases partakes wholly of the characteristic features of hemorrhoids. On other occasions the complaint appears in connexion with blind piles. Frequently again it either immediately precedes a fit of bleeding piles, or exhibits itself in alternation therewith. The mucous discharge takes place for the most part periodically, generally subsequent or anterior to an evacua^ tion, but occasionally at other times, and involuntarily. It is usually attended with more or less tenesmus, spasmodic and burning pains in the rectum. The discharge for several days is either watery or viscid, sometimes streaked or mixed wTith blood, an d, though small in quantity, commonly continues for several days.
This form of blenorrhoea is not unfrequently preceded by indiges- tion, flatulence, colic, spasms in the stomach, bowels, and abdominal muscles, local intestinal constrictions, pains in the hips and sacrum, spasm of the bladder, scanty urine, itching in the glans. These symptoms increase in intensity as the period for the flow of mucus approaches, -but as soon as it makes its appearance they commence to subside in a similar ratio.
The exciting causes of blenorrhoea recti, as well as blenorrhoea intestinorum, of which the former is but a variety, are nearly the same as those we have given under Blenorrhoea Ventriculi, to which may be added the debilitating effects or the transposition (Blenor-: rheea metastatica) of catarrhal, venereal, or rheumatic, gouty and other more purely dyscratic diseases.
Therapeutics. Hellehorus niger, Colchicum autumnale, Mercurius, Spigelia, Capsicum, 'Pulsatilla, Nux vomica, Carlo vegetabilis, and Sulphur, will in the majority of cases prove of the greatest efficacy.
Helleborus is extremely serviceable when the stools consist of mucus, generally in solid pieces, and without any admixture of proper
230 DIGESTIVE SYSTEM.
fecal matter. ColchicumIs equally serviceable under such circum- stances ; but particularly when the motions are preceded by severe griping, in which event it maybe exhibited in preference to Hellebore.
Where the presence of worms in the alimentary canal, or the existence of hemorrhoids form the exciting cause of the malady, Mer- curius is one of the most important medicaments, especially when at the same time the evacuations consist of mucus intermingled with degenerate fecal matter, during the expulsion of which, violent colic and tenesmus are experienced. Spigelia is useful under nearly similar conditions; it may consequently be had recourse to with advantage in many instances where Mercurws affords only partial relief. Cap- sicum is an excellent remedy when the disorder occurs in lymphatic subjects, and is connected or not with hemorrhoidal disease ; the motions copious, somewhat frequent, and accompanied with distress- ing burning pain in the rectum and anus. Pulsatilla may follow, or be given in alternation with Capsicum, when the pains are in a great measure removed, but the stools unaltered in character. Nux v. will be found of essential service in meagre, debilitated subjects, of san- guine or bilious temperament, addicted to sedentary or intemperate habits. Carbo v. may be prescribed with benefit after Nux when there is excessive flatulence, or burning pains in the lower intestine, especially after stool.
When we have obtained from the action of Nux v. and Carb. v., all the improvement that they are evidently capable of effecting, we may follow up the treatment by the administration of Sulphur, by means of which a cure will often be obtained in cases of the most obstinate character. Lachesis, Rhus toxicodendron, Ignatia, Antimo- nium crudum, and Borax, etc. have also been recommended as being capable of affording considerable assistance in the treatment of this variety of blenorrhoea.
DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM.
CATARRH, or COMMON COLD. CATARRHAL FEVER.
This term is given to an affection, which consists of a mild degree of inflammation of the lining membrane of the nostrils, and windpipe, and occasionally also of the ramifications of the latter, induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere, with insufficient clothing, particularly as regards children. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings ; there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses it is termed a cold in the head ; of which latter affection, as well as hoarseness and cough, we shall treat separately.
Therapeutics. In many instances catarrh is carried off, or runs to a salutary termination in a day or two. This desirable result is frequently obtained by having timely recourse to the simple proceeding of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel ; bathing the feet and legs in warm water, at the temperature of about 98-100 degrees of Fahrenheit, is also a useful auxiliary mode of restoring perspiration, but the patient should go to bed immediately afterwards. Very robust persons, who are accustomed to be in the open air in all weathers, but who have caught cold after having overheated them- selves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed ; when, however, they have learned by experience that little benefit is to be derived therefrom,
232 RESPIRATORY SYSTEM.
a few globules of Carl. v. or Silicea should be taken instead. A moderate degree of abstinence should, at the same time, be observed ; veal or chicken broth, bread, sago, or semolina pudding, being sub- stituted for the ordinary diet. The drink may consist of water-gruel, barley-water or toast-water, All strong liquors must be abstained from.
The following are the principal medicines to be employed in the majority of cases, when called for:—
Aconitum, Bryonia, Camphora, Nux vomica, Chamomilla, Coffea cruda, Belladonna, China, Dulcamara, Arnica montana, Mercurius, Acidum phosphoricum, Sulphur, Calcarea, Ipecacuanha, Arsenicum, Silicea.
Nux vomica, when the symptoms of common cold declare them- selves, will often check the attack. It is especially indicated by the following symptoms : Tickling or scratching irritation in the larynx, dry cough, particularly in the morning, and sometimes during the day, rarely during the night; occasionally a small quantity of adhesive mucus is with difficulty expectorated after a fit of coughing ; and the paroxysms are frequently attended with a painful sensation in the umbilical region, as if arising from the effects of a bruise or blow. This remedy is further of great utility in catarrhal fever with disposition to chilliness, or wandering fever chills, worse during movement, coming on, and gradually increasing, in the after part of the day, and alternating with flushes of heat. Warmth and absolute rest mitigates these symptoms. When convenient, it is preferable that this remedy should be taken towards evening.
Chamomilla: — In the treatment of children this medicine is generally more efficacious than Nux vomica in arresting the attack. It is (like Belladonna, Bryonia, China, Dulcamara, Sulphur, and Silicea) extremely valuable in restoring the suppressed perspiration, and removing the following symptoms : colic, with pains in the head, ears, and teeth, thirst, ill humour, and impatience ; or dry heat of skin with chilliness (in any part of the body, which may happen to be uncovered for a short time), or on lifting up the bedclothes; burning heat in one part (as for instance one cheek) and chilliness in another ; severe, dry cough, especially at night, excited by tickling in the larynx,
Coffea cruda. This remedy is indicated where there is excessive sensibility, fretfulness, and sleeplessness, with general pains, especially in young persons.
Belladonna, when there is a throbbing, bursting headache,
COMMON COLD. 233
attended with determination of blood to the head, and increase of the pain from movement or exposure to cold air.
Cinchona : — Aching pains in the shoulder-blades, and in the extremities, increased by the slightest pressure on the affected parts, with great restlessness, and constant desire to change the position of the limbs.
Dulcamara, when the pain is more of a passive or dull, aching description, and felt only in particular parts of the head, with hum- ming in the ears, and obtuseness of hearing; catarrhal fever with hoarseness, dry, rough cough, or cough with copious mucous ex- pectoration, severe coryza, great heat, dryness, and burning of the skin ; pains in the limbs, increased when at rest, and attended with a feeling of coldness, stiffness, and numbness ; or when an offensive perspiration breaks out after an attack of cold ; and wrhen the affec- tion has been brought on by suppressed perspiration, from exposure to a cold and humid atmosphere.
Drosera : — Painful or bruised-like pains, and paralytic weakness in the extremities; frequent rigors, with coldness of the hands and heat in the face; hoarseness, and cough excited by roughness and scraping in the throat, aggravated by talking.
Arnica Montana, when aching pains, or pains as if arising from a bruise, are felt in the limbs after exposure to cold, causing excessive restlessness and a constant disposition to change the position of the affected parts, and increase of pain from the slightest touch or movement.
Mercurius, when the lining membrane of the eyelids, nostrils and bronchi, is highly irritated, and gives rise to copious lachrymation; coryza and cough with profuse expectoration ; headache, or feeling of tightness, and fulness in the head, with pulsation extending to the nose ; general heats predominate over the chills. Conium macu- latum is of great service in catarrhal fever with internal heat, much thirst, and great debility, scraping or scratching, itching and creeping sensations in the throat, which produce a dry, almost incessant cough. The patient dreads the slightest noise or whisper ; passes a restless night, the sleep being unrefreshing, and disturbed by anxious dreams ; urine cloudy and whitish. When the pains in the limbs and joints are accompanied with profuse sweating, which affords no relief; this remedy may be followed by Dulcamara should the sweat continue, and be of an offensive odour, or by : Euphrasia, if the lachrymation and coryza remain unmitigated.
234 RESPIRATORY SYSTEM.
Acidum phosphoricum, aching pains, relieved by movement.
Silicea, pains in the limbs, colic and general derangement arising from suppressed perspiration, particularly in those who are subject to sweating at the feet.
Sulphur, in cases of swelling of the knee, or of the joints of the hand and fingers, from taking cold. It may, in many such cases, be followed by Calcarea carbonica in a week or ten days.
Mezereum : — Alternate heats and chills (the febrile heat occur- ring chiefly in bed, and the chills when out of bed) ; extreme sensi- bility to cold air, acrid coryza, burning irritation in the larynx and trachea, which provokes cough, attended with difficult mucous expectoration.
Lycopodium : — Inveterate catarrh, with lemon-coloured, often bitter-tasting, mucous sputa; tearing, throbbing, frontal headache, aggravated in the afternoon or evening. (Goullon, Arch. XX, 3-54.)
Ipecacuanha: — Nausea and inclination to vomit, or Dyspnoea, almost amounting to suffocation, arising from having taken cold, followed by —
Arsenicum, should no amelioration declare itself in six or eight hours. (See also the indications for this remedy in the article on Cough and Influenza.)
Hepar s. is indicated by many of the symptoms which call for Merc, JEupAr., and Nux. It is moreover of service, where the respi- ratory organs are solely or particularly affected, the cough loose and attended with mucous rattling in the chest ; pain in the larynx while coughing, and a feeling of weakness of chest which renders talking oppressive.
Pulsatilla : — Useful in cold in the head, with loss of the senses of taste and of smelling in consequence of a chill, — followed or pre- ceded by Belladonna, should there be an uncomfortable sensation of heat in the eyes and head, and heat and smarting in the nose : or by Nux v., should there be complete stuffing or dryness of the nose. (See Coryza and Cough.)
Rhus toxicodendron: — General indisposition from exposure to a thorough wetting, when in a state of perspiration : followed by Bryonia in a few hours, if no improvement is experienced.
Sepia. Catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating with heat ; nocturnal spasmodic cough, with shortness of breath and inclination to vomit, coryza, occipital headache.
COMMON COLD. 235
Aconitum is one of the principal remedies in febrile attacks, provoked by cold, and particularly from exposure to a dry, cold wind, or to a draught, with hot, dry skin, or general shivering chills, alternating with burning heat of the - surface, great thirst, especially towards evening, sensation of dryness, and roughness or scraping, slight burning, and excoriation in the region of the larynx, or even throughout the whole of the chest, which gives rise to an incessant, short, dry, hollow cough (more of a hoarse or rough description at night) ; restless sleep, disturbed by confusing dreams, or crowding of fantastic ideas, when not by the cough.
Bryonia, may follow Aconitum, or it may be selected in preference at the commencement of the attack, when there is an excessively dry, hollow cough, accompanied by tenderness of the larynx on pressure, inclination to vomit, and pain in the chest, as if it would be torn asunder, severe headache, aching pains in the limbs, increased by the slightest movement, violent coryza, thirst and coldness of the right half of the body.
Camphora. Incipient catarrh, coming on after getting the feet wet, is frequently cut short by smelling spirits of camphor. When there is usually weariness, heaviness, and general uneasiness, attended with shivering, and dryness or coldness of the skin, and symptoms of approaching fever, one to twro drops, every ten minutes, for two or three times, will generally succeed in preventing the development of an attack, either of common catarrhal fever, or of influenza.
The remedies for any other effects, arising from cold, will be found under the different heads, such as Sore Throat, Diarrhoea, Cough, Hoarseness, &c.
Some individuals, particularly among those of the fair sex, are tormented with an extreme degree of susceptibility to cold ; the best corrective of which is, to rub the throat, chest, and indeed the whole body every morning with a wet towrel, until a glow of heat is pro- duced,— drying one part before another is commenced, — also to acquire a habit of going out every day, provided there is no inherent predisposition to pulmonary consumption ; all extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. When these means are not sufficient to remove the tendency to suffer from the slightest exposure to cold, the practitioner will find Silicea, Carb. v., and Calcarea, administered at intervals of from two to three weeks, of considerable power in removing this constitutional delicacy. In
236 RESPIRATORY SYSTEM.
other cases, one or more of the following remedies must be had recourse to : — Bryonia, Belladonna, Dulcamara, Nux v., China, Mercurius, Rhus, Chamomilla, Arsenicum, Lachesis, Rhododendron, according to the character of the sufferings, which are experienced after each exposure to the influence of the atmosphere.
INFLAMMATION OF THE LARYNX.
Laryngitis.
This disease consists in a suppurative inflammation, having its seat in the lining membrane of the larynx, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally forms a part; but occa- sionally the inflammation is exclusively restricted to the larynx ; and it is a frequent cause of a fatal termination in scarlet fever and small- pox. , It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passages) rather than a violent and involuntary cough, — and by the character of the sputa, which consists of a thick tenacious mucus rather than a coagulable and membranaceous-looking exudation. The invasion of the disorder is announced by the usual signs of inflammatory fever ; the voice soon becomes hoarse and inarticulate, whilst a pain- ful sense of constriction is experienced in the throat ; the breathing is laborious and shrill during inspiration; the larynx extremely sensitive to the touch, so that the slightest pressure against it, either externally by the hand, or internally from the performance of the act of deglutition, is productive of 'the most distressing spasms, and threaten death from suffocation. The heat of skin is great, the pulse rapid and hard, the thirst considerable, but incapable of being . satisfied from the suffering that is occasioned by the attempt. On examining the throat, the fauces are often found to present a red, inflamed, and turgid appearance ; in some cases the epiglottis is involved, and the motions of the tongue thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen and sometimes livid ; the eyes protruded as in threatened strangula- tion, and life is speedily cut short by asphyxia. The disease -if not arrested, occasionally runs its course in a few hours to a day or two at the farthest.
LARYNGITIS. 237
^Therapeutics. We have stated that the symptoms of laryngitis bear a close analogy to those of croup; and experience has proved that the same remedies, which are so eminently successful in the treatment of that affection, are equally efficacious here. , The prin- cipal of these are : Aconitum, Spongia, Hepar sulphuris, Lachesis, Belladonna, Phosphorus. In some cases of a less formidable nature, Chamomilla, Mercurius, or JDrosera rotundifolia may prove serviceable.
Aconitum must be immediately exhibited when the signs of inflammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of the febrile movement ; on the consummation of which, or as soon as the breathing becomes shrill, and the pain and sensibility of the larynx more decided, with increase of hoarseness and difficulty of articulation, — Spongia must be administered, and will, for the most part, be found of great efficacy in forwarding the curative process. When we have satisfied our- selves that, we have obtained from the action of Spongia all the benefit which it is capable of effecting, we may then prescribe Hepar s., which will generally be found sufficient to complete the cure, or at all events to place the patient out of danger, and thereby enable us to make a careful selection of the remedy required to combat the remaining symptoms. {Hepar may be selected in prefer- ence to Spongia, if the fever and burning heat of skin continue, not- withstanding the previous employment of a dose or two of Aconite.) In some instances it will be found necessary to return to Aconite again, or to exhibit Aconite, Hepar s>, and Spongia in alternation, but the remedy from which we have derived the most marked benefit, when the more prominent features of the malady did not yield to, or were only palliated by, the use of Aconite, Spongia, or Hepar, is Lachesis, the pathogenetic properties of which correspond very accurately to the symptoms of the malady, particularly the extreme sensibility of the larynx, and the pain and difficulty experienced in performing the act of deglutition. From Belladonna we have likewise derived very appreciable service, especially when there was considerable heat of skin, much thirst, but complete inability to satisfy its cravings from, the spasms which the attempt occasioned : further, when, on looking into the throat, it is found to present an inflamed and swollen appear- ance. Should Belladonna have previously been employed, as would naturally be the case if the disease made its access during, or im- mediately after, an attack of Scarlatina pura, the substitution of Hyoscyamus for Belladonna may be found advantageous.
238 RESPIRATORY SYSTEM.
Phosphorus may prove useful against remaining hoarseness with more or less pain and frequent expectoration of viscid mucus. Or Carlo v. when the hoarseness is accompanied by a burning and scrap- ing sensation in the larynx, and some degree of cough or hawking up of phlegm of a less viscid nature than in the preceding instance. (See also the articles on Hoarseness, Chronic Laryngitis, and Croup.)
hoarseness.
Haucitas.
Hoarseness, or roughness of the voice, arises from some abnormal condition of the larynx or trachea. In the majority of cases the seat of the affection is in the mucous lining of the larynx, which is extremely liable to be affected by the common causes of catarrh ; hence it is a frequent accompaniment of the latter disorder.
The remedies, mentioned under Catarrh and Cough, are gene- rally found the most useful in this complaint. Amongst these, in cases of recent origin, the following deserve particular notice : namely, Pulsatilla, Mercurius, Nux vomica, Capsicum, Rfais toxicodendron, Sambucus nigra, Chamomilla, Carlo vegetabilis, Drosera, Sulphur, and Hepar sulp/mris.
The indications for the employment of these medicines are as follow :
Pulsatilla : — Almost complete aphonia, particularly when accompanied with loose cough, or thick yellow coryza.
Mercurius. This remedy will often be found useful in removing any symptoms remaining after the above, but is to be preferred should the hoarseness, from the commencement, be attended with thin coryza, * and when a sensation of burning or tickling is com- plained of, in the larynx, with the characteristic indication of Mer- curius, namely, a disposition to profuse sweating, especially at night.
Nux vomica :— Hoarseness, accompanied by a dry fatiguing cough, worse in the early hours of the morning, with dry obstruc- tion of the nose.
Capsicum : — Hoarseness, and dry obstruction in the nose, at- tended with an unpleasant sensation of crawling and tickling in the
* Sulph., Calcarea, and Silicea are of great service in obstinate hoarseness attended with coryza.
HOARSENESS. 239
nose ; a severe cough, worse towards evening : and pains in other parts of the body, such as the head and abdomen. It is better suited than Nux vomica for individuals of a lymphatic temperament.
Rhus toxicodendron : — Hoarseness, accompanied by sensation of excoriation in the chest ; oppressed breathing, with frequent and violent sneezing, unaccompanied by coryza, but occasionally by a great discharge of mucus from the nose, during the attacks of ster- nutation.
Sambucus nigra: — Hoarseness, with deep, hollow cough ; op- pression at the chest ; frequent yawning ; restlessness, and thirst.
Chamomilla : — Hoarseness, with accumulation of mucus, in the throat ; cough worse at night, continuing even during sleep, and frequently with a degree of fever towards evening, and great irrita- bility of temper. This remedy is frequently specific in cases of children.
Drosera : — Hoarseness, with very low, or deep and hollow voice.
Carbo vegetabilis : — Chronic hoarseness, worse in the morning and towards evening, with aggravation after talking.
Sulphur : — Hoarseness, attended with roughness and scraping in the throat ; and of great value in obstinate cases, where the voice is low, and nearly extinct, particularly in cold damp weather. {Sulphur is especially useful after Puis.)
Hepar sulphuri s is a most useful remedy in chronic hoarseness, particularly in individuals who have taken large quantities of mercu- rial preparations ; otherwise Ammonium carhonicum is of equal efficacy. (See Coryza, Catarrh, and Cough.)
When we find individuals in whom this affection occurs frequently at different seasons, or on the slightest exposure to cold or damp, we may naturally infer that there is a constitutional predisposition to chronic laryngitis, a malady requiring the most careful and judicious treatment, as, if neglected, it may eventually end in
Chronic laryngitis. (Phthisis laryngeal) This is a com- paratively rare disease, and, when present, is generally attended with a degree of ulceration. The following are its principal symptoms : pain in the larynx, and round the glottis ; pain and difficulty in swallowing; hoarseness, and difficulty of respiration ; frequent attacks of severe cough, with scanty, and occasionally sanious ex- pectoration; it sometimes ends in hectic fever, which carries the patient off.
240 RESPIRATORY SYSTEM.
The medicines, to which we would particularly direct the atten- tion of the practitioner in the treatment of this malady, are Hepar sulphuris, Lachesis, Phosphorus, Garbo vegetabilis, Acidum nitrieum, Cal~ carea carhonica, Arsenicum, Spongia, Sanguinaria canadensis — (this re- medy proved of singular efficacy, after the previous employment of Sulphur, in chronic laryngitis with the following symptoms : sensa- tion of swelling, and pain as if arising from excoriation, in the larynx, during empty deglutition ; expectoration of whitish, saline- tasting mucus ; hectic fever) #— and Argentum fol. (The latter has been found very efficacious in affections of the larynx occurring in public speakers, with a sensation at a small spot in the fore part of the larynx, as if a foreign substance were sticking there, and giving rise to a feeling of coldness and some degree of pressure, writh fre- quent inclination to cough, but no abatement of the irritation in the larynx after coughing.) f
The patient should adhere rigidly to dietetic rules, avoid unneces- sary exposure, and enter as little as possible into conversation.
Tracheitis. For the treatment of this disorder, see Croup.
COLD IN THE HEAD.
Coryza.
This affection is a very general attendant upon common catarrh.
Therapeutics. When it is the leading symptom, or exists inde- pendently of those already mentioned, the best medicines for expe- diting its removal are : Nux vomica, Euphrasia, Pulsatilla, Chamomilla, Mercurius, Hepar sulphuris, Belladonna, Ammonium, Natrum, and Arsenicum, Lachesis, Silicea, &c.
Nux vomica: — Dry obstruction, especially during the night only, with pressive heaviness in the forehead, and confusion in the head ; heat in the face, increasing towards evening. If these sensations occur in combination with other catarrhal symptoms, see the indica- tions already given for the exhibition of this remedy under the several heads of Catarrh, Hoarseness, and Cough. This direc- tion equally applies to the other medicaments here quoted.
* Neues Archiv. Zweiter Band, Zweites Heft, p. 148. f Neues Archiv. Ill Band, 1 Heft, p. 99.
COLD IN THE HEAD. 241
Lycopodium, will often be found efficacious after Nux v., in obsti- nate cases of stuffing of the nose, particularly at night, rendering it necessary to sleep with the mouth open, which causes a disagreeable dryness without much thirst, attended with confusion in the head, and burning pain in the forehead. This remedy is frequently more or less useful in colds in the head of all hinds.
Pulsatilla : — The discharge thick, fetid, greenish yellow, or mixed with clots of blood ; loss of taste and smell, headaches, sneez- ing, chill, especially towards evening ; disposition to weep, lowness of spirits, heaviness or confusion of the head in a warm room.
Chamomilla :— When the affection has arisen from checked per- spiration, and there is an acrid discharge from the nose, causing redness of the nostrils, and excoriation or soreness under the nose ; chapped lips ; shivering ', with thirst.
Mercurius : — Dryness of the nose, with obstruction; profuse discharge, producing excoriation, swelling, or redness of the nose, pains in the head and face. This is a valuable remedy in the gene- rality of ordinary cases of cold in the head, particularly when the complaint is, as it were, epidemic*
Hepar sulphuris : — Chiefly when only one nostril is affected, or when there is headache which is aggravated by the slightest move- ment ; or when the complaint is renewed on each exposure to cold air ; further, in most cases in which Mercurius, though apparently indicated, has produced little or no improvement.
Belladonna may follow the above, after an interval of a few hours, if the headache continues unabated. When the sense of smelling is variously affected, being at one time too acute, and an- other too dull, there will be additional reason for resorting to this remedy.
Ammonium : — Stuffed nose, especially at night ; swelling and pain- ful sensibility of the nostrils ; dryness of the nose.
Natrum: — Cold in the head, renewed by the slightest chill, or exposure to a current of air ; obstruction of the nose every second day.
Lachesis : — Swelling and soreness of the nose and nostrils, with copious watery secretion.
Arsenicum : — Obstruction of the nose, with, at the same time, dis-
* When the secretion from the nose is excessive, and there is, at the same time, con- fusion in the head, with redness and soreness of the eyes and eyelids, and copious acrid or scalding lachrymation, Euphrasia should be prescribed.
16
242 RESPIRATORY SYSTEM.
charge of thin, acrid, excoriating mucus, and burning heat in the nostrils, &c. buffering relieved by heat ; pain in the back, feeling of general debility, or prostration of strength. Dulcamara is useful when fresh obstructions arise from every trivial exposure to the air. Ipecacuanha may be had recourse to after Arsenicum, if the latter has only partially relieved.
Ammon. cars.: — Cold in the head with copious discharge, parti- cularly of an acrimonious, burning, watery fluid ; hoarseness, tick- ling, suffocating cough, with alternate heats and chills.
Graphites, and also Silicea, are useful in all cases which are of frequent recurrence, and always of a most obstinate character.
Camphor : — In the premonitory stage of the complaint, with shi- vering and headache, the attack may frequently be checked by a drop or two of spirits of weak camphor administered, &c.
Sulphur, Calcarea, Silicea, Natrum, and Pulsatilla are the best reme- dies for removing extreme susceptibility to colds in the head.* Against the effects of a suddenly suppressed catarrh, the following are the most important remedies: Aconite against headache, followed by Pulsatilla, and then Cinchona, if the secretion does not return ; difficulty of breathing, — Ipecacuanha, followed, if required, by Bryonia and Sulphur. In other cases Nux v., Arsenicum, or Cina, may be re- quired to remove the sequelae resulting from the suppression. (See also Hoarseness, Cough, and other affections of the organs of respiration.)
COUGH.
Tussis.
Diagnosis. Forced and audible expiration without fever; or a symptom in acute diseases,— such as fever, pneumonia, or phthisis ; either dry or accompanied with expectoration.
Cough, although not dangerous of itself, may become so, or form
* In other cases, this desirahle result may be attained by the administration of Mercu- riusyUepar s., and Belladonna, on each successive attack (when the symptoms resemble those which have been described under these remedies)— and failing these; Silicea, Sulphur and Calcarea: the other remedies also, mentioned above as useful in removing this suscep- tibility, must sometimes be had recourse to. The state of the digestive functions ought, at the same time, to be attended to ; and if found to be in a disordered state, such remedies as NuXrV., Pulsatilla, Bryonia, &c, must, in addition to Sulph., Silic, Calc, be had recourse to. (See Dyspepsia.)
cough. 243
an important feature of other diseases. As a precursor of phthisis it is too often neglected.
It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes ; or be merely sympathetic or the consequence of derangements of other important viscera. We purpose here to treat more1 particularly of idiopathic, mucous or moist and dry cough.
Therapeutics. The following are the medicines most useful in this affection : Aconitum, Dulcamara, Belladonna, Hyoscyamus, Nux vo- mica, Pulsatilla, Ammonium carhonicum, Ammonium muriaticum, Chamo- milla, Hepar sulphuris, Ignatia, Ipecactianha, Mercurius, Carlo vegetabilis, Capsicum, Bryonia, Rhus toxicodendron, Arsenicum album, Drosera, Silicea, LacJiesis, Caustieum, Sulphur, Calcarea carbonica, Euphrasia, Sepia, Stannum, Verbascum, Arnica montana, Squilla, &c.
Aconitum : — Violent short cough, with quick hard pulse and feverish heat; pricking in the chest when coughing, or during inspiration. (See Acute Bronchitis.)
Dulcamara. The following are indications for the selection of this remedy : moist or loose cough, with copious expectoration after exposure to wet ; or cough with hoarseness and copious secretion of mucus in the bronchial tubes, sometimes accompanied by expecto- ration of bright-coloured blood during the night ; barking, shaking- cough, increased or excited by taking a deep breath. (Compare with Rhus.)
Belladonna :— Short, dry, barking {spasmodic, catarrhal, or nervous) cough at night in bed, and also during sleep, renevjed by the slightest movement ; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the larynx, or as if dust had been inhaled ; spasmodic cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough with rattling of mucus in the chest, pricking in the sternum or in the hypochondria^ and expectoration of thick white mucus, coming on especially after meals; lancinating pains in the abdomen; hoarseness, redness of the face, headache, sneezing after coughing, and pain in the nape of the neck.*
* Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy, when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed ; also, when there is mucus rattling in the throat. In dry, spasmodic cough, increased at night, Conium is a valuable remedy.
244 RESPIRATORY SYSTEM.
Nux vomica. This is a valuable remedy in many cases either of a catarrhal or nervous character, and is particularly efficacious where there is a dry hoarse, fatiguing, and sometimes spasmodic cough, which occurs in an aggravated form in the morning, and occasionally also towards evening, and attacks more or less during the day, but relaxes again at night when, however, it is occasionally supplanted by oppression at the chest, on lying down or on awaking during the night, accompanied with a feeling of heat, and dryness in the mouth ; if there be any expectoration, it consists merely of a little mums, which is detached with great difficulty. The cough is generally excited by a disagreeable Holding or scraping, with a feeling of roughness and rawness in the throat, sometimes attended with Hoarseness and feeling of roughness in the chest, but more frequently with severe Jieadache, or pain as if from a How or bruise in the epigastrium and hypochondria ; it is frequently aggravated after meals, or by move- ment, not unfrequently also by reading or meditation, and is occa- sionally followed by vomiting.
Pulsatilla : — Severe shaking, catarrhal or nervous spasmodic cough, worse towards evening and at night, frequently followed by vomiting ; sensation of suffocation, as if from the vapour of sulphur ; increase of cough when in the recumbent posture ; cough which is at first dry, then followed by copious expectoration of yellowish or whitish mucus, sometimes of a salt or bitter taste ; or expectoration of mucus streaked with blood; wheezing, or rattling of mucus in the chest ; the paroxysms of coughing are frequently accompanied wdth soreness in the abdomen, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and sometimes followed by a sensation as if the stomach became inverted from the violence of the cough ;. involuntary emission of urine when coughing ; loose cough^ with aching in the chest, hoarseness, cold in the head ; excited by a sensation of scraping or of erosion in the throat ; shivering.
Chamomilla : — Dry cough, excited by continued tickling or irritation in the larynx and chest, and increased by talking; the cough is most troublesome during the night, but also occurs during the day, particularly in the morning and towards evening ; accumu- lation of tenacious mucus in the throat ; wheezing in the chest ; cough during sleep, sometimes accompanied with paroxysms, as of threatening suffocation ; cough with scanty expectoration of tena- cious bitter mucus. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the gymp-
cough, 245
toms above described, or with hoarseness, cold in the head, dryness in the throat and thirst ; great fretfulness ; fever towards evening ; paroxysms of coughing after crying, or after a fit of passion.
Bryonia : — Catarrhal cough occurring in winter during the preva- lence of frost and cold easterly winds, with aggravation of the fits of coughing on coming from the open air into a warm room. The fol- lowing are the general indications for its employment : Dry cough, excited by constant irritation in the throat, or as if caused by vapour in the larynx and windpipe, with greatly accelerated respiration, as if it were impossible to obtain sufficient air; spasmodic, suffocating cough, after partaking of food or drinks, and also after midnight ; cough with prickings in tlie chest, and violent bursting headache, especially at the temples, also with prickings in the pit of the stomach, or in the side ; further, in loose cough with yellowish expectoration or slight spitting of blood, this remedy wTill frequently be found of great service; and likewise in dry nervous cough.
Rhus toxicodendron : — Short, dry cough, worse towards evening, and before midnight, excited by tickling in tlie chest, attended writh hoarseness, or a feeling of roughness or rawness in the throat, con- gestion in the chest, a sensation of suffocating constriction, anxiety and shortness of breath ; cough on waking in the morning, or short cough with litter taste in the motith, on lying down at night and on waking in the morning, with expectoration of viscid mucus, some- times followed by vomiting. Cough with expectoration of bright blood, with sensation of insipidity or exhaustion in the chest, or shooting pains in the chest and sides.
Ipecacuanha : — Catarrhal, nervous, or spasmodic cough, parti- cularly at night, attended with painful shocks in the head and sto- mach, and followed by nausea, retching, and vomiting ; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable, when they ap- pear to be threatened with suffocation from the accumulatian of mucus, or where the paroxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. (Calo. is often useful after Ipec.)
Mercurius : — Catarrhal cough, with hoarseness, or watery coryza, or accompanied by diarrhaa ; or dry cough, excited by irritation in the throat, or the upper part of the chest, which becomes particularly troublesome towards evening, and at night ; sometimes with slight
246 RESPIRATORY SYSTEM.
prickings in the chest when coughing 'or sneezing; excited or in- creased by talking ; cough in children with discharge of blood from the nose, which coagulates as it flows, vomiturition, and headache ; dry spasmodic cough, with retching after the paroxysms, and ex- pectoration of blood.
Carbo vegetabilis: — Hollow cough excited by irritation, or a troublesome sensation of crawling in the throat and attended with burning pain and sensation as if from excoriation in the chest ; catarrhal or nervous spasmodic cough, frequently followed by inclina- tion to vomit or vomiting, occurring in paroxysms throughout the day; cough with hoarseness, especially towards evening, or morning and evening, increased by speaking. Chronic cough with expectora- tion of greenish mucus, or even of yellowish pus— or with expectora- tion of blood and burning sensations in the chest (a characteristic indication for this remedy as well as Arsenicum.)
Capsicum : — This remedy is frequently very efficacious in cases of cough occurring in individuals of the lymphatic temperament. It is par- ticularly indicated when the paroxysms are more severe towards evening and at night, frequently attended with unsettled pains in various parts of the body, and bursting headache; also painful pressure and aching in the throat and ears ; cough with offensive breath, and disagreeable taste in the mouth.
Hepar sulphuris : — Obstinate cases of violent dry, hoarse cough, sometimes attended with a dread of suffocation, and ending in lachry- mation. The attacks are frequently excited or aggravated on any part of the body being exposed or becoming cold from the bedclothes slipping off, and are generally worse at night ; — also dry deep cough excited by a feeling of tightness in the chest, or by talking, stooping, or ascending stairs; hoarseness.
Ignatia : — Shaking spasmodic cough, or short hacking cough, as if arising from the presence of dust or feather-down in the throat, which becomes aggravated the longer the paroxysm of coughing con- tinues; dry tickling cough with coryza, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after eating, or on lying down at night, or on rising in the morning, and when the patient is of a mild and placid temper, or subject to alternations of high and low spirits.
Arsenicum : — Cough with oppression at the chest, and tenacious mucus in the larynx and chest ; cough excited by a sensation of
cough. 247
dryness and burning in the larynx. Dry cough chiefly in the evening after lying down, often with difficult respiration and fear of soffocation {suf- focative catarrh, catarrahal asthma), as if arising from inhaling the vapour of sulphur ; dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as soon as the open air is encountered ; thin acrid coryzaj sneezing ; periodic dry cough — nocturnal cough with general burning heat; cough with expectoration of sanguineous mucus; pulmonary catarrh in old people, attended with tenacious mucous sputa, which is extremely difficult to eject, and causes rattling in the chest, oppressed respiration, and frequently symptoms of impending suffocation, or paralysis of the lungs. (Ipecac, Tartarus emet., and Baryta c, are sometimes required after, or in alternation with, Arsenicum.)
Ammonium carbonicum : — Dry, tickling, suffocating cough, espe- cially in the morning, sometimes with fever, occurring during the prevalence of a cold, stormy, bleak, state of the atmosphere, and attended with a sensation of heat or burning behind the stermim, resem- bling that which is occasioned by drinking spirits ; hoarseness ; cold in the head with copious discharge of acrid watery fluid*
Ammonium muriaticum : — This remedy is sometimes serviceable after the former, when the cough sounds looser, yet is unattended with expectoration.
Drosera : — In many cases of chronic cough with hoarseness; or deep hollow cough, with pain in the chest and under the ribs, alleviated by pressing the hand on the side, excited or aggravated by laughing ; cough on lying down in the evening and during the night. Matutinal cough, with bitter and nauseotcs expectoration ; dry, spasmodic cough, aggravated at night, or towards evening, and frequently followed by vomiting of ihgesta, or bleeding from the nose and mouth.
Silicea : — Cough with oppressed breathing on lying on the back, or cough attended with tightness and oppression at the chest, as if something stopped the respiration while speaking, or coughing* Fatiguing, or deep hollow cough, day and night, aggravated by move- ment or speaking, and sometimes attended with aching and pain, as if from a bruise, in the chest ; cough with copious expectoration of trans- parent mucus, or pus, sometimes streaked with blood ; cough with asthmatic breathing and emaciation, with dread of suffocation at night ; cough irritated or excited by a sensation as if a hair were on the tongue.
Lachesis: — Fatiguing cough, excited by dryness or continual
248 RESPIRATORY SYSTEM.
tickling in the lazynx or chest ; or by pain or tickling in the pit of the stomach or the epigastrium ; also by the slightest pressure on the exterior of the throat ; cough excited by talking, laughing, or reading aloud, or anything which may tend to increase the dryness or irritation in the throat ; short, dry, suffocating cough, as if caused by the presence of a crumb of bread sticking in the throat, with ineffectual efforts to expectorate. Cough on rising from the re- cumbent posture, or attacks of cough always after sleeping, or on lying down to sleep ; or cough during the day, and at night during the sleep, so that the patient is unconscious of it; continual hoarse- ness, with a sensation as if something were in the throat which could not be detached.
Sulphur: — In some cases of chronic cough, and particularly in cfoy cough, which disturbs the patient at night as well as during the day; the cough is frequently excited after partaking of food, or during deep inspiration, and is generally attended with a sensation of spasmodic constriction in the chest, sometimes followed by incli- nation to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest; headache, pains in the chest, abdomen, loins, and hips ; also cough, with expectoration of thick, whitish or yellowish mucus, or of a greenish yellow, fetid mucus, or pits, of a saltish or sweetish taste ; feverish cough with spitting of blood.
Calcarea carbonic a: — Dry cough, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there were a feather down in the throat j also loose cough, with rattling of mucus in the chest, and expectoration of offensive thick, yellow mucus; anxiety.
Euphrasia :— Cough, with violent coryza and tachrymaiion ; diurnal cough, with difficult expectoration of mucus ; or matutinal cough, with copious expectoration, and oppressed breathing.
Sepia :— Cough, with copious expectoration of mucus of a saltish taste, of a yellow or greenish colour ; also dry spasmodic cough, par- ticularly at night, or on first lying down,' attended, in children, with crying, fits of threatening suffocation, nausea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taint, such as the scrofulous, scorbutic, &c. ; and in chronic coughs, with thick, yellowish, greenish, or even puriform expectoration, with a putrid taste, it is also a valuable remedy.
Stannum: — Cough, with copious greenish yellow sputa, of a
cough. 249
sweetish ox saltish taste, attended with great weakness and disposition to sweats ; soreness at the chest as from internal excoriation ; feeling of weakness or sinking in the chest, as if it were empty, parti- cularly after expectorating, or even after speaking ; or dry shaking cough, worse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of ingesta.
Lycopodium is very efficacious in obstinate coughs which are worst at night, and are attended with expectoration of tenacious mucus, and sometimes vomiting ; paleness of the face, emaciation, precordial pains and oppression, flatulence, ill-humour.
Cinchona : — Paroxysms of cough as if excited by the vapour of sulphur, with whistling or rattling in the throat from mucus ; ex- pectoration difficult, consisting of clear tenacious mucus, sometimes streaked with blood; pains in the shoulders, or prickings in the chest and windpipe ; cough, sometimes with bilious vomitings ; cough after hemoptysis.
Verbascum : — This remedy is frequently of great service in children, though less frequently so than Chamomilla. Indications: dry, hoarse cough, worse towards evening and at night, occurring during sleep.
Iodium : — Cough in plethoric children, with copious accumulation of mucus in the bronchi, and ineffectual efforts to expectorate.
Phosphorus : — Dry cough excited by tickling irritation in the throat or chest, or by laughing, talking, or drinking, or by cold air, and accompanied writh pricking in the larynx ; hoarseness, or pains in the chest as if from excoriation; cough with hoarseness, fever, and depression of spirits, sometimes with apprehensions of death ; dry sounding cough, followed by expectoration of viscous or sanguineous mucus.
Arnica, is of great value in coughs attended with bleeding from the nose and mouth ; headache, pricking in the chest (pleurodynia), rheumatic pains in the loins and extremities, and soreness or pain, as from a bruise in the chest and abdomen.
Staphysagria : — Cough attended with pain under the sternum as if arising from excoriation or ulceration ; expectoration of yellow, purulent-looking mucus; sometimes spitting of blood, and invo- luntary discharge of urine ; exacerbations at night.
ArgentuM foliatum: — Cough excited by laughing; or cough attended wdth a feeling of rawness or soreness in the throat, and
250 UESPIRATORY SYSTEM.
sometimes with accumulations of viscid mucus on the palate, which causes a disagreeable scratching or scraping sensation.
Squilla : — In shorty dry cough, excited by a full inspiration, or chronic cough, or catarrh with copious secretion of whitish, viscous mucus, which is alternately expectorated with ease and difficulty, this remedy is useful,
Spongia : — In acute inflammation of the bronchial membrane, this remedy is often of essential service (see Bronchitis), — but it is of equal utility in the chronic variety when the following symptoms prevail : cough with expectoration of muco-purulent sputa, emaciation, redness and deformity of points of the fingers, lividity and incurvation of the nails, hectic fever.
These are the principal remedies to be had recourse to in this disorder ; but in complicated cases, we may have to call in the aid of other medicaments. When the symptoms take on an inflammatory character, the treatment recommended in acute bronchitis will generally be found applicable. In obstinate nervotts or stomach or duodenal coughs, w7hich frequently occur in highly irritable, nervous, and hysterical habits, or in women during the last months of pregnancy, and which are generally dry, or attended with scanty and difficult expectoration, consisting of a little clear • mucus, are to be relieved by the remedies mentioned under Dyspepsia. Change of air is often beneficial in such cases. For cough arising from Worms, see the remedies mentioned under that head ; or from teething, see Dentition.
Finally, the following summary of a few characteristic indications may prove useful in selecting the appropriate remedy. Cough, increased or excited by cold air : Bachesis, Arsenicum, Phosphorus, Cough, excited by a feeling of dryness in the chest: Bachesis, Pulsatilla, Mercurius. Cough provoked by a tickling sensation in the throat: JSTuxv., Merc, Cham., Arnica, Bryonia, Phosph.y Bep.y Sulph., Bycop., Kali, Bros., Puis., &c. (see also the other indications, given above for most of these medicines.) From tickling in the pit of the throat: Cham., Bella.* Silicea. Cough from a sensation of down in the throat : Calcarea, Ignatia, Amm. c. From a sensation as if from dust in the throat : Bella., Teuc, Ferr. mag. Cough from a sensation of scraping, or a feeling of roughness or rawness in the throat: Nux v., Puis. Cough from a feeling of dryness in the throat : Puis., Bach., Carlo a., Mang., Petr. Cough excited by a tickling in the chest : Veratrum, Phosphorus, Cham., Bach., Puis., Ammon. c, Sep., Stann., 8tc. From a burning sensation in the chest : Phosph., Buphorb., &c. From accumulation
COUGH. 251
of mucus in the chest : Stannum, Arsenicum, Ipecac, Tart., Kreos., &c. From roughness or scraping in the chest : Puis., Acid, phosph, Grat. nitr. Cough, particularly when in the recumbent posture : Arsenicum, Lachesis, Hyoscyamus, Puis., Sidph, Nix v., Merc, Hepar, Con. Cough when lying on the back : Phosph, Nux, &c. When on the right side : Am. m., Stann. On the left : Ipecac, Par., &c. Cough which comes on chiefly after eating : Nux v., Bryon., Tartarus, Cham., Bella., Sulph., Amm. m., China, Digit., Per., Sec. Cough after drinking : Arsen., Bach., Bryon., Aeon., Bros., Hepar, Bye, Phosph. After eating and drinking : Bryon. Cough on exerting the intellectual faculties : Nux v.,Mgs., &c. Cough, especially in the morning: Puis., Nux, Baches., Calc, Etcphr., Sep., Stann., Sulph, Rhus, &c. Cough, chiefly at night: Bella., Puis., Nux, Ars., Bach., Merc, Sulph, Tart., Veratr., Verb., Cham., Hyosc, Phosjph., Con., Sep'., Silic, Rhus, Staph., Sec. Midnight (towards) : Bella., Mgs. arct. During the day, exclusively or principally : Calc, Baches., Nux, Phosph., Stann., Am. c, Alum., Euphr.^ Nitr., Rhus, Sec. Day and night : Bella., Nux, Puis., Bulc, Stann., Sulph., Silic, Bycop., Natr. m., Ignatia, Buphorb., Bismuth, Spong., Sec. Cough excited or aggravated by laughing : Phosph., Stann., China, Argent., Bros. Cough during sleep : Bach., Cham., Verb., Bella., Calc, Am., Merc, Sec. Cough excited by speaking : Merc, Phosph., Cham., Bach., China, Silic, Stann., Sulph., Caust., Anac, Sec. Cough which comes on periodically (every second or third day) : Nux v., Ars., Bach. Cough when reading aloud: Phosph., Magn., Staph., Sec. When singing: Stann., Bros., Sec. Cough exacerbated or excited by movement : Nux v., Bachesis, Arseni- cum, Bella., China, Ferr., Silic Cough on entering a heated room : Bryon., Natr., Veratr. Cough on touching the larynx: Bachesis, Spongia, Hepar. On pressing against the pit of the stomach: Calad. Dry cough ; Aeon., Nux, Bella., Cham., Bryon., Baches., Merc, Bye, Phosph., Hepar, Ign., Sulph., Spongia, Natr. m., Sec. Sec. Cough with expectoration : Bide, Pids., Stann., Tart., Sepia, Sidph., Calc, Kali, Euph, Caustic, Merc,— Bryon., Carb. v., Bye, Phosph., Bella., Squill, Staph^ Natr. m., Acid, nitr., Sec. Sec. Cough with difficult expectoration : Bachesis, Aur., Staph, Sulph., Sep., Kali, Zinc, Euph., Am., Canst. Cough with easy expectoration : Bulc, Stann., Alum., Veratr., Kreos. Cough with offensive expectoration : Sanguinaria canad., Kreosotum, Carb. v., Sulph., Calc,—Guai., Sed., Natr., Arsen., Stann. With expectoration of mucus : Bella., Bulc, Puis., Bryonia, Am. c, Bachesis, Sqtdlla, Hepar, Carb. v., Phosph., Merc, Stann., Sep., Sulph., Tart., Sil., Thuja, Sec. With purulent expectoration : Sulph., Sil., Staph., Calc, Phosph., Acid, phosph, Gtiaiac, ylcid. nitr., Kali, Bycop., Carb. v. et a > Plumbs
252 UESPI&ATOUY SYSTEM.
Stann., Bros., China, Sep,, &c. With expectoration of a bitter taste : Puis., — Ars., Cham., Bros. With expectoration of a putrid taste: Carb. v., Kreos., Sep., Stann., Con., Ptils, Ferr., Cupr. With expectora- tion of a saline taste : Bycopod., Natr., Sep., — Phosph., Stann., Sulph., — Ambra., Magn., Samb. Of a sour taste : Bachesis. Of a sweetish taste : Stann., Phosph., Sulph., Calc., Kreos., Samb. Cough with greenish sputa ; Stann., Sulph., Thuja, Cann., Bye, Sep., Phosph., Carb. v. et a., &c. With grayish sputa : Bycopod., Bros., Thuja. With frothy sputa : Bach., Ars., Baph., Op., Sec. Gough with thick sputa: Puis., Sulph., Stann., Calc, Phosph., Am. m., Argent., Bella., Kreos., Ruta, Op. Cough with transparent sputa : Ars., Silk., Per., Sen., Nux. With viscid, tenacious sputa : Phosph., Senega, Baches., Nux, Puis., Stann., Staph., Cann., Par., — Spong., Arsen., Cham., China, Per. With serous or watery sputa : Arg., Magn., Stann., Baph. Cough with whitish sputa : Sulph., Puis., Am. m., Arg., Ambr., Aeon., China, Cupr. Ac. phosph., .Kreos. Cough with yellowish sputa: Sulph., Calc, Puis., Staph., Thuja, Con., — By cop., Stan., Sep., Acid, nit., Acid, phosph., Carbo v., Kreos., Baph., Spong., Bros., Aug., Bug., Magn., Mang., Carbo v., Arsen., Bryon., Ruta, &c. Cough with expectoration of mucus mixed or streaked with blood : Aeon., Phosph., Bryon., Am., Bach., China, Per., Natr. m., Sab., Silic, Baph., Bug., Btcph., Later., Iod., Op., Zinc, &c. Deep cough : Hepar, Veratr., Verb., — Arsen., Bach., Aug., Sil., Samb. Hollow cough : Veratr., Spong., Verb., Carbo v., Tart., — Phosph., Sil., Kreos., Caust., Buph., Sed., Merc, Op., Samb., Staph., Spig. Hoarse cough : Hep., Merc, Verb., — Carb. v., Cham., Kreos., Nux, Natr., Natr. m., Verat., Cina. Shaking cough : Ipecac, Bella., Ilyoscy., Puis., Sulph., Anac, Bachesis, Ars., Ign., Bycop., Merc, Sed., Caust., Ac nitr., Rhus, Sil., China, Ant., Sen., Mgs. arct. Spasmodic cough : Bella., Hyos., Ipec, Cupr., Brosera, Veratr., Nix, Puis., Sulph., Hepar, Cina, Merc, Carbo v., Bryon. — Aeon., Ambra, Calc, China, Con., Big., Per., Ign., Iod., Kali, Kreos., Bact., Sed., Magn., Magn. m., Natr. m., Nitr. ac, JPkcmb., Sil., Mags., Mags. arc. Short cough: Bella., Coff., Bach., Baur., Natr. m., Nux v., Squilla, — Aeon., Alum,, Anac, Arg., Asa., Ign., Nitr. ac, Cham., Petr., Plat., Rhus, Sabad., Stdph. ac Suffocating cough : Ipecac, Arsenic, Tart., Samb., Hep., Lach., Bros., Cham., Bryon., China, Spigel., Sulph., — Con., Ind., Bed., Op., Natrum m., Petr., Phell., Tab., Mags, arc Cough attended with pain in the abdomen during the paroxysms : Ars., Bella., Coloc, Con., Nux, Phosph., Stann., Stdph., Vei\ Cough with pain, as if from a blow or bruise in the chest : Am., Ferr., Veratr., Zinc In the hypochondria: Nux v. Cough with
cough. 253
burning in the chest: Card. v., Ant., Caustic., Seneg., Iod., Magn., Spong., Zinc. With coldness * in the chest (after coughing) : Zinc. With constriction in the chest (while coughing) : Ars.', Lack., Sulph. With pain, as from excoriation or soreness in the chest ; Carl, v., Tills., Phosph., Stann., Caust., Am. c, Sulph., — Nux v., Lack., Acid, nitr., Calc, Magn. m., Magn. s., Merc, Natr. s., Nitr. ac, Sep., Sit., Spig., Spong., Zinc, Sec. Cough with rattling (mucus) in the chest : Ipec, Tart., Natr. m., Bella., — Puis., Sep., Arg., Sec. Cough with shooting pains in the chest: Aeon., Bryon., Phosph., Nitr., Squil., Sulph., — Bella., Lack., Merc, Ac. nitr., Kali, Bids., Natr. m., Sep., Con., Bros., &c^ Cough with pain as if the chest wrould burst : Bryon., Merc, Zinc, Sec. Cough with pain in the chest as if arising from ulceration, Staph., Bat., Sec. Cough followed by eructations, or regurgitation of ingesta: Ac. sulpk. Cough attended with pain in the eyes, Bach. Cough accompanied by sensations of shocks or concussions in the head : Ipecac, Bach., Natr. m., Rhus. Cough with pain in the head : Nux v., Bryon., Sulph., Calc, Arnica, Ipecac, Bella., Con., Merc, Phosph., Card, v., Rhus, Bycopod., Alum., Ambr., Natr. m., Nitr., Nitr. ac, Squil., Salad. With pain as if the head would split : Nux v., Bryon., Sulph., Phosph., Natr. m., Caps. With pains in the hips : Sulphur, Causticum, Bella. With pains in the hypochondria : Nux v., Brosera, Bryonia, Bycopod., Bachesis, Am., Arsenic, Bryon., Bachesis, Am. m., Hellel., With pain in the loins : Merc, Sulph., Am. c, Acid. nitr. With pain in the nape of the neck : Bella., Alum. With pain in the occiput : Merc, Ferr. Cough preceded by pain in the stomach : Bella. Cough, with pain in the stomach, (epigastric region) : Bryon., Baches., Arsen.,, Am. c, Phosph., Thuja. Cough accompanied by a sensation as if the stomach turned round during the paroxysms, Pulsatilla. Cough with scraping or a feeling of roughness in the larynx : Kreos., Natr. s. With pains in the throat : Nux v., Hep., Phosph., Caps., Magn. s., China,: Carl. a. Cough with lancinating pains in the throat : Nux v., Merc,, Kali, Acid. nitr. With involuntary emission of urine: Puis., Sulph ., Kreos., Natr. m., Ant., Staph., Squilla, Zinc (See the additional indica- tions which have been given under some of the foregoing remedies, at the commencement of this chapter ; as also those which are men- tioned in the articles on Bronchitis, Croup, and Hoarseness.)
Unmedicated jujubes, sugar-candy, or gum arabic may be allowed occasionally, to moisten the throat or mouth, in cases of dry irritat- ing coughs.
25 A RESPIRATORY SYSTEM.
HOOPING-COUGH.
Tussis Convulsiva. Perttcssis.
This is almost peculiarly a disease of childhood, and one which few individuals escape during that period ; it generally appears as an epidemy ; and is, by the majority of physiologists, acknowledged to be communicable by contagion ; we seldom find an instance of a person suffering a second time from its attacks.
Over many the affection passes lightly, but in the majority of cases it proves a distressing, and in some, a fatal malady, baffling especially all the ill-directed efforts of the allopathic physician to conduct it to a favorable termination.
Under the old practice, not only was a great deal of valuable time frequently lost in endeavouring to subdue inflammation by antiphlo- gistic measures, but the patient's vital energies were weakened, and rendered less capable of contending with the disease, when it assumed the spasmodic type.
Now, however, on the contrary, we have it in our power, by the administration of remedies specific to the affection, sometimes to check the inflammation at its outset, subdue the distressing attendant symptoms, and almost invariably to shorten the duration of the com- plaint, without allowing it to leave after it any of those evil conse- quences, such as debility and emaciation, which oblige the patient to endure a tedious and protracted period of convalescence.
Diagnosis. Paroxysms of violent and convulsive expirations, in rapid succession, interrupted by long whistling inspirations, and in young subjects a loud shrill whoop, terminated by the expectoration of a quantity of mucus, or a fit of vomiting, after which the attack ceases for some time. If the case is severe, the features swell and become livid ; blood escapes from the nose, and mouth, and even from the ears. A complete cessation of respiration with threatening suffocation takes place in the more violent paroxysms, as if from spasm of the lungs. The attacks return every three or four hours^ and oftener in severe cases ; the least excitement brings them on ; they are more frequent and violent at night. Respiration is free during the intervals, and the patient in every respect healthy, although suf- fering from weakness.
Pathologists generally consider this disease under three stages ;
HOOPING-COUGH, 255
the distinction between the second and third is, however, not often very clearly marked.
The first or febrile stage commences with the symptoms of an ordinary catarrh, attended with slight fever, which gradually increases, the breathing becomes more difficult, and is accompanied with irri- tative cough and pains in the chest.
In the second or convulsive stage * the febrile activity disappears, and the characteristic cough and other symptoms of the disease develop themselves.
In the third or nervous stage there are longer intermissions be- tween the paroxysms, but increased weakness from the duration of the cough,.
Therapeutics. In the incipient, febrile, irritative, or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those we have already pointed out in the treatment of com- mon Cough, and must be selected according to the indications there given, and administered in the same manner, unless otherwise speci- fied. By a careful selection of these remedies it is frequently pos- sible to check the disorder in the first stage. Accordingly, the most suitable medicaments for this purpose are Dulcamara, Pulsatilla,. Mercurius, Belladonna,. Hepar sulphuris, Chamomilla, Nux vomica, Arnica, Ipecacuanha, Aconite, Bryonia^ and Phospkoms.
Dulcamara : — When the attack has apparently been excited by exposure to wet (a thorough wetting); the cough loose, with copious and easy expectoration.
Pulsatilla : — Cough loose, and accompanied with laehrymation, weakness of the eyes, sneezing, thick discoloured coryza and slight hoarseness, and inclination to vomit after coughing ; occasional diar- rhoea, especially at night.
Mercurius : — Hoarseness, watery coryza, with soreness of the nostrils ; dry fatiguing cough, generally occurring in two successive fits.
Belladonna is one of the most important remedies in the catarrhal stage of hooping-cough, when there is dry, hollow, or harsh and barking nocturnal cough, or which becomes materially aggravated at night. This medicine is also particularly well adapted to the angina or sore throat, which is not an unfrequent concomitant at the commencement of the affection.
* The congestive and nervous of some authors.
256 RESPIRATORY SYSTEM.
Hepar sulphuris: — Cough worse at night, but looser than that indicating Belladonna. This medicine is also useful in forwarding the secretory process.
Chamomilla : — Dry hoarse cough, or cough with difficult expec- toration of tenacious mucus, followed by a feeling of soreness at the part from which the mucus seems to have been detached. The paroxysms of* coughing are excited by an almost incessant irritation of the larynx, and in the upper part of the chest.
Nux vomica, is of great service, when the cough approaches the second stage. It is indicated by the following symptoms: dry, fatiguing cough, attended with vomiting, and occurring particularly from about midnight until morning, the paroxysms so protracted and Violent as to produce apparent danger of suffocation, with blueness of the face, and occasionally bleeding from the mouth and nose. (Arnica is better adapted to this latter symptom, when it occurs with a copious discharge of blood).
Ipecacuanha is, like the former, of great value wrhen the cough is attended with danger of suffocation, and each inspiration appears to excite a fresh fit of coughing. It is further indicated when the fits are attended with spasmodic stiffness cf the body, and blueness of the face, great anxiety, and accumulation of mucus in the chest.
Aconite may be had recourse to from time to time, when marked febrile or inflammatory symptoms are present, it being carefully borne in mind that the action of this medicine is of short duration, and may be followed in a few hours by any other of the remedies which appear more particularly indicated. Bryonia and Phosphorus are chiefly called for, when the cough threatens to become associated with inflammatory action in the lungs, &c.
Second, or convulsive stage. Therapeutics.
Veratrum album. Cuprum aceticum, Arnica, Ferrum metallicum, and Conium maculatum.
Drosera is one of the principal remedies in the treatment of the disease, when it has reached this stage ; and in cases where the con- stitution has not been enfeebled by the transmission of hereditary weakness or other causes, it will speedily declare its beneficial effects, and materially shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are : violent paroxysms of cough, occurring in such rapid succession, as to threaten
HOOPING-COUGH. 257
suffocation, and attended with the characteristic shrill sound during inspiration, and sometimes fever ; after each fit of coughing, vomiting of food, or of stringy mucus ; relief on moving about.
Veratrum album is indicated when the child has become reduced in strength and emaciated ; or when it suffers from cold sweats, particularly on the forehead, with excessive thirst, involuntary emission of urine, vomiting, and other symptoms common to this stage; also pain in the chest and inguinal region ; fever.*
When the vomiting, as also the cough, become more distressing at night than at any other time, Conium may follow Veratrum, if the latter fails to relieve this peculiarity.
Cuprum aceticum. This remedy is found most useful in the nervous stage, particularly when convulsions with loss of consciousness ensue after each paroxysm. Also when we find vomiting after the attacks, and rattling of mucus in the chest, and wheezing at all times. In almost all cases a marked benefit has followed the employ- ment of this remedy; sometimes it has been found sufficient of itself to cut short the disease, and in others, has so far modified it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked effect, and completed the cure.f
Arnica is serviceable as an intercurrent medicine when the epistaxis or hemorrhage from the mouth is considerable; and also against the affection itself, when each paroxysm is succeeded by crying. (Hepar s. is also useful, when the latter symptom followed a hoarse dry cough.)
Ferrum metallicum, is often very efficacious as an intermediate remedy, when there is, invariably, vomiting of food on coughing soon after a meal.
Conium : — When the paroxysms occur particularly at night, and with great severity, and are generally followed by vomiting of mucus or of ingesta, (Veratr. and Tartarus emet. are also useful when the vomiting is liable to take place during the night.)
* Carlo vegetaUlis is frequently useful in bringing this stage of the affection to an early and successful termination, after the previous use of Veratrum or Drosera, or both of these important remedies ; particularly when, notwithstanding the decrease of cough, the tendency to vomit still remains. (See also Ferrum.)
t Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of coughing, particularly in children affected with worms,
17
258 RESPIRATORY SYSTEM.
Third or nervous stage. Therapeutics. The same medi- cines as have already been given., according to the indications that present themselves. On the suppression of all the more serious symptoms, the remedies which have been recommended in the first stage, are also useful in removing any catarrhal cough which may remain behind. Change of air is likewise beneficial.*
Diet. The diet must be light and of easy digestion ; bread- pudding, semolina, and other light puddings of this description, pro- vided the fever be not high, in which case, weak gruel, barley-water, and the like, must alone be partaken of; when the more serious symptoms have been subdued, or in all mild cases, we may give a little chicken-broth, or beef- tea, — and so on, gradually increasing the amount of nutriment, as the disease declines. The drinks should consist of toast-water or barley-water.
CROUP.
Angina membranacea. Angina pemiciosa. Cynanclie laryngea. Cynanche
tracheitis, s. trqchealis, &c. &c.
Diagnosis. Short, difficult, and hoarse respiration, accompanied by a shrill whistling, squeaking, harsh, rattling, or metallic sound, with cough of the same character ; the patient throws the head back \ fever, and sometimes comatose state of the brain.
This well-known disease is one that requires the promptest treat- ment, to avert the danger. From the moment we are assured of the nature of the complaint, recourse must be had to the remedy most clearly indicated by the assemblage of the symptoms, so that not an instant be lost in arresting its further progress, since, if not skilfully kept in check, it sometimes runs to a fatal termination within twenty- four hours ; although in the generality of cases, when such an event does take place, it happens about the fourth or fifth day.
Croup consists of a peculiar inflammation of the lining membrane of the windpipe, causing the secretion of a thick, viscid substance, generally opaque, of about the consistency of the boiled white of an egg, which adheres to the interior of the windpipe, and takes the
* In neglected or obstinate cases occurring in delicate constitutions, Sulphuris tinctura and Sepia have been found useful. See also the remedies Jfor coughs of a bad character under the head of cough.
croup. 259
form of the parts it covers ; when this., generally denominated the false membrane, has been allowed to form, the case becomes extremely critical.
That crousp arises from inherent constitutional taint is evident, from the fact of some families having a peculiar tendency to this disorder. It particularly affects early childhood. The principal exciting causes seem to be exposure to cold or damp, and derange- ment of the digestive functions, from a too nutritious or heating diet, too much animal food, or stimulants, such as wine or coffee. It seldom attacks adults, though we occasionally see exceptions to this rule, and is not unfrequently found in complication with other affec- tions both of the lungs and windpipe.
The attack generally commences with the symptoms of a common catarrh, such as cough, sneezing, and hoarseness, with a greater or less degree of fever ; in a day or two the cough changes its character and becomes shrill and squeaking, or deep, hoarse, or sonorous, attended with a ringing sound during speaking and respiration, as if the air were passing through a metallic tube ; as the disease pro- gresses, the cough becomes more shrill, and when long continued, resembles the crowing of a young cock. There is seldom much expectoration, and when any matter comes up in coughing, it has a stringy appearance, resembling portions of a membrane. After inflammation has set in, considerable. fever and restlessness continue, occasionally varying in intensity, but never wholly remitting ; the countenance expresses great anxiety, and alternates from a red to a livid hue ; the paroxysms are followed by a profuse and clammy per- spiration of the whole body, more particularly of the head and face. When danger threatens, the pulse is hard, frequent, and occasionally intermittent ; the breathing, particularly during inspiration, difficult and audible; the features become livid, and almost purple from the sense of suffocation ; the head is thrown back ; the cough assumes a veiled and husky tone ; the voice sinks to a whisper ; the eye has a dull, glassy, or dilated appearance, and the whole system seems in a state of utter prostration.
Therapeutics. The medicines which, for the most part, will be found most appropriate to meet the incipient catarrhal symptoms, and thereby prevent, in many cases, the development of croup, are Chamomilla, Bryonia, and Aconitum (see Cough for indications) ; but those upon which the greatest reliance is to be placed in the treat-
260 RESPIRATORY SYSTEM.
ment of the disease itself, are Aconite, Hepar sulphuris, Spongia, and Lachesis.
Aconite is called for during the inflammatory period of this dan- gerous disease, when attended with great febrile burning heat, thirst, short dry cough, and hurried, laborious breathing. It may be exhibited as below specified, until these symptoms begin to abate.
R Tinct. Aeon. 3, gtt. ij. Aq. pur. Jij. Dose. A teaspoonful every half hour to six hours, according to the violence of the fever.
Hepar sulphuris : — Either when the febrile symptoms are par- tially subdued by Aconitum, the skin having become moist or covered with a profuse sweat, the cough more loose and the breathing freer, but there remains a dry, harsh, deep, hollow cough, with a weak, hoarse voice, and more or less difficulty of breathing ; or when, from the commencement, the cough, so peculiar to croup has already set in, and is accompanied by a constant mucous rattling in the respi-. ratory organs, during which the patient is incessantly but ineffectually occupied in endeavouring to obtain relief by expectoration ; or fre- quently grasps at his throat and tosses back the head ; — when, more- over, there is a' considerable degree of fever and restlessness, together with a burning hot skin, and excessively quick and laborious respi- ration.*
R Hepar Sulph. Calc. 3, gr.j. Aq. pur. Jj. M. Dose. A teaspoonful every two to six hours, or oftener ^even every half or quarter of an hour) if required. So soon, however, as the medicine begins to make a favorable impression, the doses must be given at much longer intervals until recovery is complete.
Spongia, is chiefly useful after Aconitum or Hepar, w7hen the skin has become moist, the breathing somewhat easier, but still very laboured, loud, grating, and wheezing, the patient appearing to carry on the process of respiration more readily with the head thrown back-
* This remedy is of itself sufficient, in many instances, to arrest the progress of the dis- ease, if administered as soon as the incipient symptoms of the attach are observed ; but Aconite, Hepar sulphuris, and Spongia, generally in alternation, become necessary when the affection is more developed. Gross.
croup. 261
wards, yet, is even then occasionally threatened with suffocation; further when the cough is hoarse, ringing, hollow, and squeaking.
R Spong. tost. 3, gr. j. Aq. pur. g. M. Dose. A teaspoonful every quarter or every half hour, or only every three to six hours, according to the intensity of the symptoms, and the effects produced by each dose.
Phosphorus has been recommended in cases where Hepar might fail to relieve the symptoms we have enumerated under that remedy ; or when Aeon, and Spong., as well as Hepar have been merely pro- ductive of temporary benefit. . Lachesis :— In very serious and obstinate cases, to which there is short dry cough with hoarseness ; great sensitiveness of the larynx and trachea to the touch, the slightest pressure affecting abnost to suffocation ; voice very low and hollow, with a sound like that of a person speak- ing through the nose ; fainting ; nausea ; swooning ; loss of sense ; rigidity of frame ; great prostration of strength, especially towards evening.
Yk Laches. 6, glob. vj. Aq. pur. 3j. Dose. A teaspoonful every half-hour, hour, or two hours, according to the intensity of the symptoms, and their abatement.
After having subdued these threatening symptoms by the adminis- tration of the last-mentioned remedy, we may, if the disease is not wholly vanquished, again fall back upon Hepar sulphuris, or Spongia, according to the indications given for those remedies.
There are other remedies which may afford valuable assistance in the treatment of complicated attacks ; but in truth it may be said, that in the majority of cases, Aconitum, Hepar sulphuris, and Spongia, administered alternately, when individually inadequate, are sufficient to effect a cure in a few hours. It need scarcely be stated, however, that it will be imperative to discontinue the administration of these remedies when improvement does not soon become apparent during their employment, or to select others from the commencement, if, from the symptoms and character of the case, they distinctly seem to merit a preference.
It may consequently be added, that Tartarus emeticus has been found valuable after Phosphorus, in some apparently hopeless cases with threatening paralysis of the lungs ; Arsenicum, Sambucus, and
262 RESPIRATORY SYSTEM.
Moschus in complications with Asthma Millari ; and Iodium either alone or in repeated doses, or alternately with Aconite, has been much recommended in obstinate cases, particularly when occurring in plethoric subjects. Kali, Bulph., Kali hydriod., Bella., Bryon., Cham., Can., Mosc/i., Sanguinaria canad., Cup., Bros., Merc., Veratr., etc., may be found useful in particular cases, either of croup or of affections of the air-passages, bearing a close analogy thereto.*
Hepar sulplmris, Phosphorus, and Lycopodium have been found useful in eradicating a susceptibility to this affection. (See also Laryngitis, Raucitas, and Bronchitis.)
INFLUENZA.
Diagnosis. Catarrh appearing in an epidemic form, attended, in addition to the symptoms described at the commencement of the article on common cold, with extreme oppression and prostration of strength ; sleepiness, followed by shuddering and general chilliness ; rheumatic pains, or pains as if caused by contusions, in the back and limbs; intense frontal headache, sometimes extending to the bones of the face, with pressive aching pains in the other parts of the head, giddiness, earache ; slight redness of the eyes, with painful weight or heaviness, and sensibility to light ; coryza, or obstruction of the nose ; dry shaking cough, which produces distressing fatigue in the chest ; dryness of the throat, and, subsequently, dry, burning heat of the skin, loss of appetite, nausea, together with soreness of the throat and some degree of hoarseness; and, in some 'cases, swelling of the parotid glands, or offensive sweats.
Therapeutics. The principal medicines in ordinary cases are
Camphor a, Aconitum, Mercurius, Arsenicum, Phosphorus, Belladonna, Pulsatilla.
Camphora. One or two drops of weak spirits of Camphor when taken at the commencement of the attack, and repeated until the chilliness or shivering begins to subside, will frequently check the further progress of the disease.
In a more advanced stage of the affection, with (laborious) asth-
* From some provings and experiments which were made with Bromium, it would appear to be a medicine which bids fair to be of great value in croup. (Vide Arch., II Bd.? 2 Heft ; as also Noack and Trink's A. M. L.)
INFLUENZA. 263
matic breathing, accumulation of mucus in the bronchi, and cold, dry skin, Camphora is further of considerable service,
Aconitum : — When the disorder assumes an inflammatory cha- racter, with quickness of pulse, dry hot skin, and short, harsh, shaking cough.
Nux vomica: — This remedy has repeatedly proved of great efficacy in influenza or grippe, after the previous employment of Aconite, when the inflammatory action predominated in the chest ; or when the symptoms complained of were chiefly as follows : ob- struction of the nose, hoarse hollow cough, excited by tickling in the throat, and attended with severe headache, confusion in the head, giddiness, want of appetite, or sickness, thirst, pain as from a bruise in the hypochondria, aching pain in the lower part of the back, con- stipation, pain in the chest as if from excoriation.
Mercurius : — Dry ox fluent coryza ; pains in the head, face, teeth, and chest ; sore throat ; swelling of the parotids ; violent shaking cough, at first dry, but subsequently moist, the paroxysms being commonly excited by irritation in the throat and chest; shivering or heat with profuse perspiration ; aching in the bones and slimy bilious diarrhoea, attended with tenesmus. This remedy has also proved of great efficacy when symptoms of pleurisy with copious, unmitigating perspiration, supervened ; as also when the liver became implicated in the general derangement, the pains in that organ par- taking more of an obtuse than an acute description.
Arsenicum. The following are the characteristic indications for the employment of this important remedy : heaviness and rheumatic pain in the head ; profuse watery and corrosive discharge from the nose, causing a disagreeable burning sensation in the nostrils; violent sneezing ; shiverings and shudderings, with severe pains in the limbs ; oppression of the chest ; difficulty of breathing ; thirst ; anxiety ; rest- lessness ; great prostration of strength, with aggravation of sufferings at night, or after a meal ; inflammation of the eyes, with sensibility to light. These symptoms may be attended with a deep, dry, fatiguing cough, exacerbated in the evening, at night, or after drinking, or sensations of dryness and burning, with mucus in the throat, which is difficult to detach.
If this remedy be not sufficient to remove the disorder, we may have recourse to the following medicines : Camphora, Aconitum, Nux vomica, Mercurius, Phosphorus^ Belladonna, Pulsatilla.
Phosphorus has frequently been found exceedingly useful when
264 RESPIRATORY SYSTEM.
there was excessive irritation in the larynx and bronchi, bordering on inflammation, with alteration of the voice, and pain during articulation.
Bryonia has often proved of great service in relieving the violent, pressive, aching, bursting, frontal headache, and cough with easily loosened mucous sputa. It has further been found of great efficacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration ; also when vomiting was liable to take place after coughing, or when the cough produced pain in the upper part of the abdomen, and caused a pain as if arising from the effects of a blow beneath the shorts ribs. (See Nux, which accords with Bryonia in the latter case.)
Belladonna ; — Dry spasmodic cough, aggravated towards night; sore throat, excessive, almost insupportable, headache, increased by talking, moving, or bright light ; fixed look ; confusion of ideas on closing the eyes.
Carbo v, has been found useful in old people, sometimes in alter- nation with Bryonia, when the chest was considerably affected, the breathing oppressive, the extremities cold, with threatening paralysis of the lungs.
Pulsatilla; — Loose cough day and night, exacerbated by lying down, thick offensive coryza, tendency to relaxation in the bowels, loss of appetite, foul tongue, disagreeable or insipid taste in the mouth.
Rhus : — In cases arising after exposure to a thorough wetting, and accompanied by great anxiety, frequent involuntary fetching of a deep inspiration, corporeal restlessness with incessant changing of posture, this remedy is indicated.
Distressing, dry cough, or cough with difficulty in expectorating the sputum which has been detached, the paroxysms of which were always followed by yawning, has frequently been cured by Opium, after many other remedies had failed to relieve.
Sulphuris tinct. has repeatedly proved useful when, at the termi- nation of the disorder, dull pricking pains are experienced in the chest on taking a deep breath, or after a severe fit of coughing ; also when there is oppressed respiration as if arising from a heavy weight resting on the chest.
Senega : — Tickling irritation and continual burning in the larynx or throat, with loud mucous rale, and fear of suffocation on lying down. Stanntm in neglected or protracted cases, with easy but excessive expectoration of mucus, and great weakness. Cinchona may
DETERMINATION OF BLOOD TO THE CHEST. 265
advantageously follow the last remedy when the expectoration has diminished, or when the fits of coughing are excited by a rattling under the sternum as if arising from an accumulation of mucus.
Finally : — Arnica may be administered with advantage in some cases, particularly when pricking pains are experienced in the chest during inspiration (pseudo-pleurisy), with aching pains over the whole body, headache, and hemorrhage from the nose ; Ipecacuanha, after Arsenicum or any of the other prescribed remedies, when there is vomiting or violent retching during or after each fit of coughing; Hyoscyamus, and in some cases Belladonna, against distressing spas- modic cough remaining after the acute symptoms of influenza have been subdued; or Conium, when the cough continued almost in- cessantly during the night until relieved by vomiting a quantity of frothy mucus ; Ferrum aceticum, cough after eating, with vomiting of the ingesta ; Kali hydriod., cough, with wheezing arid rattling in the chest, and expectoration of a gray coloured, saline or sweetish tasted sputum. Stannum and Carlo v<, in alternation frequently served to prevent the development of phthisis, where there was a predisposition to that disease before the invasion of influenza ; and Arsenicum and Lachesis have been employed with much success against sequelas in the form of obstinate inflammation of the eye and ulceration of the cornea. (See also art. Cough.)
DETERMINATION OF BLOOD TO THE CHEST.
Congestio ad Pecttis.
Diagnosis. Sensation of great fulness, throbbing, weight, or pressure in the chest and palpitation of the heart, attended with anxiety, short sighing respiration, and dyspnoea.
We find that the predisposition to affections of the chest and lungs is greater during the period preceding puberty, and for some years after, than at any other epoch of man's existence.
As remarked in the Diseases of Children, in infancy and during very early childhood, from the disproportion between the cerebral system and other portions of the economy, the diseases which the physician has chiefly to combat, are those arising from over-excite- ment of the nervous organization. In maturer years the tendency to abdominal congestion generally develops itself. This is easily
266 RESPIRATORY SYSTEM.
explained by entering into the physiology of these different periods of human life ; but as my object is rather the treatment of disease than the elucidation of these interesting points, I shall here content myself with briefly alluding to them.
There is no doubt, as already remarked, that a particular period of human life is peculiarly liable too chest affections, and, among others, to this disorder, which is but too frequently the precursor of other more serious maladies. Some constitutions, however, especially those in which an hereditary phthisical taint exists, exhibit a marked predisposition to pectoral congestion. Amongst the most frequent causes of this predisposition being called into dangerous activity are, exposure to extremes of heat or cold ; stimulants, such as alcoholic, vinous, or fermented beverages, or coffee ; the abuse of narcotic drugs ; violent exercise, such as running, dancing, &c, or over- exertion even of the voice in speaking or singing ; a sudden check of perspiration ; cold or damp feet ; sedentary habits ; metastases \ repercussed cutaneous eruptions ; or suppression of customary dis- charges, such as the catamenial and hemorrhoidal flux.
Therapeutics. Aconitum, Nux vomica, Ipecacuanha, Belladonna, Aurum foliatum, Mercurius, Pulsatilla, Spongia, Cinchona, Sulphur are the best remedies in general cases.
Aconitum is especially indicated, when there is violent oppression with great heat and thirst, palpitation of the heart, great anxiety, and shaking cough. It will be found particularly valuable for plethoric females of sedentary habits, who suffer considerably from congestion before and during the catamenia. In such cases it may be advan- tageously followed by Mercurius, to prevent a relapse, (in others by Belladonna.)
Nux vomica; — When the affection has been developed by sedentary habits or by habitual indulgence in the stimulants already alluded to, or from hemorrhoidal metastasis or suppression: in which cases this remedy is frequently sufficient to effect a radical cure.
Ipecacuanha will frequently complete the cure, when Nux vomica has not removed the whole of the symptoms. In other cases Sulphur will answer better after the previous employment of Nux. (See Sul ph.)
Belladonna: — Oppression and throbbing at the chest, with shortness of breath and strong palpitation of the heart, extending into the head ; short cough, chiefly at night ; internal heat ; and considerable thirst.
DETERMINATION OF BLOOD TO THE CHEST. 267
Aurum : — Extreme oppression of the chesty as if suffocation im- pended^ sometimes with loss of consciousness and livid hue of countenance ; palpitation of the heart ; and excessive anguish.
Mercurius, as already remarked, is valuable after Aconitum, on certain occasions (see that remedy) ; and also when there is burning heat and oppression at the chest, and frequent desire to take a deep inspiration ; or, cough with expectoration streaked with blood, and palpitation of the heart.
Pulsatilla : — Ebullition of blood in the chest with external heat; constriction in the chest with impeded respiration; palpitation of the heart; anxiety and aggravation of the symptoms towards evening ; also when pectoral congestion has arisen in phlegmatic sub- jects from hemorrhoidal suppression, or in females from stoppage of the menstrual flux.
Spongia tosta : — When the symptoms are provoked by the slightest exertion or even movement, and are attended with anguish, sensation of threatened suffocation, nausea, prostration, and fainting.
Bryonia : — Burning heat in the chest, with a sensation of tight- ness, dyspnoea, and anxiety ; palpitation of the heart, occasional prick- ings in the chest during inspiration.
Cinchona, when we can trace the affection to debilitating losses, with palpitation of the heart and oppressed breathing.
Sulphur: — Ebullition of blood, weight, fulness, and pressure in the chest, aggravated by coughing, palpitation of the hearty dyspnoea, chiefly on lying down at night ; it is also most serviceable in sup- pressed hemorrhoids, after Nux vomica or Pulsatilla, and after the latter remedy in checked catamenia.
Phosphorus. In some obstinate cases this remedy is often successful in affording speedy relief, particularly when, in addition to the more usual symptoms, shooting or pricking pains are frequently experienced on laughing, speaking, or walking quickly ; palpitation of the heart, anxiety, sensation of heat extending from the chest into the throat.
Some one or more of the preceding remedies, if judiciously selected, and timely administered, will generally check the disease, and pre- vent it assuming a more dangerous form : as, for example, running into hemoptysis, phthisis, pneumonia, carditis, &c. The following, among others, have also been found useful in peculiar cases : Rhus toxicodendron, Sepia, Natrum muriaticum, Phosphorus, Carlo Acidum nitricum, Ammoniacum carhonicum, and Ferrum metallicum.
268 RESPIRATORY SYSTEM.
INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. COLD ON THE CHEST. PULMONARY CATARRH.
Bronchitis*
This disease consists of a greater or less degree of inflammation of the mucous membrane of the bronchi, and is divided into acute and chronic. Of the former it is intended more particularly to treat. The disorder is of frequent occurrence both as an idiopathic affection, and as a concomitant of measles, scarlatina, smallpox, hooping-cough, &c.
Symptoms of Acute Bronchitis. Chilliness, succeeded by fever; hoarseness, difficulty of respiration; severe, frequent, and distressing cough, at first dry or with scanty expectoration of frothy or viscid mucus, which subsequently becomes copious and occasionally streaked with blood ; excessively laborious respiration, attended with a feeling of constriction and oppression of the chest, which sometimes increases to such a degree as to threaten suffocation ; general weak- ness, foul tongue, and loss of appetite ; paleness of the lips, cadaverous and anxious countenance, loud wheezing, and, on applying the ear to the chest, a louder sound is heard than the natural respiration, either rattling, whistling, or droning, or harsh and broken, according to the advance of the disease.*
In the cases which terminate favorably, the first symptom of im- provement which sets in, is a greater freedom of breathing, with remission of the fever, and an alteration in the expectoration, which becomes thicker, whiter, and diminished in quantity. But when the disease takes an unfavorable turn the difficulty of breathing increases ; a state of excessive debility and collapse supervenes ; the face becomes livid, the body covered wdth a cold and clammy sweat ; the mucus accumulates rapidly in the bronchial tubes, and the cough which has become feeble through the exhausted and sinking energies of the patient, is insufficient for its ejection ; aeration of the blood in the cells of the lungs is prevented ; cerebral symptoms declare themselves from impeded circulation, or the effect of unarterialised blood circu-
* Sibilant and sonorous rhonchi, in the early stage, and mucous or bubbling rhonchus when the secretion becomes increased, indicate both the nature and extent of the disease.
BRONCHITIS. 269
lating in the brain, and the patient is carried off in a state of asphyxia.
In many cases of acute bronchitis, although a degree of oppression at the chest be present, no particular pain, heat of skin, or fever may exist ; this is a most insidious form of the disease, and one in which the complaint is but too frequently neglected until beyond the power of the physicians art : it occurs most frequently in children who may apparently be only troubled with a slight wheezing, of wThich scarcely any notice is taken or any medical aid called in, until suddenly suffocation threatens, or some organic lesion is produced, so that an affection which probably might have been easily subdued at the commencement, is now beyond control.
The frequency of the disease in infancy and early life deserves a particular notice. It generally begins, as in adults, with the symp- toms of a common catarrh; the breathing becomes quick and op- pressed, and from the increased action of the diaphragm, the abdo- men is rendered prominent ; both the shoulders and nostrils are in continual motion, but the wheezing is often more marked than the difficulty of respiration, and on applying the ear to the chest a mu- cous rattle is heard over almost every part ; expectoration sometimes temporarily relieves, and occasionally the mucus is expelled from the air-passages by vomiting ; the countenance is pale and anxious, and, somewhat livid: — these symptoms are interrupted and relieved by occasional remissions, during which the child generally appears drowsy ; but they return with additional severity, and, if not checked, an accession of extreme dyspnoea ensues, and death takes place from suffocation. When sore throat is also present, coughing produces considerable pain, and the child for that reason frequently endeavours to suppress it. There is also impaired appetite with thirst, although when the disease has advanced, it is found difficult to take a long draught from its impeding respiration : this is very observable with children at the breast, who, after eagerly seizing the nipple, will bite it, and discontinue sucking, cry, and throw back the head, and even after vomiting up the phlegm, continue for some time in that position.
In some cases, from the character of the voice and cough, bron- chitis has been mistaken for croup.
The tubes of one lobe, or of one lung only, may be affected, but frequently those of both lungs are attacked by the disease.
270 RESPIRATORY SYSTEM.
The exacerbation of suffering at night is a very remarkable symp- tom in this complaint.
The causes are the same as those of common catarrh.
Therapeutics. The remedies which are the most appropriate in ordinary cases of this affection are : Aconitum, Bryonia alba, Pulsatilla, Spongia, Belladonna, Nitx vomica, Lachesis, Phosphorus, Mercurius, Cannabis, &c.
Aconitum is the remedy upon which we must place our chief reliance in the inflammatory stage of the disease, and throughout its course whenever high febrile action sets in. Its more marked indi- cations are hot, dry shin, with strong, hard, and accelerated pulse ; hoarse- ness^ with roughness of the voice ; short, dry, and frequent cough, excited by tickling in the throat and chest ; obstructed respiration, sibilant or sonorous rhonchus, anxiety, restlessness, headache, and thirst, with occasionally scanty expectoration of viscid mucus.
R Tinct. Aeon. 3, gtt. iij. Aq. pur. Jiij. M. Dose. To adults a tablespoonful, to children a teaspoonful every three to six hours, according to the urgency of the case, until relief be obtained, after which we may either lengthen the intervals, or select some other remedy more appropriate to the remaining symptoms.
It will sometimes be found necessary, as above remarked, to return to this remedy, during the course of the disease, particularly during the nocturnal febrile exacerbations.
Should the skin not become moist, the respiration easier, and the cough looser after the second or third dose of Aconitum, Bryonia will, in most cases, be required (see Bryonia). But it rarely hap- pens that Aeon., when at all indicated, does not produce a favorable effect, even after the first dose. As soon as a decided melioration has been effected, the repetition of the dose must be restricted to intervals of eight to twelve hours, or even longer ; or another medi- cine must be selected if Aeon, be found inadequate to complete the cure. (See Pulsatilla.)
Bryonia is of great service in a large number of cases of bron- chitis, at the commencement of the attack. We should therefore not hesitate to prescribe it immediately when we meet with labo- rious, rapid, and anxious breathing, with constant inclination to take a deep inspiration ; hoarseness; headache; dry cough, attended with
BRONCHITIS. 271
a burning pricking pain extending from the throat to the middle of the sternum ; or cough with scanty and difficult expectoration of viscid sputa, in some instances streaked with blood; sibilant rhon- chus ; dryness of the mouth and lips, excessive thirst. When, more- over, the respiration is impeded by shootings in the chest, and the affection threatens to become complicated with pleurisy, this remedy- is still more particularly called for. (Hepar s. is sometimes required after Bryon. in bronchitis, particularly when the latter remedy pro- duces only temporary relief.)
Form of prescription, same as Aconite.
Spongia is often of great service after the previous administration of Aconite, when there still remains a considerable degree of inflam- mation in the bronchial tubes, especially the larger, with sibilant or sonorous rhonchus ; and also, at a more advanced stage of the disease, when the mucous rhonchus is distinctly audible; with hollow, dry- cough day and night, but worse towards evening ; or cough with scanty, viscid, ropy expectoration ; heat in the chest, burning, tick- ling irritation in the larynx, quick, anxious, laborious respiration ; inability to breathe unless the head is thrown backwards; hoarseness, (Hepar s. is sometimes useful after Spongia, especially when the mucous rhonchus is predominant, the skin hot and dry, and the efforts to expectorate ineffectual.)
Belladonna. This remedy is useful when there is severe head- ache, materially aggravated by coughing ; oppression of the chest, and constriction, as if bound, with loud, wheezing, and rattling of mucus in the bronchi ; short, anxious, and rapid respiration ; dry, fatiguing cough, especially- at night, which is endeavoured to be suppressed on account of the pains it creates ; heat of the skin and thirst ; soreness of the throat. Belladonna is often exceedingly efficacious in children, particularly in those insidious cases which commence with a slight wheezing, and then suddenly become aggravated to such a degree as to threaten suffocation ; the heat of skin being at the same time considerable, and the pulse excessively- rapid, and sometimes even intermittent. Sulphur is, in some instances, required to establish the cure after Bella*
Form of prescription, the same as Aconite, but the repetition of the dose at intervals of eight or twelve hours.
Nux vomica; — Dyspnoea, with excessive tightness of the chest, particularly at night; hoarseness; dry cough, worse towards morn- ing, attended with pain as if caused by a blow or bruise, in the
272 RESPIRATORY SYSTEM.
epigastric or hypochondriac regions ; cough, with difficult and scanty expectoration of viscid mucus; dryness of the mouth and lips, thirst, constipation, peevishness.
Prescription, the same as directed under Belladonna.
Lachesis : — Oppression at the chest, with short and hurried respi- ration, anxiety, and dejection; mucous rale; dry, fatiguing cough, sometimes followed by the expectoration of a little tenacious or frothy mucus, after much effort, occasionally streaked with blood; hoarseness.
Prescription, as directed under Belladonna.
Phosphorus. This important remedy is frequently of great utility in bronchitis when the more inflammatory symptoms have been subdued by Aconite, but the respiration, continues much oppressed, accompanied with great anxiety, and heat in the chest ; dry cough, excited by tickling in the throat or chest, aggravated by talking or laughing, and followed by expectoration of stringy mucus of a saltish taste. Further, when the disease has been neglected, or when, from the phenomena which present themselves at the commencement, we have reason to dread complication, or an extension of the inflamma- tion to the substance of the lungs, which we generally recognise by the invasion of crepitation, rusty sputa, &c- — there will be additional reason for employing Phosphorus. (See Pneumonia.)
Pulsatilla. This remedy is often required in the second stage to complete the cure, after the previous exhibition of Aconitum, when the acute inflammatory symptoms have been subdued, and the expectoration has become thicker and more copious. It may, how- ever, be prescribed before or after any of the medicaments wre have named, especially when the disease occurs in persons of mild dispo- sition, or of lymphatic constitution, and the symptoms are as follows : Respiration short, accelerated, and impeded, attended with rattling of mucus, heat in the chest, and anxiety ; hoarseness ; shaking cough, worse towards evening, at night, or in the morning, accom- panied with considerable expectoration of tenacious, or thick, yellow- ish mucus, sometimes mixed with blood ; coryza with copious dis- charge of thick, discoloured mucus.
Prescription and dose the same as mentioned under Belladonna.
Sepia may be selected in preference to Pulsatilla, when the expec- toration is very copious, though somewhat difficult, and of a salt taste ; exacerbation of cough in the morning and towards evening. (If the sputa be still profuse, but more easily detached and ejected, greenish, and less saline, or of a sweetish taste, Stannum may follow Sepia.)
BRONCHITIS. 273
Lycopodium : — When the cough is materially worse at night, and attended with thirst and quickness of pulse,, but moist skin or ten- dency to sweat ; the sputa yellowish gray, and of a saltish taste; oppression at the chest.
Mercurius. This remedy may occasionally be found useful when the symptoms of bronchitis are accompanied by excessive per- spiration; when the cough is fatiguing, worse in the evening, and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder respira- tion than ordinary ; hoarseness ; coryza with watery, acrid discharge ; swelling of nose. Dulcamara is occasionally serviceable after Mer- curius, when there is a continuance of night sweats of an offensive odour.
Chamomilla is often a most useful remedy in cases of children, after the previous exhibition of Aconite, when a slight degree of whistling or sonorous rhonchus still remains ; dry cough worse at night, occurring even during sleep. For further indications, see this remedy under the head of Cough.
Ipecacuanha is also very valuable as a remedy for children, but generally at a more advanced stage of the disorder, writh mucous rhonchus in the chest, and when on coughing they are almost suffo- cated by the excessive secretion of mucus, and become livid in the face ; shortness of breath, and perspiration on the forehead after each fit of coughing.
Dose. One globule of the sixth dilution, in a teaspoonful of water, every two to six hours, until improvement results.*
There are other remedies which have been found of great value in the treatment of this affection, such as Tartarus emeticus, Arsenicum, Sulphury &c.
Tartarus emeticus is chiefly found useful in those extreme cases where the smaller tubes are clogged with mucus, and suffoca- tion threatens ; when the cough suddenly ceases either from weak- ness or other causes.
Dose. A grain, of the second or third trituration, in four dessert- spoonfuls of water, one dessert-spoonful to adults and a teaspoonful to children every quarter, every half, every hour, or every three or four hours, according to the severity of the symptoms, or the effects pro- duced.
* See the " Rules for the administration of the remedies, " given in the Introduction.
18
274 RESPIRATORY SYSTEM.
Arsenicum is occasionally of the utmost service in those unfavor- able cases in which the pulse becomes very quick, feeble, and irre- gular, and the patient is reduced to a state of extreme debility and collapse.
Dose. One or two drops of the sixth dilution to an ounce of water, a teaspoonful to be given from time to time, as required.*
Sulphur is frequently useful in winding up a cure, and preventing the disease running on to the chronic form, or when the expectoration has increased in quantity and become wThitish and less viscid.
It may be added that Hepar sulp/mris, Ammonium carhonicum, Can- nabis, Brominmfy &c, may also be found useful in some particular cases ; and that Belladonna, Lachesis, and perhaps also Opium, in addi- tion to Tart, em., may prove serviceable against the symptoms of stupor, which are so liable to set in in severe attacks of this disorder. Where there is a peculiar tendency to inflammation or cold on the chest, whenever an easterly wind prevails, Aconitum and Belladonna have been recommended as two of the most useful remedies by means of which this predisposition is to be overcome. (Gross, Allg. Horn. Zeit. No. 12, 19terBd.)
Diet. In the severe forms of bronchitis, the diet to be observed, should be the same as that mentioned under Fever ; but when the febrile and inflammatory symptoms have been completely removed, the patient should gradually return to a more nutritious diet, even though a considerable degree of cough and expectoration remain.
In the slighter forms of the complaint, spare diet, confinement to the house, in short, the simple measures laid down for the treatment of common colds in another part of this work, will frequently check or at all events materially shorten the attack. See also article Cough, in which further indications will be found for the selection of the remedies.
Chronic bronchitis. Bronchitis chronica. This complaint may be the result of the acute affection, or it may arise as a gradual and insidious inflammation of the mucous membrane of the bronchial tubes, or proceed from the inhalation of dust or other minute par- ticles carried into the lungs ; it may also be coeval with diseases of
* See the " Rules for the administration of the remedies," given in the Introduction. f The provings of this medicine are given in the ' Nues Arch/ Zweiter band, Drittes heft.
BRONCHITIS. 275
the heart, or declare itself after eruptive fevers. It differs from acute bronchitis chiefly in the greater mildness and longer duration of its symptoms, the continuance of which varies from several weeks or months to many years. It affects elderly persons more frequently than the young, but is of course liable to occur at all ages as the result of an acute attack (although such a circumstance is compa- ratively of rare occurrence under proper homoeopathic treatment), the sequel of measles, &c. A comparative exemption from cough, is frequently experienced during summer ; but in winter, or in incle- ment springs, the patient is tormented with harassing cough, and copious viscid expectoration, especially in the morning, which in the severer forms of the disorder is peculiarly distressing. The expec- torated matter in the chronic affection is of a different nature from that in the acute, being of a thicker consistence, and of a greenish or yellowish- white colour, it is not unfrequently muco-purulent, and sometimes decidedly purulent, and occasionally streaked with blood, particularly in obstinate, inveterate cases. There is generally more or less dyspnoea, with acceleration of pulse after slight corporeal exertion ; but in other respects the health may be good, and continue so. In the more trying forms of the disorder, an aggravated state of all the symptoms enumerated is met with ; moreover where the sputa is of a purulent nature, hectic fever, extreme emaciation, nocturnal sweats, and occasional attacks of diarrhoea are frequent adjuncts : the latter symptoms are sometimes liable to cause the disease to be mistaken for tubercular consumption ; but in the majority of cases, auscultation, and percussion, together with a careful attention to the symptoms and the history of the case, enable us to form an accurate diagnosis between them.
In chronic bronchitis, the resonance of the chest is, on percussion, little if at all diminished. On applying the ear or stethoscope to the chest, the respiratory murmur is found to vary much in intensity, but is never permanently absent in any part of the chest, and is frequently even puerile. The mucous rhonchus, in most of its diver- sified forms, is heard in various parts of the chest at different times, and occasionally the whistling and sonorous rattles are discernible. When the dilatation of the bronchial tubes is considerable, as is not unfrequently the case in this affection, a loud bronchophony is heard, which is with difficulty if at all to be distinguished from pectoriloquy, and a rale, closely resembling the cavernous, is apparent in the vicinity of the dilated tube. The sound on percussion will, however,
276 RESPIRATORY SYSTEM.
generally enable us to form a distinction ; the dullness of tone being not so great over a dilated tube, as it is in the vicinity of a vomica ; the difference of the situation of the cavity in the two cases, is also a useful discriminating guide ; dilated bronchi being, as is well known, most frequently detected in the scapular, mammary, and lateral regions, and vomicae in the subclavian and axillary regions.* How- ever^ as before said, we must, in all doubtful cases, combine the history of the attack, the constitution of the patient, the progress of emaciation, &c, with the symptoms to be heard by the ear after repeated examinations, ere we come to a definite conclusion as to the exact nature of the complaint, where that is of material consequence ; but as regards the prognosis, chronic bronchitis, with purulent expecto- ration, dilated tubes and hectic fever, has been truly considered to be nearly as formidable and serious a malady as phthisis itself, and hence ultimate recovery almost as doubtful.
As this is a disease which requires a long and judicious treatment for its removal, I shall merely confine myself to the enumeration of the remedies hitherto found most useful in cases of this nature.
These are Sulphur, Calcarea carbonica, Carbo vegetabilis, . Pulsatilla, Hepar sulphuris, Phosphorus, Stannum, Sepia, Lycopodium, Kali c, Natrum carbonicum, Natrum muriaticum, Baryta c, Lachesis, Causticum, Arsenicum, Silicea, Staphysagria, Acidum nitricum, and Conium mam- latum.
See, however, the article Cough, where indications for the selection of most of the above remedies will be met with.
INFLAMMATION OF THE LUNGS. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmonitis.
This disorder consists in an inflammation of the parenchyma of the lungs.
Diagnosis. Rigor, followed by heat ; dyspnoea; respiration short and hurried ; cough, short, continuous, and distressing, dry at the commencement, afterwards attended with scanty expectoration of viscid, lumpy, and extremely tenacious or glutinous mucus, of various
* A peculiar fetor of the sputa is deemed by M. Louis as a characteristic indication of a dilated state of the tubes.
INFLAMMATION OF THE LUNGS. 277
shades of colour, but generally of a dingy, brick-red, or rusty hue,* when the proportion of colouring matter is greater. The cough is invariably excited or aggravated by every deep inspiration, or on every attempt to speak ; the speech is interrupted, or there is a pause after every articulation ; the respiration is abdominal ; a dull pain is occasionally felt in the chest, but more frequently rather a tightness than pain ; the pulse is variable, sometimes not beyond the normal standard, but more generally full, strong, and quick at the commencement, or, when the inflammation runs high, hard, wiry, and greatly accelerated ; the tongue parched and dark-coloured. The fever is usually of the inflammatory type, but is sometimes typhoid. The patient, particularly in severe attacks, lies upon his back.
In the first stagef of many cases, when not marked by complica- tion with bronchitis, on application of the stethoscope, or the ear to the chest, the crepitous rale may be heard ; but the sound on per- cussion may appear to be only slightly impaired. As the inflam- mation gains ground, and the substance of the lung becomes altered in structure (second stage or that of hepatization), bronchial or tubular respiration is perceptible, with louder respiratory murmur than natural, in the sound parts of the lung, particularly in severe attacks ; also bronchophony may be present, andthe tone elicited by percussion, (excepting when the inflammation is restricted to a small central spot in the parenchymatous substance,) more or less dull according to the seat of the structural derangement, but rarely so complete or extensive as in pleuritis with copious liquid effusion.
In the third, or suppurative stage of the disorder, the sound on percussion becomes more dull, the tubular respiration and vocal resonance commonly disappear (a gurgling mucous rale is occasionally substituted, denoting the existence of a fluid in the larger bronchi), and the expectoration becomes muco-purulent or converted into a brown serous fluid. Slight shiverings generally attend the invasion of suppuration, and the pain, or sense of fulness or tightness becomes abated ; the patient is, moreover, commonly enabled to lie on the side which was affected, without much inconvenience.
If the disease be not checked in the second stage, the face becomes patched with red, and sometimes livid, and is of considerable extent,
* This rusty or sanguinolent hue is intimately combined, not in streaks. It appears usually about the second or third day, and is a characteristic indication of the presence of the disease in question ; at the same time it must be borne in mind, that its absence is by no means a certain criterion of the non-existence of inflammation of the lungs.
f That of simple inflammatory injection or engorgement.
278 INSPIRATORY SYSTEM.
the vessels of the neck swollen and turgid, the pulse weak and irregular, and the patient is deprived of life by the obstruction which is offered to the circulation in the lungs. In the third stage the pulse becomes weak and thready, and the strength commonly sinks rapidly; but a fatal result is often averted by proper homoeopathic treatment. When an abscess forms in the solidified lung, a cavernous or gurgling rhonchus will be heard, as the air passes through the pus ; and pectoriloquy with cavernous respiration will supervene, — when the cavity has been emptied of the fluid by expectoration.
Such are the general symptoms of pure Pneumonia, but in severe cases it is often found combined with pleurisy, in which case the pains of the chest are intense, and mostly of an acute shooting cha- racter. Another and still more frequent complication is formed with bronchitis. When pneumonia terminates by resolution, some striking evacuation frequently attends it, such as a very free and abundant expectoration of thick white or yellow matter, often slightly streaked with blood ; or a profuse and general sweat ; diarrhoea ; a profuse discharge of urine, with a copious sediment ; or an attack of epistaxis.
If no hepatization have taken place, the crepitous rale, at first audible, becomes gradually less perceptible, and the natural respira- tion is heard, till at last the former wholly disappears ; if the lung have already partly solidified, but the disease is approaching a cure, the crepitous rale is first heard, then gradually yields to the natural respiration ; in fact, the disease, so to speak, runs its course back again.
Therapeutics. Aconitum, Bryonia alha, phosphorus ', Tartarus emeticus, Tinctura sulplmris, Rhus toxicodendron , Belladonna, &c.
Aconite. In the stage of simple inflammatory congestion, with severe inflammatory fever, whether or not accompanied or followed by severe shooting pains in the chest, this remedy is unquestionably of great service.
Form of prescription, the same as in Inflammatory Fever.
Bryonia is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by that medicine. But Belladonna* is generally required before Bryonia, when the fever
* When Aconitum does not effect the desired amendment, Belladonna is generally of greater service than Bryonia in pulmonic inflammation. Again, if Aconitum produces only a slight degree of improvement when prescribed at the third or sixtn dilution, the employ- ment of a higher attenuation, such as the twelfth or twenty-fourth, is often followed by the happiest success. I consider Aconitum, Belladonna, and Phosphorus to be the most impor- tant remedies in pneumonia. — Rummell. Allg. Horn. Zeit. No. 21. 32ster Bd.
INFLAMMATION OF THE LUNGS. 279
returns after having been apparently subdued by Aconitum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest continue (particularly when the pain experienced seems more at the sternum), the sputa tinged with, blood, and difficult to expectorate, the cheeks flushed, lips and tongue dry and parched, the skin hot, and the thirst incessant. In young plethoric subjects, Aconitum and Belladonna may be given, in rapid alternation, with the most satis- factory results during the first or congestive stage. In such cases indeed the further progress of the disease is not unfrequently arrested, or at all events such a degree of improvement is effected, that any remaining symptoms, such as some degree of oppression, expectora- tion of viscid sputa, with little or no dullness of percussion or other signs of hepatization, readily yield to the employment of Bryonia* Bryonia may, however, be prescribed at the commencement, when the following indications present themselves : — cough, attended with expectoration of viscid or tenacious mucus, of a brick-dust colour, oppression at the chest accompanied by acute shooting pain, or rheumatic pains in the pleura, and pectoral muscles, or in the extremities, with increase of pain on movement ; foul tongue, consti- pation, and other signs of gastric derangement. A complication with pleurisy (pneumo-pleuritis), indicated by increased dullness on per- cussion, and in some instances a double-sounding voice, central bronchial respiration, and bronchophony, is often an additional reason for the selection of this remedy. (See also Pleuritis.)
R Tinct. Bryon. alb, 3, gtt. iij. Aq. pur. 3 iij. Dose. A dessert-spoonful every four, six, or eight hours, according to the severity of the case.*
PHOSPHORUS.f This remedy has been lately almost exclusively employed by Dr. Fleischmann, of Vienna, in almost every stage of pneumonia, under whatever form it may present itself, and with the most marked success, even when extreme hepatization has taken place. Although the homoeopathic treatment hitherto adopted with Aconitum, Bryonia, Merc, Sulpk., &c, has proved eminently successful, yet this remedy, which seems to have such a specific influence over this serious disease, deserves a more extensive trial : at the same time we cannot too strongly reprobate the impropriety of blindly selecting this
* Vide " Rules for the repetition of the dose," in the Introduction.
+ I have cured some of the most desperate cases of pneumonia by means of Phosphorus, although prescribed only in the form of globules, but always at low potencies, (3—6.) — Kummell, Allg. Horn. Zeit. No. 21. 32ster Band.
280 RESPIRATORY SYSTEM.
remedy, when others, such as Bryonia, Tartarus, Sulphur, &c, may, on a careful comparison of the symptoms, be found better indicated ; or of persevering in its employment, in cases where no signs of im- provement have set in, after we have allowed a sufficiency of time to elapse to admit of the manifestation of its favorable action.
R Tinct. Phosph. 3, gtt. vj. Aq. destil. Jij. Dose. One dessert-spoonful every four hours, lengthening the inter- vals according to the effects produced.
Tartarus emeticus s. stibiatus has been chiefly recommended as valuable in promoting resolution after hepatization has taken place (which is indicated by the greater or less degree of dullness on per- cussion, the bronchial or tubular respiration, and the peculiar pectoral sounds given by the voice. Oppression at the chest, laborious respiration, no expectoration, or expectoration of mucus (untinged with blood) chiefly during the night ; or, mucus rattling in the chest with temporary diminution of the obstructed respiration after ex- pectorating the sputa detached by the cough, appear to be the principal general indications for the selection of Tartarus emeticus.*
R Tart, stibiat. 3, gr. iv. Aq. dest. ^iij. Dose. A dessert-spoonful three times a day.
Tinctura sulphuris may deserve a preference to the last-men- tioned remedy in similar cases, when they occur in strumous habits, also where hepatization has advanced to some extent, and where Phosphorus, or other remedies, may have only effected a degree of improvement ; also where there is complication with pleurisy, and obstinate constipation.
R Tinct. Sulph. 3, gtt. iij. Aq. dest. Jij. Dose. A dessert- spoonful every six to twelve hours, according to cir- cumstances ; if amendment ensues, the medicine should be allowed to continue its action undisturbed, as long as the improvement continues.
* Bosch, in his remarks on the treatment of pneumonia, states, that although the fever may have abated under the employment of Aeon., Bella., or Bryon., whenever the oppression at the chest and anxiety continue or increase, the pulse at the same time becoming small, soft, and irregular, and auscultation clearly indicating the establishment of hepatization, he resorts to Tartarus stibiatus, and with such striking success, as cannot be surpassed by any remedy, not even by Phosphorous. The latter he always considered called for when solidifi- cation had made some progress, and was accompanied by signs of incipient paralysis of the lungs ; symptoms which are prone to threaten even in the first stage of pneumonia, when the disease occurs in old people, especially those who are subject to asthma, or have been affected with chronic mucous (pituitous) coughs. — Hygea, XX Band, 4 Heft.
INFLAMMATION OF THE LUNGS. 281
Bromium and Nitrum, particularly the former, promise to be of as much importance as Phosphorus in so-called complicated cases of pneumonia, and where there is incipient hepatization.*
In obstinate or chronic cases, with weak, thread-like pulse and clammy sweats, Lachesis. and Lycopodmm have been found very useful after, or in alternation with, Sulphur, Kali n., &c. Carb. v. and Am. m. have also been suggested as likely to be of service in some cases of the foregoing description.
The preceding are the principal remedies used in the majority of cases of this disease ; but the following have likewise been found excellent auxiliaries in some instances, and merit attention.
Acidum nitricum has been of service in some cases, where, after Aconite, a cessation of pain has taken place with increase of fever.
Squilla has been recommended as useful in forwarding the crisis : further, in pneumonia accompanied with gastric symptoms, and where the expectoration is copious, or in cases which had previously been treated by venesection, and China has not proved sufficient to rouse the sinking energies of the patient.
Mercurius, when the fever has been lowered by the employment of Aconite, but pain and difficulty of breathing remain, or copious nocUirnal sweats, exhaust the patient's strength, and the pulse is small and quick ; also where there is prominent bronchitic complication. In the latter instance Capsictcm, Nux v., Pulsatilla, and Bryonia, have also proved efficacious : Capsicum particularly in the case of phleg- matic subjects ; Nux v., alternately with Phosphorus, especially in the case of drunkards ; and Pulsatilla in chlorotic females. The indica- tions for Bryonia have already been given. Cannabis has also been found useful in this frequent complication, and, moreover, in one or two cases where there was disease of the heart and large vessels, writh greenish vomiting and delirium.t
Arnica — against effusion into the air-passages, with local con- gestions and hemoptysis, {pulmonary hemorrhage or apoplexy of the kings,)
Rhus toxicodendron may be found serviceable in the congestive stage of pneumonia, when we meet with extreme restlessness, anxiety, palpi- tation of the heart, and excessive redness of the face. But should
* Neues Arch., Zw. Bd., Drit. Heft, p. 113.
t Cannabis is sometimes useful in pneumonia, when the oppression and dyspnoea is greater than the other symptoms, such as the state of the pulse, etc., would lead us to anticipate.— Rummell..
282 RESPIRATORY SYSTEM.
diarrhoea supervene, accompanied by clammy sweats and great fre- quency of pulse, Arsenicum will generally be required.
Banguinaria canadensis. This important medicament is considered by Constantine Hering as likely to prove a valuable remedy in certain cases of pneumonia. Cantharides seems calculated to prove serviceable in pneumo-pleuritis.
When the inflammatory symptoms have been subdued, but the expectoration presents a muco-purulent appearance, and there is great prostration with nocturnal sweats, Lycopodium has been found very efficacious. When the disease has gone on to the third stage, announced by attacks of shivering succeeded by heat, and other signs of suppurative fever, together with the, physical changes already mentioned,— Sulphur, Lycopodmm, and Kali c, form, along with others, such as Merc, Hepar, China, &c, the principal remedies by means of which we may entertain some hope of averting a fatal issue.
Lachesis has proved beneficial, sometimes in alternation with Ar- senicum and Cinchona, in those almost desperate cases which threaten to turn to gangrene of the lungs, (with fetid breath and sputa.)
Phosphorus, Kali, and Lycopodium are efficacious remedies in pneu- monia occurring in phthisical subjects. When there exists a tendency to suffer from inflammatory injection in the chest, whenever an easterly wind prevails, Aconitum and Belladonna {Bryonia ?) have been recommended as prophylactic remedies. The state of the digestive functions ought, at the same time, to be attended to. But when this predisposition arises in consequence of an attack of pneumonia, which had degenerated into the chronic form, and left certain portions of the lung in an indurated state, with more or less bronchial voice- and breath-sounds at the seat of the previous inflammation, such remedies as Stilph., Lachesis, Phosph., and Lycopoch, must be resorted to.
Ere we conclude this chapter, we trust we shall be excused for introducing the following somewhat diffuse but important remarks of Dr. C. M tiller,* on the employment of Tartarus emeticus and Phosphorus in pneumonia, as also some extracts from the observations of Dr. H. G. Schneidert and Dr. WatzkeJ on the treatment of pneu- monic inflammation.
" The information to be gleaned from homoeopathic authors, as to the efficacy of Tartarus emeticus in pulmonary affections, is nearly as
* Tartarus emeticus und Phosphorus in Lungenentziindungen, von Dr. CI. Midler. Allg. Horn. Zeit., No. 4—5. 30 Bd. f Ibid. No. 1. 21 Bd. % Ibid. No. 7. 21 Bd.
INFLAMMATION OF THE LUNGS. 283
follows : Dr. Wurm (Hygea, xii, 1, p. 41) recommends it in pleuritis complicated with bronchitis, when the expectoration is difficult.
Dr. Buchner (Hygea, xv, 6, p. 509) recommends its employment in pneumonia when the fever and the typical signs have, for the most part, disappeared, but the patient is affected with constant rattling in the chest, and expectorates large confluent masses ; the expectoration being, at the same time, difficult, the respiration op- pressive, the chest affected with a burning sensation extending to the throat, and gastric symptoms predominating.
An anonymous writer (Horn. Archiv, xix, 2, p. 31) considers Tartarus emeticus the only specific remedy in Pneumonia gastrica, and in the second stage of pure pneumonia.
Dr. Bosch (Hygea, xx, 4, p. 304) gives several detailed cures of pneumonia by means of emetic tartar, and intimates that he has always found it useful when, on the abatement of the symptoms of inflammatory fever, the oppression at the chest and the anxiety increased, the pulse became small, soft, and frequently unequal, and the physical signs afford distinct indications of hepatization, (dull-stroke sound, and crepitation or bronchial respiration.) Dr. Kurtz (Hygea, v, 2, p. 141) holds Tart. emet. to be a really specific remedy only in the stage of hepatization.
The following pathogenetic effects of Tart. emet. denote its action on the bronchi, lungs, and pleura : much coughing, and sneezing violent, tickling in the air-passages, which provokes cough; loose night cough; mucous rhonchus ; cough after a meal, with vomiting of the contents of the stomach; gasping for breath at the commence- ment of every paroxysm of coughing ; burning sensation under the sternum ; continuous violent, rheumatic pain in the (left) side of the thorax ; fits of soreness in the chest, attended with hopeless despair ; sensation as if the chest were lined with velvet; short, laborious breathing, rendering it necessary to sit up in bed, — relieved after coughing and expectorating; nocturnal paroxysms of orthopncea; irregular or unequal, intermittent respiration during sleep ; less fre- quent inspiration; interrupted or oppressed breathing, with dys- phagia ; unusual oppression at the chest.
The symptoms which have been attained from animals that have been poisoned by Tartarus emeticus are as follows : lungs congested and distinctly inflamed, and in a state of splenization, in some parts even in that of hepatization, of a violet colour, and deprived of crepitation. (Magendie — arising from the injection of 6 — 8 grs. into a vein. Orfil.
284 RESPIRATORY SYSTEM.
Toxicologia, Bd. 1, p. 460) ; lungs materially altered, of an orange- yellow or violet-blue colour, increpitating, gorged with dark blood, and of dense texture ; inflammation of the bronchial tubes, and, to a greater extent, of the lungs also. (Schropfer, in Christison's c Treatise on Poisons/ p. 503, from 1 scr. injected into the trachea of a dog.) The lungs of those of the human species who have been poisoned by Tart, emet., exhibit black discoloration in several parts. That emetic tartar exerts a specific action on the bronchi, pleura, and lungs, and that the alterations which it is capable of producing on these parts correspond to those which are commonly and intrinsically met with in inflammatory affections of these organs, there cannot be the slightest shade of doubt; the more precise indications for its application are, however, less determined.
The majority of physicians (allopathic) understood the multifarious recommendations of Tart. emet. in the sense that it was immaterial in what description of inflammation in the chest it was employed, pro- vided only the affection was either pneumonia or pleuritis ; the solitary question on which they were not united was, whether blood should be abstracted or not in the first instance. The result of this summary mode of proceeding was naturally very variable ; and it accordingly happened that, whilst one party spoke in the most enthusiastic terms of praise, another gave a depreciatory opinion ; others, again, felt that the sphere of its efficacy must be somewhat narrowed, and therefore recommended Tart. emet. in those instances of pectoral inflammation in which it was uncertain wThether to bleed or not. (Bersius, Miguel, and others.) A similar discrepancy of opinion arose as to the time and stage of the disease in which the remedy was more appropriate ; some employed it at the very com- mencement of the disorder, others, particularly in pleuritis, only when effusion had taken place, making the Tart. emet. a sort of resolvent and substitute for the ordinary mercurial friction. As already shown, the homoeopathic physicians have, upon the whole, employed Tart, emet., but rarely in thoracic inflammations, and that more apparently from the circumstance that they conceived they possessed sufficient resources in their other remedies, or because they attached but little credit to recommendations emanating from allopathic practitioners, rather than that any want of confidence in the remedy had arisen from established trials. No homceopathist, however, ever expected to find in Tart. emet. a never-failing specific in pulmonic inflammations. It therefore remains for us, from the physiological effects of this
INFLAMMATION OF THE LUNGS. 285
remedy, and the experience which has been derived from clinical observation, to consider more narrowly those symptoms which, when encountered in pulmonic inflammation, justify us, according to homoeopathic principles, in selecting emetic tartar as an appropriate remedy. In the first place, then, as regards the painful sensations which Tart. emet. is capable of exciting in the chest, we find only a single symptom: violent fixed rheumatic pain in the (left) side of the thorax. Now, we know^ that in pneumonia the pain is commonly either very trivial or altogether absent, from the circum- stance that the parenchymatous substance of the lungs is but little qualified to give rise to painful sensations. With the serous covering of the lungs, howrever, it is far otherwise ; for if the pleura be affected, and particularly when inflamed, acute pain is always present, but this pain is almost constantly of a shooting or cutting description (as is for the most part the case in all serous membranes), and conse- quently not continual or incessant, but intermitting, excited by movement, breathing, &c. As the above-mentioned pain is, strictly speaking, the only one that is proper to Tart, emet., it therefore follows that its applicability in pleuritis, at least in the first two stages of that complaint, is untenable.
Concerning the phrase " rheumatic pain," there is some difficulty in finding a positive definition : if employed to designate the chang- ing or erratic nature of the pain, it contradicts the succeeding term " fixed ;" if, on the other hand, the expression is received in the sense in which, in popular language, it is commonly employed in refer- ence to pains arising from exposure to cold, such a signification ought not to find place in a scientific (homoeopathic) work ; most probably, therefore, it is intended to be implied that the pain has its seat in the pectoral muscles, inasmuch as rheumatic affections are especially seated in fibrous structures. Consequently, although Peschier regarded pricking or darting pains in the chest as an espe- cial indication for Tart. emet. in pleurisy, his opinion would seem to be unjustifiable, since the aforesaid pains counter-indicate the employment of this remedy. The paucity of painful pectoral symp- toms speaks much more in favour of the application of Tart. emet. in pneumonia.
The following three symptoms ought to be taken into consideration here : sensation as if the chest were lined with velvet ; soreness or pain as from excoriation in the chest, occurring in paroxysms ; burn- ing sensations behind the sternum, evidently arising from affections of
286 INSPIRATORY SYSTEM.
the mucous lining of the bronchi, and their ramifications ; they therefore denote the existence of common catarrh, or of the catarrhal affection which always accompanies inflammation of the lungs, and do not correspond to pleurisy, from the circumstance that catarrhal symptoms more rarely attend the latter affection. The symptoms of abnormal respiration are strongly marked : short, oppressed breathing, rendering it necessary for the patient to sit up in bed ; frequent fits of unequal, intermittent respiration during sleep ; extreme pectoral oppression ; dyspnoea, compelling the pa- tient to sit up, meliorated after coughing and expectorating ; noctur- nal attacks of orthopncea ; respiratory disturbance with dysphagia. When we compare these numerous symptoms with those which the few which were previously mentioned as appertaining to Tart, emet., it wall be seen that they predominate so much over the latter, as to be evidently of much greater importance, and correspond particu- larly with those of pneumonia, for in that affection, as is well known, the oppression and disturbance to the respiratory functions hold a prominent place, and the remaining symptoms are of a less decided character. The symptoms referring to the expectoration are of a less satisfactory nature ; the cough is certainly chiefly loose, and even accompanied with mucous rhonchus, but with regard to the character of the sputa, a point of considerable moment in inflammation of the lungs, we have not the slightest notification. But although this deficiency of observation is much to be regretted, we yet may reason- ably conclude that sanguineous sputa can hardly have been met with either during the provings of Tartarus, or in *cases of poisoning therefrom, otherwise, so important a symptom would most assuredly have been recorded. The following two symptoms may also be said to be of considerable importance : gasping for breath at the com- mencement of every fit of coughing ; and dyspnoea, diminished after coughing and expectorating; since this dependence of the oppression on the accumulation of mucus in the bronchi, and its disappearance and cessation for some time after expectorating, is in like manner to be observed in certain forms of pneumonia, viz. after the act of coughing, or merely by expectoration, the bronchial ramifications which intercept the hepatized portion of lung may be cleared of the fluids or the hard substances which have been secreted, or the communication between the bronchi and the trachea, which had been obstructed by mucus, may be restored by the aforesaid means ; which fact can in some measure be accounted for, by the sudden
INFLAMMATION OE THE LUNGS. 287
decrease of the oppression subsequent to expectorating, and also by the circumstance that bronchophony, the bronchial respiration, the simultaneous rattling rhonchi, sibilus, etc., previously absent, often follow a paroxysm of coughing. (Vide Scoda, p. 251.)
Had any doubt remained as to the specific relation of Tartarus to the lungs and pulmonic inflammations, it would have been uncon- ditionally removed by the results which have been obtained from post-mortem examinations after cases of poisoning. The pheno- mena there met with having exhibited the greatest possible similarity to those which are found after pulmonic inflammation. The symp- toms indicated unequivocally that stage of pneumonia in which the lung or a portion of the same, after previous simple engorgement with blood (engouement), has become more solid', compact, heavy, and no longer possessed crepitation ; which condition has been named that of the red hepatization by most authors, and ramollissement rouge by Andral.
Taking everything into consideration therefore, we shall find that the following are the indications for Tartarus emeticus : it is particu- larly applicable in pneumonia, and especially in the so-called second stage, when little or no pain, but an extreme degree of oppression and obstructed respiration, is encountered ; when there is a loose cough attended with mucous rattling and considerable expectoration, followed by melioration of the pectoral oppression ; when the sputa contains very little or no blood, and consists chiefly of mucous masses ; and when percussion and auscultation demonstrate that a portion of the lung no longer contains air, and is consequently hepatized. With reference to the said physical signs, the following particulars may be determined : percussion will elicit a dull sound over a greater or lesser extent of surface, with increased resistance, — but it may also yield a hollow or tubulous tone (viz. when the subja- cent portion of lung is hepatized throughout); the parts of the chest immediately adjacent to this spot, may emit a tympanitic sound, (when, as is often the case, the portions of the lung bordering on that which is hepatized, are emphysematous,) or, like the remaining extent of the lung, the usual normal sound. Should the hepatized portion be very small in circumference and diameter, the percussion- sound would again be normal, but this is naturally of rare occurrence. Auscultation, over the spot where the stroke-sound was dull, will afford more or less distinct bronchophony (when, namely, the hepa- tized portion is sufficiently large to embrace one of the larger
288 RESPIRATORY SYSTEM.
bronchial ramifications, and the latter is not filled with fluid, or a dense exudation, or a coagulum of blood, and the communication with the trachea thereby intercepted), and, further, bronchial respira- tion and consonant rattling, or one or the other. The presence of bronchophony does not, however, necessarily imply the existence of bronchial respiration or consonant sibilus, or rhonchi, and vice versa, bronchophony is not always heard when bronchial respiration is present ; these signs are sometimes only perceptible after the act of expectoration, as has been stated above. At those parts of the thorax where the lung is not hepatized, auscultation will detect weak, vesicular, or puerile respiration, or indefinite respiration, and various kinds of rhonchi. It must yet be observed that the cited physical signs remain the same in the third stage of pneumonia, the so-called gray hepatization, hepatisation grise, ramollisement gris (in which Tart, emet. is inapplicable, at least the symptoms do not indicate it) : but this conversion of the effused lymph in the hepatized lung into purulent matter will not be readily mistaken or confounded, because the accompanying group of characteristic general symptoms would lead sooner to the selection of Phosph., Ars., RJms, Lachesis, &c, than to Tart, emet., which has either none or but a limited number of the said symptoms.
It now remains to be ascertained whether, in addition to the symp- toms which have already been notified, there are any peculiar general indications for the employment of Tart. emet. According to the usual opinions,, derived from theory and practice, it is in pneumonia attended with gastric or bilious derangement, the so-called pneumonia biliosa {erysipelas pulmonum) that emetic tartar is particularly appropriate. The characteristic marks which distinguish the said form of pneumonia from the common species are, the light bilious discoloration of the skin, and especially of the albuginea, alae nasi, and corners of the mouth; further, the coating of the tongue, merging from light yellow into a brownish colour, the bitter taste, nausea, or vomiting, the brownish-yellow bilious urine, (the blood drawn by venesection is also stated to exhibit instantaneously a saffron-yellow colour under the test of nitric acid.) Along with the foregoing, a lancinating pain is commonly experienced under the right false ribs, or pain and dis- tension are complained of in the scrobiculus, with frequent eructa- tion and hiccough ; moreover, a peculiar pressive, severe piercing pain is centered in the forehead, which sometimes gives place towards evening to violent delirium ; frothy mucus of a saffron-yellow or
PNEUMONIA, 289
greenish hue, rarely combined with blood, is ejected after the fits of coughing, which are often accompanied by vomiting.
Amongst the pathogenetic symptoms of Tart. emet. will certainly be found the majority, but not the whole, of those above given. The fellow colour of the skin, for instance, as also the brownish- yellow coating of the tongue and the bitter taste are wanting ; it must be admitted, however, that even in pneumonia biliosa, the bilious aspect of the skin is only occasionally a well-marked symp- tom. On the other hand, the distension and sensibility of the epigastrium and hypochondria, together with the eructations, hic- cough, and vomiting, the dark reddish-brown coloured, cloudy urine, the pressive frontal headache, and the cough with vomiting, are well determined symptoms of Emet. tart. ; concerning the sputa, as has already been observed, wTe are in the possession of no positive testi- mony. It therefore follows that Tartarus (as also Senega, Mere., or Nux v.) may without doubt be deemed a useful remedy in pneumonia associated with so-called bilious and gastric states ; but to maintain that it alone corresponds to pneumonia with such complications is unjustifiable.
Phosphorus. The experience of homceopathists as to the efficacy of Phosphorus in inflammations of the respiratory organs, is more extensive ; the observations detailed thereon, in various journals and essays, are so numerous that we shall here quote merely a selec- tion of the most appropriate and authentic amongst them.
Dr. Wurm (Hygea, xii, 1, p. 38, and ix, 1, p. 55) recommends it inpleuritis and pneumonia, in connexion with tuberculosis pulmonum ; as also in complications of pleuritis with pneumonia or bronchitis. Dr. G. Schmidt expresses himself in accordance with the foregoing. (Hygea, iv, p. 68.)
Dr. Griesselich (Hygea, xiii, 6, p. 528) cured a case of pleuro- pneumonia by Phosphorus which had continued to gain ground not- withstanding the employment of Aeon., Bryonia, Mosch., and Arnica, w7hen, in consequence of the existence of muttering delirium and carpologia, paroxysms of threatening suffocation, extremely laborious respiration, critical debility, small, quick pulse, paralysis of the lungs was momentarily to be dreaded ; in the right lung there was no longer any respiratory murmur, but loud rubbing sound was distinctly audible. Very shortly after the administration of Phosphorus ex- pectoration set in, and the breathing became freer, so that after
19
290 RESPIRATORY SYSTEM.
twenty-four hours incipient slight respiratory murmur, pectoriloquy, cegophony became audible, and recovery followed soon afterwards.
Dr. Buchner (Hygea, xv, 6, p. 507) recommends Phosphorus where great prostration, paleness of face, dimness of the eyes, powerless, dry cough, particularly at night, are encountered ; further, when the following state of matters is met with : difficult expectoration from exhaustion, burning, darting, rattling in the chest, danger of paralysis of the lungs, complication with bronchitis, imperfect crisis from depressed physical power.
Dr. Horner (Archiv, xx, 1, p» 118) found Phosphorus curative in an extremely severe case of peripneumony, in which, after the em- ployment of Aconitum and Bryonia, exhausting epistaxis, subsultus tendinum, delirium furibundum and involuntary stools had super- vened.
Schellhammer (Archiv, xx, 3, p. 120) found benefit still to arise from the employment of Phosphorus in neglected pulmonic inflam- mations, where there was coldness of the breath, cold, clammy sweats, tremulous, scarcely perceptible pulse, rusty, with difficultly expectorated sputa, extreme anxiety, facies hippocratica, and fre- quently such absolute dullness of tone on percussion, that it seemed as if a wall were struck instead of the chest.
Dr. Eichhorn (Hygea, xix, 1, p. 31) found Phosphorus particularly to be approved of, when incipient hepatization, in pure and (so-called) asthenic pneumonia, is indicated, in addition to the known physical signs, by the livid, sharp face, cold sweats, small, quick, and hard pulse, frequent cough, with frothy or brown (sometimes gelatinous - looking) sputa, &c. ; and also in those cases of typhus, where, not- withstanding the pneumonic concentration, sensibility to the touch, and borborygmus in the caecal region as well as diarrhoea, are present.
Dr. Schneider (A. H. Zeitung, 21 Bd., p. 4) saw greater benefit from Phosphorus in 1839-40 than from any other remedy; in general he also found this remedy indicated, where Aeon., Bryon., Merc, had not rendered the expected relief before the pneumonic crisis ; and in neglected cases with rattling rhonchus in the bronchi, difficult purulent-looking, copious sputa, and great debility.
Dr. Watzke (A. H. Zeitung, 21 Bd., p. 109) states Phosphorus to be appropriate in the second stage of primary pneumonic croup ; further, in pneumonia complicated with pleuritic exudation, or with bron- chitis.
PNEUMONIA* 291
The most decided defender of Phosphorus in pneumonia* is Dr. Fleischmann ; in the year 1840 he employed it (Hyg., xiv, 4, p. 358) exclusively with success in 51 cases of inflammation of the lungs, and found it equally useful in nearly every stage of the disease ; the same striking results ensued in the following year, (Hyg., xviii, 5, p. 468.) The physical signs were almost constantly as follows : dull- ness of sound on percussion, bronchial respiration, frequently attended with crepitation or rattling.
Descriptions of cures performed by means of Phosphorus in severe, partly so-termed, nervous pulmonic inflammations, have also been given by Dr. A. Noack (A. H. Zeit., 21 Bd. p. 321 ;) Dr. Bethmann ( Annalen, 14 Bd., 3 Stuck, p. 459 ;) Dr. Hartlaub (Annalen, 4 Bd., 4 Stuck, p. 459.)
The known pathogenetic symptoms which Phosphorus exerts upon the organs of respiration are about as follow: shooting and violent stiches in various parts of the thorax, right and left side, sometimes with burning at rest and during movement, especially while sitting and during respiration ; pain in the chest, particularly during inspira- tion, itching in the interior of the chest with dry cough. Oppression at the chest; precordial anxiety with obstructed respiration, and throbbing in the right side of the chest ; great oppression and short- ness of breath; tightness of chest as if caused by a band; tension and dryness in the chest; constrictive pressure in the upper part of the thorax ; loud rattling respiration; dry, hollow cough without subsequent expectoration ; hacking cough, with a suffocating sensa- tion in the chest, and some mucous expectoration ; cough with ex- pectoration of transparent mucus accompanied by tensive and sub- sequently pricking pain in the chest ; straining cough with white, viscid sputa, which is difficult to loosen or detach ; streaks of blood in the mucous sputa; muco-purulent sputa; expectoration of blood with mucus during a short, slight cough ; pricking pain in the scro- biculus cordis while coughing, rendering it necessary to support the part with the hand: great startness after each fit of coughing.
The symptoms which have been obtained from the dissection of dogs, which had been poisoned by Phosphorus, are as follows : " A few minutes after the introduction of a solution of Phosphorus in oil into the jugular vein, the dog emitted, at each respiration, a voluminous white vapour, which contained a considerable quantity of phosphoric acid, and died soon aftei*wards ; on dissection the vessels of the lungs exhibited a state of obstruction (hepatization.")
292 RESPIRATORY SYSTEM.
(Magendie, Experiences pour servir a Phistoire de la transpiration pulmonaire, 1811, p. 19.) In like manner Orfila observed: "The dog soon began to pant and breathe with extreme difficulty, and vomited a large quantity of a. bloody serous-looking substance. At the sectio cadaveris, the lungs presented several blue patches of a dense and less crepitating texture than in the normal state; in the remainder of their extent they were of a rose colour. In another dog the lungs were found red and congested, and did not crepitate/5 (Orfil. Toxicol. Gener., Bd. I, p. 56.) In cases of poisoning in the human subject, the inferior lobes were of firm consistence and gorged with venous blood. (Oesterreich. Med. Wochenschrift, 1843, No. 39.) The above-mentioned symptoms of Phosphorus are characteristics, and distinctly correspond to the appearances which are commonly observed in certain inflammations of the lungs. The sensations of pain which Phosphorus is capable of producing consists, for the most part, of stitches and shootings, which are more particularly excited or increased by respiration, coughing, and movement. Identical symptoms are met with in pleuro-pneumony, the pain, which is almost constantly of a shooting or darting description, being, in the said disease, all but exclusively experienced during a deep inspiration or the act of coughing. The symptoms of tightness of chest and dyspnoea form a prominent feature in the pathogenesy of Phosphorus, but they undergo no mitigation from the acts of coughing and ex- pectorating, as is the case with Tart. emet. ; on the contrary, each paroxysm of coughing is productive of increased difficulty of breath- ing. The cough is either perfectly dry and hollow, or it is loose, yet straining, fatiguing, and generally productive of severe pain ; the sputa consists of white, transparent, tenacious mucus, or of mucus intermingled with blood, or it is purulent. The results obtained from the cases of poisoning, and post-mortem examinations are very similar to those detailed under Tart, emet.^ i. e. the lung or a portion of the same wras firmer, more solid and impermeable, and consequently in a state of so-called hepatization. If, from the fore- going, we now attempt to determine the kinds of pneumonia, the time and stage in which Phosphorus is appropriate, it is requisite in the first place to point out those pulmonic inflammations, where (in contradistinction to Tart, emet.) the shooting pectoral pains, as well as the dyspnoea and the respiratory disturbances, are especially excited and aggravated by coughing and respiration, — and these are the so-called pleuro -pneumonic inflammations in which the pleura is
PNEUMONIA. 293
pretty extensively (for perhaps in no case of pneumonia does it wholly- escape) implicated^ and more particularly in the second stage when mucus or sanguineous mucus is expectorated, and the physical signs are the same as those mentioned under Tart. emet.> viz. dull stroke- sound and bronchophony or bronchial respiration, and perhaps con- sonant rales. So far, therefore, it would seem that Phosphorus cor- responds somewhat closely with Tart. emet. in its sphere of action, differing only from the latter in certain isolated instances. But there yet remains a group of symptoms under the head of Phosphorus which have not yet been taken into consideration, and in reference to which the sphere of action of Phosphorus is altered and considerably extended, viz. those general appearances, which, without inducing any peculiar change in the local and physical symptoms, sometimes connect themselves with pneumonic inflammations, and have by the older physicians been denominated nervous. These " nervous" appearances develop themselves probably only when the pulmonic inflammation enters, unchecked, into the third stage, that of the gray hepatization (hepatisation grise, ramollisement gris) with threatening paralysis of the lungs; and perhaps also in the first stage of those inflammations which occasionally occupy the lungs in typhus. When pneumonia is verging on the third stage, the purulent infiltration of the parenchyma, the following symptoms chiefly declare themselves : mental depression, slight delirium, with carphologia and subsultus tendinum, rapid prostration of strength, cold, clammy sweats, small, feeble, frequent pulse, dim eyes, sunken features, dry lips and tongue, short, laborious breathing, oppression and anxiety, tedious cough and expectoration, frequently, loose and involuntary stools. The physical symptoms, as already stated, remain the same as in the second stage, excepting that the sound, on percussion, becomes perfectly dull and deprived of resonance over a larger surface, and the respiratory murmur, at that spot, inaudible or extremely faint. The expectoration either ceases altogether or consists of a purulent mucus or a brown serous liquid. Nearly the whole of these symptoms are also to be found amongst the pathogenetic properties of Phosphorus ; and more particularly the delirium with carphologia, the sunken, hippocratic visage, with deep-set eyes, dryness of the lips and tongue without thirst, the short and anxious respiration, with slight, tedious cough and ex- pectoration, the purulent sputa, clammy sweat with coldness of the face, small, quick pulse. Hereunto must be added the numerous and, in great part, authentic clinical observations which almost unanimously
294 RESPIRATORY SYSTEM.
recommend Phosphorus in the so-called slow, asthenic, nervous pneu- monic inflammations, — corroborated, moreover, by the testimony of Dr. Fleischmann, whose position as the physician to an hospital gives additional weight to his evidence. It consequently follows that Phosphorus, according to homoeopathic principles, must prove valuable at the commencement of the third stage, with so-called nervous symp- toms and threatening paralysis of the lungs, as well as in the second stage. On comparing, therefore, its sphere of action with that of emetic tartar it will be seen, in addition to the distinctive marks already given, that the field embraced by Phosphorus is greater than that of Tart, emet., and that the former may be advantageously em- ployed in pneumonic inflammations of a more advanced stage than where there could be the slightest prospect of obtaining a favorable result from the administration of the latter. But that Phosphorus should still be capable of effecting a cure, when extensive purulent infiltration of the parenchymatous substance of the lungs has taken place, is as little to be expected as the attainment of so desirable an event by means of any other remedy.
Dr. Schneider * writes :—
i. For the last eight years — i.e. from the time that I commenced to substitute the specific or homoeopathic for the antiphlogistic me- thod, I have usually seen pneumonia last only four to five days, and terminate on the fifth inclusive, at most on the seventh inclusive, by profuse sweats and hypostatic urine.
II. I seldom met with epistaxis in pneumonia, — although arti- ficial bleedings had not been employed, and I never (which may certainly depend upon the stadium) saw this or any other hemorrhage appear critically.
I have moreover never observed critical diarrhoeas in pneumonia.
in. If, in addition to critical sweats and urine, the evolution of a scabby eruption about the mouth appeared* to be necessary to ensure the termination of the inflammation, the decrease of the disease proceeded somewhat slower, and that more especially when the urine was at the same time of a light colour.
iv. If critical sweats made their appearance on the fourth or fifth day, without effecting a decrease of the pneumony, and they wrere moreover accompanied by anxiety and restlessness, with increased oppression, cough, and pain during the act of coughing, the eruption of a critical miliaria was to be expected.
* Klinische Aphorismen. Allg. Horn. Zeit. No. 1, 21ter Band.
PNEUMONIA.
295
v. A miliary eruption (consisting of small whitish vesicles on a red ground) was always sufficient (when the inflammation could not otherwise be removed) to terminate the pneumony within nine days. In the meanwhile the sweats diminished, and the miliaria soon after- wards scaled off.
vi. In one case, where the patient had wantonly exposed herself to cold on the fifth day of the disease,* about the termination of the crisis bona (by sweat, hypostatic urine, and eruption about the mouth) relapse took place, accompanied by great anxiety, restlessness, and sleeplessness, excessive oppression and tightness of the chest, and very difficult, painful cough, which indicated a termination (on the ninth day, reckoned from the first appearance of the disease) in a miliary eruption.
vn. On the decline of the pneumonic inflammation, the op- pression at the chest, and the obstructed inspiration, as also the pricking pain whilst making a moderate inspiration, and the frequent pulse, were generally the first symptoms that were alleviated ; at the same time the rust-coloured sputa became more and more light- coloured, (subsequently dirty- white and globular,) the cough gra- dually easier and the expectoration less troublesome ; somewhat later, the stitches during coughing disappeared, and lastly the cough itself, after having (in the form of a normal cough) removed the last trace of the disease.
viii. For the last eight years I have invariably seen pneumonia simplex, when treated homceopathically, (provided the treatment commenced as early as the third day of the existence of the disease,) terminate favorably, and always more regularly and speedily than during the ten preceding years, when the treatment was conducted according to the principles of the old school.
ix. During the last eight years I have lost eight patients, of neglectedf and badly-treated pneumonia: two women of the age of 60 ; two men of the same age ; one man of 40, one man of 30, and two children. The person of the age of 30 was already in a dying state when I arrived.
On the other hand, I have saved, during the same space of time,
* The patient, a woman of very violent, impatient temper, being tired of the sweating, and feeling herself otherwise well, left the bed and seated herself in the passage, in a current of air, coming from two opposite open doors.
f By neglected pneumonia, I mean a case in which the period of the first normal crisis has passed unfavorably.
296 RESPIRATORY SYSTEM.
six other patients similarly affected : four men in the7third stage of the disease, one boy of 12, and one girl of 13 years, both were in a hectic state, &c, and had already commenced to expectorate large quantities of purulent matter, of an offensive, pungent smell.
x. Two cases of pneumony occurring in previously diseased lungs terminated fatally, — the one on the seventh day suddenly, in consequence of the bursting of a vomica,* the other on the sixth day, through paralysis of the lungs.f Some other cases, in phthisis exulcerata, terminated favorably.
With the exception of those mentioned under ix. and x, I have never met with a fatal case of pneumonia during the last eight years.
xi. I generally prescribed Aconitum for only one day at the utmost in pneumonia ; I only continued it the day following if the fever was still very violent ; and in that case I gave it alternately with the other appropriate remedy.
xn. If the patient came under my treatment only on the third day of the existence of pneumonia, I immediately gave Aconit, alter- nately with the other medicine indicated.
xin. If the vascular irritation was very great at the beginning of the pneumony, and accompanied by determination of blood to the head, or also by talking in the sleep, I gave Aconite and Belladonna alternately.
xiv. The second remedy which I employed in pneumony was generally Bryonia; I soon discovered, however, that this medicament operated much better when given alternately with some other which was appropriate to the genus morhorwm, or- the individuality of the patient, or also the causa occasionalis of the pneumony, with Belladonna or Mercury (most frequently with the latter) or with Nux v., (e.-g. with drunkards) or with Arnic. or Rhus (after external causes).
xv. In 1839 and 1840, about the time when ganglionic typhus prevailed, Phosphorus proved more effective, than any other remedy in pneumonia. During the prevalence of scarlet fevers and anginse,
* The patient had, several years before, been severely contused by being pressed by his horse against a tree, and subsequently suffered from frequent attacks of pneumonia, accom- panied by very copious expectoration.
t The patient, a woman, had suffered two years before she was attacked with this fatal (asthenic) pneumonia, from complaints of the chest ; and during the latter months she had experienced increasing tightness about the chest, attended with cough and expectoration, and very perceptible emaciation and diminution of strength. I saw her for the first time on the third day of the disease. The expectoration was nearly black.
PNEUMONIA. 297
Belladonna deserves particular attention; and during that of influenza, Mercury.
xvi. I usually employed Mercurius with good effect with that otherwise indicated remedy, if a critical eruption about the mouth was to be foreseen.
xvii. When a critical eruption about the mouth was fore- seen, the employment of Mercurius in alternation with the remedy otherwise indicated, was attended with good results. If all remedies above-mentioned did not effect the desired amendment before the crisis of the pneumonia, I usually found, after a renewed examina- tion, Phosphorus or Sulph. indicated, more rarely Rhus, or Sepia, or Squilla, and still more so, some other remedy.
xv in. On appearance of great anguish and restlessness, and oppression in the chest (iv), &c, before the evolution of miliaria, I found either Arsen. or Veratr., or Hyoscyam. indicated, and effective.
xix. In neglected pneumony, with rattling noise in the bronchi, difficult, purulent and copious expectoration, great weakness, &c, I have found Belladonna, Arsen*, Phosphor, and By cop. very beneficial.
xx. In neglected pneumony, with copious, very offensive, purulent expectoration (ix) I found especially Sepia, Conium, Card., Silic. and China effective.
xxi. Latterly, I commonly prescribed Aconitum, Bryon., and Bettad. in the I — I dilution, and the other medicines in the 4 — II, as follows : gtt. iv.— gtt. viij in |iv. of water, 1 tablespoonful to be taken every 1 — 2 hours."
Dr. Watzke* states that—
" The homoeopathic or specific treatment of pneumonia presents very considerable advantages — although more in reference to the direct and indirect consequences, and period of convalescence, than with regard to the course of the disease. In our hands, as a general rule, more or less distinct indications of critical symptoms make their appearance on the fifth day ; on the seventh, the perfect crisis takes place, and on the fourteenth day the patient is enabled to attend to his usual occupations.
Aconitum has been too unconditionally and generally recommended and employed against pneumonia. We only expect direct benefit from it in active hyperemia, and incipient splenization.
* Allg. Horn. Zeit. No. 7. 21ter Band.
298 RESPIRATORY SYSTEM.
Bryonia we employ only in those forms of pneumonia which are sympathetically founded on pleuritic inflammation with predomi- nating plastic — serous exudations.
In the first stage of pneumony in robust individuals, with exist- ing consensual irritation of the brain, as also in pulmonic inflamma- tions in general, resulting from severe and continuous exertion, or from mechanical lesion, the best remedies are Arnica, Rhus, and Conium,
Belladonna is indicated when pneumonia is accompanied by an acute exanthema, with violent cerebral symptoms and general turgor venoms. In pneumonia occurring in females labouring under primary or secondary chlorosis, or associated with chronic, neglected, or acute bronchial catarrh, measles, or smallpox, Pulsatilla will not easily be excelled by any other remedy.
" In the second stage of primary pneumonic croup we would call attention, besides to the well-known and successfully employed Phosphor, and Antimonium, to Bismuth magesterium, and Arg. nitr. : in addition to the well-known and successfully employed Phosphorus and Antimon. tart. Arg. nitr. promises to be more especially of service against lobular hepatization occurring as a sequela.
In the stage of purulent or serous infiltration Bromium is, next to Sulphur, Senega and Carbo v. the most worthy of attention.
In irregular reactions, insufficient crisis in asthenic, torpid inflam- mations of the lungs, which frequently take place in consequence of bleedings, China, Camphor, 01. tereb., and Moschus, are often bene- ficial even in apparently hopeless cases.
Opium, Nux vomica, Hyoscyarmis, Lachesis, Conium, Cocculus, Stram., do not appear to have any primary and direct effect upon the lungs ; they are indicated in secondary pneumonic processes, in pneumo- typhus, in delirium tremens complicated with inflammations of the lungs, and in various forms of so- called nervous pneumony.
In pneumonia catarrhalis, or in pneumony occurring in lymphatic, flaccid, fat habits, Senega is indicated; in pneumonia complicated with bronchitis, Senega, Mercury, Phospor., Brom., Nux mosch.; in that with hepatitis (pneumonia biliosa?) Senega, Mercury, Nux vomica, and in pneumonia interstitialis — aur-chlor.
Pneumonic states, which originate from tubercles in the lungs are sometimes to be cured by means of Mercury, Iod., Sulphur, Spongia, and Ol.jecoris aselli.
In the pneumonia of old persons, Arsenicum is the principal remedy ;
SPURIOUS PERIPNEUMONY. 299
in that arising from repercussed eruptions, Arsenicum and Sulphur ; in complications with endocarditis Arsenicum,, Camphora, Mercurius, Bromium ; and in those with pleuritic exudations Arsenicum, Cam- phora, Phosphorus, Scilla, and Acidum mwriaticvm are the most important medicaments."
Diet. It is scarcely necessary to remark that during the inflam- matory period of pneumonia, an almost total abstinence must be observed : even during convalescence there is caution required, and care must be taken not to allow the patient to over-indulge his returning appetite, as any error in this respect may entail troublesome consequences. The drinks may consist of water, toast-water, and sometimes whey, rice- or barley-water, sweetened with a little sugar if desired.
PERIPNEUMONIA NOTHAS. OCCULTA. CATARRHUS BRONCHIORUM.
Spurious Peripneumony.
This affection, which is usually most insidious in its approach, is more frequently met with in old than in young or middle-aged sub- jects, and is liable to terminate in paralysis of the lungs. Sometimes the attack is preceded by a feeling of general prostration ; or comes on like an attack of common cold, with cough and alternate heats and chills. The cough is generally loose from the commencement ; the sputa, white, yellow, slimy and generally blood-streaked. There is great weight or oppression at the chest, with quick laborious breathing ; pain only when taking a deep inspiration, and generally in a small circumscribed spot. All these symptoms are usually aggravated by anything which calls for an increased play of the lungs, such as talking, or laughing loudly, ascending stairs, &c, lying upon either side, particularly in the more severe attacks, becomes oppressive, so that the decubitus is generally on the back. Pulse soft but quick, the cheeks slightly flushed; the skin moist and damp, and sometimes there is nocturnal sweating which affords no relief; towards morning the febrile action subsides a little, and the patient feels somewhat easier. The voice is low and weak, occasionally dying away to a whisper. In the treatment of this affection a dose or two of Aconite may be given when the fever runs rather high, but Mercurius is more frequently called for even at the very commencement, and particularly
300 RESPIRATORY SYSTEM.
when there is nocturnal sweating, and moist or clammy skin during the day; after the employment of Mercurius, Belladonna will generally be found useful, and especially when a short dry cough remains, attended with spasmodic constriction in the chest which impedes respiration and causes an oppressive sensation of suffocation. If Belladonna does not complete the cure, and the cough is accompanied with sibilant or wheezing respiration, a dose of Aconite may be given, followed, after an interval of a few hours, by Chamomilla, Nux vomica is serviceable when there is dry cough, or cough with difficult ex^ pectoration of a little slimy mucus, and excessive tension and op- pression in the chest. In those cases in which Mercurius affords little relief, and the breathing continues quick and laborious, and the countenance is expressive of great anxiety, Ipecacuanha in repeated doses is frequently followed by satisfactory results ; but should the extremities become cold, and the sensation of constriction in the chest, with extreme anxiety increase, Veratnim should be prescribed ; on the other hand, if the paroxysms of threatening suffocation become more and more distressing, and the patient appears sinking from exhaustion.
Arsenicum must claim a preference, and will often succeed in restoring the expiring energies of the patient when the case has assumed an almost hopeless appearance. {Tartarus emet. may be substituted for, or administered alternately with Arsenic, when there is an excessive accumulation of mucus in the bronchial tubes.
It may be added that Arnica has been found useful in some instances, in the early stage of the disorder, when the pleura costalis and the intercostal muscles seemed to be the principal seats of pain, which was rendered more acute by pressing the fingers against, or drawing them along the spaces between the ribs ; or when a bruised or beaten pain was experienced in the chest, and the cough not very troublesome, but attended with blood-streaked slimy sputa. Pulsatilla has been employed with advantage after Arnica, as soon as the expectoration became more considerable, attended with melioration of the pectoral symptoms. Pulsatilla and Sulphur are two of the best remedies to prevent the disease from assuming the chronic form, when the more acute symptoms have become subdued. (See also Bronchitis Pneumonia vera, and Pleuritis, and select any of the remedies given under these different heads, if the symptoms, general or physical, call for them.)
TYPHOID PNEUMONIA. 301
TYPHOID OR CONGESTIVE PNEUMONIA.
In this variety of pneumonia the local symptoms are usually very obscure, and the accompanying fever is of the typhoid kind, the pulse quick and very weak, the skin harsh, dry, or clammy, tongue brown and parched, and the urine of greatly diminished quantity and high coloured.
In some cases the following physical signs can be detected : dull- ness on percussion, and absence of respiratory murmur in the lower and back parts of the chest, and occasionally bronchophony and bronchial respiration when the central or middle portion of the lung is the part affected.
The remedies which have been used with the most advantage in typhoid pneumonia, are Opium, Arnica, Veratrum, Arsenicum, Phos- phorus, &c.
Opium. This remedy is generally the most appropriate as soon as the disease becomes clearly defined, and may be repeated once or twice, after which, if no change be effected, Arnica should be em- ployed.
If no improvement result from the foregoing remedies, Veratrum may be administered, particularly when there is clammy sweat on the forehead, with coldness of the extremities and great weakness, and the respiration unequal^ laborious, and rattling.
Arsenicum may follow Veratrum if the prostration, and rattling respiration increase, the pulse become irregular, and the tongue dark brown or black : the alternate administration of these two remedies every half hour, to every hour or two hours, according to the urgency of the symptoms, is frequently attended with the best results ; in other cases, Veratrum, Ipecacuanha, and Arsenicum answer better. But when only temporary improvement results, a few glo- bules of Sulphur may be administered ; and then again Veratrum, and Arsenicum, or Veratrum, Ipecacuanha, and Arsenicum alternately, or any one of these remedies alone from which any marked degree of improvement may previously have been observed to arise. Bryonia Rhus, Senega, and Phosphorus will be found useful in certain cases. Some of the leading indications for the employment of the two former will be found under the head of Nervous Fever (which see). Senega is chiefly serviceable when the lungs are loaded with
302 RESPIRATORY SYSTEM.
mucus. Phosphorus when we find great debility, black incrustations on the lips, rapid and laborious breathing, and bronchial respiration. Belladonna will commonly be found serviceable when temporary blindness is complained of, and Natrum m. when the prostration of strength increases, notwithstanding the administration of Arsenicum which is generally so valuable in such cases. When galling or excoriation has ensued from lying in bed, Cinchona and Arsenicum must be administered alternately ; in milder cases, Arnica in the form of lotion (one part in ten) will frequently remove this evil.
INFLAMMATION OF THE PLEURA. PLEURISY.
Pleuritis.
Diagnosis. Severe cutting, lancinating pain in the side, con- fined to one circumscribed spot, interfering with breathing, and acutely increased by taking a deep inspiration, or by coughing ; dif- ficult and anxious respiration, but not so oppressed as in pneumonia and bronchitis ; quick hard pulse ; hot skin, particularly over the chest, or the seat of the disease ; (short dry cough ;) parched tongue ; scanty and high-coloured urine ; and occasional cerebral symptoms, position in bed, usually dorsal ; and if the effusion be free and par- tial, a change to the sound side creates great uneasiness. The pro- gnosis must be formed according to the severity and character of the symptoms. If the heat and other febrile indications gradually sub- side, and if the performance of the act of respiration becomes more free and less painful, and a copious and free expectoration ensues,* an early recovery may be expected ; but if the fever and inflamma- tion have been intense, and the pain should suddenly terminate, followed by sinking of the pulse and a change of countenance, danger is to be apprehended.
Pleurisy seems to consist in a peculiar inflammation in the pleura, with a disposition to effusion or to the secretion of plastic lymph ; and it may run its whole course without any of the symptoms above given, declaring themselves.
* Care should be taken not to allow this profuse expectoration to go on too long, which it is sometimes prone to do in certain constitutions, otherwise it might degenerate into a chronic affection. Its suppression, when called for, may be effected by means of such reme- dies as Pulsatilla, Dulc, Stann., Sulph., Ipecac, Seneg., Scilla, Bryon., Sep., Lack., Calc, &c.
INFLAMMATION OT THE PLEURA. 303
At the commencement of the disease there is diminution of motion and respiratory murmur from pain (subsequently these abnormal signs arise from effusion,) and a rubhing sound is not unfrequently heard, generally about the centre of the chest, accompanying the pectoral movements. Soon after the onset of the inflammation, in the greater number of cases, exudation ensues, and, if not encysted, accumulates at the lowest parts of the chest. When^ in such instances, the quantity exuded is considerable, and the lung is not restrained by adhesions, that organ will be floated upwards to some extent, and a dull stroke-sound elicited from the parts beneath it, whilst the upper parts will be found unusually resonant.
As the fluid accumulates and ascends in the chest, the antecedent clearness of stroke-sound becomes impaired, as is more especially obvious on gentle percussion, — the breath-sound diminished, and respiration more impeded. When these latter abnormal symptoms are met with as high as the middle regions of the thorax, the vocal resonance there, and particularly anteriorly, becomes preternatural ly distinct, and is changed to a small, sharp and tremulous note resem- bling the bleating of a goat, and hence termed cegophony; posteriorly the resonance partakes somewhat more of the character of broncho- phony from the greater caliber of the tubes at the root of the lung. (Egophony and all sound of the voice ceases at the affected side of the chest, as the liquid effusion increases, except at those portions where the lung may have been adherent, or at the space within an inch or two of the spine ; percussion now gives an extremely dull sound from the lung being deprived of and rendered impermeable to air by compression, and the respiratory murmur is no longer audible, or only heard in the interscapular and subclavicular regions, parti- cularly the former.
In those cases in which the effusion is very considerable, enlarge- ment of tJie affected side takes place. This enlargement is generally discernible only during expiration at first, but as the exudation increases, the difference can readily be detected during the entire performance of respiration. In attenuated subjects, the intercostal spaces will also be observed to have become prominent instead of presenting their natural depression. But should absorption be effected after such an enlargement, the state of matters is reversed, and the side which was previously enlarged becomes abnormally contracted— the result of atmospheric pressure, and unantagonised muscular action.
304 RESPIRATORY SYSTEM.
Displacement of organs adjoining the seat of the effusion, such as the heart, liver, and mediastinum, is also an occasional result of extensive effusion.
On examining the sound side of the chest, in addition to the negative proofs of the absence of disease, an excess of the usual normal signs will also be perceived, indicated by an accelerated and deeper action, together with a greatly increased degree of respiratory murmur, resembling that of children, and hence denominated puerile.
The signs »of improvement and approaching recovery are marked by a diminution of pain, fever, dyspnoea, and enlargement of the side ; and by a return of the respiratory murmur, together with an increasing clearness of sound on percussion. When the result is fatal, death occasionally supervenes very rapidly from the compression of both lungs ; but in most cases, this event is more gradual, and arises from atrophy of the lungs, as also affections of the heart, with consequent dropsy, caused by the efforts required to propel the blood through the compressed lung.
In all cases of pleurisy the whole of the above-detailed symptoms are not to be deemed constant, or even certain diagnostic signs.
The absence of marked dullness on percussion, is not a conclusive test that effusion has not taken place. The greater or less degree of clearness of tone appears to depend upon the condition of the lung under effusion, and the elasticity of the parietes that cover it. If the quantity of the effusion be very considerable, and the lung deprived of its air by compression, the sound on percussion is neces- sarily almost uniformly dull ; but when the exudation is inconsider- able and the compression is not sufficient to deprive the lung of its air, the stroke- sound will be found to consist more of a tympanitic, and frequently even a louder tone, than that of the normal expanded lung. Subsequently, however, if the pressure be unrestrained, the lung will be deprived of its air, and the part formerly so resonant will then yield a dull sound. The auscultatory phenomena are, in like manner, naturally liable to be materially modified by circum- stances. Much depends on the extent of the exudation, and also on the state of the lung on which it rests. If the lung still contain air, both voice and respiratory sound will be found indistinct or inaudible. If, from the extent of the effusion, or from the long continuance of the disorder, the portion of lung be entirely emptied of air, weak bronchophony and bronchial respiration will be discernible ; but
INFLAMMATION OF THE PLEURA. 305
when the amount of effusion is very great, possibly filling the whole cavity of the pleura, no sound whatever will be heard.* On the other hand, when the quantity effused is inconsiderable, the normal sounds frequently remain unchanged. Again, the physical signs are liable to be further modified by old and close adhesions of the lung to the walls of the chest, resulting from previous disease, which renders the lung adherent to the walls of the chest. The upper lobes are the most subject to these adhesions ; and in such cases the free portion of the lung is pressed upwards by the subjacent effusion, against the superior part of the thorax. And although the lung may yet admit air, still, from the degree of compression to which its vesicular structure is subjected, both breath- and stroke- sound will be bronchial, and loud bronchophony will pervade the upper part of the affected side. The lower part of the chest, from whence the lung has been separated or raised upwards by the effusion, will necessarily emit decided dullness on percussion.
Finally, it may be added that wgopliony, although a frequent phe- nomenon in pleuritis, has no necessary connexion Mdth the presence of liquid in the pleural sac, and is consequently not to be held as an essential link in the chain of evidence for determining the existence of this disease.
The same remarks will, in a great measure, apply to the intercepted vibration of the voice, usually felt by the hand when placed against the chest, — for this, although a very useful and early corroborative indication of the accumulation of fluid in the cavity of the pleura, is yet liable to some exceptions both positive and negative.
The rubbing sound already referred to is an important sign ; is is not so audible at the commencement of the attack, as it is at a later period when the effusion becomes more consistent, and then it is rarely absent.
Pain is, with few exceptions, an invariable concomitant on pleurisy, still if it be unaccompanied by the confirmatory evidence of other important symptoms, it must not be implicitly relied on, as it may arise from a totally different cause than an inflammatory condition of the pleura. But when taken in combination with other signs, its presence and intensity have been found of great use in estimating the amount as well as the quality of the effusion ; for it has been ascertained that the greater the quantity of plastic lymph it contains
* British Journal of Homoeopathy, vol. i, p. 42.
20
306 RESPIRATORY SYSTEM.
the greater will be the pain.# Great rapidity of effusion is also a frequent, though not an infallible source ef extreme pain. The greater or minor degree of dyspnoea depends on the quantity and rapidity of the effusion, as well as on the condition of the lungs ; when both sides of the chest are the seat of the effusion, the op- pression is usually excessive. The fever is in like manner modified by the nature and extent of the exudation, being generally slight, or altogether absent, w7hen the quantity is trivial ; slow, and not unfre- quently intermittent, when more extensive but of a serous character ; and highly inflammatory, when much plastic lymph is contained in the effusion.f
From what has been stated, it will be seen that most of the so- called characteristics of pleurisy cannot, individually considered, be taken as conclusive indications of the existence of that disease. The collective physical signs, however, in the majority of cases, are far from equivocal, and are mainly to be depended on in forming the diagnosis.
Cough is not an accompaniment of simple pleurisy, so that when this symptom is present there is either bronchitic or pneumonic complication, or the case may be one of hemorrhagic pleuritis.
Therapeutics. The chief remedies are Aconitum napellus, Bryonia alba. Sulphur, Belladonna, Mercurius, Arsenicum, Arnica Montana, Hepar sulphuris calcarea, Phosphorus, Zycopodium clavatum, Carlo vege- tabilis et animalis, Cinchona officinalis, Digitalis purpurea, Kali carbonicum, Ipecacuanha, Helleborus niger, Sabadilla, Scilla maritima.
Aconitum — is an indispensable remedy in allaying inflammatory fever when attendant on pleurisy; and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It rarely fails to produce a favorable impression in from six to eight hours ; should it not do so in that space of time, another remedy must be selected. In most instances Bryonia will be the most appro- priate, but we must not hesitate to select Sulphur in preference, if called for, or indeed any other remedy that may seem more strikingly indicated.
R Tinct. Aeon. 3, gtt. vj, Aq. pur. 1 iij. Dose. A few globules every two hours ; or one drop of the tincture to an ounce of water ; a dessert-spoonful every two to six hours.J
* Brit. Homoeop. Journ., vol. i, p. 44. f Ibid.
I Vide Rules for the repetition of the dose in the Introduction.
INFLAMMATION OF THE PLEURA. 307
Bryonia alba should, in general cases, follow Aconitum when the fever has been somewhat allayed by that remedy. It is more particularly indicated, either in simple or complicated pleurisy, when the following symptoms are encountered at an early stage of the disease ; aching, burning, but more especially 'acute shooting or cutting pains in the chest, much increased during inspiration or on movement ; dry cough, or dry sounding cough, followed by expectoration of dirty yellow-coloured mucus, streaked or tinged with blood, and attended with great aggravation of pain ; oppressed and anxious respiration ; pal- pitation of the heart; dry, cracked, brown, ox 'yellow coated tongue ; bitter taste, nausea* and occasionally vomiting of mucus, or of a bitter bilious-looking fluid ; aching or painful pressure at the scrobiculus and hypochondria ; intense thirst, especially at night ; constipation ; head confused and heavy ; giddiness on sitting up in bed ; aching and shooting pains in the head, or pain as if the head would burst, particularly at the temples, with exacerbation on coughing, or mov- ing ; fiery, or blueish redness, and puffiness of the face ; restless, disturbed sleep, frequent startings ; nocturnal delirium, with alterna- tions of comatose sleep ; burning heat of skin ; occasionally, partial, clammy perspiration ; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent, and weak ; aching in the limbs. Lastly, when in connexion with any of the above, the follow- ing symptoms are met with : dullness on percussion, with puerile respiration ; cough on lying on the side, or impossibility of lying otherwise than on the I ach,— Bryonia will rarely fail to render unde- niable service, and can indeed with difficulty be dispensed with. (See the symptoms mentioned under this remedy in the chapter on Pneumonia.)
R Tinct. Bryon. alb.., 3, gtt. vj. Aq. pur. -pij. Dose. A dessert-spoonful every three to six hours.
Sulphur may with advantage follow Bryonia when the pain men- tioned has been removed by that medicine, but the inflammation is not wholly subdued, and often completes the cure. It is also of value when the fever continues after the administration of Aconite, and may be administered without the previous employment of Aconi- tum, when, although the fever is not violent, we have reason to sus- pect recent effusion of plastic lymph. Again, when the affection has already been of some days* duration, and is complicated with pneumonia,
308 RESPIRATORY SYSTEM.
it is our chief stay in preventing solidification, or effecting resolution where that has already commenced, and may therefore generally be selected in preference to Bryonia, in such cases, unless the latter be otherwise strongly indicated, in which event a dose or two of that medicine, previous to the employment of Sulphur, will be found serviceable.
R Tinct. Sulph. 6, gtt. vj. Aq. pur. Siij. Dose, A dessert-spoonful every six hours ; or, in very severe cases, every two hours.
These three are the most important remedies in the greater num- ber of cases of pleuritis, and are frequently found sufficient to effect a speedy cure. There are often occasions, however, in which it will be found necessary to select one or more of the following remedies :
Belladonna, Mercurius, Arnica, Arsenicum, Hepar s., Phosphorus, Carlo v., China, Lycopodium, Digitalis, &c. v
Belladonna has been recommended in cases where the fever returns, and pain and dyspnoea continue notwithstanding the employ- ment of Aconite :
R Tinct. Bellad. 6, gtt. iij., Aq. pur. Jij Dose. A dessert-spoonful every six hours.
Mercurius has been found very useful in cases where the fever has been subdued, but pain and dyspnoea have not been relieved by Aconite, and the patient's strength is becoming exhausted by copiotis nocturnal sweats :
R Merc. v. 6, gtt. iij. Aq. pur. Jij. Dose. Same as Belladonna.
Arnica Montana, — principally when pleuritis has been caused by external injury ; but also in other cases when the more inflam- matory symptoms have been subdued by Aconite, &c. ; and pain in the chest, with oppressed respiration, only remains ; it is also useful to promote absorption when considerable effusion has taken place :
R Tinct. Arn. Mont. 3, gtt. iij. Aq. pur. Jij. Dose. A dessert-spoonful every three or four hours, until the pain begins to yield, and the breathing becomes freer, when the intervals be-
INFLAMMATION OF THE PLEURA. 309
tween the doses must be lengthened, or the medicine discontinued, and only resumed should the improvement proceed tardily ; but if pain re- turn, Aconitum, must again be resorted to, after which, Belladonna is often of great efficacy. In other cases, Bryonia or Sulphur will be seen to be more appropriate, and must be selected accordingly.
Arsenicum is the remedy on which we mainly depend in those serious cases, where serous effusion to a very great extent has taken place, and where the respiration is painfully impeded and asthmatic, attended with extreme prostration of strength.
R Arsenic, alb. 6, gtt. iij. Aq. pur. Jij, Dose. A dessert-spoonful every two hours, until a beneficial effect is produced.
Hepar sulphuris has been particularly recommended when the effusion is plastic, and the disease is of some duration (chronic plastic pleurisy), or where, even at the commencement, there appears — from the pain, fever and dyspnoea, continuing with but slightly diminished severity after Aconite, — every probability that the case will prove extremely obstinate and tenacious. Complication with pericarditis or bronchitis is an additional indication for the employ- ment of Hepar under the above circumstances. {Lachesis, Digitalis, Arsenicum and Belladonna are also deserving of attention when there is pericarditic complication.)
R Pulv. Hep. 3, gr. vj. Dose. As much as will lie on the point of a penknife, every two to six hours, according to circumstances.
Phosphorus. From what has been said of this remedy in Pneumonia, it will readily be conjectured to be useful in cases of complication of pleuritis therewith, as indeed it has repeatedly proved. In complications with bronchitis, and in that form of pleuritis which so frequently shows itself in phthisis pulmonalis, it has further been found of essential service. (Vide Pneumonia and Bronchitis.)
R Tinct. Phosph. 3, gtt. vi. Aq. destil. Jiij. Dose. A dessert-spoonful every three or four hours, or oftener if necessary, until the respiration becomes easier.
Carbo vegetabilis is a good remedy when pleuritis is compli- cated with chronic bronchitis ; or at an advanced stage of the dis- order, when the patient is much emaciated and hectic at night, presenting in short the usual symptoms of threatening purulent
310 RESPIRATORY SYSTEM.
degeneration. It is also peculiarly useful against asthmatic sufferings resulting from an attack of pleurisy, in chronic cases.
Dose. Same as Arsenicum, except in the latter instance, when it must be given at longer intervals.
Cinchona is chiefly useful after severe depletion, to restore the energies of the patient*
Lycopodium will be found serviceable in similar cases to those in which both Arsenicum and Curb, vegetabilis (or animalis) have been found applicable, also where there are considerable dropsical swell- ings and obstinate constipation.
Digitalis has proved useful in many cases of serous pleurisy with slow fever, small weak pulse, accelerated by the slightest move- ment ; and coldness of the extremities, with internal heat.# In conclusion, Kali carbonicum may be instanced as serviceable in pleu- ritis occurring in tuberculous subjects ; and Ipecacuanha as a useful palliative against dyspnoea and convulsive cough in complications with bronchitis. Helleborus niger has been recommended in some cases of serous, and Scilla in plastic pleurisy, but they, as well as Colchicum, Lachesis, and some others which need not be mentioned here, require the test of further experience to corroborate even the little that has been adduced in their favour in the treatment of pleuritis.f
When, either through neglect or otherwise, pleuritis has termi- nated in purulent degeneration, and become chronic, Arsenicum, Carbo, Lycopodium, Hepar s., and Kali carbonicum, are the principal remedies from which the greatest assistance can be obtained where the cure is at all practicable. (See also Hydrothorax.) Pains in the chest arising from adhesions or from thickening of the pleura, after an attack of pleuritis, are often relieved by Ranunculus bulbosus, Miphorb., Mez., Nitr., Thuja, may also be found serviceable. In chronic pleurisy, Sulphur, Sepia, Kali c, Ammon. <?., Lgcopodmm, and Mezereum, may prove useful.
Diet. The same rules are to be observed as in Pneumonia.
* British Journal of Homoeopathy, No. 1, p. 53.
f Rhus toxicodendron has been strongly recommended in serous pleurisy. When low, typhoid symptoms become apparent, this remedy will deserve an additional claim on our attention. Typhoid appearances, and important complications of any kind, a bad habit of body, or indications of a purulent, sanious, or hemorrhagic effusion, are all to be held as unfavorable signs.
PLEURODYNIA. 311
SPURIOUS OR BASTARD PLEURISY.
Pleurodynia, Pseudo-Pleuritis, Pleuritis Muscularis.
By these terms is here meant that painful affection usually referred to the intercostal muscles, which is productive of many of the symp- toms described under true pleurisy, and is consequently liable to be mistaken for that disease, particularly when attended with febrile excitement, as is frequently the case in hysterical females. The history of the commencement of the affection, together with the aid of auscultation and percussion, enables us to draw a correct distinc- tion between the two diseases.
When, therefore, we have satisfied ourselves from the normal condition of the auscultatory phenomena, &c, that the case we have to deal with is one of pseudo-pleurisy, we must select a remedy from amongst the following : Arnica Montana, Bryonia, Nux v., Pulsatilla, Ranunculus hulbosus, Sahaclilla.
In the majority of cases Arnica is the principal remedy, and is occasionally sufficient to effect a speedy cure after a single dose. In other instances, however, the disorder does not yield so readily, and consequently one or more of the other remedies enumerated must be had recourse to.
Bryonia : — When the pain is of an acute darting description, as if from a sharp instrument running into the side, and is at times almost insupportable during inspiration or even the slightest movement of the body, and when the patient is of a nervous or bilious temperament.
Pulsatilla. This remedy is frequently very useful in alterna- tion with Arnica ; it is more particularly indicated when the pain is occasionally of a fugitive character, moving from one part of the chest to another, becoming increased towards evening, and some- tines experienced more during expiration than inspiration. Tem- perament phlegmatic.
Nux vomica. Shooting pains in the hypochondria, increased by the respiratory movements of the chest ; especially when the affection occurs in hypochondriacal subjects, or in those who are addicted to indulgence in vinous or spirituous drinks. Temperament bilious or sanguine.
812 RESPIRATORY SYSTEM.
It is, moreover, one of the best remedies in this complaint ; the characteristic indications are as follows, and show a marked resem- blance to the symptoms which are so frequently met with in, and are in some respects peculiar to pseudo-pleurisy : stitch in the side, or shootings, with painful sensibility of the external parts of the chest, but particularly of the intercostal spaces, aggravated by any movement, and especially by taking a deep inspiration, yawning, or stretching.
Ranunculus bulbosus. The value of this medicine in pains resulting from adhesions of the pleura has already been alluded to. (Vide Pleuritis.)
In acute pains in the chest of every description of a purely nervous character, depending upon an abnormally exalted sensibility of the pleura, this remedy is one of primary importance.
Sabadilla has also been recommended as a useful medicine in pseudo-pleuritis.
Administration of the remedies. In some cases a single dose of one or two globules is sufficient to effect a cure, in others it will be found necessary to repeat the dose every six, twelve, or twenty-four hours, according to the severity of the attack, until relief is obtained,
DIAPHRAGMITIS.
Inflammation confined to the muscular structure of the diaphragm is considered to be of extremely rare occurrence, the disorder in almost every case appearing in combination with inflammation of the pleural or peritoneal covering ; in either of which investing mem- branes, moreover, the disease, for the most part, seems primarily to commence, and only subsequently to extend itself to the connecting cellular tissue and muscular or tendinous substance of the diaphragm. Whether the disease arises in the upper or lower surface or covering, the symptoms are closely analogous. If the inflammation be ex- tensive the pain is extremely violent, spreading from the lower ribs to the dorsal vertebrae, and accompanied with intense fever. The upper part of the abdomen, and particularly the scrobiculus cordis, is usually hot, very sensitive to the touch, and retracted, but often distended, tense, and accompanied with throbbing and deep-seated burning. There is often at first low muttering delirium, but as the fever increases it becomes more violent ; simulating phrenitis, from
DIAPHRAGMITIS. 313
the circumstance, as has been supposed, of the irritation which is communicated to the phrenic nerve.
Owing to the interruption which is caused to the functions of the diaphragm the respiration is always impeded, and a dry, extremely distressing cough is commonly present, especially when the upper or pleural surface of the diaphragm is the principal seat of the inflam- mation.
Along w7ith the foregoing symptoms there is frequently obstructed deglutition, severe hiccup or vomiting, extreme anxiety and restless- ness, twitchings, or spasmodic retractions of the angles of the mouth, (risus sardonicus.) The exacerbations on movement or on attempting to take a deep breath are excessive, and the only position in which the patient experiences any degree of amelioration is when sitting up with the body inclined forwards. The affection may terminate in resolution, or in the effusion of fluid either into the cavity of the pleura or peritoneum, or the patient may speedily sink under the intensity of the fever.
Therapeutics. When the fever runs high and is of the synochal type it is necessary to exhibit Aconitum in repeated doses ; but when the accompanying fever partakes of the character of synochus, Bryonia is to be preferred, and may, in most cases of the said description, be prescribed at the very commencement of the attack. If the scro- biculus and the region of the false or lower ribs be swollen, and pressure increase the short and distressingly interrupted breathing, as also the pulsating burning pain, which extends from the stated points backwards towards the spine ; moreover when there is a dry, fatiguing cough, or violent vomiting and convulsions, great agitation and constant moaning, — Chamomitta is the best remedy. But should there be great tightness, as if caused by the constriction of a cord drawn around the chest, with dry, short cough, anxiety, and consti- pation,— Nux vomica is the most appropriate remedial agent. Cannabis, Pulsatilla, CoccuUis have been recommended as being useful where the symptoms of inflammation continue to occupy a prominent place ; and Hyoscyamus, Veratrum album, Arsenicum, Stramonium, and Ipe- cacuanha where a nervous condition predominates.
When diaphragmitis exists in connexion with pleuritis Bryonia is one of the most important remedies ; as also when it is symptomatic of pneumonia, peritonitis, splenitis, and hepatitis, particularly when the pains are aggravated by the slightest movement and are attended
314 INSPIRATORY SYSTEM.
with violent fever, small, quick, hard pulse, delirium, extreme agita- tion, cough.
Nux v. is equally useful when the disease occurs as symptomatic of the above-named disorders, provided the symptoms encountered are analogous to those we have given as characteristic indications for its selection. (See also Pjleuritis, Pneumonia, Peritonitis, Splenitis, and Hepatitis.) Diaphragmitis arising from antecedent gout or rheumatism, is the most dangerous and fatal form in which the affection is met. The remedies chiefly to be relied on under such serious circumstances are the same as the foregoing.
spitting of blood, hemorrhage from the lungs*
Sputum Oruentum. Hmmorrhagia Fulmonum. Hcemojotysis*
Diagnosis. Expectoration of blood by coughing, in greater or less quantity, attended by symptoms more or less severe.
This disease displays itself in three varieties : first, by an effusion of blood from the mucous lining of the bronchial tubes; secondly, by congestion of the lungs, with engorgement of the parenchyma from effusions ; and thirdly, by the rupture of a blood-vessel in the tubercular qavity of the lungs, during the course of phthisis pulmo- nalis. It is, however, proposed to deal generally with the subject, and to point out the different remedies found useful in the treatment, according to the symptoms present. We must be careful not to confound this disease with affections of the mouth or gums, or the occurrence of blood from the nose escaping through the posterior nares, and being returned by the mouth. When the blood proceeds from the chest, it is almost invariably attended with a sensation as if it came from a deep-seated source, is warm, generally tastes sweet, and there is frequently a simultaneous burning and painful sensation in the thorax.
When the attack is preceded by well-known premonitory symp- toms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing wind instruments, violent exercise of the arms, running,' ascending stairs, or, in short, anything calculated to increase the respiratory action, or otherwise fatigue the chest.
When spitting of blood occurs in a robust and healthy person of sound constitution, it is not very dangerous, but when it attacks
SPITTING OF BLOOD. 315
slender and delicate persons of weak lax fibre, it is more serious and delicate of removal. It is, however, chiefly when the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, that the case may be considered dangerous;
The disease may present itself without any marked pains or diffi- culty of breathing, and pass off with no return of the attack ; or be preceded by dry cough, oppression, or tightness at the chest, shiver- ing, coldness of the extremities, great lassitude, and high pulse, — and be accompanied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance, — cease, and then return in a few hours, and be followed by difficulty of respiration and cough ; in still more serious cases, when a marked tendency to phthisis exists, anxiety, oppression at the chest and febrile symptoms are more severe, pure blood is coughed up, and the paroxysms fre- quently return. The rupture of a blood-vessel is a rare occurrence, although it sometimes occurs in phthisis. When, however, a blood vessel of any consequence, included in a tuberculous excavation, does give way, the result is generally fatal.
Causes. Indulgence in spirituous beverages, overheating the body by immoderate exertion, or too great external heat; blowing wind instruments ; contusion of the chest or back ; falls ; lesion of the lungs ; breathing a vitiated atmospnere, or vapours charged with acrid substances; colds or coughs ; violent mental emotions; diseased state of the lungs, whether from pneumonia or phthisis ; a general strumous habit ; suppressed menstrual, hemorrhoidal, or other dis- charges ; or repercussed cutaneous eruptions.
Therapeutics. In by far the greater number of cases, the dis- charge or spitting of blood soon ceases of its own accord ; the most important object, therefore, is to seek to cure the complaint when the hemorrhage has ceased, and thereby prevent its return, or check the development of organic disease of the lungs. The principal homoeo- pathic remedies are : Pulsatilla, Nuos vomica, Bryonia, Sulphur, Arnica montana, Aconitmn, Ipecacuanha, Acidum sulphur icum, Arsenicum, Opium, Cinchona, Carlo, Ferrum metallicum, Mhus, Phosphorus and Sepia, These are not only calculated to arrest the hemorrhage, but also to prevent a relapse, where that is practicable.
Pulsatilla : — In cases of females, arising from suppression of the monthly discharge, or, in either sex, of a hemorrhoidal flux,
316 RESPIRATORY SYSTEM.
(particularly when the individual is of leucophlegmatic tempera- ment^) and also in other instances, with the following symptoms : expectoration of dark coagulated blood, attended with shivering, especially towards evening, or at night, and great anxiety ; pain in the lower part of the chest ; feeling of flaccidity in the epigastrium, and weakness. (Hamoptysis vicaria.)
When, in females, the menses do not return, notwithstanding the employment of Pulsatilla, — Cocculus, Sepia, Sulphur, or any other remedy better adapted to the entire case, should be selected. (Vide Chlorosis, Amenorrhea, or Catamenia, Suppression of.)
Bryonia is a good remedy in cases where the expectorated blood is excited by a tickling cough, and is often in a coagulated state ; and where there is oppression at the chest, with frequent necessity to take a deep inspiration ; anxiety and irascibility.
Nux vomica is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. (Haemoptysis vicaria.) It is further indicated by dry cough, which causes headache, with excessive tickling in the chest and exacerbation of the symptoms towards morning.
When Nux v. does not afford speedy relief, Sulphur will generally be found to succeed; but should any other remedy appear to be more appropriate, it should unhesitatingly be selected in preference.
Rhus : — When the blood expectorated is of a bright red, the mind much agitated, and the patient irritable and rendered worse after the slightest vexation or contradiction.
Arnica Montana : — Principally in cases arising from external lesion, such as a severe blow in the chest, or from lifting a heavy weight, or any other exertion, even blowing wind instruments ; but also in almost all cases, where the stethoscope detects effusion of blood into the parenchyma, attended with a sensation of constriction and burning in the chest, pain as from contusion in the scapular and dorsal regions, and dyspnoea. Moreover, profuse .expectoration of dark-coloured blood or coagula, brought up without much exertion, or bright frothy blood, mixed with mucus and clots; sensation of tickling behind the sternum ; general heat, great weakness and syncope. (Aconite is sometimes necessary before, or alternately with Arnica, &c.)
Acidum sulphuricum is frequently of service after Arnica when the cough continues, and brings on fresh bleeding.
SPITTING OF BLOOD. 317
In severe cases attended with manifest danger: Aconitum, Ipecacuanha, Arsenicum, Opium, Cinchona, and Kreosotum are the most useful, and must as usual be selected according to the prevailing symptoms. When one of these is insufficient to check the hemorrhage entirely, another must be chosen to meet the remaining symptoms.
Aconitum is often found exceedingly serviceable in warding off an attack, by the great power it possesses in controlling the cir- culation, and is indicated, previous to the paroxysm, by the premo- nitory symptoms of shivering, with accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burn- ing and fulness in the same region ; paleness and expression of anxiety in the face ; great anguish and anxiety, aggravated by lying down ; or during the attach when the expectoration is profuse, coming on in gushes, and excited by a slight dry cough. {Hemoptysis plethorica.)
Ipecacuanha: — When a taste of blood remains in the mouth a few hours after the employment of Aconite has been commenced, when there is frequent tussiculation, with nausea, weakness, and expectoration streaked with blood.
Arsenicum: — When the anxiety, anguish, and palpitation of the heart increases, notwithstanding the administration of Aconite ; and when, in addition, we find extreme restlessness and general dry burning heat.
The employment of this remedy alternately with Ipecacuanha has been found to succeed in many instances, when neither of them separately have been found sufficient to conquer the disease ; an occasional dose of Nux vomica should be prescribed as soon as the hemorrhage has in a great measure been checked, to such indi- viduals as have been in the habit of indulging in spirituous, vinous, or fermented liquors, or coffee. Should hemorrhage return after a temporary cessation, Sulphur may be given, followed in turn, if required, by Arnica.
Opium : — Heat, dyspnoea, with sensation of burning heat at the region of the heart; coldness, particularly of the extremities; tremor in the arms ; dry hollow cough, with expectoration of blood and frothy mucus, and sometimes also weakness of the voice; drowsiness, with sudden starts ; aggravation of cough after swallowing. It will be found useful in the most serious cases, particularly to persons addicted to spirituous liquors ; in the latter case it may be useful to follow up the treatment with Nux vomica.
318 RESPIRATORY SYSTEM.
Cinchona, as already mentioned in several places in this work, is one of our best remedies in restoring the vital energies of the patient after considerable loss of fluids, whether of blood or other secretions ; it is therefore particularly efficacious after a severe* attack of this affection, but is also indicated during its' course, when the spitting of blood takes place after a violent cough, or when there is a continual taste of blood in the mouth, or when we find shivering alter- nately with accesses of heat, frequent and short-lived perspirations ; tremor, and confusion of vision, with a sensation of vacuity or light- ness in the head, weakness and desire to remain constantly recumbent.
Ferrum metallicum, may be used with advantage after Cinchona in severe cases, or may be preferred if the expectoration follows a slight cough, and is scanty, but consists of pure bright red blood, attended with pain between the scapulae, with inability to remain long in a sitting posture : the patient feels the concomitant symp- toms relieved by movement, but is speedily fatigued, especially by conversation. It may, in some cases, be advantageously alternated with Cinchona, Carlo v., Arnica and Arsenicum? — in others Sulphur may be required to complete the cure in some cases.
Sulphur. This remedy is frequently useful in winding up the treatment after the employment of other medicines ; and it is also particularly suitable for individuals disposed to hemorrhoidal affec- tions, in derangement of the menstrual flux, or hemoptysis arising from suppressed cutaneous eruptions, such as scabies, &c. {Hemo- ptysis vicaria, &c.) Nux v. and Arsenicum may occasionally be advan- tageously given in alternation with Sulphur at intervals of five to ten days, particularly when the disease occurs in drunkards.
Kreosotum has been found of great efficacy in cases where the patient has had a succession of severe attacks, and the blood is thrown off in large quantities ; also when the patient complains of w feeling of burning heat in the chest, or a pain as if from a bruise, together with oppression in the chest and frequent desire to take a deep inspiration.
x\fter hemoptysis has disappeared (besides having to guard against a relapse, in which, as above stated, Sulphur is our chief auxiliary), we have to take every precaution lest inflammation arise in the part primarily affected, or the disease degenerate into Phthisis, which objects will sometimes be best attained by the administration of Phosphorus, in combination with a strict observance of an antiphlo- gistic regimen, and the other rules about to be given for the conduct of patients suffering from this affection.
CONSUMPTION. 319
Pkosjohorus, it may be added, is, in conjunction with Aconitum, one of our chief remedies in hemorrhages from the lungs -during the course of phthisis.
Sepia is also useful in this affection occurring in Phthisis, but when it is rather to be looked upon as one of the general symptoms, than as forming a disease of itself; by its powrer over the economy of the uterus, it is also of great service in cases of hemoptysis, arising from derangements connected with that organ. (Hemoptysis phthisica et vicaria.)
The following remedies may also be noted as worthy the atttention of the practitioner in peculiar cases: Kreosotum, Belladonna, Acid, nitricum, Bryonia, Carlo vegetahilis, Hyoscyamus, Ignatia, Dulcamara, Cocculus, Crocus, Conium macttlatum, Lachesis, Acidum sulphuricum, Ledum palustre, Bycopodium, Millefolium, Silicea, Staphysagria, and Cuprum metallicum, Sec.
Diet, &c. The rules given under H^ematemesis ought to be observed as regards regimen ; both mind and body should be kept perfectly quiet ; the patient should speak as little as possible, and be kept in a semi-recumbent posture, or, if his strength allow, sit upright.
PULMONARY CONSUMPTION.
Phthisis Pulmonalis.
One of the earliest symptoms of tuberculous phthisis is a short cough, which is. either dry or accompanied by the expectoration of a frothy mucus, and is generally slight at the commencement, but more or less constant. Shortness of breath, proceeding from ob- struction, caused by the granular and diffused indurations, is another early symptom of consumption. It is, at first, experienced only during exertion, but subsequently comes on after every fit of coughing, or on lying on the one or the other side, and is much increased by the slightest movement. Symptoms of gastric derangement are frequently present, with redness of the tongue, or white furred centre, with inflamed and projecting papillae, and vivid red tip and margins ; the patient falls off in flesh, becomes indolent, dejected, and over- powered with languor. A feeling of soreness is often complained of behind the sternum, or under the clavicles, particularly after any fatigue, or after a fit of coughing, and sometimes on exposure to
320 RESPIRATORY SYSTEM.
cold air. The pulse is often normal in the first stage of the disease, but soon becomes full, hard, and accelerated. Fever of an intermittent character soon makes its appearance ; it declares itself most towards night, remits from about two in the morning until the following day at noon, when it returns in a slighter degree, and continues until about five in the afternoon, and is then followed by another remission. This hectic fever is, in the first instance, chiefly manifested by flush- ing of the face (which is often most apparent after a meal), and heat in the palms of the hands and soles of the feet ; but, as the disease advances, night sweats supervene, which leave the patient in a state of great exhaustion in the morning. As the expectoration increases it becomes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in conse- quence of the obstruction offered to the blood-vessels, by the indura- tions or granulations already alluded to. As the disease advances and passes into the second stage, or that in which the dark red or grayish indurations are converted into crude yellow tubercles, the respiration becomes more difficult, the emaciation and debility go on increasing, the cough is rendered more severe and troublesome, par- ticularly at night, and the fever, though of shorter duration, is attended with more profuse sweating, and the pulse loses tone. The expectoration becomes, at the same time, more free and copious, particularly towards morning, and is less thin and transparent.
During the febrile exacerbations, or after meals, or at times of excitement, a circumscribed red patch still appears on each cheek, but at other times the colour of the cheek is faded, and the counte- nance wears a dejected expression.
In the third (or suppurative and ulcerative) stage of the disorder the tubercles become soft, and are expectorated at first in the form of curd or cheese-like particles, and subsequently mixed up with pus, mucus, shreds of lymph, blood, and occasionally, though rarely, portions of pulmonary tissue. The bowels, from having been more inclined to be costive at the commencement of the disease, are now more prone to be relaxed, so that attacks of diarrhoea often recur frequently, and, by alternating with colliquative sweats, induce an excessive degree of weakness and prostration. In this, the last stage of the disease, the patient becomes reduced to a skeleton ; the face is thinned, the cheek-bones prominent, the eyes look hollow, the hair falls off, the nails are livid and incurvated, and the feet eedematous ; but, notwithstanding all this, the countenance presents a degree of clear-
CONSUMPTION. 321
ness, and the eyes a lustre that are rarely, if ever, met with in other maladies, moreover, the state of mind is generally so serene and hopeful, that the patient seems often quite unconscious of his dangerous condition, and speaks and acts as if in full anticipation of a speedy recovery. The senses commonly remain entire and collected to the end of the disorder, but in some cases delirium precedes death and continues until life is extinct. The usual duration of phthisis pul- monalis is from eight or nine months to a year and a half; but circumstances tend much to vary the length of the disease ; and there is a rapidly fatal form which runs its course in from two to three months, sometimes indeed only in one. When the malady makes slow progress, the patient is affected with cough, weakness, and emaciation chiefly in winter and spring, and in many respects restored to comparative health in summer ; but is always extremely susceptible to cold, and commonly complains of breathlessness on the slightest exertion. In this state the patient continues for a considerable time, sometimes even for several years, until at length the symptoms of confirmed consumption are developed by the invasion of an inflam- matory attack proceeding from cold or some other irritating cause.*
When we take the general symptoms in conjunction with the physical signs, the diagnosis of phthisis pulmonalis is, in general, unattended with difficulty. It is true that in the early stage, when the miliary indurations are equally diffused or scattered through both lungs, they do not give rise to any marked diminution or change in the respiratory murmur, or in the resonance of the thorax on percussion. But it much more frequently happens that the indura- tions, even in the early stage, accumulate in clusters, particularly about the apices of the lungs, and usually more on one side than the other. The sound, on percussion, will therefore generally be found dull at the clavicle (more commonly the left) and the subclavicular region; the breath-sound during expiration will, at the same time, be unusually audible, and the voice will transmit a diffused resonance or preternatural clearness.
When the spaces immediately beneath the clavicles give no signs of disease or discrepancy of sound, the regions below, at the sides, and at the back should be examined (between the scapulas in the case
* Hoarseness is often an early accompanying symptom of phthisis. Laryngeal phthisis, with thickening and ulceration of the lining membrane of the larynx, independently of its own serious character as a disease, is moreover very frequently complicated with tubercular formations in the lungs.
21
322 RESPIRATORY SYSTEM.
of children in particular). A slight flattening is sometimes observable under the clavicles. On comparing the movements of the two sides of the chest, when the patient breathes deeply, a difference in their individual mobility will frequently be perceived. When the disease has attained the suppurative stage, and the tubercles have consequently become soft, or entirely liquid, a clicking or bubbling sound will be heard either under one of the clavicles or above the spine of one, of the scapulae. As the evacuation of the softened matter of the vomica progresses, a more continued gurgling, or the so-called cavernous rhonclms, will then be heard. Again, when the vomica or abscess has become completely softened and evacuated by ulceration into the bronchial tubes, a cavity is left, over the seat of which, cavernous respiration and, when the patient speaks, the phenomenon designated pectoriloquy are encountered.
Therapeutics. It would require a separate treatise to do justice to the treatment of this deplorable disease, by giving or attempting to give a full and minute description of the characteristic indications for the medicines which are appropriate to the various forms of the different stages of the disorder. We must therefore content our- selves here, by presenting our readers with a brief notice of the principal remedies which are employed in homoeopathic practice against the inflammatory, suppurative, and ulcerative stage of tuber- cular consumption.
In \he first stage of the malady, when the tubercles are in a crude, unsoftened state, or when they are inflamed and commencing to soften, the remedies by means of which the malady may be retarded, if not arrested, and, with due collateral precautions, kept harmless for years, are chiefly Aconitum, Bryonia, Belladonna, Lachesis, Hepar, Spongia, Phosphorus, Dulcamara, Pulsatilla, Arsenicum, Nux v., Hyo- scyamus, Silicea, Calcarea c, Carlo v., Acidum nitricum, and Sulphur. These must be selected according to the aggregate symptoms of the case under treatment. Their leading indications may be gleaned from the chapters on Cough, Pleuritis, Pneumonia, and Hemoptysis.
In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are : Acidum nitricum, Silicea, Kali c, Sulphur, Calcarea, Natrum m., Mercurius, Lachesis, Phosphorus, Lycopodium, Carlo v., Samlucus, Hepar sulphuris, Spongia, Cinchona, Ferrum, Conium, Zincum, Ammon. c, Laurocerasus, Graphites, Nitntm, Iodium, Drosera, Plumlum, etc.
CONSUMPTION. 323
In the third, or ulcerative stage, the same remedies as the fore- going, together with Guaiacum, Sepia, Stannum, Stapliysagria, Acidum pliosphoncum, Sangninaria canadensis, are those by means of which the symptoms may be materially mitigated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in the chapter on Cough. When the colliquative sweats are peculiarly distressing, " Sambucus, Stannum, Cinchona, Phosphorus, Arsenicum, Carlo v. et a., Silicea, Mercurius, Nitrum, Lachesis, Sulphur, and Lycopodium are the medicines which are of the greatest service. The remaining morbid symptoms must regulate their selection. When col- liquative diarrhoea predominates : China, Ferrum, Arsenicum, Phosphorus, Acid. phosphoricum, and Sepia are the most useful. (See Diarrhoea.)
In phthisis resulting from imperfectly treated pulmonic inflammation, or from excessive pulmonary hemorrhage, and occurring in habits which are not of the consumptive diathesis, the remedies which are best calculated, under favorable circumstances, to effect a cure are : Lachesis, Lycopodium, Sulphur, Mercurius, and Ledum. But, in some cases, one or more of the other medicaments noticed under tubercular consumption, may be better indicated. (See also Pneumonia.)
In pittcitous phthisis, or blenorrhcea of the lungs, the most effective medicines are Stannum, Dulcamara, Pulsatilla, Sulphur, Sepia; and Calcarea, Lycopodium, Cinchona, Phosphorus, Silicea, Arsenicum, Zincum,. Capaiva, &c.
While conducting the treatment of consumption the state of the digestive functions, and in females the condition of the uterine system likewise, must be strictly attended to. This is, however, a superfluous precaution to the homoeopathic practitioner, as he is ever careful to pay due regard to every symptom not only in this, but in every other disease. Should none of the remedies above quoted correspond to the derangements alluded to in particular cases, although they may be otherwise indicated, an intercurrent remedy may be selected from amongst those we have mentioned in the articles on Dyspepsia, Chlorosis, &c. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies.
In conclusion, it must be remarked that as the irritation which is so repeatedly created in the lungs by the vicissitudes of climate^ so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means be
324 RESPIRATORY SYSTEM.
taken to avoid that pernicious influence. It has been much in vogue with man)'' medical men to recommend warm climates, or well-sheltered situations, even, although the atmosphere might be of a humid and relaxing nature. But we confess that wre are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry and not of very variable tem- perature. Much, however, depends upon the peculiarity of the case, —the air, as well as the food, which may be well adapted to one patient, being often perfectly inappropriate and therefore injurious to another.
ASTHMA.
This affection is characterised by the following phenomena : dif- ficulty of breathing, recurring in paroxysms, attended with a sensa- tion of suffocating constriction in the chest, cough, and wheezing. The paroxysm is frequently preceded by a sense of coldness, languor, headache, heaviness over the eyes, sickness or flatulence, and a sense of oppression in the chest. During the attack, the patient feels much wrorse in the recumbent posture, and consequently sits up, requests the door or window to be thrown open, to admit more air into his apartment, and uses every effort to dilate and empty the lungs. He also experiences great restlessness, making frequent attempts to force something out of the air-passages, which he thinks impedes the breathing, by coughing. The face is pale or livid, and wears an anxious expression. The extremities, and even the nose and ears, are frequently cold, and the face and chest are covered with cold perspiration ; the heart palpitates ; the pulse is variable, being quick and full, or small and quick, or weak and irregular ; often inter- mitting. These symptoms continue with a greater or less degree of violence for some hours or even days, until expectoration takes place, which affords relief as it increases in quantity. A remission also sometimes takes place soon after an accession of copious perspiration or a profuse discharge of urine. The disease is more frequently met with at an advanced than an early stage of life, and oftener in men than women. The attacks occasionally come on in the afternoon, or on retiring to rest, but much more frequently during the night, and in the midst of a sound sleep, from which the patient is suddenly awoke by a sense of suffocation.
The recurrence, as well as the duration, of the attacks is very
ASTHMA. 325
various. One attack generally leads to another, and the paroxysms commonly become more and more frequent and distressing ; still if no organic disease result, patients who are subject to returns in con- siderable frequency, sometimes survive to an advanced age. But this is unfortunately not often the case, for unless the disease be arrested, the repeated obstruction and disturbance which is offered to the respiration and circulation seldom fails, in the majority of cases, to induce organic lesions either of the heart or large vessels, or of the lungs, with the usual concomitants of water in the chest or abdomen. The quantity of expectoration is small, and even entirely absent in some cases of asthma, whilst in others it is excedingly copious; and hence, the disease has been divided into dry and humid asthma. In the former {Asthma siccum), the attack is usually sudden, violent, and of short duration ; the cough slight ; the expectoration scanty, appearing only towards the termination of the fit, and in some instances entirely wanting. In the latter [Asthma Immidum), the paroxysm is gradual and protracted ; the cough severe ; the expectoration supervenes early, is at first scanty and glutinous, and afterwards copious, and productive of great relief.
Therapeutics. In nervous or convulsive asthma [Asthma siccum), the remedies which have been employed with the most satisfactory results are : Arsenicum, Cuprum, Ipecacuanha. — Nux v., Bryonia, Pulsatilla. — Opium, Tartarus, Sambucus. — Aconitum, Belladonna, Phosphorus. — Sulphur, Lachesis, Sambucus, — Ferrum, Veratrum, Moschis, Stannum, Hyoscyamus, Stramonmm, Chamomilla, Carlo v., Aurum, Lyco- podium, Acidum nitr., Ignatia, Kali, Ambra,' Mercurius, Silicea, Calcarea, Dulcamara, Coffea, Lobelia infiatai &c. In moist, humid, pituitous asthma [asthma humidum) : Pulsatilla, Dulcamara, Stannum. — StilpJmr, Sepia, Tartarus, Cuprum, Sambucus —Ipecacuanha, Belladonna, Bryonia. — Ferrum, Calcarea, Lachesis, Graphites, China, Silicea, Hepar, Baryta c, Conium, Camphor a, Zincum, Mercurius. In flatulent asthma : Nux v., Cinchona, Carbo v., Lycopodium, Chamomilla, Phosphorus, Sulphur, Opmm, Zincum, &c. In spasmodic asthma, pulmonary spasm [cramps in the chest) ; Cuprum, Nux v., Bryonia, Belladonna, Hyoscyamus, Arsenicum, Lachesis, Stramonium, Cocculus, Nux m., Sambucus, Tartarus, Zincum, Sulphur, Kali, Causticttm, Sepia, Stannum, Lycopodium, &c. Asthma arising from exposure to irritating vapours, such as copper or arsenic [asthma vapor osum) : Ipecacuanha, Mercurius, Hepar s. — Camphor a, Cuprum, or Arsenicum. From the vapour of sulphur; Pulsatilla
326 RESPIRATORY SYSTEM.
chiefly ; and when caused by the continued inhalation of stone-dust, and other irritating particles : Sulphur, Calcarea, Silicea, Hepar, have principally been recommended, and in some cases, also, the follow- ing : Arsenicum, Belladonna, Nux v., Phosphorus, Ipecacuanha, and Cinchona. Where the repercussion or retropulsion of an eruption, or the suppression of an habitual discharge has been the occasional cause [asthma metastaticum) : Sulphur, Carho v., Arsenicum, Bryonia, and Phosphorus are the most appropriate remedies in the majority of cases. If the affection is attributable to suppressed catarrh: Arsenicum, Ipecacuanha, Nux v., &c. Where a chill has given rise to an attack of asthmatical breathing : Ipecacuanha and Arsenicum ; or, Dulcamara, Aconitum, Belladonna, Bryonia, Chamomilla, And when mental dis- turbance has brought on a paroxysm of dyspnoea : Aconitum-, Chamo- milla, Ignatia, Coffea, Nux v., Pulsatilla, Veratrum. When congestion of blood in the chest forms the occasional cause of dyspnoea, see that article. When the disorder occurs as a sequela of bronchitis, see Bronchitis.
The remedies which are best calculated to afford relief during a paroxysm of asthma are, Ipecacuanha, followed, if it produces but little benefit, by Arsenicum. In other cases Cuprum, Moschus, Opium, Tartarus and Sambucus ; or, Nux v., Bryonia, Chamomilla, Belladonna , Cinchona, Nux moschata, or Pulsatilla will prove more useful. And those which have principally been recommended to eradicate the tendency to suffer from continual recurrences of the disorder, — where that is practicable from the absence of serious organic disease, &c. — are as follows : Sulphur, Calcarea, Arsenicum, Nux v., Antimonium, — Stannum, Sepia, Silicea, Cuprum, Lachesis, Carho v., — Bycopodium, Causticum, Graphites, Acidum nitricum, Phosphorus, Ammonium c, Ferrum, Zincum, Tussilago. In ordinary cases the subjoined remedies wrill be found serviceable, when the leading symptoms are in accord- ance with those which are described.
Ipecacuanha. During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in children or adults. It is more especially indicated when the patient is awoke from a sound sleep, with a suffocating sensation of constriction in the windpipe, with quick laborious breathing and gasping for breath : wheezing and mucous rattling in the chest ; short dry cough ; paleness and coldness of the face, sometimes alter- nately with heat and redness: coldness of the feet ; anxiety and dread of suffocation; feeling as if dust were inhaled during the act
ASTHMA. 327
of respiration, and caused the suffocating sensation in the chest ; spasmodic rigidity of the body, and livid hue of the face. After a dose or two of Ipecac, it is occasionally requisite to have recourse to Arsenicum to afford further relief. In other instances Nux v. or Bryonia will be found better adapted to remove the remaining symptoms.
Arsenic um, is chiefly called for (either in acute or chronic asthma), when, during the attack, the respiration appears to become more and more laborious, and is attended with extreme agitation, moaning, and jactitation ; great exhaustion and anguish, as if at the point of death, %vith cold perspiration. In confirmed asthmatics, it forms a most important remedy, when the breathing is liable to become much oppressed when walking rather quickly, or when going up a hill, or ascending stairs ; and when, particularly in the case of old people, even the effort of laughing, or the exertion of getting into bed brings on a fit of dyspnoea. Arsenicum, as well as Ipecacuanha, is further indicated when the paroxysms of asthma are most liable to occur on retiring to rest, or before midnight, the patient being dis- turbed from sleep by a sense of spasmodic constriction in the chest and larynx, which is soon followed by laborious, panting, and whistling respiration with gasping for breath. These symptoms are occasion- ally relieved by remissions, but the attack is prone to recur on using the slightest exertion : for the most part, however, the paroxysm continues with more or less intensity until relieved by the accession of a fit of coughing, with expectoration of viscid mucus filled with vesicles. Arsenicum, though principally called for in cases in which the attacks come on at night, is also useful when they are liable to be excited during the day, on exposure to a cold bracing air, or on going out during the prevalence of disagreeable, damp, or stormy weather. Likewise when changes of temperature, or tight and very warm clothing are frequent sources of fits of dyspnoea. Sensation of burning heat in the chest during the fit of asthma, as an additional indication fox Arsenicum. {Acid, hydrocy. or Kali hydro, may some- times be had recourse to with decided advantage when Arsenicum fails to give much relief.)
Bryonia. This medicine, as already mentioned, is frequently useful after the previous employment of Ipecacuanha. The indications are chiefly : obstructed respiration at night or towards morning, with frequent cough, pains in the hypochondria, and inability to recline on the right side, and not without inconvenience on the left, so that
328 RESPIRATORY SYSTEM.
the patient is constrained to lie on the back ; frequent coughing, with expectoration at first frothy, and subsequently thick and glu- tinous,, and frequently attended with retching or vomiting ; aggra- vation of the dyspnoea from talking, or from the slightest movement ; frequent efforts to obtain sufficient air by deep inspirations, accom- panied with moaning, palpitation of the heart, and great anxiety. The attacks are often attended by shootings in the chest on taking a full inspiration, also on coughing, or after any movement of the arms or trunk. At other times there is colic, eructations of the taste of the food partaken of, irritability of temper, and disposition to find fault with everything. [Bryonia and Mix v. are often administered with great advantage in alternation.)
Nux vomica : — Nocturnal attacks of suffocating tightness, especially at the lower part of the chest, preceded by disagreeable or anxious dreams ; also when the paroxysms are prone to occur in the morning or after a meal, and are attended with anxiety, aching and pressive pains in the precordial region, as also in the hypochondria ; feeling of distension in the abdomen and epigastrium ; flatulence ; tension, pres- sure, and aching in the chest ; palpitation of the heart ; short hacking cough, with difficult expectoration ; inability to bear the slightest pressure from the clothing, particularly around the chest and waist ; the clothes seem to fit tightly and increase the difficulty of breathing, whilst in reality they are quite the reverse ; dyspnoea when walking and conversing in the open air, especially if the temperature be somewhat cold ; dyspnoea after trivial corporeal exertion of any kind. Meliora- tion of the asthmatic sufferings when reclining on the back, or on changing from one posture to another, such as sitting up, and then lying down again, or turning from one side to the other. Disposition irritable and passionate.
Pulsatilla: — Oppressed, rapid, and laborious breathing from a feeling of spasmodic constriction in the chest, especially at the inferior portions; or suffocating feeling in the windpipe as if caused by the vapour of sulphur : tension, and sensation of fulness, pressure and aching, attended with mucous rattling in the chest ; short fits of coughing in rapid succession, and appearing to 'threaten suffocation ; or cough with copious expectoration of mucus. The attacks usually coming on at night, or in the evening when in a horizontal posture ; extreme anguish, palpitation of the heart, and sometimes lancinating pains in the chest during the paroxysms.
Pulsatilla, is generally more suitable for hysterical females, or indi-
ASTHMA. 329
viduals of a mild, timid, sensitive, or fretful disposition. In dys- pnoea, with mucous rattling, and cough, occurring in children from taking cold, it is likewise a most useful remedy.
Tartarus emetic us : — Dyspnoea with suffocating cough and anxious oppression at the precordia, arising from an excessive secretion of mucus in the bronchi; this remedy is frequently of great service, either in aged persons or in children.
Opium : — Obstructed breathing, either from congestion or from pul- monary spasms, with suffocating cough and livid hue of the face ; loud mucous rattling in the chest, with extreme anguish from dread of suffocation; dyspnoea during sleep resembling nightmare (incubus).
China; — Paroxysms of asthma at night, as if caused by an ac- cumulation of mucus in the windpipe : wheezing in the chest during inspiration; difficult expectoration of thick transparent mucus; op- pression at the chest, palpitation of the heart, and inability to breathe, unless the head and shoulders are propped up with pillows ; great weakness, and tendency to copious sweating at the slightest exertion, or when too warmly clothed.
Sambucus : — Rapid and laborious respiration with loud wheezing ; oppression at the chest as if from a weight, attended with anguish and dread of suffocation, and sometimes swelling and livid hue of the face and hands, general heat, tremor, inability to talk much above a whisper ; suffocating cough ; aggravation of the symptoms in the recumbent posture. In the case of children this remedy is often of great service, when, in consequence of a chill, they are seized with spasm in the chest, and awake from sleep with a start, and exhibit many of the symptoms detailed. (See Spasms in the Chest.)
Moschus : — Acute asthma occurring in hysterical females, or in children from exposure to cold ; sense of spasmodic constriction in the larynx and bronchi ; or oppression at the chest with paroxysms of suffo- cating feelings, as if caused by the inhalation of the vapour of sulphur, commencing with a fit of coughing and succeeded by distressing op- pressive constriction, sometimes to such a degree as almost to drive the patient to exasperation and distraction.
Belladonna :- — Difficulty of breathing, particularly when occur- ring in females of an irritable habit, and subject to spasms, with tension in the chest, and lancinating pain behind the sternum ; dry cough at night, with, moaning respiration, which is sometimes deep and full, and at others short and rapid, with gasping for breath and great efforts to dilate the chest to the utmost to obtain a sufficient supply of air ;
330 RESPIRATORY SYSTEM.
sensation of constriction in the larynx, and feeling as if suffocation would ensue on putting the hand to the larynx, or on turning the neck ; paroxysms of asthma, with loss of consciousness, &c.
Laches is is often useful when only partial relief has been effected by the action of Belladonna.
VeratruMo In violent attacks of acute spasmodic asthma, with symptoms of threatening suffocation, cold perspiration, coldness of the nose, ears, and lower extremities, this remedy will often afford relief when Cinchona, Ipecacuanha, and Arsenicum have failed to do so.
Dulcamara. In moist asthma [Asthma humidum) this medicine is one of the most useful remedies, particularly when the attacks are liable to be excited by a cold and damp state of the atmosphere. In severe dyspnoea, with loose sounding cough, rattling of phlegm in the chest, and copious expectoration, arising from exposure to wet, it is likewise a valuable remedy.
Stannum : — Humid asthma, with wheezing and obstructed respira- tion, particularly at night, or on preparing for bed ; but also when the paroxysms come on during the day, and render it necessary to loosen the clothing. The attacks are attended with oppression at the chest, and mucous rattling : cough, with copious expectoration of viscid or grumous, or transparent and watery, or yellowish mucus of a sweetish or saline taste. Phosphorus, Sulphur, Calcarea, Sepia, and Lycopodium, are also of much value in humid asthma, and of great service in some of the most obstinate cases. In chronic asthma, a dose of the medicine required may be taken at intervals of from four to eight days or so ; but in acute cases, or when the remedy is prescribed during the paroxysm, the dose may be repeated at intervals of from half an hour to two hours and upwards, according to the severity of the case. When the medicine first prescribed affords no relief after from two to three repetitions, another must be selected, preference being given to that remedy which corresponds the nearest to the existing symptoms. .
DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM.
DETERMINATION OF BLOOD TO THE HEAD.
Congestio ad Caput.
This is an affection to which many individuals who lead a sedentary life are subject : intense mental application and habitual indulgence in the use of spirituous liquors, or other stimulating liquids, such as coffee, &c, are also its frequent exciting causes, particularly in those who inherit a predisposition to the disorder.
Diagnosis. Fulness of the vessels of the head and neck, the pulsation of which the patient experiences through the entire frame ; heat, redness, and turgidity, or pallor and puffiness of the face, with anxious expression of countenance ; repeated attacks of giddiness, particularly after sleeping, or sitting in a warm, confined apartment, or on exposure to the rays of the sun when exercising in the open air; headache, generally above the orbits, and in the forehead, increased by stooping or coughing ; dimness of vision ; buzzing in the ears ; tightness around the throat ; oppressed breathing ; furred, red-pointed, or enlarged and very red-looking tongue; dyspepsia, constipation, disturbed, unrefreshing sleep ; drowsiness during the day.
Therapeutics. Aconitum napellus, JSfux vomica, Belladonna, Opium, Coffea, Chamomilla, Ignatia, Arnica, Mercurius, Pulsatilla, Dulcamara, Cinchona, Sanguinaria canadensis, &c.
Aconitum. This is the principal remedy to commence within all recent cases, and is alone sufficient speedily to remove the affection, particularly in children, when fright and anger combined have been the exciting causes.
Nux vomica. As has already been repeatedly observed, this remedy is exceedingly efficacious in complaints arising from sedentary habits, intense study, or that much more culpable habit, the ex-
332 NERVOUS SYSTEM.
cessive indulgence in spirituous or vinous liquors, &c. ; it is accord- ingly one of the most useful remedies in determination of blood to the head, induced by such causes ; it is also very serviceable in cases arising from a violent fit of passion, and is more particularly indicated when we meet with the following symptoms : distension of the veins, with violent pulsation in the head ; heat and redness, or paleness or sickly hue of the face ; attacks of giddiness, violent headache, particularly in the forehead and over the orbits, aggravated by reflecting, or by any attempts at mental application, also by stooping or coughing ; disturbed sleep ; nervous excitability, and disposition to be angry at trifles ; constipation. Calcarea will frequently be found of signal benefit after Nux v., in obstinate cases occurring in persons addicted to indulgence in spirituous liquors.
Belladonna. After a previous administration of Aconite, when necessary, this is one of our most important remedies in the treat- ment of congestion to the head. Indications : great distension of the vessels of the head, attended with severe jerking burning pains in one half of the head, aggravated by the slightest movement or the least noise ; fiery redness and bloatedness of the face, redness and protrusion of the eyes, sparks before them, and sometimes dimness of vision; darkness before the eyes (obscurity); diplopia ; buzzing in the ears ; bright redness of the throat ; attacks of fainting ; somnolency.
Opium is of speedy service in cases arising from fright ; but it is, moreover, a remedy of extreme value in the most serious cases of congestion, either arising suddenly from the effects of a draught of cold or iced water, especially when heated, or from other causes, with the following symptoms ; vertigo, heaviness of the head, humming in the ears, dullness of hearing, stivpor ; also when the attack is occasioned by constipation, or the effects of a debauch, with pressure in the forehead from within outwards, with redness and bloatedness of the face, great depression, fugitive heat ; violent thirst ; dryness of the mouth ; acid regurgitations, nausea or vomiting.
Coffea. In cases arising from excessive joy, this remedy will be found to exert a salutary influence. Symptoms: excessive and uncontrollable liveliness ; great heaviness of the head, or aggravation of the sensations when speaking ; sleeplessness.
Ch amomilla. Congestion caused by vexation, or a fit of passion, particularly in children, is speedily relieved by this remedy.
Jgnatia, when induced by stifled vexation, or harrowing, concen- trated grief.
DETERMINATION OF BLOOD TO THE HEAD. 333
Arnica. In cases arising from external violence, such as severe falls or contusions, followed by stupefaction, vertigo, sensation of pressure or coldness over a small circumscribed space ; tendency to close the eyes ; disposition to be frightened, and vomiting, — the ex- ternal and internal administration of Arnica, when timely had recourse to, will frequently be found specific. This remedy is, however, equally useful in other cases with the following symptoms : heat in the head, with coldness of other parts of the body ; sensation of obtuse pressure on the brain ; painful burning or throbbing in the cranium ; humming in the ears ; vertigo, with confused vision, espe- cially on assuming the erect posture after sitting for some time.
Mercurius : — Congestion with sensation of fulness, or as if the head were compressed ly a band; nocturnal aggravation with darting, piercing, tearing, or burning pains ; disposition to sweating. After Arnica, Belladonna, or Opium, Mercurius is frequently found serviceable in completing the cure.
Pulsatilla. This remedy, as wTill be found stated in the proper place, is well adapted to many cases of congestion occurring in young girls at the critical age, or to all cases occurring in cold, lymphatic temperaments with the following symptoms : distressing semi-lateral pain in the head, particularly of a pressive character, or if the pain in the head commences at the occiput and extends to the root of the nose, or invertedty. Amelioration of the symptoms from exercise, or from pressing or binding the head ; exacerbation wThile sitting : sense of weight in the head ; vertigo ; face pale and wan-like, or red and bloated ; inclination to wTeep ; anxiety ; coldness, or shivering.
Lyco podium is a valuable remedy in some obstinate cases of congestion attended with giddiness, ebullition, flatulence, anxiety, and habitual constipation.
Dulcamara : — Congestion attended with continual buzzing in the ears, dullness of hearing, and particularly when the affection has arisen from getting the feet wet,- or from a chill in cold, damp weather.
Sanguinaria canadensis : — Distension of the vessels, heaviness of the head, with fulness and aching as if the head would burst ; pressure behind the orbits. The pains are chiefly complained of in the forehead, sinciput and right side of the head.
Cinchona. Congestion occurring after repeated bloodlettings, or hemorrhage in general, is generally relieved by this remedy.
After the completed action of Cinchona, a dose or two of Sulphur
334 NERVOUS SYSTEM.
and Calcarea carbonica, at intervals of about a week, will materially tend to strengthen the impaired constitution, when Cinchona is not of itself sufficient to effect that desirable object.
Nux v., Veratrum, and Valerian are also valuable remedies in par- ticular cases arising from debilitating losses. Attention may also be directed to the following remedies : Rhus toxicodendron, Bryonia alba, Cicuta virosa, Hepar sulphuris, Silicea; the two latter, together with Sulphur and Calcarea, are more particularly adapted to the treat- ment of chronic cases. (See also Dyspepsia and Apoplexy.)
In those cases where patients have habituated themselves to the periodical abstractions of blood, as a temporary mode of relief, the employment of Aconitum and Belladonna, in alternation, commonly suffices to obviate the necessity of having recour'se to such a culpable practice. Occasionally, it will be found requisite to select other remedies, such as Nux v., Sulph., China, &c, in addition, or in pre- ference to, Aconitum and Belladonna.
In cases of giddiness simply, or when that is the prevailing symptom, the following remedies are amongst the most useful : Mercurius, when the giddiness pomes • on only in the evening, especially on assuming the erect posture ; or in the morning on getting out of bed ; and is attended with nausea, dimness of sight, heat, anxiety, and desire to lie down. Nux vomica, — giddiness during mental application, or after a meal, or when in the recumbent posture, particularly in nervous or bilious subjects ; and in cases where sedentary habits or dissipation have given rise to the affection. Pulsatilla, — giddiness, especially on looking upwards, or when sitting, or at other times, such as during or after meals, attended with heaviness of the head, buzzing in the ears, headache, and paleness of the face, sometimes alternating with heat ; confusion of sight ; lowness of spirits ; nausea, and incli- nation to vomit; phlegmatic temperament. CinchonAj— giddiness on elevating the head, or during movement, relieved by reclining. Rhus, — giddiness on lying down> but which becomes relieved after retaining the recumbent posture for some time, and then returns on assuming the erect posture, sometimes to such an extent as to occasion falling, attended with fear of dissolution; giddiness after a hearty meal. Chamomilla, — giddiness on rising, with tendency to faint : giddiness during a meal ; irritability. Arnica, — violent giddiness during dinner or after a hearty meal ; in the latter instance, Nux v., Pulsatilla, Rhus, or Chamomilla, are also very useful, and must be selected according as they may be otherwise indicated.
INFLAMMATION OF THE BRAIN. 335
Giddiness on rising from the recumbent posture, or on stooping • Aconitum, followed by Belladonna, particularly if, in addition to the foregoing symptoms, there is frequently partial loss of consciousness, with cloudiness of vision. Giddiness from the motion of a carriage, sometimes with disposition to faint : Hepar s., — followed by Silicea, should the former not suffice, or afford only a slight degree of im- provement. Sulphur is often very serviceable after Pulsatilla, when the attacks of giddiness are most liable to come on while sitting ; or it may be selected in preference to the said remedy, when the giddiness generally comes on whilst walking up a hill or ascending stairs ; or is at other times attended with nausea, fainting, or bleed- ing from the nose. Lycopodium, — giddiness with tendency to con- gestion, accompanied with flatulence, headache, anxiety, and obstinate constipation. Lachesis, — giddiness with confusion of ideas, or paleness of the face, nausea, and vomiting ; fainting, bleeding from the nose, particularly when the attacks come on chiefly in the morn- ing on waking.
Opium: — Threatening vertigo with confusion of ideas ; or decided giddiness, with humming in the ears, and clouded vision on sitting up in bed, which renders it necessary to lie down again ; vertigo from fright.
Conium : — Violent giddiness, with dread of falling to one side when looking backwards.
Giddiness arising from disordered stomach, with nausea or vomit- ing : Aconitum, followed by Antimonium crudum, and subsequently Pulsatilla, if necessary from a continuance of the symptoms in a greater or less degree.
Diet. The homoeopathic regimen already given in the Introduc- tion should be rigidly adhered to, and stimulants of all kinds care- fully avoided ; moreover, early rising, and daily exercise in the open air should not be neglected ; the use of the flesh-brush in the evening is also of some service.
INFLAMMATION OF THE BRAIN AND ITS TISSUES. BRAIN FEVER.
Phrenitis. Encephalitis.
Diagnosis. Goma, or constant delirium, or both, with signs of determination of blood to the head ; fulness and redness of the face
336 NERVOUS SYSTEM.
and eyes ; breathing of the carotid and temporal arteries ; occasional attempts to grasp the head.
When it is caused by inflammation of the tissues, the pain is more acute than that arising from inflammation of the substance of the brain- Paralysis also more frequently accompanies the latter form.
In inflammation of the brain or its membranes, the symptoms are exceedingly diversified; the extent and duration of the disease, the age, the sex, and constitution of the patient all combine to give to the affection a variety of character. Much assistance may be derived, in ascertaining whether the brain is affected or not, from examining the eyes and general expression of the countenance. The pupils in the first stages are commonly found more or less contracted, but as the disease advances, they often become dilated. Occasionally the attack is preceded by premonitory symptoms, such as congestion of blood to the head, attended with sensations of weight or stupefying, pressive, constrictive, and sometimes shooting pains in the head. In some instances slight feverish symptoms are complained of, with ringing in the ears for about the space of a week; giddiness, and a sense of weight on the crown of the head ; pulse rather quick, and the heat of the skin somewhat increased at night, attended with restlessness and a difficulty of lying long in one position; moreover, the patient is observed to be irritable and annoyed at trifles ; anomalies in the mental powers may next be observed, such as ob- stupefaction, drowsiness, with slight delirium ; or a high degree of excitement, in which the patient is affected by the slightest noise, and the eyes have a brilliant and animated expression, or are bloodshot, with fiery redness of the face, violent delirium [delirium fer ox). Accord- ing to the seat of the inflammation, or the constitution of the patient, the accompanying fever is of greater or less intensity ; the pulse is very variable in the course of the same day ; it may be regular, intermit- ting, quick and weak, or very slow and strong. A very slow or very quick pulse generally indicates danger. The patient frequently com- plains of heat in the head, whereas the extremities are cold. When there is stupor, or a tendency to it, the eyes look heavy and void of all expression; vomiting sometimes takes place, and proves very intractable ; the stupor becomes more profound, convulsions appear, and death sooner or later ensues. The peculiar and delicate structure of the brain and its membranes in children, renders them much more susceptible of the attacks of this serious disease, and great attention ought to be paid to the following symptoms : heaviness and tendency
INFLAMMATION OF THE BRAIN. 337
of the head to gravitate backwards, attended with pain (of which latter circumstance we are sometimes made aware, in very young children, by the little sufferer frequently raising its hands to the head; alternation of temper; intolerance of light; nausea, occasionally followed by vomiting ; tendency to costiveness ; drowsiness; wake- fulness, or starting during sleep. Secondly, continuous boring of the head against the pillow ; a high state of excitement, in which the slightest noise or ray of light throws the child into a fit of screaming, or a state of discontentment ; heavy sleep ; great heat in the head; redness and swelling of the face, with perceptible throbbing in the vessels of the head and neck ; great agitation, with continued tossing about, especially at night ; eyes red, sparkling, convulsed, or fixed ; pupils immovable, and generally dilated.
Causes. Anything tending to irritate the brain, such as extremes of heat or cold ; the abuse of ardent spirits ; external injuries of the head ; concussion from falls ; mental emotions, or over-exertion of the faculties ; excesses of all kinds ; sanguineous congestion ; metas- tases ; contagious diseases ; repressed eruptions, &c.
Therapeutics. We should have immediate recourse to Aconite at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indications of pure Inflam- matory Fever, which is especially liable to, be the case in young ple- thoric subjects.
After the employment of Aconite we may have recourse to any of the following remedies] as indicated ; namely, Belladonna, Hyoscyamus, Opium, Stramonium, and Cuprum aceticum.
Belladonna. This medicine seems to possess a certain specific influence over inflammation of the brain and its meninges J and is generally the remedy we should select, when the following, amongst other symptoms, present themselves: great heat of the head; redness and bloatedness of the face, with violent pulsation of the carotids ; boring of the head in the pillow, and increase of suffering from the slightest noise, with extreme sensibility to light ; violent shooting and burning pains in the head ; eyes red and sparkling, with protrusion or wild expression ; contraction or dilatation of the pupils ; violent and furious delirium; loss of consciousness; sometimes low muttering; convulsions, occasionally symptomatic hydrophobia; vomiting; in- voluntary evacuations of faeces and urine.
22
338 NERVOUS SYSTEM.
Bryonia. This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial improvement, and the symptoms indicate a tendency to rapid effusion ; in wich case also Helleborus may follow Bryonia if required. (Vide Hydrocephalus.)
Hyoscyamus is appropriate when there is drowsiness, loss of con- sciousness, delirium about one*s own affairs; inarticulate speech; tongue coated white, with frothy mucus about the lips; dilatation of the pupils ; fixedness of vision ; skin dry and parched ; redness of the face ; and picking of the bedclothes with the fingers.
Opium: — When there is lethargic sleep, with stertorous breathing ; half open eyes, and confusion or giddiness after waking ; sanguineous congestion ; complete apathy and absence of complaint.
Stramonium: — When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and tossing about ; vision fixed, and the patient frequently appears in a state of dread, and utters cries; redness of the face; feverish heat, With moisture of the skin; In many of the symptoms this remedy bears a close resemblance to Belladonna, with the exceptions of being indicated by the more pro- minent existence of spasms, and less acuteness of pain in the head.
Zincum may be employed after, or in alternation with Belladonna, when that remedy produces only a partial degree of amendment. In those extreme cases where symptoms of threatening paralysis of the brain are manifested by the following indications : loss of conscious- ness ; half closed eyes ; dilated, insensible pupils ; icy coldness of the extremities, or of the entire body ; blueness of the hands and feet ; impeded respiration ; small, weak, scarcely perceptible pulse— Zincum\&& repeatedly been found effectual in preventing a fatal issue.*
Dose. Gr. ss. to gr. j of the first trituration, every hour, until signs of improvement set in, in which case the intervals between the doses must be lengthened. (See also Hydrocephalus).
Cuprum aceticum : — The reputed value of this remedy in cases of repercussed exanthemata, and the consequences therefrom arising;, have been already noticed under Scarlet Fever; under which also some of the symptoms indicating its employment are commented upon ; it is also called for in a peculiarly sensitive rather than an inflam-
* Allg. Horn. Zeit. No. 15. 31ster Bd.
APOPLEXY. 339
matory or irritable state of the brain, which not linfrequently appears: in children, during the course of catarrhal fever or difficult dentition, of which affection the following are the symptoms : at the commence-: ment, crossness or fretfulness, or apathy and indifference ;' sleep dis- turbed and restless. As the disease gains ground, drowsiness, with inability to sleep ; incapability of holding the head erect, and flushing of the face ; dryness of the mouth without increase of thirst ; disgust to food, nausea, even vomiting ; torpor of the bowels, rarely diarrhoea ; shudderings; followed by heat, and occasionally burning, unfrequent perspiration; pulse variable, generally rather accelerated and full; exacerbations of fever (synocha) towards evening and at night; sub- sultus tendinum, and grinding of the teeth during the exacerbations.
Belladonna, Rhus. Lachesis, and Mercurius have also proved service- able in cases arising from repercussed exanthemata.
Cina is useful in irritation of the brain in children, apparently arising from helminthiasis.
In chronic cases, Sulphur, Hellehorus niger, Arsenicum, and Lachesis, are the more generally useful.
It may be added, that Aconite followed, if required, by Belladonna, Camphora, or Lachesis, is the most appropriate course of treatment, when the affection has arisen from exposure to the sun {coup de soleil)*
Aconite, Bryonia, Arsenicum, Hyoscyamus, when resulting from a violent chill in the head. From suppressed otorrheea, Sulphur, Pulsar tilla. External injury, Arnica, Belladonna, Mercurius. Abuse of ardent spirits, Opium, Lachesis. And wThen from intense mental application, Belladonna, &c, according to the symptoms.
Antimon. tart, has been recommended as deserving of attention in inflammation of the brain and its membranes.
APOPLEXY.
Apoplexia.
Diagnosis. Sudden or gradual loss of consciousness, sensation, and motion, with greater or less disturbance of the pulse and respiration.
Few diseases offer a greater number of varieties in form than apo- plexy ; and there is scarcely a single classification of the many, that eminent medical writers have given to the world, which is not more or. less liable to objection.
It is also extremely difficult to diagnose clearly between the diffe-
340 NERVOUS SYSTEM.
rent varieties, the external symptoms not always bearing a uniform relation to the internal injury; thus all the indications of serous apoplexy may declare themselves from sanguineous extravasation ; and it is not always possible to decide in apoplexy whether effusion or simply congestion of the vessels 6f the brain has taken place.
Premonitory Symptoms. Continued inclination to somnolence, heavy profound sleep, with stertorous breathing, incubus, grinding of the teeth, shocks or cramps, a general feeling of heaviness or disin- clination to the least exertion; frequent yawning and fatigue after the slightest exercise. A sense of weight and fulness, and pains in different parts ofcthe head, sometimes very deep seated. Cephalalgia and megrim, or vertigo and fainting ; pulsation of the temporal and carotid arteries, with swelling of the veins of the head and forehead ; disturbance of the cerebral system, evinced by loss of memory, for- getfulness of words and things, irritability of temper, or mildness and indifference, despondency and weeping ; infiltration of the conjunc- tiva, dimness of vision, specks or motes before the eyes, or flashes of fire or sparks during darkness ; acuteness of vision or diplopia, some- times also the words in a line appear to run into one another ; diffi- culty of opening or closing the eyes ; noises, humming, singing, &c# in the ears ; dullness of hearing, dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odour, sneezing, and slight epistaxis ; stammering, and indistinct enuncia- tion ; difficulty of deglutition, numbness or torpor, or pricking sensa- tion in the extremities, with occasional partial attacks of paralysis in the face, distorting the features and affecting the utterance, or in some of the muscles of the limbs ; pains in the joints ; weak or unsteady mode of progression, difficulty of micturition, &c.
Their Treatment. Against the preceding, Homoeopathy possesses remedies, by whose proper application the practitioner may, if consulted in time, succeed in warding off the attack of this dreaded malady.
The following are the medicines most appropriate to the treatment of the foregoing symptoms, and also most generally called for in the treatment of the disease itself: Aconit%m, Belladonna, Nux vomica, Lachesis, Opium.
Aconitum. In all cases where there are evident symptoms of plethora, determination of blood to the head, characterised by redness
APOPLEXY. 341
and fulness of the face, distension of the veins of the forehead, quick full pulse, restlessness, and anxiety.*
Belladonna :— Should the symptoms of congestion not speedily yield to Aconite, or should only a partial degree of amelioration have taken place ; or further, should the following symptoms present them- selves : redness and bloatedness of the face, injection of the conjunc- tiva, violent beating of the carotid and temporal arteries, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, by the least noise or bright light ; or diplopia, and almost all the symptoms relative to the eyes already mentioned; dryness of the nose, with unpleasant smell and epistaxis; difficulty of deglutition ; slight attacks of paralysis in the face ; paralytic weak- ness or heaviness in the limbs.
Nux vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those who have long been affected with dyspepsia, either bilious or nervous, and have consequently more or less of the rheumatic or gouty diathesis, and also when the following symptoms present themselves : headache, deep seated or frontal, but more especially at the right side, with vertigo, confusion and humming in the ears, nausea, and inclina- tion to vomit ; turgescence of the capillaries of the face, or redness only of one cheek; drowsiness, feeling of languor, with great disin- clination to exertion, either mental or bodily, cramps of the limbs, especially at night, and weakness in the joints; constipation and dysuria, irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air, bilious, sanguine, or nervous temperament.
Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms : marked congestion to the head, indicated by stupor, vertigo, heaviness in the head, and violent pressure in the forehead, singing in the ears, and obtuseness of hearing, sleeplessness or agitating dreams, or fre- quent and almost overpowering drowsiness during the day, redness of the face, and constipation ; pulse slow, but full.
Lachesis is indicated by many of the same symptoms which
* Some homceopathists persist in employing the lancet here ; but we believe there are few instances, if any, in which the use of Aconite, followed, if required, by Belladonna or Opium, and sometimes Nux v., according to the characteristic features of the remaining symptoms and the nature of the case, will fail to act as speedily, and certainly with more beneficial ultimate results.
342 NERVOUS SYSTEM.
have been enumerated under Nux v., together with the following distinctive characteristics : frequent abstraction of mind, or vertigo; with congestion, pains deep in the brain, or severe aching pains 'at the left side of the head, and lowness of spirits; face pale and puffy, or turgid and somewhat livid ; pulse weak and slow.
The moment any of the symptoms before noticed present them- selves is the proper time to prevent the attack running on to apo- plexy ; sometimes the signs are so marked, that we can have but little doubt of the result, unless timely precautions are taken ; at other times, so slightly as to be almost imperceptible ; and at others again, the attack comes on suddenly, without any marked premoni- tory symptoms whatever. (See also Congestio ad Caput.)
Apoplexy. The following are the principal remedies which have hitherto been chiefly recommended, or found most successful, in the treatment of the disease itself :— Opium, Nux vomica. Belladonna, Lachesis, Arnica, Pulsatilla, Baryta carboniaa, Silicea, Stramonium, Zincum metallicum, Acidum hydrocyanicum, Agaricus, &c.
In sanguineous or sthenic apoplexy, (generally characterised by bloodshot eyes, redness of the face, full, hard pulse, oppressed and stertorous breathing. The paroxysm more usually comes on without warning, — although sometimes preceded by fulness, weight, and a dull pain in the head, attended with giddiness and drowsiness, — the patient suddenly falling to the ground, and seeming as if in a heavy sleep,) Opium, Aeon,, Bella., Nux v., Lack., Stram., Ant., Coff., Hyos., Puis., &c., are the principal remedies.
In asthenic apoplexy, (chiefly defined by pale and sallow, but puffy, bloated countenance ; feeble and easily compressible pulse, heavy, laborious respiration. This variety is more commonly ushered in by premonitory symptoms than the preceding, such as headache, giddi- ness, loss of memory, illusions of hearing, inarticulate speech, som- nolency, and a disposition to clonic spasms,) Ipecac, Merc, Big., Am., — Baryl. c, Cocc, Con., Nuxw., Puis., Zinc, Bella., Coff., Hyos., Stram., Cup., ho,., are more frequently called for.
Opium is held as a most important remedy in all cases of apoplexy when the disease has attained considerable height. It is one of the best remedies to commence with, when the attack has arisen from excess in drinking, and the symptoms are as follows; slow, stertorous, breathing ; red and bloated face; heat of the face and head, which latter is also covered with sweat : insensible and dilated pupils .; stupor ; tetanic rigidity of the entire frame, or convulsive movements
APOPLEXY. 343
and trembling in the extremities ; foaming at the mouth. In elderly persons/ Vpium is, as has already been stated, a remedy of primary importance. Baryta c., as will be hereafter noted, is also valuable in such cases, but chiefly, perhaps, after the previous use of Opium. Digitalis, Mere., or Con., &c, may, however, be required subsequent to Baryta or Opium, and even in preference to these in some instances, especially when of the serous type.
Nux vomica has been found of great service in completing the cure after the previous use of the above remedy ; but may also be employed at the commencement, when the attack has occurred in an individual of bilious, sanguine or nervous temperament, and of irritable temper, in consequence of over-indulgence in vinous or spirituous liquors ; or when the attack has resulted during or after a fit of passion, and the patient appears' in a state of drowsiness approaching to stupor; the breathing stertorous; eyes dull and glassy; hanging of the lower jaw, with copious secretion of saliva ; paralysis, parti- cularly of the inferior extremities (paralysis paraplegica) ; hemi- plegia.
Lachesis is also a valuable remedy in this disease, especially when occurring in habitual drunkards ; or in choleric, hypochon- driacal persons, or those who are frequently affected with melancholy, and are of a spare habit, or of exhausted constitution, with drowsi- ness or loss of consciousness ; lividity of countenance, convulsive move- ments or tremor in the extremities; stupor or paralysis, especially of the left side ; pulse weak and slow.
Arnica. Apoplexy after too hearty a meal, with loss of con- sciousness (drowsiness or stupor) ; stertorous breathing ; moaning or inarticulate muttering; invohmtary evacuations; paralysis of the extremities (hemiplegia, left side) ; pulse strong and full.
Belladonna. Lethargy, loss of consciousness; the patient lies speechless, with the mouth drawn to one side ; convulsive movements of the limbs or facial muscles ; hemiplegia, particularly of the right side; dilated immovable pupils ; red and bloated face.
Pulsatilla. Lethargy, loss of consciousness ; bloatedness and blueish-red hue of the face, occurring after a full meal, which has been hurriedly swallowed ;* or sudden loss of the power of movement ; palpitation of heart; pulse almost entirely suppressed; respiration stertorous ; temperament phlegmatic.
* Ipecacuanha is equally indicated when the attack has arisen from such a cause, and may therefore be employed after, or in alternation with, Pulsatilla, should the latter remedy not afford speedy relief.
344 NERVOUS SYSTEM.
Baryta carbonica : This remedy, like Opium,, -is peculiarly well adapted to the treatment of many of the affections of old people. It has accordingly, like the latter medicine, been found very service- able, when the serious affection at present under consideration is met with in patients of advanced age, particularly when the following symptoms are encountered : Coma somnolentum, vrith moaning and mut- tering, circumscribed redness of the cheeks ; mouth drawn to one side; paralysis of the tongue, or of the upper extremities ; hemiplegia (right side) ; confusion of ideas ; childish manners. The following remedies may also be pointed out as being worthy of the attention of the homoeopathic practitioner: Ignatia, Tart, emet., China, and Cocculus, (the two last named, particularly in cases which have been brought on by excssive depletion, by loss of blood, &c. ;) and in the para- lysis resulting from apoplexy, Belladonna, Baryta, Carbonica, Nux vomica, Rhus, Silicea, Zycqpodium, Lachesis, Graphites. Carl, v., Olean., Bryonia, Cocculus, Plumbum, Stramonium, Stannum, Sulphur, Calcarea, Zincum metallicum, and Electro-magnetism, particularly when occasional twitchings take place in the limbs.
During the paroxysm of apoplexy, the patient ought be be placed in a cool room, with the head raised, or put, in short, in such a posi- tion as will least favour determination of blood to the head. The clothes ought to be loosened, especially about the neck ; and the feet or legs allowed to hang down. It may also be useful to increase the force of the circulation in the feet and legs by means of friction, or by putting them in warm water.
We cannot conclude this article without giving expression to the gratification we feel, in common with the majority of the most eminent of our homoeopathic medical brethren, at the gradually increasing distaste to bloodletting evinced by our allopathic col- leagues. Many have renounced the use of the lancet altogether; and others, while they do not wholly discountenance its employment, sur- round the cases, in which they allow it ought to be had recourse to, with so many restrictions as almost to amount to a prohibition of its use. At all events, we may hope that the time has already arrived, at least for the more enlightened of our profession, when even those who still adhere to the practice in particular cases, will not rashly prescribe bleeding in all instances of cerebral compression, where, if it be had recourse to before a reaction has set in, it may destroy the patient, either by causing him to sink under it, or by producing effu- sion, if that has not already taken place, or by increasing it if it has.
MYELITIS, 345
ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES.
Myelitis, Meningitis spinalis.
This affection is indicated by pain, more or less severe, in some cases of an intermittent character, either confined to the lumbar, dorsal, or cervical region, or embracing the entire length of the spine. The pain is aggravated by the slightest movement, and an exalted sensibility of various parts of the cutaneous surface is often perceptible from the dread and shrinking, which the patient exhibits at the slightest touch. Sharp pain at the epigastrium, sometimes spreading over the whole of the abdominal region, and increased on pressure ; palpitation of the heart, sensation of constriction and weight in the fore part of the chest, with oppressed respiration ; small, quick, hard pulse, — are symptoms which are generally encoun- tered in the course of the disorder.
When the inflammation occupies only a part of the cord, the symptoms vary according to its locality. Thus, when the commence- ment, or the cervical portion is principally affected, strabismus, spasm of the pharynx, trismus with loss of voice, spasm, or other abnormal conditions of the muscles of the neck, chest, and superior extremities, with general clonic convulsions, declare themselves. When the dorsal portion of the cord is the seat of the inflammation, opisthotonos usually results ; and when that of the lumbar region is attacked, retention of urine, or paralytic or spasmodic affections of the pelvic viscera generally, are met with. In each of the latter cases, the inferior extremities are commonly either convulsed or paralysed.
When the membranes of the cord are principally or solely affected, the sensibility of the surface is said to be always increased, and the spasms more frequently general, and of a tonic character. While in inflammation confined to the substance of the cord, the sensibility is usually lessened, the muscles of the extremities are affected with clonic spasm or paralysis, and only those of the back in a state of tonic contraction. In the former, moreover, the bowels are for the most part constipated, — while in the latter, diarrhoea has almost uniformly been found to predominate. Finally, according as the power of motion or the sensibility is abnormally altered, so it may be concluded will the anterior or posterior columns of the spinal cord form the seat of the inflammation.
346 NERVOUS SYSTEM.
Causes. Exposure to cold and damp, and external injuries ap- pear to form the leading exciting causes of this inflammation.
Chronic Inflammation of the spinal cord and its coverings is generally accompanied with a trivial degree of local pain, and its prominent features chiefly consist in derangement of the functions of the viscera, deprivation or diminution of the sense of feeling, para- lysis, cramp, and emaciation. The chronic variety is even more dangerous than the acute.
The disease, when confined to the substance of the cord, may terminate in softening (ramollissement) ; induration ; suppuration ; gangrene ; in effusions of serum, pus, or blood ; or in thickening of their structure, when the membranes have been the seat of the inflammation.
Therapeutics. Aconitum must be prescribed in repeated doses, in all cases where the accompanying fever is intense ; and on the completion of its beneficial action, recourse must be had to Belladonna, Dulcamara, Arsenicum, Digitalis, Pulsatilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Veratrum, — according to the portion of the cord which is evidently attacked*
Belladonna is the most important remedy when the upper part is the seat of the disorder. If, from the invasion of delirium, &c, there is some reason to apprehend an extension of the inflammation to the brain, this remedy will still be the most appropriate, and, indeed, that on which we must rest our chief hope in so serious a complication of a malady, sufficiently dangerous in its simple form. Hyoscyamus, Stramonium, Bryonia, Zincum, (particularly with signs of threatening paralysis of the brain), and in some instances Sulphur may, however, be found necessary and prove useful in warding off a fatal result. (Vide Phrenitis.) Dulcamara* may follow Aconitum and Belladonna, when the more acute symptoms of myelitis have been removed, and particularly when the disease has been excited by exposure to cold and wet. Arsenicum, Pulsatilla, and Digitalis have been recommended as useful auxiliary remedies, when the thoracic viscera are prominently affected, evidenced by laborious and anxious respiration, palpitation of the heart, &c. ; and Veratrum, Nux v.,
* Rhus is perhaps still more appropriate than Dulcamara in such cases. The instances in which the latter remedy has heen reported to have acted beneficially are involved in some degree of obscurity.
PALSY. 347
Cocculus, and Ignatia, when the abdominal viscera are seized with coldness and spasms.
Should opisthotonos result from inflammation of the dorsal division of the cord: Belladonna, Rhus, Ignatia, and Opium are chiefly to be recommended. Again, when the inflammation is restricted to the lumbar portion of the cord: Nuxv., Cocculus, Digitalis, and Bryonia ; or Pulsatilla, Rhus, Veratrum, and Sulphur, In general tonic spasms resulting from inflammation of the entire cord, or rather its enveloping membranes, — Belladonna, Lachesis, Hyoscyamtis, Opium, Natrum m., and Ignatia are the remedies from which, in general cases, we may expect to derive the greatest benefit. Arnica, Hyoscyamus, and Opium may claim a preference in myelitis arising from external injury ; but we must be guided in our selection by the nature of the symptoms, and not hesitate to have recourse to one or more of the above-mentioned medicines if called for. (Vide Hydrophobia and Tetanus.) In the chronic form of the malady, the medicines from which the most benefit may be looked for, when the disease has not reached an irremediable stage, are, in addition to most of those required in the acute variety, — Sulphur ',- Silicea, Lachesis, Baryta c.s w, &c.
PALSY. PARALYSIS.
This affection consists in the abolition or diminution of the power of voluntary motion. It usually comes on suddenly, but in some instances it is preceded by numbness, coldness, paleness, and slight convulsive jerking or twitching in the parts affected. The treatment must be regulated according to the originating cause. When it results from apoplexy, see that article. When we find it occurring as a sequel of rheumatism : Arnica, Ferrum, Rnta, — as also Bryonia, Rhus, Lycopodium, Sulphur, Silicea, &c. When in consequence of debility from loss of fluids : China, Ferrum, Baryta c, and Sulphur. From the sudden suppression of an eruption, or of a wonted dis- charge : Sulphur, Lachesis, &c. And when it is attributable to ex- posure to the fumes of lead, or the frequent handling of white-leadl Opium and Belladonna ; or Platina, Alumina, Pulsatilla, and Nunc v. (These remedies are equally useful in Lead Colic, Colic of
348 NERVOUS SYSTEM.
Pa i n t e ii s, Colic of Po i c t o u, colica saturnina, colica pictonum, colica
phombariorum s. pictorum, colica damnoniorum.)
With reference to the parts which are affected with the disorder; Belladonna, Graphites, and Causticum are chiefly recommended in paralysis of the facial muscles. Belladonna, Opium, Hyoscyamus, Stramonium, Lachesis, and Graphites, in that of the tongue. Belladonna,
. Nux v., Cocmlus, Zycopodium, Calcarea, Silicea, Opium, Zinctom, Ruta, &c, in paralysis of the upper extremities. And in that of the in- ferior extremities : Cocculus, Nux v., Opium, Sulphur, Silicea, Stannum, and Oleander principally.
Electricity or galvanism {electro- magnetism), in moderation, is fre- quently of considerable service in facilitating the cure, or, at all events, in promoting improvement in obstinate cases, and particularly when painful jerkings or : twitchings frequently take place in the affected parts.
TETANUS.
This is a disease characterized by a general spastic rigidity of the muscles. Its varieties are Trismus, the lock-jaw. Opisthotonos, — which is the most common, — when the body is drawn or bent backwards by the spasmodic contraction of the muscles, sometimes to such a degree that the occiput touches the heels. Emprostho- tonos, when the body is bent forwards ; a rare form of the disease. Pleurosthotonos, in which the body is bent to one side; a still more rare variety.
The disorder is chiefly occasioned either by exposure to cold (idiopathic tetanus), or by some irritation of the nerves resulting from local injury, particularly of tendinous parts (traumatic tetanus). It is of much more frequent occurrence in warm than in cold climates* In this and in other climates the amputation of a limb, or the twitching of a nerve by a ligature, are not unfrequent sources of its occurrence. When it takes place in consequence of such a cause, or of any other external lesion, the symptoms generally set in about the eighth day, and sometimes later; but when it supervenes on exposure to cold, they usually declare themselves much earlier. In some cases the attack comes on suddenly, and with extreme violence . l#it it more generally approaches in a gradual manner ; a slight stiffness being at first experienced in the back part of the neck, together with an uneasy sensation at the root of the tongue, and a
TETANUS 349
difficulty in performing the act of deglutition^ an oppressive tight- ness is complained of in the chest, with a pain at the inferior ex- tremity of the sternum, or the scrobiculus cordis, extending into the back; the respiration is impeded; the countenance pale, pulse small, bowels constipated, and urine high coloured ; a stiffness also takes place in the lower jaw, which ere long increases to such an extent, and compresses the jaws so closely and firmly that the smallest opening is unattainable, and the patient is now afflicted with what is termed lock-jaw. In some instances the spasmodic contractions proceed no further ; in others they return with great frequency and increased severity, and also extend to the arms, the abdominal muscles, the back, and inferior extremities, so as to bend the body forcibly in one or other of the directions before stated. Finally, the arms, lower extremities, head, and trunk become rigidly extended, from an equipoised spasmodic action of the flexor and extensor muscles. The tongue is also seized with spasm, and is, not unfre- quentlyy injured by the teeth becoming clenched together, just as it happens to be convulsively darted out.
As the affection advances, the eyes become fixed and immovable, the whole countenance frightfully distorted and expressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings, generally about the fourth day in acute cases, by one concentrated spasm. In some cases the fatal termination is protracted considerably beyond the stated period.
The spasmodic action does not continue unremittingly, the mus- cular contractions occasionally admitting of some abatement, but is generally immediately renewed as soon as the patient makes an effort to speak, drink, or change his posture.
Thebapeutics. The remedies which have chiefly been used in homoeopathy, in the treatment of this distressing disease, are : Bella- donna, Stramonium, Cicuta virosa, Arnica, Opium, Hyoscyamus, Angustura, Rhus, Ignatia, Lachesis, Natrummuriaticum, Mercurius, Aconitum, Sulphur, Veratrum, Phosphorus, Camphor, Staphysagria, and Moschus.
Belladonna is one of the most important of these, particularly in idiopathic tetanus, properly so called, or in trismus ; it has also proved useful in the traumatic variety as well, after the previous employment of Arnica. It is principally indicated when a sensation of constriction is experienced in the throat, with tightness at the chest, grinding of the teeth, spasmodic clenching of the jatvs, distortion of the
350 NERVOUS SYSTEM.
mouthy foaming, obstructed deglutition, and a renewal or exacerbation of the paroxysms on attempting to drink. In some cases of trismus the alternate use of Belladonna and Lachesis, or Belladonna, Angustura, and Cicuta virosa has been found necessary ; and of Belladonna, Lachesis, Hyoscyamus, and Stramonium, or Opium, Rhus, and Belladonna, in opisthotonos.
Arnica Montana. In cases of traumatic tetanus, which is by, far the most fatal variety, this remedy is, in most instances, the most appropriate to commence with, and should be used both internally and externally, in the form of an extremely weak lotion (about a teaspoonful or a drachm to half a pint of water.) Should symptoms of improvement not set in in twenty-four to forty-eight hours, Opium and Hyoscyamus must be had recourse to. Any local irritation which may seem to have excited the disease ought, at the same time, if possible, to be carefully removed.
Opium has proved extremely useful in some of the severest forms of opisthotonos arising from cold ; but, as above stated, it is also valuable in traumatic tetanus. (Likewise in tetanus from fright.)
Rhus and Ignatia have been found very efficacious in severe cases of opisthotonos, in which the body has been bent up in the form of an arch, and on some occasions with the back of the head touching the heels, when the complaint -has arisen from terror.
Mercurius has frequently succeeded in curing inflammatory trismus, with swelling of the angle of the lower jaw, and tension of the muscles of the throat and neck, from cold.
These are a few general indications for the employment of the foregoing medicines. The following may also prove serviceable in various forms of tetanus : Aconitum, Sulphur, Veratrum, Phosphorus $ Camphora, Staphysagria, Moschus, Bryonia, Nux, Platina, Ipecacuanha, Secale comutum, Cannabis indica, Cantharides, Cicuta virosa, Cina, Rhus toxicodendron, Gratiola, Stannum ; but considerable care must necessarily be bestowed on the selection of the proper remedy.
When, from the spasmodic clenching of the jaws, it is found im-. possible to • introduce the medicine into the mouth, -the . effect of olfaction must be tried ; it has also been found useful to moisten the lips and nostrils with the medicine dissolved or diluted in water ; and in some cases, the administration of the remedy in the form of of enema (a few drops to an ounce or two of water) has been found very efficacious. (See also Hydrophobia, Hysteria, and Myelitis.)
DELIRIUM TREMENS. 351
DELIRIUM TREMENS POTATORUM.
This malady consists of an affection of the brain, and is so called from being nearly peculiar to drunkards. There are a few instances on record, in which it has arisen from exhaustion caused by excessive depletion; from the effects of lead, and also from the prolonged use of opium. The intemperate use of ardent spirits, vinous or strong malt liquors, is, however, beyond comparison, the exciting cause in by far the major number of instances. The disease generally comes on in drunkards, during the state of prostration which ensues when they have in a great measure given up, or been suddenly deprived o£ their accustomed stimulus.
The first symptoms of the malady are generally indicated by extreme irritability of temper, weakness of memory, but constant activity of mind, anxiety, and uncontrollable restlessness with in- creased muscular mobility.
The appetite is often pretty good, but more frequently impaired in consequence of the previous habits, and the tongue is sometimes foul but moist. Soon after these premonitory signs, vigilance sets in, and little or no sleep can be obtained ; or it is unrefreshing and disturbed by frightful dreams, imaginary visions and sounds. Fixed ideas then take firm possession of the patient's mind, such as the supposition that some one is bent upon poisoning him or doing him some other grievous injury, &c, yet he generally dreads being alone. The speech is frequently stuttering and inarticulate ; the counte- nance quick, wild, and exceedingly variable, according to the prevail- ing impression on the mind ; the face in most cases pale or sallow ; the eye rolling, expressive, and restless, and the conjunctiva blanched; the skin damp, or covered with sweat, chilly and relaxed, very rarely above the natural temperature; the hands are commonly tremulous, and muscular twitchings are often observable. As the disease ad- vances, sleep is completely banished; loquacity, with perpetual bustling occupation, becomes incessant ; and eventually, when it is fully developed, delirium supervenes. The pulse is soft and com- pressible, and rarely quick when unruffled by the struggles or exertions of the patient — for his corporal activity keeps pace with the restless- ness of his mincl, and it is difficult to confine him to his bed or apartment; at the same time, exhaustion is liable to come on very
352 NERVOUS SYSTEM.
rapidly after greaj exertion, and the patient is prone to drop down from fatigue. Occasionally, convulsions take place, but though sometimes serious, they are usually not of a fatal character. The history of the case, together with the distinctive nature of most of the above-described symptoms, enables us to discriminate between this disorder and that of inflammation of the brain or its membranes.
Therapeutics. Nux v., Opium (provided of course, the attack has not been excited by the effects of Opium or its alkaloid, in large doses), Aconitum, Belladonna, Lachesis, Hyoscyamus, Sulphur and Calc. form our main remedial agents.
Nux v. is particularly useful in the first stage of the disorder, and may frequently be the means of arresting its further progress, when administered at that period. The dose repeated in from six, to twelve, or twenty-four hours, according to the effects produced.
But when the disease has become fairly established, and the patient is affected with delirium or convulsions, and we find an aggra- vated degree of all the symptoms remarked at the commencement of the attack, we must have recourse to Opium, in frequently repeated doses. The curative properties of this drug, in the malady under consideration, do not, as is erroneously supposed by the majority of allopathic practitioners, arise from its property of producing sleep, but from its komosopatMcity, or specificity, if I may use the expressions ; the pathogenetic effects which it produces being exactly similar to those symptoms which are developed in the course of the disease as it occurs in drunkards.
In some cases, particularly where the patient exhibits extreme irritability of temper, with more or less derangement of the digestive functions, considerable advantage will be attained from the alternate employment of Nux v. and Opium.
In some rarer varieties of the affection, which are more liable to occur in young, robust, or plethoric subjects, we meet wdth symp- toms indicative of active cerebral congestion, which call for the administration of a dose or two of Aconite, followed in a few hours hy Belladonna, or by Belladonna and Lachesis alternately, if only partial benefit is obtained from the action of Belladonna alone, and the trembling of the hands and arms forms a very prominent symptom. Hyoscyamus may be prescribed in preference to Belladonna, when the patient's insanity is more particularly apparent in the exhibition of excessive and uncalled-for jealousy.
EPILEPSY. 353
In extremely obstinate attacks, Sulphur, Opium, and Nux v. may be given in alternation, at longer or shorter intervals according to the greater or less severity of the symptoms. Calcarea is also a remedy of considerable importance in such cases, but more especially when . they occur in plethoric or lymphatic habits. Finally, — Stramonium may be mentioned as likely to be useful when Belladonna, Hyoscyamus, and even Opium fail to do much good, and the spasms or convulsions are very severe. Coffea and Camphora have also been named as likely to prove serviceable against the vigilance, or the mental and bodily activity above described, when the remedies already enumerated fail to answer the purpose required. But it may safely be averred, that there are few instances in which Nux v. and Opium, when timely administered, will not succeed in subduing the more violent features of the disease \ and Sulphur, Opium, Nux v., and Calcarea, in removing any inveterate sequelae. These medicines, together with Arsenicum and Acid, sulphuricum* administered at intervals of from four to eight days, have also been recommended as useful in correcting the vice, which gives rise to this disease as ordinarily met with. f Delirium tremens arising from exposure to the vapour of lead, chiefly requires Opium, Belladonna, and Nux v. ; and that from poisonous doses of Opium, is mainly to be subdued by Nux v. and Belladonna.
EPILEPSY.
Epilepsia, Morbus sacer. Morbus caducus. Morbus divinus. Morbus herculeus. Morbus comitialis.
This is a malady which consists of clonic spasms, or convulsions,
* In the morning sickness of drunkards, Acidum sulphuricum is a most useful medica- ment.— Gr. u St. h. Arch., 1. 1, 173.
f Dr. Hering, of Philadelphia, recommends, in the case of inveterate drunkards, a drop of sulphuric acid in a tumbler of water, early in the morning, every two or three days, until disagreeable symptoms arise ; in the event of which he orders the patient to smell camphor frequently. When the drunkard has an unconquerable craving for liquor, he advises his friends or relatives to proceed as follows: "Take pure sulphuric acid, mix it with a large proportion of water so that it may taste only slightly acid, and give the mixture to the patient in everything he eats or drinks, and that as liberally and as frequently as possible, although others should occasionally or even constantly have to participate in his meals, &c. ; mix it especially in acidulated sauces or lemonade. If it impairs the digestion, give tea made of bitter herbs, roots, or oranges, continuing the sulphuric acid at the same time, but ceasing as soon as the mouth becomes sore. Should obstinate diarrhoea, protracted derangement of the stomach, vomiting, and giddiness result, give Pulsatilla; if bad ulcers
354 NERVOUS SYSTEM.
with loss of consciousness and voluntary motion, and generally foaming at the mouth.
It comes on by fits, and is usually characterised by the suddenness of the attack, although it is occasionally preceded by pain in the head, dimness of vision, flashes or sparks of fire, tinnitus aurium, pal- pitations, flatulency, and languor ; or, by a peculiar feeling, partaking partly of pain, and partly of a sense of cold, com- mencing in some remote part of the body, as in the toes, abdomen, or fingers, and proceeding gradually upwards towards the heart or head. (Aura epileptica.) During the paroxysm, the muscles of one half of the body are commonly more severely agitated than those on the other, and those concerned in the performance of respiration are always more or less implicated ; the eyes are hideously convulsed, and turned in various directions, but at length become fixed^ so that the whites of them alone are seen ; the fingers are firmly clenched, and the muscles of the jaws are often spasmodically affected, in consequence of which the tongue is sometimes lacerated by being thrust out immediately before the sudden and violent approximation of the teeth ; the mouth is frequently filled with phlegm, which is expelled with considerable force in a frothy state. The face is either of a dark-red or livid colour, or it is pale, or alternately pale and red, or pale one side and red on the other. The faeces and urine are sometimes passed involuntarily. On the abatement of the spasms the patient gradually recovers. Sometimes a fit of vomiting termi- nates the attack. The memory and judgment are generally some- what impaired for some little time after the fit, and a sensation of languor and exhaustion, or weight and other uncomfortable feelings in the head are complained of. Comparatively few patients are carried off during a fit, but it sometimes happens that one fit suc- ceeds another in rapid succession, or with increasing intensity, until a comatose state ensues, and the patient sinks. Idiotcy is an occa- sional melancholy result of this distressing malady.
The prognosis is more or less favorable according to the age of the
form in the mouth, give Mercurius vivus. Schreiber's method of attempting to cure the pernicious habit, consists in locking the patient up by himself, allowing him to drink brandy mixed with one third part of water ad libitum, and adding one third part of brandy to every other liquid, and all the food the patient partakes of. Although intoxication may be the result of this procedure, during the first day or two, still, the subsequent disgust which takes place (generally about the fifth day) commonly puts a stop to further relish for the intoxicating beverage. Carlo v. has recently been suggested as likely to be of service in some cases of delirium tremens. (Allg. Horn. Zeit., No. 1, 33 Bd.)
EPILEPSY. 355
patient and the species of the epilepsy. When the disease occurs before the age of puberty, or when purely sympathetic, it is generally cureable without much difficulty by means of homoeopathic reme- dies. On the other hand, when it comes on after the age of puberty, is idiopathic, or of hereditary origin, and has been of long duration, the cure is not easily accomplished. It is generally possible, how- ever, even in the most inveterate cases, to lengthen the intervals between the attacks, and to mitigate their violence by means of steady and judicious treatment.
Therapeutics. This must be regulated by the character and causes as well as by the symptoms of the malady ; the latter guiding us in the selection of one from amongst a class of remedies. When the disease proceeds from plethora with determination of blood to the head, Aeon., Bella., Op., Nux v., Puis., Bry., Merc, Ign., Sulph., Veratr., Silic., are the most effective remedies. (See Congestio ad caput.) When from debility, caused by loss of humours (hemorrhage, venereal excess, masturbation, etc) : China, Phosph., Ac. phosph., Nux, Sulph., Calc, Staph., Sil., principally. When from the irritation of worms : Hyos., Bella., Cine, Cina, Merc, Sulph. (See Invermination.) When from that of teething: Bella., Cham., Cina, Ign., Sulph., Calc, Stann. (See Dentition and Convulsions in Children.) When from hysterical affections {Epilepsia uterina) x Bella., Plat., Sep., Ign., Sulph., Mosch., Nux, Cocc, Veratr., Puis., Aur., Magn., Magn. m., Sec corn., Stram., Hyos., Ac hydroc (See Hysteria and Metritis.) When from the retropulsion of an eruption : Sulph., Calc, Sil., Ipecac, Tart., Bry., Lach., Nux v., Stram. From the abuse of intoxicating drinks, or narcotics — as wine, spirits, tobacco, opium, malt liquor, (adulterated) : Nux v., Lach., Ign., Bell., Hyos., Cupr., Cham., Op., Calc &c. From exposure to the fumes of arsenic and copper: Camph., Cup., Merc, Ipecac, Chin., Nux v., Veratr., Ars. To those of mercury, Stramonium chiefly, in the first place. From checked perspiration: Cham., Sulph., Aeon., Bella., Nux v., Lach., Cic, Sil., Chin., etc. From moral causes such as fright, fear, etc.: Artem., Op., Aeon., Cham., Hyos., Nux v., Plat., Cupr. (See Moral Emotions.) From crudities of the stomach : Ipec, Nux v., Puis., etc. (See Dyspepsia and Derangement of Stomach.) And when from an injury of the head {Epilepsia traumatica) : Arnica, Aeon., Ang., Cic ; and Bella., Rhus, Sulph. An operation may sometimes be necessary to remove the source of the irritation, particularly when we have reason to
356 NERVOUS SYSTEM.
apprehend .that a spicula or morbid growth of bone is pressing upon the brain.
In recent cases of idiopathic epilepsy, either attacking suddenly without manifest cause [Epilepsia cerebralis), or preceded by a peculiar and disagreeable or painful sensation ascending from some part of the body (Epilepsia sympathica) , Bella., Hyos., Ignatia, Nux v., Op., Cocculus, etc., are most frequently indicated; and those which are chronic: Sulphur, Calcarea carbonica, Silicea, and Cuprum chiefly ; but also, Bell., Lack., Hep., Stann., Stram., Ars., Agar., Cawph , Mere., etc., and likewise the others which have been named as the more appropriate in ordinary cases of recent origin. The follow- ing are amongst the leading indications for these remedies :
Belladonna : — Commencement of the attack with a sensation of crawling and torpor in the upper extremities ; jerking of the limbs, espe- cially of the arms, convulsive movements of the mouth, muscles of the face and eyes.; congestion in the head, with vertigo, deep redness, heat and bloatedness of the face, or paleness and coldness of the face, with shivering ; photophobia ; convulsed or fixed eyes; dilated pupil ; cramps in the larynx and throat, with obstructed deglutition and danger of suffocation ; foam at the mouth ; unnoticed emission of faeces (and of urine), or loose evacuation of ingesta ; oppression on the chest and anxious respiration ; renewal of the fits on the slightest contact or the least contradiction ; dizziness, or complete loss of consciousness ; sleepless- ness between the fits, with agitation and tossing, or deep and lethargic sleep, with smiles and grimaces ; waking with a start, with cries. (Com- pare with Cham., Hyos., Ign., Op., Stram.)
Cuprum :— Commencement of the paroxysm in the fingers or toes, or in the arms ; retraction of the thumbs ; loss of consciousness and of speech ; salivation, sometimes frothy ; redness of the face and eyes ; recurrence of the fits every month, and especially at the catamenia.
Hyoscyamus : — Bluish colour and bloatedness of the face, foam at the mouth, prominent eyes ; convulsive movements of certain limbs, or of the whole body; violent jactitation; retraction of the thumbs; renewal of the fits, on endeavouring to swallow the least drop of liquid ; cries, grinding of the teeth ; loss of consciousness ; unnoticed emission of urine ; cerebral congestion ; deep and lethargic sleep, with snoring, (See Bell, and Op.)
I gnat i a i — Convulsive movements of tjie limbs, eyes, eyelids, muscles of the face and lips ; throwing bach of the head ; retraction of the thumbs ; red and bluish face, or redness of one side and paleness of the other,
EPILEPSY. 357
or paleness and redness alternately ; frothy salivation ; spasms in the throat and larynx, with threatening suffocation and difficult deglutition, loss of consciousness ; frequent yawning, or drowsy sleep, great anxiety and deep sighs between or before the attacks ; daily paroxysms.
Lachesis : — Loud cries, falling, and loss of consciousness, foaming at the mouth, cold feet, eructations, pale face, vertigo, heaviness and pain in the head, palpitatio cordis, distended abdomen, coma somno- lentum, nausea, &c.
Nux vomica ; — Shrieks, throwing bach of the head, trembling or convulsive jerks of the limbs or muscles; renewal of the fits after contradiction or an angry emotion ; unnoticed evacuation of faeces and urine ; sensation of torpor and numbness in the limbs; vomiting, profuse perspiration, constipation, ill-humour and irascibility between the attacks.
Opium : — Occurrence of the fits at night or in the evening ; throwing bach of the head, or violent movements of the limbs, especially of the arms ; loss of consciousness, insensibility, cries ; closed fists ; threat- ening suffocation; deep and lethargic sleep after or between the pa- roxysms. (See Bell., Hyos., Ign.)
Stramonium : —Throwing back of the head, or convulsive move- ments of the limbs, and especially of the upper part of the body and of the abdomen ; pale and haggard face, with stupid expression, or redness and bloatedness of the face, loss of consciousness and of sensation, some- times with cries, &c, renewal of the fits by contact, and also by the sight of bright and brilliant objects. (See Bell.)
Arsenicum — chiefly when the fits are attended with burning in the stomach, vertebrae, and abdomen.
Sulphur : — Chronic epilepsy, often preceded by a sensation as if a mouse, or some other small animal, were running over the muscles, cries, stiffness of the body, fits excited by cool air, or by a current of air. {Bella, is very useful before or after Sulph. in some cases.)
Calcarea : — Especially when the fits occur at night, and in chronic cases. (After Sulph.)
SiL-iCEA is chiefly useful in chronic epilepsy. (After Calc.)
C amphora — against epilepsy, with snoring, red and puffed face, coma somnolentum.
Cicuta :— Paleness, or yellowish colour of the face, trismus, distortion of the limbs, cries and frothy salivation, colic, as if caused by worms, &c.
358 NERVOUS SYSTEM.
Cocculus — especially in women during the catamenia, or also from a traumatic cause.
Mebcurius :— Cries, rigidity of the body, distension of the abdo- men, itching in the nose, thirst, and nocturnal attacks.
St annum : — Jactitation of the limbs, retraction of the thumbs, paleness of the face, backward traction of the head, loss of conscious- ness, appearance of the fits in the evening.
Veeatrum : — Loss of sense and movement, distortion of the eyes, and convulsive movements of the eyelids ; anguish, discourage- ment and despair, between the fits.
During the epileptic seizure or paroxysms, the patient should be placed in the horizontal posture, and such precautions taken as will obviate any injury which maybe sustained by the violence of :he convulsive movements. In order to prevent any lesion of the tongue, something ought to be inserted between the teeth. The neckcloth should be removed, the stays loosened, and cold water sprinkled over the face, especially when the breathing is much affected by the spasms of the muscles concerned in respiration. A dose of Aconite, followed by Belladonna if relief be not speedily obtained, is necessary, when the fit occurs in plethoric subjects, and is attended with strongly marked signs of congestion of the vessels of the head and neck.
The diet of epileptic patients ought to be very moderate, simple, and easy of digestion. Stimulants ought to be strictly avoided where there is plethora, with tendency to congestion. Debilitated persons require a somewhat more generous diet than the robust, but in all cases care should be taken never to overload the stomach. Excessive corporal or mental exertion must be abstained from.
NERVE-PAIN. FACE-ACHE. FACE-AGUE.
Neuralgia, Neuralgia facialis. Tie douloureux. Prosopalgia.
This distressing malady consists in an excruciating pain, which has its most frequent seat in the branches of the fifth pair of nerves, and is accordingly experienced with great acuteness under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face, and frequently into the orbit and cranium. The paroxysms occasionally continue with shorter or longer intervals, for several days or weeks in succession.
NEURALGIA. 359
The disease is, unfortunately, generally of great obstinacy, and, in some melancholy instances, utterly incurable.
When the malady is symptomatic, remedies which are appropriate to the primary disease must be had recourse to. Thus, when from derangement of the digestive functions, Nux vomica, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha or Lycopodium, will usually prove the most serviceable medicines. When arising from or connected with uterine disease : Nux v., Puis., Plat., China, Ignatia, Bella. When connected with, or arising from invermination : Spigelia, Bella., Cina, Graph., Ferr., Stann., Sulph., chiefly.
In Rheumatic face-ache, or prosopalgia, — Aconitum, Bryonia, Rhus, Mercurius, Phosphorus, Pulsatilla, Mezereum, Sulphur, Nux v., Lachesis, Sec, are the remedies that have generally proved the most effectual.
In Arthritic, — Nux v., Rhus, Colocynthy Merctmus, Causticum, etc.
In Neuralgia, with Inflammation of the Neurilemma: Aeon., Bella., Bryon., principally ; or, Merc, Phosph., Staph., Sulph., Am. ; or, Spig., Bach., Plat., Veratr., Baryta c., Thuja.
Face-ache from the effects of Mercury chiefly requires the employ- ment of Auriom, Hepar, Bella., Carlo v., Sulphur, China, Mezereum, &c. That from periostitis in the vicinity of the affected nerves : Aeon., Bella., Puis., Mez., Bry., Ruta, Aurum, Silicea, chiefly; and that which appears to arise from enlargement of a bone : Sulph., Calc, Silic, Aurum, Assa., Mez., Acid, nitr., Sec. (See Bones, Diseases of the.)
When Neuralgia facialis is attended with purulent discharge from the nose and thickening of the schneiderian membrane, or with obstruction of the lachrymal duct: Aurum, Lach., Petrol. , Silic, Ars., Marum verum, &c. ; and when nerve-pain has resulted from external injuries, such as accidents or surgical operations, Am., Aeon., Rhus, Calendula, are the medicaments which are chiefly to be relied on.
In neuralgia occurring in young, plethoric persons : Aconitum and Belladonna ; or Calc, Phosph., Plat., Lach. That in nervous persons : Bella., Lach., Spigel., Plat. ; and that in excessively debilitated con- stitutions : Cinchona and Ferrum. When the sacro-sciatic nerve is the seat of the neuralgia : Aconitum, Chamomilla, Ignatia, Nux v., Pulsatilla, Colocynth, and Rhus are, in general, the most efficacious medicines. (See Sciatica.)
Finally, in prosopalgia generally, the following have proved more or less useful : Aconitum, Arnica, Verhascum, Sulphur, Calcarea, Capsi- cum, Pulsatilla, Stannum, Conium, Thuja, Baryta c, Coffea, Kali, Cam- phora, Flectro-magnetismus, Sec.
360 NERVOUS SYSTEM.
In idiopathic neuralgia facialis or tic douloureux, the remedies which have hitherto been employed in homoeopathic practice with the most success are : Belladonna, Platina, Zgcopodium, Colocynth, Arseni- cum, China, Mezereum, Veratrum, Mags, arc., Sulphur, &c.
Belladonna. When the pain chiefly pursues the course of the infra-orbitary nerve, but sometimes also the other branches of the fifth, and is prone to be excited by rubbing the usual seat of the sufferings : darting pains in the cheek-bones, nose, jaws, or zygoma- tic process ; or cutting and tensive pains, with stiffness at the nape of the neck, and clenching of the jaws ; twitches in the eyelid, or violent shooting and tearing and dragging pains in the ball of the eye; jerk- ing pains in the facial muscles, and mouth ; heat and redness of the face. The pain is generally preceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insupportable.
Platin a : — Feeling of coldness and torpor in the affected side of the face, with severe spasmodic pain, or tensive pressure in the zygoma- tic process, with a sensation of creeping or crawling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; lachrymation ; redness of the face, &c.
Lycopodium is often useful when the symptoms are much the same as described under the preceding remedy, with the exception of the torpor and creeping, and particularly when the right side of the face is the part affected.
Colocynth : Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to all parts of the head, temples, nose, ears, teeth, &c.
Arsenicum ; — When there is a tendency to periodicity in the attacks or paroxysms, and the pains partake, more especially, of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples : the sufferings being occasionally of so severe a description as almost to drive the patient distracted ; great anguish ; excessive prostration, with desire for the recumbent posture ; sensation of coldness in the affected parts ; exacerbation during repose, from fatigue, in the evening, when in bed, or after a meal ; temporary melioration from external heat.
China : — WThen, as in. the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibility of the skin, and conse- quent aggravation from the slightest touch ; sensation of torpor and paralytic weakness in the affected part; great loquacity, with ill-
HEADACHE. 361
humour, paleness of the face, frequently followed by or alternated with redness and transient heat of the face.
Mezereum. Pains which occupy the left zygomatic process, chiefly of a spasmodic stupefying description, and extending to the eye, temple, ear, teeth, neck, and shoulder, with exacerbation from par- taking of warm food or drink, or on coming into a warm room after being in the open air.
Veratrum. Insupportable pains which almost drive the patient to distraction ; excessive weakness even to fainting ; general chilli- ness, exacerbation of suffering on getting warm in bed, or towards morning ; temporary relief on moving about.
Assafcetida may generally be prescribed with decided benefit wrhen the pain is chiefly of a dull, subdued description, and occurs intermittingly ; but also when it partakes of a burning or shooting cha- racter, and proceeds from wdthin outwards.
Spigelia is frequently a useful palliative remedy in all cases when the pain is excessive ; but is more especially required when the pains are of a jerking, tearing character, exacerbated by the slightest touch or by movement of the affected parts ; or when they appear to shoot from the centre of the brain to the sides of the head or the ears ; further, when the pains partake of a burning and pressive aching character, and have their seat in the zygomatic process; glossy tumefaction of the affected side of the face ; excessive agitation and anguish.
In other cases : Lachesis, Phospkoms, Hyoscyamus, Mags, arc, Oleand., Verb., Graph., Kali, Con., But a, Anac, Baryta c, Magn. m., Manganum, Merc, Rhus, Ignatia, Arnica, Capsictcm, Staphysagria, Coffea, &c. may be found useful.
HEADACHE.
Cephalalgia. Cephalcea. Cephalalgia arthritica. Cephalalgia nervosa. Hemicrania {megrim.) Clavus hystericus.
Headache is often but symptomatic of disease, and, in such cases is only to be cured by the removal of the primary affection. When, therefore, it arises from derangement of the stomach, or dyspepsia, constipation, cold in the head, mental emotions, congestion of blood in the vessels of the head, &c, the remedies most appropriate to the treatment of these different disorders must be had recourse to.
In the treatment of nervous headaches, hemicrania, or megrim,
362 NERVOUS SYSTEM.
the following remedies have generally been found the most useful :
Nux v., Veratrum, Colocynth, Pulsatilla, Sepia, Ignatia, Bryonia, Rhus, Ipecacuanha, Chamomilla, Coffea, Hepar, China, Cicuta} Belladonna, Arsenicum, Arnica, Acid, nitr., Petroleum, Sulphur, Silicea, Platina, Causticum, Graphites, Natrum m., Phosphorus, Zincum, Sec. Rheumatic headaches : Aconitum, Chamomilla, Mercurius, Nux v., Pulsatilla, Lyco- podium, Spigelia, Sulphur, Bryonia, Belladonna, China, Ignatia, Phosphorus, Sec. (In fugitive rheumatic pains in the head, or pains which are aggravated by movement and at night, and are attended with sensi- bility to the touch, fits of vomiting, and frequent sweating, Nux v., followed by Cham, and Puis.) Arthritic : Ipecac, Ignatia, Mix v., Coloc, Bryonia, Belladonna, Sepia, Ignatia, Veratrum, Sec. Hysterical : Ignatia, Moschus, Platina, Veratrum, Valeriana, Sepia, Aurum, Acid, nitricum, Magnesia c. eJt m., Cocculus, Phosphorus, Sec. Against head- aches occurring in extremely sensitive individuals : Aconitum, Ignatia, Chamomilla, Coffea, Spigelia, Veratrum, Cina, ov Ipecacuanha, have usually proved the most appropriate. Headaches arising from the habitual use of coffee are generally curable by means of Nux v., Chamomilla, or Ignatia. From gastric derangement: Pulsatilla, Antimonium crudum, Ipecacuanha, Nux v., Sulphur, Bryonia, Cocculus, Carlo v., or Nux moschata. From constipation : Bryonia, Nux v., Opium, Conium, or Veratrum. And those from long-continued excessive mental appli- cation: Nux v., Opium, and Sulphir chiefly ; but also, Lachesis, Pulsa- tilla, Calcarea, Aurum, Natrum m., Silicea, Lycopodium, Sec.
If the affection arises from sitting up late, or prolonged watching at the bedside of a sick person ; Cocculus, Nux v., or Pulsatilla. When headache is always excited by exposure to a current of air, Aconikcm, Belladonna, Colocynth, Nux v., or Cinchona have often been found successful, either in removing the said susceptibility, or in shortening the attacks, and rendering them of a much more bearable 4 character. And when cold, damp, or boisterous weather is generally productive of headache : Bryonia, Nux v., Carlo v. ; these last-named medicines, moreover, together with Silicea, are frequently equally useful, if head- ache is always experienced during hot, sultry weather, — the air being overcharged with electricity. Against headaches arising from the effects of mercury in large doses : Carlo v., Pulsatilla, Cinchona ; or Hepar sulphuris, Acidum nitricum, Aurum, or Sulphur. Headache after drinking cold or iced water, &c. : Aconitum, Arsenicum, Opium, Bella- donna, Pulsatilla, Sulphur, and Natrum. Headaches from congestion : Aconitum, Belladonna, Bryonia, Sanguinaria canadensis, Opium, Mercurius, Pulsatilla, Rhus, Nix v., Veratrum, Coffea, Lachesis, Chamomilla, Cocculus,
HEADACHE. 363
Sulphur, Siliceciy &c. Headache from exposure to metallic vapours, Sulphur; and from that of copper especially, Hepar $.
In general cases, the subjoined remedies will prove useful, and may be selected according to the indications given.
Belladonna. When headache is periodic, or nearly constant, and the pain is increased by the slightest movement either of the head or body, and particularly on stooping, or by moving the eyes ; or when a bright light, or the most trivial noise tends to aggravate the pain, which consists of a dull pressure at the vertex, or is of a lancinating description, and occupies either the entire head (cephalaea), or merely one side (hemicrania), extending from the occiput into the orbit and root of the nose, and is then described as a violent, screwing, piercing, bursting, or tearing pain, sometimes attended with great heat at the vertex ; or the seat of the pain is in the fore- head, and is of a dull, aching, or cutting description, attended with a sense of fulness or a feeling as if the brain would be forced through the forehead in stooping. At times these pains become so violently increased as almost to deprive the patient of consciousness whilst they last ; or the headache is attended with extreme restlessness, sleeplessness, and delirium ; and there is a falling off of the hair, in consequence of the headaches. Platina answers well, in some cases, after Belladonna, when the pain is chiefly lateral, and of the same description ; or when there is, at the same time, coldness of one half of the face, &c, with humming or buzzing in the head. Mercurius and Hepar s., and, in very obstinate cases, Sepia and Silicea are fre- quently very useful' after Belladonna.
Bryonia : — Aching, piercing, or digging, tearing pain, at a small fixed spot (clavus hystericus) ; or piercing, aching pain in the fore- head daily after a meal, or coming on in the morning, and afterwards becoming lancinating; or pain coming on in the morning, disappear- ing in the afternoon, and returning again in the evening with great violence, when it is attended with a sensation as if the head were pressed together, particularly at the temples ; burning, tearing pain over the entire head; shootings in one side of the head. The pains are in- creased by movement, and are attended with irascibility, and dispo- sition to chilliness or shivering ; they are sometimes relieved or terminated by a fit of vomiting. Nux v. and Rhus often serve to complete the cure of the foregoing symptoms, or, at all events, to curtail or remove each attack, after the previous administration of Bryonia.
Rhus : — Shooting and rending pains, extending^ to the ears and
364 NERVOUS SYSTEM.
root of the nose ; burning or pulsative pains ; headache after a meal, with desire to assume the recumbent posture, and remain quiet ; ful- ness and weight in the head ; renewal of the headache at the slightest contradiction, or on going into the open air : undulation of the brain at every step j or sensation as if water were in the head, or as if the con- tents of the cranium were in a relaxed or loosened state, and shifted about with every movement of the head ; feeling of creeping or crawling in the head.
Sepia : — Periodic cephalalgia, aggravated by mental emotion, particularly in hysterical subjects ; the pain is either of a lancinating description, and affects the whole head, or is merely seated under the eye, or occupies one half of the head or forehead ; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with extreme sensibility of the eyes to the light. Sepia is also very efficacious in cases of chronic hemicrania, with violent piercing or rending pain, intermingled with lancinations, so excru- ciating that the patient is afraid to move, and can only obtain a trivial degree of relief by remaining perfectly quiet with the eyes closed ; at other times, the pain is so violent as to cause the patient to scream out, and is attended with heat in the head, orfaintness and giddiness, followed by nausea and vomiting.
Sijlicea is especially useful where a sensation is experienced as if the brain were about to protrude through the forehead or orbits ; or pain so severe that the head feels as if it would split; or semilateral, shooting, rending pains, commencing at the temple, and extending to the nose, the upper and lower jaw-bones, and teeth of the same side. When there is a tendency to frequent sweating of the head, or when there is frequently great tenderness of the scalp, Silicea is further indicated; as also in cases wThere the parties affected are subject to the formation of small tubercles on the head.
Hepar sulphuris is also a good remedy to follow Belladonna in the treatment of headaches, when only partial relief has been obtained from that medicine, or it may be administered alternately with Silicea in cases where there are painful tubercles on the head. The pains chiefly piercing, generally aggravated at night, and frequently limited to a small fixed spot, with a sensation as if a nail were being driven into the head. Against this latter species of headache (clavus hyste- ricus), Nux vomica, Ignatia, Coffea, Mosch., Magn., and Staph, are also most important remedies.
Nux vomica may be selected when the following symptoms are complained of. Pain commencing with a slight pressure, or a sensa-
HEADACHE. 365
tion of coldness at the part which is subsequently affected ; succeeded by throbbing, and then an intense shooting, piercing, rending, or stunning pain confined to a small space, which can frequently be covered with the point of the finger, and is extremely sensitive to the touch ; or the pain causes a sensation as if a nail were driven into the head : at other times, the pain extends over the nose down to the lip, and also to the gums; or, on the other hand, it commences at the eyelid or the orbit, causing constant lachrymation, and extends over the forehead and temples to the ears, back of the head, and nape of the neck ; or it is seated in the crown of the head, and produces a sensation as if the head would split, or were being opened at the coronal suture ; or rending, aching pain, affecting only one side of the head, sometimes combined or alternating with shootings ; the pain becomes heightened to such a degree occasionally, and more particu- larly in the morning, as wTell nigh to drive the patient to despair, or deprive him of consciousness ;* great heaviness of the head, and sensa- tion as if the brain were bruised or lacerated; tenderness of the scalp. The pains are aggravated by movement, such as walking or stooping, or by reflexion ; also after eating, or on going into the open air, and are frequently attended with considerable giddiness or confusion in the head; the headache is generally attended with extreme irasci- bility, and is renewed or aggravated after partaking of coffee, the constant habit of drinking, which is not an unfrequent cause of the complaint ; sudden attacks of headache are frequently excited by a fit of passion, a fright, the effects of a chill, or an overloaded stomach.
Ignatia is also an excellent remedy, as already stated, in cases in which the pain is confined to a small space, and causes a sensation as if a nail were driven into the brain; and when there are nausea; dim- ness of the sight, and sensibility of the eyes to light ; paleness of the face, and temporary alleviation from change of posture ; aggrava- tion from noise or strong odours, or after partaking of coffee. Ignatia is sometimes serviceable in completing the cure after the previous administration of Nux v. or Pulsatilla. It is especially applicable to nervous, hysterical females of a mild and sensitive disposition.
Coffe a. In cases of megrim, brought on by meditation, vexation, or exposure to cold, attended with irritability, sensibility to noise, great anxiety, and chilliness, and a sensation as if a nail were driven
* Compare with Belladonna and Arsenicum.
366 NERVOUS SYSTEM.
into the brain, or a ; feeling as if the brain were bruised, occurring in individuals who are extremely impatient under suffering, and are not habituated to the use of coffee, this remedy is frequently a very effi- cacious one.
Pulsatilla : — Megrim, characterized by rending or shooting pains> with heaviness of the head, dimness of the sight, sensibility to light | or buzzing or singing in the ears, and earache; nausea, pale- ness of the face, lowness of spirits ; headache with pain in the nape of the neck ; aggravation of the headache, with chilliness towards evening, during repose, or particularly when sitting; melioration in the open air. Disposition mild ; temperament phlegmatic.
China: — Headache worse at night, accompanied with a sensation as if the head would split; or dull, aching, pressive, or boring pains, particularly at the crown of the head, increased by movement, or by the open air : tenderness of the scalp ; great sensibility to pain ; taciturnity and obstinacy.
Veratrum : — Headache preceded by coldness and shivering; pain in the head as if the brain were bruised or lacerated; or lateral, ach- ing, constrictive, and throbbing pains, sometimes attended with a sensation of constriction or tightness in the throat ; feeling of coldness at the crown of the head, as if ice were placed upon it ; or sensation both of coldness and heat on the exterior of the head, with deep- seated or internal burning heat ; headache with paleness of the face, nausea and vomiting, and preceded by a copious discharge of colour- less urine; headache, with pain at the pit of the stomach, or painful stiffness of the neck, headache with extreme weakness and melancholy ; painful sensibility of the hair to the touch; chilliness, with general cold perspiration. Arsenicum and Acid. phos. are sometimes useful after feratrmn.
Lachesis : — Deep-seated pains in the head, or severe aching pain in the occiput, in the sockets of the eye or above the orbits, with stiffness of the neck, particularly at the nape ; heaviness and feeling of expansive pressure, sometimes to such an extent as if the head would burst; tension in the head as if caused by strings or threads drawn through the occiput towards the eyes; lancinations in diffe- rent parts of the head ; headache every morning on waking, or after dinner, or at every change of weather.
Mercurius :— Rending and burning, or lancinating and piercing pains, generally lateral, sometimes extending to the teeth and neck, with shootings in the ears ; tightness round the head ; excessive
HEADACHE. 367
nocturnal aggravation of the headaches, often accompanied by profuse sweating.
Colocynth : — Nervous headaches, attended with smarting in the eyes ; excruciating lateral aching ; rending, dragging pains ; nausea and vomiting ; feeling of compression in the forehead increased by stooping or lying on the back ; headache every afternoon or evening, with great anguish and excessive restlessness, so that it is impossible to remain in the recumbent posture ; offensive perspiration ; profuse discharge of colourless urine during the headache.
Chamomilla : — Headaches occurring in individuals who are extremely impatient under suffering, and exasperated by the slightest pain, or who exhibit symptoms and expressions of suffering appa- rently uncalled for by the nature of the complaint; the headaches are often confined to one side of the head (hemicrania), and the pains are of a rending, aching, or shooting character, and sometimes extend into the upper and lower jaw ; sweating at the head is a frequent concomitant symptom.
Chamomilla is occasionally very useful after the previous adminis- tration of Coffea, when not called for from the commencement. Moreover, hemicrania attended with extreme excitability, arising from the daily use of black coffee, but which is usually relieved for the time by partaking of a cup of that beverage, will generally be materially relieved, if not cured, by Chamomilla ; sometimes a subsequent dose or two oiNux is required to complete the cure.
Sulphur : — Chronic headache ; headaches occurring daily, or every eight days, worse in the morning, or during the night, and attended with heaviness of the head, aching or pressive pains in the forehead above the eyes, (causing the patient to knit the brows, or keep the eyes closed,) or over the entire head; incapability of mental exertion from the pains in the head; pains as if the head would split ; Qr rend- ing, shooting, dragging, jerking pains on one side of the head ; aggra- vation of the headaches from meditation, the open air, or movement; extreme tenderness of the scalp to the touch; falling off of the hair.
Calcarea: — Chronic headaches, frequently attended with a sen- sation of extreme coldness, either interiorly or on the scalp; the pains either affect the entire head, or merely the forehead, the side, or the crown of the head, and are chiefly of a stunning, aching, throbbing, or hammering description, compelling the patient to retain the recumbent posture ; at times the head feels as if compressed in a vice, or the forehead feels as if it would burst open, particularly
368 NERVOUS SYSTEM.
when in the open air ; headache, with humming noise in the head, confusion of ideas, excited or aggravated by close application to study, or by movement; falling off of the hair. Calcarea is gene- rally very useful after Sulphur ; and Silicea, Lycopod., and Acid. nitr. after ' Calc.
Arsenicum : — Headaches so intolerable as almost to drive the patient to despair, occurring periodically and aggravated by par- taking of food : the pain sometimes extends to the gums, where it is so excruciating as to render it impossible to fall asleep ; tenderness of the scalp to the touch; temporary amelioration of the headaches from the application of cold water.
Aurum :- — Headaches in hysterical persons, attended with buzz- ing or other noises in the head ; and pain as if the head had been bruised, especially on rising in the morning or during mental occu- pation.
Eugenia : — Severe one-sided headache (megrim) coming on in the evening, attended with a sensation of pressure or forcing ^outwards behind the eyes, lachrymation, and sometimes nausea and vomiting, which produce exacerbation ; aching pains in the entire head (cepha- lsea) at night with burning in the eyes, thirst, and copious discharge of urine.
Bromium : — Headache (weight in the forehead), in the heat of the sun, disappearing in the shade j headache after drinking milk ; relieved by resting on the right side with the arms over the head.
One remedy is seldom sufficient to effect a cure of cephalalgia of long standing, particularly when of a nervous character; and indeed, in some. cases of this description, it is only possible to effect a degree of melioration. In comparatively recent cases, the medicines may be repeated at intervals from an hour to six or twelve hours, when the headache is excessively severe ; but in those of a more chronic and obstinate nature, in which it is necessary to have recourse to such remedies as Sulphur, Calcarea, Sepia, Coriaria myrtifolia, Silex, &c, con- siderably longer intervals must be observed between the doses^ when our object is to attempt to eradicate the disorder, or destroy the susceptibility to headache from trivial causes. In chronic head- aches of various kinds, and particularly in megrim, or where the pain is for the most part confined to the right, side of the head, or to the forehead and sinciput, Sanguinaria canadensis promises to be one of the most valuable remedies. It has been employed with great benefit in cases of the following symptoms. Headache commencing in the
HEADACHE. 369
morning, relieved by sleep, or disappearing after the night's rest to that of the night following. The pain is chiefly experienced in the right side of the head, but in some instances, it is transferred from one side to the other during the same or at the succeeding attack. More rarely, the left side alone is affected. The eyes are almost always sympathetically affected; and relief is sought by having the apartment darkened. Nausea is nearly uniformly present; but melioration is seldom derived from, or the attack ever terminated by, a fit of vomiting. Chronic headaches with the aforesaid characteristic symptoms are frequently mitigated (the attacks shortened, and the intervals between them lengthened), by means of Aconitum, and especially by Belladonna. The relief afforded by these remedies is, however, for the most part, merely temporary; the radical cure being commonly only attainable by the employment of such medicines as Sulphur, Sepia, Sanguinaria canadensis, &c. Dr. Helfrich recommends chiefly Aconitum and Belladonna, at the commencement and during the height of the attack, and Sanguinaria on its decline, in all cases of nervous headaches where there are no particular indications for other remedies.*
* Neues Archiv. Zweiter Band, Zweites Heft, p. 150.
24
DISEASES OF THE CIRCULATING SYSTEM,
ANGINA PECTORIS.
The pathology of this disease is very obscure. It is frequently associated with organic lesions of the heart and large vessels. Many authors have accordingly attributed such derangements as the cause of this disorder ; others have considered it as depending on a species of spasm of the diaphragm and other muscles concerned in the process of respiration, on diseases of the pericardium, ossification of the coronary arteries, and on inflammation of the mediastinum. There are many, again, who are of opinion that it is produced by asthma, by scrofula, or by syphilis, — by general plethora with ac- cumulation of blood in the heart and large vessels, or by disordered action of the cardiac and pneumogastric nerves.
The disease seldom attacks individuals under forty ; it appears to occur more frequently in men than women, and particularly in those wrho are of a corpulent make, of a rheumatic or gouty diathesis, and are exposed to much mental uneasiness, or are addicted to habits of intemperance. The pain of this distressing malady is always severe, and sometimes excruciating. The paroxysm usually comes on in the following manner : the patient is suddenly seized with an agonizing sensation in the chest, especially about the lower part of the sternum, a little towards the left side ; a painful feeling of constriction and suffocation is generally experienced, and if the party affected be walking he is compelled to stop until the attack is over. In the early career of the affection, the paroxysms are commonly only brought on by some exertion, such as walking up a hill, but when it has reached a more advanced stage, the most trivial degree of excitement, or mental or corporal exertion, as also an error in diet, such as partaking of some indigestible article of food, is sufficient to excite an attack ; and, finally, the incursions come on suddenly
ANGINA PECTORIS. 371
and unexpectedly without any manifest cause, even when in bed and during slumber.
At the first invasion of angina pectoris the pain is ordinarily con- fined to the chest ; but subsequently it extends to the left shoulder, or to the deltoid muscle, and frequently it affects the entire length of both superior extremities.
In the milder forms of the disease the paroxysms terminate in from a few minutes to half an hour ; but in those of a severer cha- racter it continues for several hours, and in some cases the un- fortunate patient is never perfectly free from distressing uneasiness and constriction in the chest. Occasionally the attack goes off as suddenly as it made its onset ; while at other times more or less soreness remains about the chest or in other parts for many hours or days.
In severe cases the patient is pale, the features haggard and con- tracted, the eyes sunk, and the countenance bears an expression of extreme anguish ; the body is frequently cold, or covered with a cold and clammy sweat; the action of the heart and lungs variously disordered; and although the patient is capable of taking a full inspiration, his respiration is rapid and difficult, and is accompanied with palpitation of the heart, excessive anxiety, and a feeling of approaching dissolution. The pulse is sometimes not much affected, but in the generality of cases it is slow, feeble, oppressed, and inter- mittent; occasionally, however, it is quick, strong, and irregular, under which circumstances the skin will usually be found warm and the face flushed. There is often considerable derangement of the functions of digestion ; and an attack is frequently terminated with a discharge of flatus.
Therapeutics. Aconitwm, Arsenicum alhum, and Digitalis piirpurea, are the remedies which have chiefly been recommended in the treat- ment of angina pectoris.
Aconitum is of considerable service in recent cases, and even in those of a more advanced stage, occurring in strong plethoric sub- jects, in whom the paroxysms are attended with flushing of the face, some heat of skin, with a full, strong, and throbbing pulse, it is a most valuable palliative when administered at the commencement of each attack. But in order to diminish the frequency of the returns, where there is local congestion, it will be necessary to have recourse to such remedies as Belladonna, Lachesis, Nux vomica, Carlo v., and
372
CIRCULATING SYSTEM.
Sulphur. The three last-named are, moreover, of service when the digestive functions are in a deranged state, and the attacks are attended or succeeded by excessive flatulence.
In cases of local congestion combined with debility : Ferrum, Cin- chona, Nux v., Acidum phosphoricum, and Sulphur are the most useful.
Arsenicum is one of the most important medicines, and one from which the most complete success has been derived in cases when the sufferings were exceedingly severe, but unattended with any signs of serious organic lesion. The indications by which we are chiefly to be guided in prescribing it are : excessive dyspnoea from the slightest movement, but especially on getting into bed, sometimes with renewal of the paroxysm on turning in bed ; palpitation of the heart, extreme anguish, and a feeling of impending dissolution ; paleness of the face, haggard and contracted features, great debility, with feeble, irregular, or intermittent pulse. [Kali hydrocyanicum, or Acid, hydrocyanicum may be substituted for Arsenic, when the latter does not afford much relief; in other cases Ipecac, and Veratr. may be more useful, — Ipecac, when Ars. or Kali hydr. fail to produce any amendment,— Veratr. when the paroxysms are accompanied by cold- ness of the extremities, cold sweats, and slow, depressed, intermittent pulse.)
Digitalis purpurea : — In more advanced cases, or in those in which the attacks come on suddenly without any assignable reason ; also when the intervals between each recurrence appear to decrease in length with the duration of the disorder.
In most cases of this dreadful affection, where no serious structural derangement has taken place, the aforesaid remedies are not only of great service in alleviating the sufferings, and in : curtailing the fre- quency of the attacks, but are even capable of effecting a cure when timely and appropriately administered. In those unfortunate cases, on the other hand, in which we meet with unequivocal symptoms ot concomitant organic disease of a formidable character, although we cannot entertain any hope of correcting the dangerous state of matters, we may yet succeed in affording some relief by means of Arsenicum and Digitalis, together with the following in particular instances : Feratrum,, Lacfoca virosa, Assqfwtida, Sepia, SpigeUa, Can- nabis, Aurum, Natrwm muriaticum, Ignatia, &c.
PERICARDITIS. 373
PERICARDITIS.
Pericarditis, or inflammation of the serous membrane which lines the pericardium and is reflected over the heart and the roots of the large vessels, is a disease which is frequently not well marked in its external characters, at least by no means so much so as an affection so intimately connected with an organ of such importance as the heart would lead us to conceive. The symptoms are exceed- ingly variable, and sometimes so insidious and deceptive as to go on until considerable disorganization is produced, before attracting our attention by their severity. In many instances, indeed, the disease has been found, on dissection, to have existed to a severe extent, where it had entirely escaped the attention of the practitioner.
The following have been given as the principal symptoms in the general run of cases of acute pericarditis: sharp, burning, pricking, or darting pain in the region of the heart, accompanied by fever of an acute inflammatory type; the pain shoots to the left shoulder and scapula, and frequently extends some distance down the arm; it is aggravated by a deep inspiration, by pressure at the intercostal spaces over the apex of the heart, and on the epigastrium; the patient is incapacitated from lying on the left side, and commonly feels easiest in the dorsal posture ; the breathing is accelerated and laborious or irregular, especially on moving; a feeling of con- traction is experienced in the precordial region, and there is extreme restlessness^ anxiety, and frequent syncope. The state of the pulse varies a good deal ; it is always accelerated, but is sometimes hard, full, and vibratory, while at others it is feeble, irregular, or intermittent ; in the advanced stage of the affection it is usually feeble and irregular, although, on applying the ear to the region of the heart, the action of the latter will be found tumultuous and violent. This inequality is.of great importance in the diagnosis, since even in insidious cases an inequality will sometimes be perceptible on comparing the strength of the heart's action with that of the pulse at the wrist. The physical signs of pericarditis are — increased and more abrupt impulse of the heart, and an unusual dullness on percussion in the cardiac region when there is considerable effusion. The sounds of superficial friction are very generally discernible when there are partial exuda- tions of lymph on the opposite surfaces of the pericardium. They commonly set in from twenty-four to forty- eight hours after the invasion of the inflammation, but, for the most part, do not continue
374 CIRCULATING SYSTEM.
for many days in succession, — the lymph being either absorbed or changed into false membrane, forming a more or less complete band of adhesion between the heart and the lung, which is productive of a gradual extinction of the sound ; or serum is secreted in such abundance that the heart plays freely in the distended sac, and ceases to rub against it. At the commencement, the sound is soft, resembling the rustling of silk, and is usually heard towards the left or about the centre of. the sternum, corresponding with the base of the heart. Subsequently it becomes louder and more prolonged, and is audible beyond the immediate vicinity of the heart, the natural sounds of which it considerably disguises. In some cases the peri- carditic friction resembles a crackling noise ; but in others, and particularly when it has increased in hardness or roughness, it is closely to be compared to the creaking of a new saddle (the new- leather sound). The normal sounds of the heart are completely muffled or disguised by a loud friction-sound ; they are sometimes to be heard, however, in the carotid arteries and at the top of the sternum.
The dullness arising from effusion of serum in the pericardium, may> when the effused fluid is very copious, extend up the whole anterior surface of the left side of the chest as high as the second rib, and spread even to the right sternum ; but it is generally limited to a space or area of two or three inches at the lower part and towards the left of the sternum. An extensive effusion commonly renders the sounds more distant and feeble, and impairs the impulse in a greater or less degree. The sounds of respiration and percussion being still found good in the back and below the axilla, and not much altered by the change of position, the case is thereby dis- tinguished from pleuritic effusion. Again, though the friction-sound is generally stopped and the impulse and normal sounds are com- monly rendered distant by displacement of the heart from copious effusion, they may be heard with their usual distinctness and intensity on listening to them in the carotid or subclavian arteries, or at the head of the sternum. By means of this circumstance we are em- powered to draw a distinction between hydro -pericardium and an excessively enlarged heart acting with great feebleness ; for in the latter in addition to the weak sound and impulse in the usual region, they would, moreover, be weak in the course of the arteries.
Infiltration of the extremities is occasionally met with; when present it ought to claim attention, as it is one of the symptoms of disease of the heart. The physical signs, taken in conjunction with the symptoms, tend much to remove obscurity from the diagnosis.
PERICARDITIS. 375
The region of the heart should therefore be always examined whenever there is a probability of implication of that organ during the pre- valence of some other disease. The duration of the affection, like that of pleuritis, varies according to the nature, rapidity, and extent of the effusion from a few days, to several weeks.
Causes. Pericarditis, like other inflammatory affections of the chest, is more prone to occur in persons of a plethoric habit, who are subject to derangement in the digestive organs. It is very frequently occasioned by a metastasis during an attack of rheumatism or gout. Prolonged grief or anxiety, and exposure to cold may be named as means which tend to excite or develop it.*
Therapeutics. The under mentioned may be considered as the most important remedies in the homoeopathic treatment of pericarditis : AconiUim, Belladonna, Cannabis, Spigelia, Bryonia, S.tilp/mr, Arsenicum, Lachesis, Arnica, Oroton, &c. In acute cases, accompanied by synochal fever, Aconitimi should be given in frequently repeated doses ; when so employed at a sufficiently early stage, in cases uncomplicated with previous disease of the heart, effusion may be prevented, and a speedy cure effected. In plethoric subjects of sanguine lymphatic temperament, it may be found requisite to prescribe Belladonna in alternation with AconiUim. Should the inflammation not yield to the employment of these remedies, although the febrile symptoms may have considerably subsided, Cannabis may be had recourse to if the action of the heart continues to be tumultuous, and is attended with oppression, anxiety, and a feeling of constriction in the precordial region ; also when signs of effusion have become apparent. Bryonia may claim a preference to Cannabis, w7hen the patient complains of sharp, pricking pains in the region of the heart, which are increased by taking a full inspiration and by movement ; and when there are symptoms of slight effusion. Spigelia may be substituted for Cannabis, in the early stage of the disease, when the patient complains of severe lancinations in the cardiac region, or a pain as if the heart were violently compressed or squeezed, and when the oppression at the chest is extremely distressing, particularly on movement, or even whilst speaking ; also when there is endocarditic complication, with
* The prognosis, in the acute stage, may, generally speaking, be considered favorable when the affection is not complicated with previous disease of the heart.
376 CIRCULATING SYSTEM,
valvular murmur. Sulphur may be used with advantage after Bryonia in some cases.
Arsenicum has been strongly recommended in diseases of the heart of various kinds. In this inflammation it may be employed imme- diately after Aconitum,, or independently of that remedy, either in the early stage — whether the attack has arisen from the metastasis of gout or rheumatism, or from the repercussion of an eruption, when there is violent palpitation, excessive rapidity of pulse, intense thirst, burning pain in the seat of the surface ; anxiety, fainting, extreme restlessness, and when a burning pain is experienced in the seat of the heart— or in a more advanced stage of the disease, when the respiration is. hurried and laborious, particularly on the slightest movement, and there is incapability of lying on the left side ; pulse feeble and irregular. Veratrum may be administered to some advantage when the extre- mities become cold, and a cold sweat covers the forehead and other parts of the body, the pulse slow and intermittent, the nose sharp^ the features sunk and contracted, &c. {Fades hippocratica.) Carlo v. may also be of service in cases of this all but hopeless description. It is particularly in conjunction with rheumatism, and especially the acute variety, that pericarditis is met with. We should therefore, as already observed, never omit to examine the region of the heart in such instances, otherwise the disease may attain . a dangerous and even incurable height before it is detected, as the general symptoms are often so imperfectly marked as not to create the slightest sus- picion of its existence ; whereas the physical signs can never fail, where any ordinary attention is paid, to apprize us of the invasion of pericarditis before it has reached a very serious, if not an incurable height.
The following cases are not inserted here from anything very remark- able in their features, but simply as illustrative of the power of the homoeopathic remedies in arresting a disorder which, in allopathic practice, is considered to require what are denominated the most prompt and vigorous measures, such as a free and bold use of the lancet, &c.
Case 1 . A. M., 13 years of age, of sanguine lymphatic temperament, was seized on the 4th of March, 1845, with acute rheumatism, for which, according to time-honoured rule, an aperient was first; given, and the pains were sought to be relieved by means of fomentations, and hartshorn embrocations. Delirium having supervened, on the morning of the 8th, I was sent for in the evening, and found the patient lying on her back, in bed, complaining of severe darting,
PERICARDITIS. 377
aching, rending pains in all the joints, but particularly those of the shoulders, elbows, and wrists, the affected parts being at the same time much swollen, tense, shining, and very sensitive to the touch ; countenance flushed, and wearing an expression of anxiety ; tongue furred white; mouth parched; thirst considerable; skin hot and dry; pulse 130, full, bounding, but regular; respiration hurried, but unattended with pain ; no cough. On examining the region of the heart, the impulse was abnormally strong, the pulsations loud, acce- lerated, and occasionally reduplicated. About the middle of the sternum, a gentle, superficial rustling sound was distinctly audible, particularly while I kept the patient in the sitting posture ; there was no dullness on percussion, and total absence of pain in the region of the heart.
R Tinct. Aeon. 3, gtt. iij. Aq. pur. J iij. Dosis. Cochleare mediocre, tertia quaque hora.
March 9. Fever diminished, pulse 120, not so full; skin moist; mouth not so parched ; thirst lessened ; recumbency on the right side supportable, not so on the left ; respiration laborious and quick ; sound of superficial friction increased in extent and loudness, audible in all positions, and in the interval beime&n, the heart-sounds as well as during their occurrence ; no perceptible dullness on percussion. The patient had passed a restless night, and was now and then delirious ; joints still inflamed and painful.
R Tinct. Bellad. 3, gtt. ij. Aq.pur. Jij Dosis. Cochleare medioc. tertia quaque hora.
On repeating my visit in the evening, I found the rheumatic suffer- ings of the patient considerably alleviated, the redness of the joints no longer so intense, and the tumefaction much reduced ; heart- symptoms little changed, perhaps a slight diminution of the friction- sound ; skin inclined to be hot and dry, pulse the same as in the morning.
Be Tinct. Aeon. 3, gtt. ij. Aq. pur. Jij. Dosis. Coch. med. sexta quaque hora.
March 10. Patient has passed a good night, perspired copiously soon after the first dose of the medicine ; skin still moist ; no thirst,
378
CIRCULATING SYSTEM.
yellow furred, moist tongue ; aversion to all food; pulse 100, some- what hard ; patient cannot yet lie on the left side, and on sitting up in bed she complained of a darting pain proceeding from the region of the heart to the left shoulder and scapula, with aggravation of the pains in the joints on movement; sound of friction same as on the previous evening ; no perceptible dullness at or near the sternum, and no abnormal sound in any other part of the chest; respiration free, slightly hurried, but occasionally interrupted by the darting pain already noticed, on making a succession of deep inspirations.
R Tinct. Bryon. 3, gtt. iij. Aq. pur. Jiij. Dosis. Coch. med. quarta quaque hora.
March 11. Considerable improvement in every respect.
Prescription as before.
March 12. Further improvement, — the patient can lie on both sides; tongue clean; appetite returning; pulse 84, feeble but regular; action of the heart still rather powerful, particularly on the least movement; friction-sound only audible after any slight exertion, such as turning in bed or sitting up ; all redness and swelling of the joints has disappeared, some stiffness and pain on movement alone remaining.
R Bryon. 6, glob. xxiv. (redig. in pulv.) Pulv. Sacch. lactis gr. iv. Misce intime, et divide in partes aequales iv, quarum capiat unam quotidie.
March 17. Convalescent. A year afterwards I saw the patient, and discovered no traces of disease of the heart of any description.
Case 2. R. H., 21 years old, of bilious temperament, was attacked with rheumatic fever about the middle of November, 1845, after having been exposed to a cold and damp atmosphere for several hours. During the three following days the sufferings were so severe that the patient was unable to remain at rest in any posture, feeling, if anything, rather easier whilst sitting up in bed with his head between his hands, resting his elbows on his knees, and giving a rocking motion to the body ; towards evening fits of coldness and shivering alternating with heat, accompanied the pains ; and about midnight copious sweats supervened, which were followed by remission of pain and some sleep. Early in the morning, however, there was recurrence of sufferings, with increased violence. On the
PERICARDITIS. 379
evening of the 5th day of his illness the patient was induced to drink some hot gin and water, in the double hope of arresting the chills and allaying the pain. The day afterwards, the rheumatic pains had nearly vanished, but were substituted by intense headache, nausea, giddiness, palpitation of the heart, and sharp pains in the left breast. These symptoms continued in an unmitigated form for five days, and on the day following, — the tenth of the patient's illness — I was requested to visit him. I found him sitting on his bed, half dressed, having been unable to complete his toilet in conse- quence of the distressing dyspnoea and palpitation which he expe- rienced on making any slight exertion ; his countenance wore an expression of intense anxiety, which, together with the history of the case, led me at once to infer, before resorting to auscultation, that some affection of the heart had arisen from rheumatic metas- tasis ; — no pain was complained of beyond an occasional twitch in the left side of the chest, during the performance of a somewhat full inspiration, or on turning the body towards the right side ; a degree of stiffness in the back and limbs was the only inconvenience com- plained of in the parts which had been previously so severely affected with rheumatism, The pulse was feeble, irregular, occasionally intermittent, and rather frequent ; the tongue furred white, loaded with mucus, and increased in volume; appetite wanting; taste metallic ; no thirst ; bowels confined for four days. On auscultation, the sounds of the heart were somewhat muffled at the cardiac region, but the impulse greater than natural, and there was distinct, though not loud, friction- sound immediately to the left of the inferior third of the sternum, particularly when the patient inclined the trunk forwards, or made any trivial effort, such as rising from his seat, or raising up the left arm quickly. On percussion there was decided dullness, confined to an area of three inches, at the lower end of the sternum. In the carotid and subclavian arteries, the normal heart- sounds were audible in their natural strength. The case thus afforded unequivocal evidence of pericarditis, from the metastasis of rheumatism, resulting in liquid effusion.
R Laches. 6, gl. xij. Aq. pur. gj. M. Dosis. Cochl. medioc. ter die.
Nov. 27. The patient intimated that he felt easier; had passed a better night than he had done since the day he was first seized
380 CIRCULATING SYSTEM.
with indisposition ; the bowels had been freely moved early in the morning ; pulse same as yesterday ; dullness on percussion, sounds and impulse of the heart unchanged ; expression of countenance still anxious. Former prescription repeated.
On the 28th, and two succeeding days, the patient remained in much the same state : he imagined himself better, but his countenance bore the same anxious expression ; and, if anything, an increase of dyspnoea with tendency to syncope on movement seemed to have taken place ; the pulse was rather more feeble and intermittent : Arsenicum 6 (dose, gl. 6 every four hours) was substituted for Lachesis, on the 1st of Dec, and continued until the morning of the 3d, when the patient's state was as follows :
Dullness on percussion over a larger space, nevertheless the friction- noise at the sternum was somewhat stronger than it had been the four previous days .; the impulse was also somewhat more powerful, but the natural heart-sounds impaired and distant; great dyspnoea and faintness on the slightest movement ; pulse still weak and quick, but not so intermittent; some appetite, but increased oppression on the introduction of the smallest morsel either of liquid or solid food into the stomach ; no pain in the region of the heart; sleep restless; decubitus dorsal, with the head and shoulders raised.
R Arsenic, 3, gtt. iij. Aq. pur. Jiss. M. Dosis. Coch. med. quarta quaque hora.
Dec. 4. Patient felt stronger, and had passed a tolerable night; no thirst ; tongue foul ; in all other respects the same as on the day previous.
R Colch. 3, gtt. iij.
Aq. pur. 3iij.
M. Dosis. Coch. ampl. tertia quaque hora.
Under the employment of this remedy, a striking improvement soon became manifest, — the patient began to breathe more freely, and to be enabled to move about without much inconvenience arising from palpitation, dyspnoea, or faintness ; the dullness on percussion commenced gradually to give way, and the sounds of the heart resumed a normal intensity. Colchicum was continued for six days, latterly at longer intervals between the doses. On the 1 1th of Dec. Nux v. and Arsenicum were prescribed in alternation, at intervals of twelve hours, — the former in consequence of the deranged state of the digestive organs, and some slight rheumatic pains, of a dragging,
PERICARDITIS. 381
aching description, in the back, chest, and joints, accompanied by a feeling of torpor in the fore-arms, — the latter, from the circumstance that the patient complained of occasional attacks of dyspnoea, and palpitation of the heart at night. A week afterwards convalescence was not only firmly established, but the patient wTas, moreover, restored to a much better state of health than he had enjoyed for a year or two past. No relapse has taken place, and recovery appears to be complete.
Case 3. C. W., aged 15, of melancholic temperament, and some- what robust and muscular build for his years, but disposed to suffer from deranged digestion in consequence of frequently over indulging a naturally keen appetite, to which an additional stimulus was usually given by the amount of severe exercise he was daily in the habit of taking, had been confined to the house for a week with a severe attack of acute rheumatism. March 3d, 1846, the patient was seen by me for the first time, when I was instructed that, three days previously, he had been seized with an increase of fever attended with palpitation of the heart and some oppression at the chest. These symptoms had continued to gain ground, and formed the reason that induced the parents of the patient to send for me, (previous to which they had been allowing the disease to take its course, — the father having become a complete sceptic in medical science.) I found distinct indications of inflammation of the peri- cardium, with some symptoms of complication with endocarditis, as was evinced by the existence of the following physical signs: loud friction-sound, not only about the middle of the sternum, but also, pretty clearly, beyond the proper cardiac region, in various directions, and greatly disguising the natural sounds of the heart; strong and very abrupt impulse, accelerated pulsations, and prolonged first sound. On listening at the top of the sternum, and also in the carotids, the normal heart-sounds were heard with tolerable distinctness, attended with a grating murmur, which, although somewhat faint, was yet sufficiently well marked to denote endocarditic implication with regurgitation through the semilunar valves of the aorta. The expression of countenance was painfully anxious, the restlessness great, the skin hot and dry, and the pulse full, strong, rapid, but regular.
R Tinct. Aeon. 3, gtt. iij. Aq. pur. Jiij. Dosis. - Jss. quarta quaque hora.
382 CIRCULATING SYSTEM.
March 4. Patient somewhat easier ; perspired freely after the second dose of Aconite ; countenance not quite so anxious; physical signs as before, impulse of the heart perhaps rather less violent; pulse still full, but softer and rather slower ; no pain in the region of the heart when the patient lay perfectly quiet, but any sudden movement was immediately followed by excessively increased action of the heart, dread of suffocation, and a sensation of severe constriction as if the heart were violently squeezed or drawn together. Position in bed either dorsal or on the right side, with the head raised, — a sense of suffocation being experienced whenever the patient attempted to recline sinistrad.
R Tinct. Spig. 6, gtt. iij. Aq. destil. Jiij. M. Dosis. Coch. ampl. sexta quaque hora.
The general symptoms having much improved under the employ- ment of the Shigella, that remedy was continued until the 7th of March, on which day the symptoms encountered were as follows : respiration freer, anxiety of expression only perceptible after the performance of any slight exertion, which was still followed by violent palpitation ; valvular murmur no longer audible ; friction- sound only perceptible when the heart is tumultuously agitated ; pulse quick, somewhat irregular, and rather feeble, even when the action of the heart is powerful. On percussion a slight degree of dullness was discernible to the left of the sternum. The appetite, which had returned immediately after the improvement effected by Aconite, and could with difficulty be kept within the proper limits necessary in such a disease, was now supplanted by a strong aversion even to the smell of food of every description, and there was considerable thirst, which seemed to be materially caused by a sensation of in- tolerable dryness and burning heat in the throat, as the patient drank but little at a time, and seemed to experience temporary relief from sipping a little cold water every now and then ; tongue rather dry and furred; bowels had not been relieved for five days. No pain was complained of in the region of the heart,' — the feeling of severe constriction having readily yielded to Spigelia.
R Arsenic, alb. 6, gtt. iij. Aq. destil. Jij. Dosis. 3SS. quartis horis.
March 8. General symptoms considerably amended ; physical sis;ns the same. Medicine continued.
PERICARDITIS. 383
March 9. Appetite returning, dryness of mouth and throat, together with the thirst, removed ; palpitation of the heart somewhat diminished; friction- sound still perceptible on particular occasions, such as after a sudden movement of the body, or even of the arms, but only to a slight degree ; dullness on percussion neither increased nor diminished since the 7th ; bowels not yet relieved ; spirits very depressed.
R Laches. 6, gtt. iij. Aq. destil. Jij* Dosis. Coch. maj. j. quarta quaque hora.
March 10. Rather less dullness on percussion ; friction-sound no longer audible ; pulse more regular, but still weak and accelerated ; impulse of the heart stronger, rather more abrupt, and the palpitation very distressing on movement, but particularly on turning in bed during the night; the patient can lie on either side, yet prefers lying on the right or on the back ; spirits better, although sudden fits of indescribable anxiety still occur at intervals. Arsenicum, and Lachesis were given in alternation every twelve hours, during the six succeed- ing days. At their expiration the patient was convalescent. The bowels were copiously relieved on the 12th without the aid of an enema. For the space of a fortnight afterwards there was some tendency to violent palpitation of the heart on going up stairs rather quickly, but this completely subsided under the action of the remedies (such as Sulphur, Bryonia, Nux v., Natr. m., and Acid, n.) which were called for by the chronic derangement of the digestive functions.
In cases of pericarditis arising from external injury, Aconitum and Arnica should be employed. When moral causes, such as prolonged vexation, seem to have assisted in developing this disease, — Arsenicum, Veratrum, Lachesis, Belladonna, and perhaps also Hyoscyamus, are medicines which should chiefly claim our attention.
Chronic pericarditis. The symptoms here are the same as those of the acute variety, differing merely in degree. When there is fever it is of the hectic type.
When dense adhesions form between the apex of the heart and the pericardium, they, by interfering with, and confining the motions of the heart, are consequently sooner or later productive of serious organic disease, more particularly hypertrophy with dilatation. The signs by which these adhesions are to be detected are not always distinctly marked. They may only be said to be decidedly appro-
384 CIRCULATING SYSTEM.
ciable when they are close and rigid, and the pericardium has, more- over, been rendered adherent to the walls of the chest. In such a state of matters, the heart will constantly be found pulsating in close contact to the ribs, its motions will be seen and felt more plainly than usual (drawing in the intercostal spaces at each systole), and there will *be dullness of sound on percussion, over a space propor- tioned to the adhesion and the size of the heart, during every stage of respiration, and in every position of the body. A projection is strikingly observable about the ends and cartilages of the middle ribs, in those cases in which an enlargement of the heart, upwards and downwards, ensues, in consequence of its general adherence to the pericardium, and of the latter to the diaphragm and walls of the thorax.
Therapeutics. When lymph has been effused, and become organized, and the adhesions formed materially interfere with the motions of the heart, the case is beyond the reach of medicine. When the exudation is serous, a cure may, in some cases, be even- tually accomplished by means of such remedies as Arsenicum, Digitalis, Veratrum, Cannabis, Sulphur, Pkosp/wrus, Carlo v., etc.
ENDOCARDITIS.
The general symptoms of inflammation of the lining membrane of the heart are, commonly, still more uncertain and obscure than those of pericarditis. There may be tumultuous action of the heart, with fever, irregular action, palpitation, oppression, anxiety, faintness, and some degree of pain, which is generally referred to the sternum or epigastrium ; but these symptoms sometimes exist in so trivial a degree as to be entirely overlooked. The physical signs are, conse- quently, to be chiefly relied on, in distinguishing this inflammation, as well as in pericarditis. The sounds of the heart are louder at first, the impulse greater, and frequently attended with a vibration or tremor, but the pulsations are not in every instance more frequent. Soon afterwards the first sound seems double, and is prolonged, or it is accompanied by a slight roughness, which ere long becomes converted into a blowing or grating noise, forming the characteristic valvular murmur, produced by the regurgitation of blood through the diseased or defectively-closed valves. By paying attention to the nature of the sound, and the situation where it is most dis-
ENDOCARDITIS. 385
tinctly heard, we may generally determine with considerable certainty in what part of the heart it occurs.
The left side of the heart is where we may almost invariably expect to meet with the deranged valves, so that when the bellows- sound or murmur is perceived we have, in nearly every instance, simply to discriminate whether the noise is produced at the mitral or aortic valves. The mitral valve, or inlet of the left ventricle, is more commonly the seat of the disease than the semilunar valves of the aorta. Whether the mitral or the aortic valves form the seat of the murmur, it wrill always be heard over the left side of the heart, synchronous with the first sound. If it is heard loudest an inch or so below, and a little to the inside of the nipple, wrhere the apex strikes, becoming more indistinct as we ascend or approach be- yond the upper half of the sternum, it is occasioned by mitral regurgitation, in consequence of the imperfect closure of the valve caused by the exudation of serum or lymph between its layers, and the irregular spasmodic action of the columnae carneae. On the other hand, if the murmur be heard most clearly at the base of the heart, along the upper half of the sternum, particularly on a level with the margin of the third rib, and even in the carotid arteries, where it usually has a harsher, more grating tone, but decreases in intensity as we approach the apex of the heart, we may be satisfied that it is generated at the aortic orifice, and is caused by tumefaction of the semilunar valves, or deposition of lymph between their surfaces. The second sound is also frequently im- paired in the latter instance, or it is accompanied or altogether supplanted by a grating noise. The pulse varies much in endocarditis, but does not partake of the violence of the heart's action. It is generally small, feeble, irregular, and not in harmony with the impulse of the heart, when the mitral valve is affected ; and more or less full, sharp, jerking, quick, but regular, when the semilunar valves are the seat of derangement.
Causes. These may in general be considered the same as those of pericarditis. The great majority of cases arise from the metas- tasis of rheumatism, or occur during the course of pleuritis. There are few instances of acute rheumatism in which some of the signs of obstruction to the current of blood through the mitral or semilunar valves are not discoverable, and the younger the patient is, the greater is the probability of his being affected with rheumatic endocarditis.
25
386 CIRCULATING SYSTEM.
Prognosis. This malady may be held as rarely fatal during its acute stage. If the valvular murmur be not removed in from ten to fourteen days, it is prone to remain permanent, and the patient will eventually sink under disease of the heart, although the fatal issue is not unfrequently delayed for from five to ten, or twenty years, and even somewhat upwards. It is consequently of the utmost import- ance to detect the disease early, as it is only during the acute stage that we may entertain any confident hope of preventing it from degenerating into a chronic, and but too often incurable disease of the heart, particularly cartilaginous or osseous disease of the valves and hypertrophy of the ventricles.
Therapeutics. The remedies which have hitherto been prin- cipally recommended in the treatment of endocarditis are, Aconitum, Arsenicum, Lachesis, Spigelia, Bis?nuth, Belladonna, Digitalis, Yeratrum, Nux v., Pulsatilla, Asparagus, &c.
Aconitum is, generally speaking, only useful in acute cases, when the pulse is full, hard, and vibrating, and there is pain of a sharp or pricking description in the cardiac region, with oppression, anxiety, faintness, and tumultuous action of the heart. We have found it, together with Belladonna, of speedy and most effectual service at the commencement of endocarditis, with indications of affection of the aortic orifice, and secondary implication of the brain evinced by delirium and occasional stupor. Arsenicum is one of the most im- portant of our remedies in diseases of the heart, and we should say^ is all but indispensable in endocarditis with disease of the mitral valves. It may, however, be of fully equal service when the outlet of the left ventricle is affected ; and is, moreover, to be considered as an invaluable remedy in complications with pericarditis. Spigelia, Digitalis, and Lachesis, are also deserving of notice in the latter instance, and may sometimes be of great service after, or in alterna- tion with Arsenicum. The observations of Dr. Clotar Mueller^ jun., on " Endocarditis Rheumatica," (which is by far the most frequent form in which inflammation of the lining membrane of the heart is encountered,) and other diseases of the heart, appear to us to be of such striking interest, that we gladly avail ourselves of Dr. J. C. Peters's translation,* to introduce an extract here :
* Endocarditis rheumatica, by Dr. CI. Miiller. Translated, with notes, by John C. Peters, M.D. Homoeopathic Examiner, Vol. v. No. 1.
ENDOCARDITIS. 387
" It is our intention here to show more particularly thaf physical examinations are always of importance in the selection of homoeo- pathic remedies, and that a continued attention to this point must lead to the most important results in the cure of disease. The present condition of our Materia Medica, at the first glance, would seem not to favour or allow of such an attempt, for we look in vain in it for even a single physical sign, which is as subtle and exact in its significa- tion as e bronchial respiration/ or ' bellows-murmur with the second sound of the heart/ &c. It could not and perhaps cannot be other- wise, for the greater part of the experiments and investigations with drugs, which constitute our Materia Medica, were made at a time when auscultation and percussion were but little known, and less practised ; and even now it would be extremely difficult to produce physical signs and symptoms in previously healthy persons, by means of drugs ; experiments with drugs on the healthy must be confined to certain, and those very narrow limits, whilst natural disease may progress to total disorganization, and often acknowledges no limits short of death. We must even do, in the treatment of organic diseases of the heart and lungs, what has been done in the treatment of other diseases, viz. conclude from slight indications what greater results might have followed, if the experiments with drugs could have been pushed far enough ; if one attempt to produce in the healthy subject, with Sulphur, Baryta, Calcarea, &c, the extensive ulcers and scrofulous derangements which have been cured hundreds of times with these remedies, he will probably be disappointed ; one will certainly wait in vain to see Kali card, produce purulent expecto- ration, and genuine symptoms of phthisis ; or for Site® to produce the manifold alterations, and new formations in the tendons, bursae mucosae, joints, &c, which it cures with wonderful celerity, &c. But there is also another source of information open to us, which was not sufficiently cultivated during the early career of Hahnemann, viz. Pathological Anatomy. When we once succeed in establishing certain constant organic lesions to be produced by drugs, as learned by post- mortem examinations in cases of poisoning with these drugs, then we come in possession of strictly homoeopathic remedies against similar diseases ; this pathological knowledge of the effects of drugs, is of especial importance in the homoeopathic treatment of endocarditis, for this disease, as it progresses, becomes attended with almost all the symptoms which attend diseases of the heart in general.
"Arsenicum : — It produces anxiety in the region of the heart;
388 CIRCULATING SYSTEM.
irritable and frequent beating of the heart, with great feebleness of the pulse; frequent, violent, irritable beating of the heart; frightful and very troublesome palpitations, especially at night ; nocturnal, irregular and violent palpitations, with anxiety; very much quickened, violent, stormy, irregular and painful beating of the heart; loss of contractility of the heart ; piercing, burning, and soreness in the region of the heart.
"Pathological Anatomy. — Very much relaxed or violently contracted heart; much thickly-fluid, tar-like blood in the right auricle; opa- lescent spots upon the inner surface of the left ventricle, from the pre- sence of false membranes; violet-red spots with softening of the internal coat of the heart (endocardium) ; red-marbled spots in the left auricle and ventricle ; smaller carmine-red spots, especially on the papillary muscles, and penetrating into the substance of the heart ; much darker redness, almost blackness of the right cavities of the heart, and some spots on the papillary muscles; red or black broad spots in the left ventricle ; inflammation of the semi-lunar valves of the aorta.
" If we recollect, in addition, that Arsenic has been found service- able in palpitations, carditis, endocarditis, rheumatic and organic diseases, especially of the left side of the heart ; in the most frightful paroxysms occasioned by hypertrophy, dilatation or valvular diseases of the heart, it will become evident that Arsenic possesses the most perfect specific and homoeopathic relation to endocarditis. It is indi- cated not only in the commencement of the disease, but also when exudations and vegetations have formed on the endocardium and valves,* especially of the left ventricle. It is hence the main remedy in Bouillaud's so-called chronic endocarditis. It is indicated when the following physical signs are present : dullness over a greater extent than usual in the cardiac region, especially in a vertical direction ; violent and irregular action of the heart, with feebleness or almost complete extinction of the pulse ; indistinctness, or roughness of both sounds of the heart, or a bellows-murmur with the first sound, heard over the left ventricle, (and along the aorta, but loudest over the aortic valves, viz.3 at the edge of the third rib, near the left edge of the sternum.)
"Bismuth: — It produces violent beating of the heart; violent palpitations, visible at a considerable distance ; a symptom which is almost peculiar to hypertrophy of both ventricles.
a Pathological Anatomy* — An intensely bright inflammatory redness
ENDOCARDITIS. 389
in both ventricles; in the left ventricle several cherry-red, pretty- broad, but not very deep spots. This evidently must prove a very important remedy in diseases of the heart, especially in the acutely inflammatory stage, although it may also prove useful in valvular disease and hypertrophy. It is indicated when the following physical signs are present : dullness on percussion over a great extent of surface; violent beating of the heart, distinctly elevating the walls of the chest (or the hand or head of the auscultator when applied) ; bellows-murmur with the systole of the heart, and heard both over the right and left ventricles.
" Colchicum : — It causes rending pain in the region of the heart ; very violent palpitations, followed by very weak beating of the heart.
" Pathological Anatomy : — Several ecchymosed spots on the pericar- dium ; effusion of serum into the pericardium ; heart large and lax, its external surface marked by dark, violet or brownish spots, and with large circumscribed patches of lymph. It would seem more homoeopathic to pericarditis* than to endocarditis. It may be used when the following physical signs are present : dullness over a small, or very great extent of surface (when there is effusion into the peri- cardium the dullness mounts higher up the sternum, in the direction of the great vessels, than when it is occasioned by mere enlargement of the heart ; distinct bulging of the ribs over the heart) ; action of the heart violent at first, and attended with a marked friction-sound (a vibratory tremor, generally perceptible to the hand ; Stokes noticed this tremor in five cases out of six ; the friction-sound is a to-and-fro sound, corresponding with the movements of the heart backwards and forwards ; it is generally more or less rough, sometimes like the rasp- ing of wood, or the grating of a nutmeg, crackling of parchment, rustling of silk ; very rarely it resembles the creaking of the new sole leather ; when the quantity of effusion increases, these sounds may change to a continuous hollow rumble, owing to the agitation of as large a quantity of fluid as is compatible with the production of a murmur). When the quantity of serum becomes great, the heart is pushed back from the walls of the chest; hence its impulse can scarcely be felt, all friction and other murmurs cease, and the natural sounds of the heart are heard very indistinctly, and at a great distance.
"Crgton: — It causes piercing pain in the region of the heart;
* The marked amendment which speedily followed the employment of Colchicum. in case No. 2, article Pericarditis, inclines me to corroborate this. — J. L.
390 CIRCULATING SYSTEM.
loud and perceptible pulsation and throbbing of the heart, especially when lying down ; sudden throbbing in the region of the aorta.
" Pathological Anatomy. — Sixteen ounces of dark bloody serum in the pericardium; softening of the heart; actual extravasations of blood into the substance of the heart ; dark stripes and ecchymoses on the endocardium of both ventricles ; inflammation of the pulmonary arteries and veins ; redness of the valves.
"This is evidently one of the most important homoeopathic reme- dies in diseases of the heart (and perhaps the most homoeopathic remedy to effusion into the pericardium, especially the haemorrhagic variety). The physical signs indicating its use are the same as those requiring the use of Colchicum, with the addition that there may be valvular murmurs heard to the right of the sternum, over the right ventricle, and during the diastole of the heart.
"Aconite: — It causes pressing together of the chest in the region of the heart ; palpitation in young plethoric persons ; palpita- tions with great anxiety, oppression of the chest, general heat, especially in the face, great relaxation of the limbs ; slow throbs in the cardiac region ; aching compressing pain below the sternum ; pain in the left side of the chest, between the fourth and sixth ribs ; disproportion between the heart and pulse beats ; for the pulse beats three times, while the apex of the heart strikes the walls of the chest once; the right auricle, however, seeming to be persistently and convulsively contracted.
" Pathological Anatomy : — No peculiar and characteristic alterations are found, viz., no signs of inflammation, or its consequences, but merely signs of relaxation and debility of the heart, with more or less of venous congestion : the heart relaxed and dilated ; the left side filled with fluid red blood, and the right with fluid or coagulated black blood, or in general, containing much black, coagulated, or brownish blood. Hence the pathological appearances afford no warrant for the use of Aconite in inflammatory affections of the heart ; still it is advised in predominant arteriality, in palpitations, in endo- carditis, with or without articular rheumatism ; also as an invaluable palliative remedy in organic affections of the left side of the heart, and large vessels, dilatation of the left ventricle, &c. ; in endocarditis it can only be homoeopathic in the very commencement of the disease, before extensive exudations or alterations of the surface of the endo- cardium and valves have taken place.
" Physical Signs :— Judging from the above, Aconite will be indi-
ENDOCARDITIS. 391
cated when there is dullness on percussion over the heart, when the motions of the heart are quick and violent, but do not evidently and visibly raise the walls of the chest at each impulse, and are not synchronous with the beats of the radial pulse ; when both sounds of the heart are heard louder, clearer [the first sound being almost as clear and clacking as the second, which is the most characteristic sign of dilatation of the left ventricle], and heard most distinctly over the left ventricle [when the apex of the heart is found beating nearer to the nipple than one inch below and within it, viz. very near the nipple, or just below it, or outside of it, or even above it, for the larger a heart becomes, the more is the apex carried outwards and upwards] .
"Asparagus : — It causes : An indistinct sensation of piercing in th§ cardiac region ; frequent violent palpitation while sitting ; palpi- tation with anxious restlessness, caused by motion or ascending stairs ; feelable and audible throbbing of the heart from moderate exercise ; irregular, quick, double beating of the heart; scarcely perceptible action of the heart. It is less homoeopathic to the inflammatory stage, than to the consequences of endocarditis, more especially to hypertrophy of both, or only of the left ventricle.
"Physical Signs: — Dullness on percussion over a very extensive surface ; the action of the heart violent, elevating at each beat, the corresponding portion of the chest, [so that when the hand or head of the examiner is placed over the cardiac region it will evidently be seen to rise and sink with every contraction and dilatation of the heart ; however violent the palpitations may be in simple nervous affections of the heart, no permanent bulging of the ribs over the heart is noticed, and the action of the heart never lifts the hand or head of the auscultator] ; violent pulsation of the carotids ; sounds of the heart natural, but louder, or attended with murmurs or other abnormal sounds at various parts, either during the systole alone, or also during the diastole.
" [Riecke says that a man in Paris, suffering with palpitations, thought he felt relief every time he ate of Asparagus; hence he pre- pared a syrup in order to have some when it was out of season ; this also helped him, and he mentioned it to his physician, who made farther and satisfactory experiments and communicated their results to Bronpais, who wrote a short article about it in 1839 ; then its use became quite fashionable, but lately it has fallen into neglect. Bronpais says, like Digitalis, it possesses the power of diminishing
392 CIRCULATING SYSTEM.
the action of the heart, and of increasing the urine, without irritating the stomach; hence it is serviceable in hypertrophy and palpitations of the heart, and also relieves the nervous pains, even when de- pendent upon organic disease. Heyfelder found it very beneficial in hypertrophy ; Andral, Fougier, Serres, &c, saw good effects from it in Cardiogmus, even Organicus, while Buchner, in his experiments with the tincture, often felt violent palpitations with anxious restless- ness, both while sitting still or moving about.]
"Belladonna: — It causes aching in the cardiac region, taking one's breath away, and causing anxiety; anxious feeling in the region of the heart, with occasional intermittence of the pulse ; irregular, unequal contractions of the heart; clucking about the heart, when going up stairs, with palpitation; trembling of the heart ; throbbing pain beneath the sternum, near the epigastrium ; very feeble beating of the heart ; violent and persistent palpitations : violent heart-throbbing, with jarring of the head and neck.
" Pathological Anatomy : — Partly fluid, partly coagulated blood in the ventricles ; blackish coagula ; lividity and great softness of the heart ; blackish and very thin blood in the arteries.
" From the above it is evident that Belladonna is not a truly homoeopathic remedy for endocarditis, but it is an admirable remedy in congestion of the chest, preventing the occurrence of actual inflammation, and moderating the stormy vascular commotions which attend organic diseases of the heart, and cutting short the frequent exacerbations of the disease which threaten to light up inflammation anew.
" Physical Signs : — Percussion sound normal, or dull over a rather large extent of surface ; action of the heart alternately violent, then weak, or even intermitting ; sounds of the heart natural, except clearer than usual, of irregular rhythm, first stronger, then weaker, then absent.
"Veratrum album: — It causes extreme agony, which takes away the breath ; palpitations, with anxiety and quick, audible respi- ration ; paroxysms of agony about the heart, which then beats very violently and feels as if it were too warm ; violent beating of the heart, which forces up the ribs ; the heart beats up very high and forcibly, so as to force the hand away, without pain. In cases of poisoning of dogs with it, the heart beats stronger, quickly, and irregularly, in strong contrast with the great general prostration and
ENDOCARDITIS. 393
stupefaction of the animal ; even an hour after death the heart still moved feebly.
" The entire absence of pain about the hearty while this organ beats so violently as to shake the chesty elevate the ribs, and lift the hand of the auscultatory deserves particular attention, for this almost never occurs except in hypertrophy with dilatation.
" Physical Signs : — The percussion sound may be dull over a very large space ; (the apex of the heart may beat directly beneath, or outside of, or above the nipple ; bulging of the ribs over the heart ;) action of the heart visibly very violent ; sounds of the heart either very loud and clear, or else one or both sounds accompanied with abnormal murmurs.
" (From the well-known action of Veratmm on the stomach and bowels, it deserves particular attention in those affections of the heart dependent upon or attended by derangement of the stomach ; 6 in some forms of nervous palpitation there is an increase of suffering after meals, or when the stomach is deranged, while amelioration is produced by dyspeptic remedies ; but, as the stomach produces the same effects when there is disease of the heart, these signs are not pathognomonic of nervous palpitation. To this point 1 [Hope] would particularly direct the attention of physicians ; because many, in forming their symptomatic diagnosis of the affections in question, regard the dyspeptic signs as paramount in value to all others, and are apt to refer to the stomach the palpitation which may really belong to organic disease of the heart/ It is easy to showr that Veratmm is homoeopathic to both these varieties. Hutchinson re- marks that, in poisoning with Veratmm^ violent palpitations, inter- mittent pulse, and a condition of things which presents much similarity to organic disease, are very apt to ensue. In the Med. Chir. Rev., vol. II, page 196, we find an article headed, ( Veratmm album used for producing artificial disease of the heart? A man by the name of Chapman, belonging to the Marine Artillery, had found out the secret virtues of the white Hellebore, and turned it to the advantage, or rather disadvantage of himself and others, to whom he sold his powders at a high price. By taking the Hellebore every appearance of dyspepsia, attended with great nervous irritability, and violent and continued palpitations, were produced. This Chap- man had deserted, and was taken in a remote part of the country, where he completely succeeded in deceiving the staff-surgeon, who
394 CIRCULATING SYSTEM.
examined him, and reported his incapacity for military service in consequence of having organic disease of the heart ! ! Dr. Quavier states that this practice of taking Hellebore was productive of some alarming consequences for a considerable period ; some were perma- nently injured, having actually produced the disease which they merely intended to counterfeit.)"
" Digitalis : — It causes in the healthy subject, slight pain, aching and heaviness about the heart ; increased activity of the heart, with, slowness of the pulse ; increased throbbing of the heart ; palpitations which arouse one from sleep ; palpitation, and commotion of the blood, with great anxiety, forcing one to get out of bed, with quick- ness of the pulse, congestion to the head, noises and roaring in the ears ; diminished action of the heart; scarcely perceptible beating of the heart ; very soft and weak beating of the heart ; evident throb- bing in the right side of the chest,
"Pathological Anatomy .-—Several blackish and quite voluminous coagula in the right ventricle ; bright-red and fluid blood in the left ventricle (in a vast majority of instances no blood is found in the left side of the heart after death, — the powerful muscular develop- ment of the left ventricle almost always seems sufficient to empty that cavity, even at the last throb which marks the cessation of life ; hence, whenever blood is found there after death, it denotes an unusual degree of relaxation, debility, and utter exhaustion of the muscular structure of the heart), fluid, dark-red blood in the heart ; extinguishing of the irritability of the heart.
(Digitaline, i. e., the active principle of Digitalis, according to Bouchardat and Sandras, in doses of one-tenth of a grain, singularly modifies the circulation, and is capable of irritating the digestive organs in a high degree ; all the patients to whom it was adminis- tered experienced a marked slowness of the pulse, the greatest depression taking place in general, some hours after the exhibition of the drug ; in several instances it was diminished in frequency to the extent of nearly one-half of the normal condition, very often only one-third or one-fourth; the next morning it became rather more frequent, but always remained from ten to more beats below the normal pulse. In all these cases the pulse was also irregular, the irregularity being of two kinds— the first and most remarkable irre- gularity was that the intervals between the pulsations were unequal ; sometimes the pulse would be hard and very quick, then hard and slow ; at others it would be soft at times, then hard ; again it would
ENDOCARDITIS. 395
remain soft persistently. Some patients would experience light- headedness^ annoying dreams and hallucinations, soon followed by more or less frequently repeated diarrhoea or bilious vomiting, which in spite of all precautions sometimes lasted two or three days ; the appetite was lost at the same time ; whenever it induced irritation of the digestive organs, the pulse again becomes frequent).
"(The marked depressant action of Digitalis on the heart, renders it homoeopathic to dilatation, with thinning of that organ, which state, according to Hope, depends upon direct debility, or deficient power. In this effect the palpitations are of a feeble, oppressed kind, and more or less distressing, frequent and prolonged, according to the extent of the dilatation : in general they are protracted ; the pulse is soft and feeble, and if the debility of the heart be great, the pulse is small ; irregularity and intermittence are common during the protracted and distressing paroxysms of palpitation and dyspnoea; when the dilatation is attended with softening of the substance of the heart, the pulse is apt to be as small, weak, intermittent, irre- gular and unequal, as in the worst cases of disease of the mitral valve ; oedema of the limbs is very common in this variety : also lividity of the face, lips, &c, ; one of the most constant and charac- teristic of the equivocal signs of dilatation of the right side of the heart, is, permanent turgescence of the external jugular veins, with- out sensible pulsation. Among the physical signs of dilatation is a change in the character of the first sound of the heart ; this, which is naturally dull and indistinct, becomes louder, shorter and clearer, so as to resemble the clear, distinct clacking of the normal second sound ; the degree of the dilatation can be judged of by observing how far the first sound resembles the second. The greater the shortness and clearness of the first sound, the thinner will the walls of the heart be found. The dullness on percussion is increased, and is found lower down than natural ; dullness over the inferior part of the sternum denotes dilatation of the right ventricle in particular. Although the heart be enlarged, the impulse is diminished, and in extreme cases absent, even during palpitation ; when felt, it is only a brief percussion of the chest, not elevating the hand or ear of the examiner ; sometimes several beats of the heart are heard, while one only is felt (Hope). There is old school authority for the use of Digitalis in this disease ; Dr. Holland says : ( The enlarged and flaccid heart, though on first view it might seem the least favorable for the use of this medicine, is perhaps
396 CIRCULATING SYSTEM.
not so ; at least I have reason to believe, that, in the dropsical affec- tions so often connected with this state of the heart, the action of Digitalis is peculiarly of avail/ (See Med. Notes, &c. p. 574.) Old school physicians also say that it helps in intermittent and otherwise irregular pulse ; Pereira says : 6 In patients affected with an inter- mittent and otherwise irregular pulse, I have several times observed this medicine produce regularity of pulsation ;' a circumstance also noticed by Dr. Holland. Dilatation of the heart is a treacherous disease to those who auscultate and percuss carelessly, as well as to the mere symptomatologist ; for the heart may be two and a half times its natural size, and yet the impulse be by no means remark- ably strong ; and when the heart is much loaded and oppressed with blood, the sound of the valves, and even of valvular murmurs may become so faint that they cannot be heard, without the patient holds his breath. In a previous article we have referred to the homceopa- thicity of Digitalis to diseases of the mitral valve).
"Spigelia : — It causes oppression of the chest and palpitations; dull stitches occurring synchronously with the pulse, and felt where the apex of the heart strikes the chest ; violent and audible beating of the heart, which may also be felt through the clothes, attended with anxious oppression of the chest, especially in the morning, soon after rising, also w7hile sitting down ; wave-like motion of the heart - want of harmony between the heart and pulse-beats ; purring sound in the chest, especially in the cardiac region, resembling the purring of cats.
cc Spigelia has been recommended in inflammations and organic diseases of the heart, but we have as yet no patholpgico-anatomical proof that it is really homoeopathic to these affections. It may prove homoeopathic to pericardial chorea ; Eberlee says that it causes spasmodic twitching of the face, alternate fits of laughing and crying, incessant inclination to run and skip about ; Pereira says it often causes spasms of the facial muscles and even gene- ral convulsions ; but spasmodic movements of the eyelids have been observed among the most common attendants of its narcotic action. It is not generally known that chorea may depend upon and mask acute pericarditis ; Dr. Bright has seen cases in which there were peculiar spasmodic symptoms, like most fully developed severe chorea, except the convulsion was more violent than is -almost ever seen in chorea ; the head being thrown from one side of the bed to the other ; the lips closed and opened with a smacking sound ;■ the
ENDOCARDITIS. 397
tongue protruded with all the grimace and difficulty as in chorea, and yet the only appearances found after death Mere recent and profuse effusion of lymph on the heart and pericardium, and recent vegetations of the semilunar and mitral valves. Shigella may prove homoeopathic and curative to this singular form of disease ; cantha- rides also produce chorea, and may light up inflammation in almost any organ).
"Physical Signs : — Spigelia may be indicated when the percussion- sound is normal over the heart, or dull over a very large surface ; the impulse of the heart increased, evidently and visibly elevating the walls of the chest at each beat ; want of harmony between the heart and pulse-beats ; (apex of the heart beating nearer the nipple than usual, or even outside of it ;) valvular murmurs at various parts of the heart, as well as with the systole as the diastole, or with both (friction or to-and-fro sound of pericarditis).
"Nux vomica: — It causes palpitation in frequent short pa- roxysms, with commotion of the blood ; pulsating throbs in the direction of the heart; great anxiety wdth severe palpitation.
"In the numerous and careful post-mortem examinations which have been made in cases of poisoning with Nux, no organic alterations about the heart have been found ; its influence upon the heart must be referred to the nervous system. It causes increased activity and evident irritation of the ganglionic system, which may be propagated to the mind and senses ; hence the above-mentioned heart-symptoms may arise in consequence of sympathy with the ganglionic and mental affections. For this reason Hahnemann laid so much stress on the mental symptoms excited hy Nux, and mentioned the presence of vexability over sensitiveness to all impressions, hypo- chondriacal humor, passionate irritability and sudden choler, great anxiousness, starting in affright, fearful anxious dreams, &c, as strong indications for the use of Nux vomica. Hence Nux cannot prove homoeopathic to endocarditis, or any other heart affection dependent upon any organic or material change of structure. From the above it becomes evident that even the negative results of physical examinations are of importance in the selection of a remedy.
i€ (We take a different view of the action of Nux ; it acts predo- minantly and specifically upon the motion-side of the spinal marrow and the muscular system in general, and tends more particularly to cause tetanic spasms. As the heart is a very muscular organ, it is
398 CIRCULATING SYSTEM.
very probable that it exerts a similar action upon it ; in fact, the spasm of the heart may become so complete and persistent, that this organ remains tightly contracted for some time, during which little or no impulse is felt, the respiration being difficult and the pulse extinct ; if the spasm of the heart be less complete and tonic, i. e., more clonic, then violent palpitation may ensue, but Nux constantly tends to produce long-continued spasmodic contraction of the heart ; according to Sobernheim it often causes an asphyxic condition, dependent upon an extremely violent contraction of the respiratory muscles and heart. Every one familiar with diseases of the heart, must be familiar with this state of things ; a patient with organic disease of the heart will be suddenly taken with what he calls spasms: he sits in speechless agony, his hands clasped over the cardiac region, his eyes protruded, his face livid, &c. ; the physician attempts to feel the pulse, and can scarcely find it, he places his hand or ear over the heart, and finds everything as still and motionless as death itself: after a while the spasm relaxes ; more or less palpitation follows, and the patient recovers for a time. Such attacks are often mistaken for paralysis, exhaustion, or debility of the heart, and treated with stimulants. Hence it will be seen that the action of Nux is exactly the opposite of that of Digitalis upon the heart ; if the latter be homoeopathic to dilatation with attenuation, the former will be so to contraction with thickening, i.e., to concentric hypertrophy, if any such disease exist. Iron, Bark, Nux vomica, Ignatia, &c, must prove the most homoeopathic remedies to simple hypertrophy, i. e., where the walls of the heart are thickened, the cavity retaining its natural dimensions ; also in that variety of hypertrophy in which the walls are considerably thickened and the cavity dilated ; and in hyper- trophy with contraction, in which the walls are thickened and the cayity diminished in size).
Pulsatilla : — It causes stitches and anxious aching in the cardiac region, with difficulty of breathing, relieved by walking; heaviness, aching and burning about the heart ; palpitation after slight mental emotions, from speaking, and after eating : palpitation with anxiety, forcing one to throw off his clothes ; palpitation in violent paroxysms, with darkness before the eyes, want of breath, especially while lying on the left side.
" Hahnemann has taught us that Pulsatilla is especially suitable for the female organism, for the sluggish, phlegmatic temperament, for gentle, quiet, and lachrymose individuals. If we seek for a reason
ENDOCARDITIS. 399
for this, we will find it in a consideration of the general action and sphere of Pulsatilla ; in its specific relation to the digestive process it exerts a marked influence upon the formation of blood, and upon the venous circulation ; every alteration of the chyme and chylification must produce changes in the blood ; excessive exaggeration of the digestive process must produce increased formation of lymph and blood, and predominant venosity (?). As women, in virtue of their sexual formation, require and use a greater quantity of blood, they are more subject to venous derangement, and hence Pulsatilla is particularly applicable to the female organism. Among the venous symptoms produced by Pulsatilla are : swelling of the hemorrhoidal tumours, enlargement of the cutaneous veins, bleeding from the nose, cough with expectoration of pieces of black coagulated blood ; redness of the conjunctiva ; the presence of chills, constant internal coldness, predominant coldness of the body, all point to a marked predomi- nance of venosity over arteriality ; as a consequence of overfilling of the large veins of the chest, and of the right side of the heart, we find anxiety, great agony with palpitation of the heart, agony in the cardiac or praecordial region, driving one to suicide; trembling anxiety, as if death were about to ensue, with fleeting heat of the body, coldness of the hands, paleness of the face, inclination to weep, &c.
^At the bedside it has been found useful in passive congestion, with distension of the veins, and in tedious heart affections; it acts principally upon the venous, i. e., the right side of the heart, and hence is rarely useful in the inflammatory stage of endocarditis ; but when insufficiency of the mitral valve has occurred, causing, as it almost always does, hypertrophy with dilatation of the right side of the heart, and consequent excessive accumulation and activity of the venous blood in the heart and chest, then Pulsatilla comes in play.
" Physical Signs : — Percussion sound dull, over a large extent of sur- face, especially in a horizontal direction ; the impulse of the heart either increased or normal; the sounds of the heart increased over the right ventricle, or a bellows-murmur in the same place ; the second sound of the pulmonary artery distinctly louder than the second sound of the aorta; normal sounds of the heart over the left ventricle, or a murmur with the systole ; the jugular veins distended, and pulsating evidently (one of the most certain signs of enlargement of the right ventricle) P
400 CIRCULATING SYSTEM.
"Rhus toxicodendron.* Symptoms which it is capable of pro- ducing in the healthy subject : violent throbbing stitches over the region of the heart, whilst in a sitting posture, so as to cause loud cries ; stitches in the region of the heart, with painful paralysis and numbness of the left arm ; palpitation of the heart, whilst sitting still, so violent that the whole body moves at each pulsation ; a sensation of weakness and trembling in the heart; excessive anxiety, with aching in the region of the heart, and tearing in the region of the os sacrum ; excessive anguish, which prevents sleep during half of the night." There is, in addition to many others, one circumstance in particular which offers considerable difficulty to the correct selec- tion of a homoeopathic medicine, viz. the apparently great identity and similarity which exists between the individual symptoms of many medicaments; if the effects of the various remedies differed more distinctly and strikingly, if the natural boundaries and deviations were more prominent, the selection of the proper remedy would be materially facilitated. It is manifest that this difficulty arises rather from the character and arrangement of our Materia Medica, than from the nature of the medicaments themselves, since it is probable that no two of them possess pathogenetic properties which entirely, or even only partially coincide in essential and particular points, excepting, perhaps, different preparations and combinations of one and the same substance. It is, therefore, of the highest importance to isolate the effects of each medicament by determining and establishing its essen- tial and characteristic qualities, and to point out distinctly its distin- guishing and differing marks and peculiarities. And in fact, when reading the accounts of successful homoeopathic cures, we may easily perceive what a decided influence a single characteristic symptom often exercised upon the correct selection of the remedy, how often, only by such means the right path was entered upon, and that a single such essential and peculiarly characteristic symptom is of much greater consideration, than many unimportant symptoms which are only vaguely or not at all connected with the dis- ease. This is undoubtedly the reason why, when two remedies appear to be equally well indicated, according to the similarity of their general symptoms, still only the one is actually suited to the case under treatment, and it is also partly owing to the same reason
* The Nos. of the " Homoeopathic Examiner," containing the remaining remarks on this and the consecutive medicines, not having reached us as yet, we have attempted to supply the deficiency by referring to and translating from the original treatise. — J. L.
ENDOCARDITIS. 401
that the thinking physician holds an advantage over the layman, who only tries to accomplish cures by opposing symptom against symptom. Hahnemann himself often directs our attention to this point, and ingeniously points out such characteristics in several medicaments." Speaking of Rhus tow. he mentions as its peculiarity, "that it pro- duces the more violent paroxysms and sufferings, whilst the body, or the affected limb is kept in a state of perfect rest, but that, on the contrary, a remission of the paroxysms and improvement is induced by motion." This assertion is also distinctly suggested and fully borne out by the above-mentioned symptoms of the heart, and it deserves here the greater consideration, from the fact that all the remedies hitherto mentioned yield no similarity to this, but quite the contrary, viz., increase of the symptoms on movement. cc Now, if we apply this peculiarity of Rhus, to Endocarditis and to diseases of the heart in general, we shall unquestionably find that it greatly limits the field of operation of this remedy ; for although, in every inflammation, an increase of the symptoms generally ensues from motion, whereascon- siderable remission follows if the body or the seat of the derangement is kept quiet, still this is more especially the case in inflammations and chronic affections of the heart. For in these, a considerable increase of the paroxysms is almost invariably created by any degree of active corporal exertion, and by any other circumstance which is capable of producing an exciting effect upon the circulation of the blood. Never- theless, there are some affections of the heart in which we meet with a certain analogy with this peculiarity of Rhus; viz., the symptoms assume absolutely no precarious or dangerous violence, in consequence of an insufficiency or defective state of the valves (usually the valves of the aorta), as long as the heart retains its contractile power in an undiminished ratio, and is yet strong enough to overcome and press on the blood in its impeded current, from regurgitation through the deteriorated and imperfectly closing valves, no interruption is given to the circulation. Everything which, in such cases, exerts a depressive influence upon the energetic action of the heart, as bleed- ing, large doses of digitalis, etc., superinduces considerable derange- ments and dangerous symptoms; on the other hand, the evil is always relieved, if we succeed in strengthening the constitution gene- rally, and in imparting to the heart that amount of energy which enables it to keep up the circulation of the blood in its normal state; hence, also, it happens that bodily exercise, judiciously undertaken, is
26
402 CIRCULATING SYSTEM.
sometimes more beneficial to persons thus affected than uninterrupted rest.
"The increase of the symptoms during rest, and their alleviation through the act of motion, consequently form decidedly characteristic and striking indications for the employment of Rhus. It is certainly not adapted to the pure inflammatory stadium, but will be found appropriate to the subsequent diseases of the valves, and the derange- ments ensuing therefrom, especially in the case of insufficiency of the valves and constriction of the ostia. As physical signs, we may point out the following : the sound on percussion is normal, or dull chiefly throughout the greater part of the longitudinal direction of the heart ; the impulse of the heart is mostly increased, and that to such a degree as to shake the entire thorax ; in place of the second sound, a pro- longed murmur is audible over the whole heart ; during the systole, there is either a sound, or an indistinct one, or none at all.
"Natrum muriaticum. It produces continual pains, violent stitches, and pain in the heart as if from contusion ; at night in bed aching beneath the heart, as if ascending from the abdomen, with palpitation of the heart, which is increased by lying on the left side, and lessened by changing to the right ; palpitation of the heart on the slightest movement, whilst in the erect posture, accompanied by anxiety ; fluttering motion of the heart ; irregular pulsation of the heart ; intermittent pulsations of the heart ; strong pulsation through- out the whole body.
" The importance of these symptoms is confirmed and increased by experience derived from the practical use of this remedy ; it is said to be of great advantage particularly in organic diseases of the heart, chronic palpitation of the heart, and in irregular pulsation of the same. Its effects, however, do not correspond as closely with acute endocarditis, but rather with the sequelae of that inflammation. The physical symptoms for its application would be : sound on percussion mostly dull throughout the greater extent of surface ; the impulse of the heart violent, irregular, and intermittent ; the sounds unequal, louder, or supplanted murmurs.
"Natrum carbonicum. It causes aching pain in the region of the heart; stitches in the heart, sometimes increased by inspiration; pressive aching sensation, as if some hard substance were placed in, and occupied a space extending from the region of the heart to the scrobiculus, with a sense of constriction in the stomach;
ENDOCARDITIS. 403
painful clucking in the cardiac region ; palpitation of the heart on ascending stairs ; anxious palpitation of the heart during the act of stooping ;. nocturnal palpitation of the heart, awakening from sleep when reclining on the left side : palpitation of the heart, which does not admit of rest on either sidei
" The symptoms of this salt bear so strong a resemblance to those of the foregoing (they are almost verbatim the same, with the distinc- tion that, amongst those which appertain to Ntibrum wiuriaticum, we meet with, in addition, c an irregular and intermittent pulsation of the heart/ a symptom, which, as has already been mentioned, is not at all very characteristic or of any importance for any given abnormal state) that we cannot discriminate between them by the physical signs, but, at the utmost, only by the general symptoms.
" Phosphorus : — It gives rise to congestions to the heart, with palpitations, which become very violent after dinner ; palpitation of the heart accompanied by anxiety in the evening, and in the morning in bed on awaking ; frequent paroxysms of violent palpitation of the heart ; violent palpitation of the heart in the afternoon after a slight mental emotion, lasting for an hour, and rendering it impossible to remain in a reclining position : recurrence of the attack on going to bed, but to a milder extent ; palpitation of the heart, early in the morning, after the usual breakfast ; palpitation of the heart, some- times several (two, three, six) violent pulsations (when walking or sitting after dinner), one or two pulsations during the night, whilst lying on the left side ; some violent paroxysms of palpitation of the heart, after a slight movement, chiefly of the left arm, on sitting up in bed, or stretching, &c, which disappeared again, when at rest ; violent palpitation of the heart in the morning in bed on awaking, and in the evening after lying down ; violent nocturnal palpitations of the heart ; accelerated circulation of the blood ; palpitation of the arteries of the neck.
"The experiments hitherto made by Orfila have been tried with too large doses, and deiath followed too quickly (after twenty minutes to a few hours) to allow of the development of any pathological alterations in those organs which did not come in direct contact with the poison. It was only observed that the blood contained in the left ventricle was liquid and black, like that contained in the right.
" Phosphorus has been chiefly recommended in palpitations of the heart with abdominal derangements and flatulence ; also when many of the described symptoms of the heart appear or become exacer-
404 CIRCULATING SYSTEM.
bated, particularly after dinner. When we consider that in organic diseases of the heart (especially in hypertrophy) the paroxysms are often increased soon after a meal, and render it necessary for the patient to abstain from all indigestible, flatulent food, this coin- cidence, taken in conjunction with the other confirmatory symptoms, cannot appear unimportant. In pure, acute endocarditis, Phosphorus can only rarely be indicated. The following physical signs are in its favour : the sound on percussion normal, or dull over a considerable extent of surface ; the impulse of the heart increased ; the sounds louder, or supplanted by murmur.
" Sepia : — It produces stitches in the heart ; throbbing in the pit of the stomach early in the morning, then undulating or fluttering sensations in the chest, similar to palpitation of the heart, followed by burning heat in the face and body ; throbbing in the left chest ; palpitation of the heart in the evening, for a quarter of an hour; palpitation of the heart, with stitches in the left side o#the chest ; the heart beats convulsively, attended with great anxiety, and trembling of the fingers and legs ; palpitation of the heart, lasting for several days, accompanied by a sensation of anguish, and rendering it neces- sary to take a deep inspiration, but unattended with any moral im- pression; intermittent pulsation of the heart, with anxiety; inter- mittent pulsation of the heart, mostly after dinner ; in the evening, when in bed, violent palpitation of the heart, and beating of all the pulses ; waking from sleep at night, in consequence of violent colic, with an unusually perceptible trembling motion of the heart (without palpitation), and a full pulse.
" Notwithstanding the rather numerous symptoms which Sepia gives rise to connected with the heart, it has been but little employed against diseases of that organ, and indeed none of its symptoms can be considered as sufficiently indicative of any special form of heart disease, the more so, as those very symptoms which are peculiar to it, viz., the trembling convulsive action and intermitting pulsation of the heart are no fixed diagnostic signs of any particular disease, but merely an irregularity in the rhythmus, which may take place in the most opposite abnormal states of the heart, and even in an apparently perfectly normal condition of the same.
" It appears to be indicated when, on auscultation, the following are the principal results : sound on percussion natural, or dull over a large extent of surface ; the action of the heart violent, unequal, inter- mittent, convulsive and trembling ; the sounds more violent and
ENDOCARDITIS. 405
louder than usual, sometimes intermitting ; or murmurs instead of the natural sounds.
"Graphites': — It produces tightness in the left side of the thorax, and about the heart early in the morning, for several hours, aching in the region of the heart during respiration ; stitches in the cardiac region ; after retiring to rest for the night, and while lying on the left side, throbbing in the region of the heart ; the paroxysm is attended with anxiety, and is of so violent a character as to cause the bedclothes to be moved by it, but disappears on turning ; violent throbbing of the blood at the heart, and in the rest of the body at the slightest motion ; strong pulsation of the heart, which moves the arm and the hand, and is productive of anxiety; violent palpitation of the heart ; violent palpitation of the heart several times, like an electric stroke from the heart towards the neck.
" Although I have not hitherto heard of anything, established by experience, concerning the use and effect of Graphites in diseases of the heart, still the above-mentioned symptoms are too important, and partly too characteristic, as to have admitted of its having been omitted here. The action or efficacy of this remedy embraces a pretty extensive sphere: certain symptoms correspond strikingly with organic lesions of the hearty which have already attained a somewhat advanced stage, particularly hypertrophy and dilatation. The follow- ing signs may be considered as appropriate indications for its employ- ment : dullness on percussion over a considerable surface ; the action of the heart so violent as to shake and raise the thorax and the head of the auscultatory the sounds of the heart loud and violent, or supplanted by murmurs.
" Calcarea carbonic a : — It causes painful aching in the region of the heart; precordial anxiety; strong pulsation of the heart after a meal; violent palpitation of the heart, with great anguish and rest- lessness, oppression at the chest, and pain in the back ; palpitation of the heart ; violent palpitation of the heart ; a long-continued spas- modic constriction in the region of the heart, which interrupts the act of respiration, with subsequent violent shocks ; great anguish and pal- pitation of the heart; stitches in the heart, obstructing the breath, and leaving behind it an aching pain in the cardiac region; very violent palpitation of the heart, with an unequal pulse ; pulsation of the large vessels in the chest.
"'The annals of homoeopathy mention several cures of rheumatic, anomalous gouty affections of the heart. It corresponds, as may easily
406
CIRCULATING SYSTEM.
be supposed, not with the pure inflammatory stadium, but with the sequelae. Physical signs : the sound on percussionnormal, or dull to the greater extent ; the impulse of the heart violent, often not synchronous with the pulse in the wrist ; the sounds of the heart louder, or supplanted by murmurs.
"In conclusion we may yet venture to make some general observa- tions on the occurrence of organic diseases of the heart, and on the possibility of their cure. Doubts have repeatedly been raised, and principally in homoeopathic writings, on the actual existence of affec- tions of the heart in rheumatismus acutus, and more particularly on the safety of depending on auscultatory phenomena for the discovery of organic diseases* of the heart, as, for example, copious loss of blood, and peculiar chlorotic and gouty dyscrasiae are in themselves sufficient to produce similar consecutive murmurs, and changes in the sounds of the heart, without the actual coexistence of the least organic meta- morphosis ; many are inclined to consider the supposed rheumatismus of the heart as nothing else than a consequence of copious bleeding. Although it must be confessed that Bouillaud, who particularly (and was almost the first who did so) directed our attention to the close relation of rheumatismus to the heart, has given occasion to this supposition by his coup- sur-coup conducted venesections, and that others have commited exaggerations, by trying to discover inflam- mation of the heart in every case of rheumatismus, still innumerable cases (which had run their course without the employment of bleed- ing, and in which the correctness of the auscultatory diagnosis could be established by autopsy), have but too often proved the existence of structural derangements of the heart. It is certainly true that in chlorotic persons, and under particular circumstances, anomalies are sometimes observed in the beating of the heart, which disappear too quickly and, in most cases, spontaneously, and are too isolated to warrant us in determining that they should have proceeded from organic metamorphosis, still this identical sudden appearance and vanishing, when taken in conjunction with the other general symptoms, and the circumstance that such inexplicable cases are of rare occur- rence^ ought to facilitate and correct the diagnosis, and will con- siderably diminish the weight of the aforesaid objection. Another reason which gives rise to the doubts which many entertain of the frequent occurrence of organic diseases of the heart, and which must necessarily make them, at the same time, very indifferent and sceptical to the possible advantages of a correct diagnosis, appear
ENDOCARDITIS. 407
to be the exaggerated and partly erroneous view which they harbour of the great danger and unconditional fatality of organic diseases of the hearty and of the utter fruitlessness of every attempt to cure them. And yet amongst all the organic diseases and derangements of noble organs, perhaps those of the heart, notwithstanding the great importance of this organ, are the least accompanied by im- mediate or direct danger ; now that we are so much more readily enabled by the improvements effected in medical science to discover them more distinctly and more correctly, we can daily convince ourselves that they often exist for many years and even without causing any serious detriment to the whole organism, that they have absolutely not always been the causa mortis, yea, that many have only been discovered at the post-mortem examination, having remained quite unnoticed during the existence of the individuals, and conse- quently without exerting any considerable detrimental influence upon life. Death is, comparatively speaking, seldom directly attributable to them, e.g. by the bursting of the heart, but for the most part indirectly by the derangement of other organs and functions, and by increased disposition to other diseases, such as hydrops, apoplexy of the brain, &c. How very different, in this respect, is the case with other organic diseases, e. g. of the lungs, which, in most instances, produce the fatal termination in a more direct, progressive, and irresistible manner, generally leaving but little prospect to the physician of averting the fatal issue, or often even of retarding it for any considerable time. Although, therefore, medical art may very rarely and perhaps never succeed in effecting a radical cure of advanced organic metamorphoses of the heart, nevertheless there is a much wider scope for preventing their threatened development, or arresting them in their progress, and consequently of obviating, meliorating, or removing the secondary, life-endangering, but not inevitable, consecutive symptoms and derangements of other func- tions, and of the system in general. It is just in such cases and under such circumstances that homoeopathy has already effected great things ; and indeed this system can be greatly promoted by, and derive much advantage from the further cultivation and practical application of the diagnostic auxiliaries.
If it appear necessary to substantiate this assertion by practical examples, I appeal, first of all, to the testimony of many practitioners, to whom such cases must have often occurred, if they have ever made their observations and examinations with the necessary atten-
408 CIRCULATING SYSTEM.
tion. For my own part, I shall in this place mention only two cases, which are interesting in more than one respect, and are confirmatory of what has been asserted above. The one is the case which Dr. Goullon has fully described, (Neues Archiv, Vol. I, Heft 2, p. 44,) and which, therefore, I must content myself with simply referring to. The other came under my own observation two years ago : —
" M. Held, the daughter of healthy parents, was from her earliest childhood subject to frequent attacks of violent palpitation of the heart, attended with anguish and swooning, which were chiefly called forth by bodily exercise and exertions ; the evil increased every year in violence, prevented materially the growth of the body, and w7as pronounced by several physicians to be hypertrophy of the heart, and treated with leeches, cupping, and vesicatories. When she had reached her eleventh year, Dr. Noack was applied to, under whose homoeopathic treatment the paroxysms became more scarce and less violent, and the entire constitution of the patient wras at the same time essentially ameliorated and strengthened. This gentleman left Leipsic a year and a half afterwards, at which period I was intro- duced by my father to the patient for the first time. She was then 12^ years old, of small stature, emaciated, and weakly; the left side of the thorax was protruded forwards and more elevated than the right, the sternum pressed dextrad, the spine also bent sideways, the impulse of the heart exceedingly violent, strongest between the sixth and seventh ribs, both to the sight and touch, and producing vibration throughout the greater part of the epigastrium ; the sounds of the heart were strong, loud, quick, irregular, and during the systole there was an additional murmur, audible particularly over the left ventricle ; the palpitation of the heart was frightfully increased by the slightest movement. The other functions of the body were all as yet pretty regular ; the mental capacities were somewhat preco- cious, the temper mild, easily excitable and anxious. After the lapse of four weeks, considerable deterioration took place, in consequence of some external, noxious influence, the dyspnoea, the anguish, and the palpitation of the heart became almost unbearable, the patient could neither walk, nor lie down, but only sit in a half erect posture, violent cough, and paroxysms of threatening suffocation appeared, par- ticularly during the night, accompanied by a continuous tormenting thirst; the feet, and subsequently the abdomen, the hands and arms then became in the highest degree cedematous; the urine clouded, dark and somewhat scanty ; the bowels obstructed. None of the remedies at
CARDITIS. 409
first prescribed, {Arsen. Digit. &c.) succeeded in producing the slightest amendment, or in stemming the progress of the malady in this frightfully aggravated form ; at length, when death appeared almost unavoidable, the violence of the most distressing symptoms abated under the employment of Pmnus spinosa (second dilution, one drop every four hours), the nights became more tranquil, the paroxysms of impending suffocation became less violent, the cedema decreased, and, in short, after the continued use of this remedy for a period of three weeks, the patient was enabled to rise, and to walk, and to lie down in an horizontal position; the respiration and the sleep were quiet, the cedema had perfectly disappeared, with the exception of a trivial degree of swelling about the ankles ; the action of the heart became more quiet, the sounds more regular and less loud. For nine months in succession, the patient enjoyed such a state of health as she had never before experienced, she became stronger, could bear a much greater amount of bodily and mental exertion without inconvenience, and the repeated physical examinations showed that the anomalous states of the heart were all still existing, but materially lessened in degree. The following year, in consequence of violent constitutional excitement proceeding from the first appearance of the menses, the patient suffered a relapse, nevertheless this event cannot in any mea- sure be considered to weaken the value of this case for proving our assertion ; for this example of such a considerable, and in all proba- bility congenital organic malformation of the heart, being borne for a period of thirteen years, notwithstanding the deformity of the thorax superinduced by it, cannot otherwise than speak forcibly against the generally received opinion of the absolute fatality of organic diseases of the heart ; it, moreover, proves the beneficial effects which homoeopathic medicines may yet exercise, even in cases of this desperate character."
CARDITIS.
Inflammation of the substance of the heart, distinct from the membranous affections, is a rare disease. The general symptoms of the cases on record present similarity to those of pericarditis. In the event of inflammation of a large portion of the heart, a fatal termi- nation is, in all probability, unavoidable, in consequence of the serious interruption which, in such a case, must be offered to its function.
410 CIRCULATING SYSTEM.
The remedies which are likely to be the most effective, in cases where there is any prospect of performing a cure, are Aconitum, Bryonia, Bachesis, Arsenicum, Pulsatilla, Cocculus, Spigelia, Croton, Digitalis, Carlo v., Nalrum m., &c. The cure of organic diseases of the heart, especially when they are of some standing, or of a complicated nature, is, unfortunately, not often within the reach of art. All that remains to be done, in the majority of such cases, is to mitigate the general symptoms, to render the patient's life as little oppressive yet as useful to him as possible, and to retard the onward march of premature decay, by means of appropriate medicines, diet, and rules of conduct.
In Hypertrophy, or morbid thickening, or increase in volume of the muscular substance of the heart, indicated chiefly by dyspnoea, increased impulse, diminished natural sounds, dullness on percussion, and full, strong, vibrating pulse, the medicaments which have been employed with more or less success are, Ars., Spigel., Bism., Digit,, Rhus, Phosph., Prunus spin., Iod., Veratr. ; and also Graph., Ferr., China, Nux, Ignatia, Natr.m., Aeon, (palliative), Bella., Rhus.
In Dilatation or an enlargement of the capacity of one or more of the heart's cavities, characterized by palpitation and dyspnoea on any sudden emotion, diminished impulse, increased and more ex- tensive sound, and soft, feeble, undulating pulse, &c, or hypertrophy and dilatation, with combination of the symptoms and signs of these two states : Spigel., Digit., Cannal., Ars., Bism., Asparag., Bachesis, Bycopod., Carlo v., Puis., Rhus, Spigel., Veratr., Nux, Phosph., Am., Sep., Sulph., Calc., Aeon., Oleand., &c.
In Diseases of the valves, indicated by bellows- or rasp-sound, heard most distinctly over the situation of the diseased valve, persisting even during quietude, and occasionally accompanied by a purring tremor or vibration, felt on placing the hand on the region of the heart ; palpitations and dyspnoea aggravated by exercise or by mental emotions ; weak, small, and sometimes intermittent pulse ; swelling of the feet towards evening ; and, as the disorganization advances, discoloration of the face and extremities, extension of oedema to the legs, dropsical infiltration into the different cavities of the body : Ars., Phosph., Argentum, Aurum, Coco., Natr. m., Croton, Digit., Spigel. ; and Rhus, Puis., Bella., Bach., Assa., By cop., Veratr., Sep., Graph., ho. (See Dr. G. Mueller's observations, page 383, where general and
CARDITIS. 411
physical indications for most of the foregoing medicaments are enumerated.)
In Aneurism of the ascending portion and arch of the aorta, which is frequently indicated by the following signs : loud whizzing or rushing at the superior extremity of the sternum, perceived on the application of the hand to that region ; rattling in the throat ; op- pression at the chest ; dissimilarity of the pulse at the wrists ; dull sound, and perceptible impulse under the sternum or below the right clavicle when the tumour is large; single or simple pulsation, with increased impulse and louder sound, in contradistinction to the double pulsation and the normal sound of the heart; bellows-sound attending the single pulsation. The general symptoms differ con- siderably according to the situation, shape, and size of the aneurism. Thus, when it may happen to be so formed or placed as to press against the gullet, it will cause impeded deglutition, and sometimes a constant clucking noise ; it may press upon the spine and give rise to severe dorsal pains, with nervous symptoms of various kinds, and great debility ; or it may compress one of the larger bronchial tubes, or produce absorption of a part of the lungs, and create difficulty of breathing, cough, &c.) : Carlo v., Lachesis, Lycopodium, Ars., Sulph. ; or Spigel., Rims, Graph., Cole, Puis., Digit, Natrum m., Zincum, &c, are the remedies which are likely to prove most useful.
The most useful remedies, generally speaking, for removing attacks of congestion, in diseases of the heart, are Aconitum, Belladonna, Lachesis, Nux v., Opium, Aurum ; or Cocculus, Coffea, Phosphorus, Ferrum, Ars., Digit., Plumb.
Affections of the heart induced by the injudicious employment of Mercury, are commonly remediable by means of those medicines which are the more powerful antidotes to the multifarious, injurious effects wThich arise from the abuse of that mineral, but especially such as : Hepar sulphur is, Acidum nitricum, Aurum, Pulsatilla, Cinchona, Lachesis, Lycopodium, etc.
Those which are manifested in a gouty habit, require the em- ployment of the remedies which correspond to that diathesis, as well as to diseases of the heart in general.
In acute rheumatism of the ^heart : Aconitum, Lachesis, Belladonna, Bryonia, Arsenicum, Pulsatilla, Spigelia, Colch., and Nux v., form the principal remedies.
412 CIRCULATING SYSTEM.
Against arterial inflammation, in consequence of a wound, etc., Rhus has chiefly been recommended. If, at the same time, there has been considerable contusion of the adjacent parts, Arnica will be necessary. When the inflammation is intense and accompanied by great constitutional disturbance, or when it threatens to extend rapidly towards the heart, Aconitum must be employed. Pulsatilla and Arsenicum may be useful in certain cases, the latter more parti- cularly in advanced stages of the affection. The same remedies are equally applicable in Phlebitis, arising from external injury. When inflammatory action is manifested, in the vena porta, with burning pain in the seat and course of that important vessel, and the commencement of its incipient and terminal ramifications, pain and distension in the right hypochondrium, bitter taste, whity-brown, or yellowish tongue, vomiting, yellowness of the white of the eye, and of the face, Nux v. is an important medicament. Lachesis, Pulsatilla, and Sulphur may answer better in other cases ; or Arsenicum when symptoms of extreme prostration, with dryness of the tongue, and delirium, supervene. In chronic phlebitis, Lycopodium, Plumbum, Carlo v., Calc, Arnica, etc., may prove of efficacy. (See also Varices.)
CUTANEOUS DISEASES.
ST. ANTHONY'S FIRE. ROSE. Erysipelas*
Diagnosis. The first local symptoms are heat, tingling or prick- ing pains, with diffused swelling, tension, and deep shining redness of the affected part. This is, ere long, followed by pungent, burning and sometimes tearing or shooting pain, which is aggravated by motion or pressure. On pressure, the redness disappears for a mo- ment, but immediately returns on removing the finger. The consti- tutional symptoms vary according to the severity of the case ; they generally consist of shiverings, succeeded by flushes of heat ; sleepiness wandering pains, dry tongue, nausea, oppression at the stomach, and headache ; vesications frequently arise on the affected parts, attended with increase of fever. (Erysipelas hullosum.) In a few days the red- ness changes into a yellowish hue. When the face is attacked, the features become much disfigured by the swellings, and delirium supervenes. The disease assumes a very serious aspect when it affects the face and scalp, and accordingly requires the utmost atten- tion and discrimination in the treatment pursued.
The hair often falls off after a severe attack of erysipelas of the face.
Causes. Derangement of the digestive functions, exposure to cold or powerful mental emotions ; occasionally it appears during menstruation ; certain kinds of food also provoke it in some idiosyn- crasies ; for example, lobsters, oysters or other shell-fish.
Therapeutics. The principal remedies in the treatment of the ordinary forms of erysipelas are Aconite, Belladonna, Bryonia, Bul- mtilla, Rhus toxicodendron, Arsenicum, and Lachesis.
Aconite, only in case there be much fever or hot dry skin at the
414 CUTANEOUS DISEASES.
commencement, or even during the course of the disease, if re- quired.
Belladonna, chiefly in Erysipelas phlegmonodes, but also in cedematodes and erraticum, when the redness expands in rays, and an acute shooting pain with heat and tingling, is experienced in the affected part, which is aggravated by movement. Facial erysipelas, with burning heat, excessive swelling, so that the eyes are almost closed, violent headache, thirst, dry, hot skin, restlessness, disturbed sleep, delirium.
In such instances, Belladonna is generally alone sufficient to effect a cure ; but sometimes it will be found necessary to have recourse to Lachesis or Rhus toxicodendron, after, or in alternation with Belladonna, particularly when vesications are evolved ; or to Hepar s. when the skin is smooth, looks less glassy and inflamed after the employment of Belladonna, but the heat, pain and swelling remain unaltered. (See Rhus.)
Bryonia is frequently useful when the disorder affects the joints, and when the pain is exacerbated by the slightest movement. Bella- donna, however, is equally appropriate in most affections of this nature. (Sulphur is sometimes required to complete the cure after Bryonia?)
Pulsatilla, when the hue of the skin is less intense, or of a blueish red, and the morbid spots frequently disappear from one place to reappear in another (Erysipelas erraticum). It is further indi- cated when the disease affects the internal and external ear, par- ticularly in vesicular erysipelas, after Rhus toxicodendron, (Belladonna and Rhus, and, in some instances, Graphites, are also frequently called for in fugitive or wandering erysipelas.)
Rhus toxicodendron is our best remedy in vesicular erysipelas, and also appropriate in erysipelas with gradual but very extensive oedema (Erysipelas oedematodes), particularly when the disease has a tendency to extend itself to the brain and membranes, and the symp- toms closely resemble those developed in Encephalitis. In some instances it is necessary to have recourse to Belladonna and Hepar sulphuris to complete the cure (see the indications for these remedies p. 311) — or to Belladonna and Rhus alternately, — or to Lachesis, which, next to Rhus, is perhaps the more generally useful remedy in Erysipelas vesicularis. (Graphites is also useful in some obstinate cases of vesicular erysipelas.)
It may be likewise remarked that Rhus is especially suitable to ery-
st. Anthony's fire. 415
sipelas arising from particular kinds of food in certain idiosyncrasies ; in other cases of this kind, however, Pulsatilla or Bryonia will be found equally serviceable, according to the symptoms and the tem- perament of the patient.
Nux v. In erysipelas of the knee or foot with extremely painful bright red swelling, this remedy is considered by Reissig to be as preferable to other remedies as Rhus generally is in vesicular erysi- pelas. He found it more especially successful in pseudo-erysipelas occurring in irritable subjects, particularly females, and even in morti- fication of the subcutaneous cellular tissue.*
Arsenicum, when vesicles of a blackish hue, with a tendency to degenerate into gangrene, present themselves {Erysipelas gangrenosum), still more clearly pointed out if great prostration of strength be present. This medicine may also be advantageously alternated with Carbo vegetabilis or with Lachesis in such cases. {Lachesis and Rhus are occasionally of great service after, or in alternation with Arsenicum.)
Cuprum aceticum. The value of this remedy, upon the testi- mony of Dr. Schmid, of Vienna, has been already noticed in reper- cussed eruptions, when a marked metastasis to the brain has taken place, under Scarlet Fever (which see).
Sulphur and Arsenicum are important remedies when erysipelas has terminated in ulceration. In some chronic forms of the complaint, Acidum nitricum, Euphorbium, Sulphur, Graphites, Silicea [pseudo-ery- sipelas), and Hepar s. have been found serviceable. The alternate use of Bella., Rhus, and sometimes Lachesis, or Crotalus, has succeeded in removing permanently a disposition to erysipelas of the face.* In Erysipelas Scroti {Chimney-sweeper's Cancer) , Arsenicum is the most important remedy ; Rhus, Clematis, and Lachesis have also been recom- mended.
The greatest care must be observed to avoid the risk of taking cold even during convalescence ; such an accident occurring during the disease is, as is well known, frequently attended with the most dangerous results. The troublesome itching so frequently attendant upon erysipelas, is often materially relieved by the application of wheaten starch, or the flour of maize.
In conclusion, I may be allowed to remark, that by the fortunate discovery of remedies, perfectly homoeopathic to most of the forms of
* Allg. Horn. Zeit. xxi, 88. ■$ Ibid, xxii, 20.
416 CUTANEOUS DISEASES.
erysipelas, we are now enabled to subdue this affection with the same facility and certainty, as we treat other diseases curable by well- known specifics.
BOIL.
Furunculus. Abscessus nucleatus.
Diagnosis. Round, or rather cone-shaped, hard elevations, of different sizes, slowly inflaming and suppurating, discharging matter, generally at first, tinged with blood, but still retaining a portion of morbidly-altered cellular tissue, which may form the nucleus of other elevations after those which appeared first have healed.
Gauses. A peculiar constitutional tendency. Boils are^ however, frequently critical, as in gout, following acute fevers or eruptive dis- eases, and sometimes forming the termination of chronic exanthemata such as itch, &c.
Therapeutics. The following are the remedies most serviceable in this troublesome affection: Arnica montana, Sulphur, Belladonna, Mer- curius, Aconitum, and Hepar sulphuris.
Arnica is the best remedy in most cases of boils, and will fre- quently prevent their return ; but, in the majority of cases, Sulphur is necessary to eradicate the affection. This desirable result, how- ever, is best accomplished by the use of these two remedies on each attack, for two or three successive times, the employment of Sulphur being invariably had recourse to as soon as cicatrization seems about to commence. It sometimes happens, however, that the pain and constitutional disturbance are so great that it becomes necessary to have recourse to one or more of the subjoined remedies.
Aconitum, when the boil presents an extremely inflammatory appearance and the affection is accompanied with considerable fever and restlessness, is promptly efficacious in subduing these symptoms, and may precede a more specific remedy for those which remain.
Belladonna, should the boil have an inflamed, fiery, or erysipe- latous red appearance ; or, moreover, should it, if situated upon the extremities, be associated with swelling and tenderness of the glands under the armpit, or upon the groin ; dry, hot skin, thirst, head- ache.
CARBUNCLE. 417
Mercurius, should the swelling refuse to yield to the preceding remedy, after the inflammatory redness has been subdued.
When matter has formed, Hepar sulphuris will be found conducive to bringing the tumour to a head, and thereby curtailing suffering.
A tendency to frequent returns of this affection is, as already stated, often obviated by the repeated exhibition of Arnica and Sulphur; but when, from some innate taint, these remedies are not found sufficient, the same result may be attained by the employment of Lycopodium, Nux vomica, Phosphorus, or Acichim nitricum.
CARBUNCLE.
Anthrax. Funmculus malignans. Pustula nigra.
Diagnosis. A livid, blueish, or black spot, upon an extended surface, extremely painful, readily running to gangrene, and proving fatal from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactitation, and sleeplessness.
Therapeutics. The best remedies in this affection are Lachesis, Silicea, and Arsenicum album.
Si lice a : — When administered at the commencement, in simple non-contagious carbuncle, is frequently found sufficient to effect a perfect cure.
Lac he sis : — When the anthrax presents a livid appearance, and seems disposed to extend rapidly or to ^burrow.
Arsenicum : — When the carbuncle threatens to terminate in gangrene ; it is also the most efficacious remedy when the disease has arisen from contagion.
In some cases Cinchona, Rhus toxicodendron, Pulsatilla, and SiUcea may be found serviceable in completing the cure after Arsenicum.
CHILBLAINS.
Perniones.
This affection is too well known to require any particular description. The exciting cause is exposure to transitions of temperature, from
27
418 CUTANEOUS DISEASES.
cold to heat, and vice versa, but the origin of chilblains is more deeply seated ; the feet are the part most generally attacked, although fre- quently the hands also suffer. When the chilblains bursty and become ulcerated, they constitute an exceedingly painful affection.
Severe suffering from chilblains is an indication of constitutional taint not to be neglected, and individuals so afflicted should place themselves under a proper course of treatment ; for, until the system is completely renovated, they are continually subject to a recurrence of this troublesome affection.
Therapeutics. The following are the most useful medicines in ordinary cases : —
Nux vomica, Pulsatilla, Belladonna, Arnica, Chamomilla, Arsenicum, and Sulphur.
Nux vomica is particularly indicated when the inflammation is of a bright red colour, with swelling, attended with itching, increased by warmth, and when the chilblains evince a tendency to burst.
Pulsatilla, when the inflammation is of a livid hue, with itching and beating in the part affected, and when the suffering comes on, or is exacerbated, in the evening or towards midnight. [Sulphur is often very useful after Pulsatilla, and Thuja is often serviceable when the indications we have given for the latter do not yield to its employ- ment.)
Belladonna, when the inflammation is of a blueish red (but lighter than that indicating Pulsatilla), and very considerable, attended with a creeping, tingling sensation.
Arnica, when the swelling is hard, shining, and painful, attended with itching.
Chamomilla, when with the inflammation and itching a burning sensation is present ; followed by
Arsenicum, when the pains are excessively violent, attended with severe burning, or when the chilblain bursts, and becomes converted into an irritable spreading sore. Arsenicttm may in some such cases be advantageously alternated with Carlo vegetabilis.
Sulphur is a valuable remedy when the inflammation and itching are very severe, and the affection has failed to yield to the foregoing medicines.
In the instance of Arnica we may also apply a lotion in the pro- portion of one part of the mother-tincture to five of water. # The
* The external application of the other remedies also, is frequently very serviceable ; in
ABSCESS, ETC. 419
following remedies may also be consulted in certain cases : Agaricus muscarius, Acidum nitricum, Petroleum, Rhus toxicodendron, Bryonia, Ledum, Mercurms, Cinchona, and Secale comutum.
CORNS.
Clavi Pedis,
That these troublesome excrescences not unfrequently arise from an inherent vice of constitution, is evident from the fact of many indi- viduals who wear tight boots and shoes (unquestionably the principal exciting cause) escaping them, while others, with every precaution, suffer severely : such being the case, the main object must be, by a course of properly-selected internal remedies, to eradicate the pre- disposing cause. Among these, Antimonium crudum (externally as well as internally, as described under the head of Chilblains), Phos- phorus, Rhus, Bryonia, and Ammonium carbonicum, Zycopodium, Petroleum, Sepia, Acidum phosphoricum and Sulphur will be found useful. Great alleviation of suffering has, however, been found to result from bathing the feet in warm water, and then applying a very weak Arnica lotion (a drop or two of the tincture to an ounce of water) after having previously had the corn pared down carefully.
While upon this subject it may be remarked that Nux vomica has been found serviceable in cases of swelling and redness of the heel, resembling chilblains, attended with acute, burning, shooting pains, materially increased by the pressure of the boot or shoe, or by walking.
Arnica may be recommended for the same symptoms, should Nux vomica be found insufficient to relieve.
ABSCESS. LYMPHATIC TUMOURS. DISEASE OF THE CONGLOBATE
GLANDS.
Abscess. By this term is meant a collection of purulent matter, resulting from morbid action, contained in a sac or cyst of or-
which case we may dissolve a drop or two of the tincture of the same remedy that we are administering internally, in about ah ounce or so of water, and bathe the chilblains with the lotion twice a day : in addition to this, it is sometimes advantageous to envelop the affected parts in a piece of linen which has been dipped in the lotion.
420 CUTANEOUS DISEASES.
ganized coagulating lymph, furnished with absorbent and secreting vessels.
Abscesses are divided into acute and chronic. The acute species is preceded by sensible inflammation in the affected part, which is soon followed by suppuration. The commencement of the sup- purative process is evinced by a change in the description of pain, which becomes more obtuse and throbbing, by an increase of the swelling, and, when matter is formed, by the perceptible fluctuation of the part, when the abscess is not too deeply seated ; lastly, par- ticularly in idiopathic cases, when the formation of pus is in con- siderable quantity, the fever which attended the previous inflamma- tion is lessened, and irregular chills or rigors supervene, succeeded in turn by heat and increase of fever.
When the abscess is mature, the tumour becomes pointed, or pre- sents a sort of conical shape, generally near the centre of the cuta- neous surface ; over this spot the skin assumes a reddish hue, becomes thin, and ere long gives way, and allows the contents of the cavity to escape.
The signs of the formation or existence of a chronic abscess, on the other hand, are in the generality of instances devoid of any apparent disorder, either local or constitutional, until it begins to approach the surface and form an external swelling. The secreted matter is un- healthy, thin, and serous, and contains substances resembling curds or flakes. When the pus is evacuated, and the air admitted into the cavity, inflammation of the cyst arises, and is productive of a salu- tary effect, if the abscess be small; but if it be large, great constitutional disturbance ensues, the cavity, instead of contracting and filling up under the process of healthy granulation or incarnation, goes on dis- charging copiously, and hectic fever is produced.
Therapeutics. In acute abscesses we may apply poultices and warm unmedicated fomentations, and forward the suppurative process by the administration of Hepar sulph. 3, gr. ss, in repeated doses.* The lancet is never necessary, except when the pus, by its extensive diffusion or pressure (especially when seated under ligamentous or tendinous expansions), is liable to injure important parts ; or when,
* WThen there is much constitutional disturbance, with intense pain and extensive inflam- mation, before the formation of pus, the employment of Aconitum and Belladonna, in alter- nation, is sometimes requisite ; antiphlogistic regimen must at the same time be observed.
ABSCESS, ETC. 421
from its situation, there is reason to apprehend its discharge into any of the cavities of the body.
When it is necessary to effect an artificial opening by means of the lancet^ the incision ought to be made at the most dependent pointy where this can be safely and readily accomplished ; but when this is impracticable, in consequence of the great thickness of the parts between the purulent matter and skin, the most prominent or pointed part ought to be selected. When, on the other hand, this latter point happens to be at the upper part of the abscess, the lancet must be laid aside, and the abscess allowed to open spontaneously, or, still better, through the instrumentality, or at all events the important aid, of Hepar sulphuris, Silicea, and Lachesis. The two former may frequently be administered in alternation with advantage; the third is more particularly to be preferred, when a considerable portion of the skin has been much distended, and presents a deep red or blueish appear- ance, or where its structure has been destroyed by the magnitude of the abscess. Mercurius is occasionally useful when there is indura- tion.* The subsequent treatment is generally more easily conducted, and the healing of the cavity more speedily effected, when the matter has been evacuated by the aid of appropriate medicine, instead of the lancet.
In chronic abscesses, it has usually been found most beneficial to make an outlet for the matter as early as possible, to prevent its large accumulation, and thereby avoid the consequent frightful constitu- tional disturbance, which is so prone to occur in such cases, from the extent of the inflammation after the bursting of the abscess. The opening should be made near the base of the abscess, and merely large enough to admit of the exit of the matter.
When the collection of matter is very extensive, it frequently accu- mulates again after having been evacuated ; hence it has been recom- mended to heal up the opening immediately, and to make a new one again when necessary, but before the pus has accumulated in any considerable quantity.
When the matter has been withdrawn, a dose or two of Mercurius should be administered, followed by Hepar sulph., Silicea, and some- times also by Calcarea and Phosphorus. Silicea and Phosphorus have
* Carbo a. is equally serviceable here, and may follow Mercurius, when that remedy fails to answer our expectations. Baryta is also useful in such cases, particularly when there is considerable surrounding swelling as well as induration, even after the opening of the
422 CUTANEOUS DISEASES.
been described as being useful when atrophy or consumption results in consequence of chronic suppuration.
It may here be mentioned that, in Lymphatic Tumours, Sulphur chiefly, but also Mercurms or Silicea, and in Encysted (whether steatomatous or otherwise), Calcarea, have been found very efficacious.* Further, that in the state of enlargement and induration of the Con- globate Glands, situated in the neck, under the chin, and behind the ears, such as is usually met with in scrofulous habits, — Mercurms and Dulcamara are two of the most important remedies. When the glands have become indurated, Conium is one of the most efficacious remedies ; or, in inveterate cases, Silic, Carl, a., Stilph., Calc, Baryta, &c; and when suppuration or ulceration ensues, Hepar sulphuris, Lachesis, and Silicea are more useful. These latter, particularly Hepar sul. and Silicea, together with Calendula officin., StilpJmr and Calcarea, in some cases, are moreover extremely useful in materially obliterating the unsightly scars, which are so frequently met with in glandular swellings, that have been neglected or improperly treated by means of stimulating embrocations, caustics, &c.f (See Scrofula.)
itch.
Scabies. Psora.
This contagious, inflammatory affection of the skin is characterized by an eruption of pointed vesicles, transparent at the summit, and filled with a viscid and serous fluid. These are subsequently inter- mixed with, or terminate in pustules. With the exception of the face, they appear on every part of the body, but much more fre- quently and abundantly about the thumb, wrist, between the fingers, and at the bend of the joints, &c, and are accompanied by incessant and almost insupportable itching, without fever. There are several varieties of the disorder, but it is often very difficult to distinguish their characteristic differences.
■■* Graphites, Silicea, Hepar s., and Sulphur, Causticum, Baryta c, Carlo v., Acidum nitricum, Lachesis, or Phosphorus, &c, may be required in some cases.
f In old-standing or obstinate cases of glandular enlargement and induration or ulcera- tion, Baryta c, Staphysagria, Carlo, a. et v., Hepar s., Sulphur, Calcarea, Calendula, and Silicea, as also, Kali c, Lycopodium, Iodium, Acidum nitricum, Bovista, Belladonna, &c, are remedies of great utility, and must be selected according to the general features of the case, when Mercurius, Dulcamara, and Silicea are found insufficient to discuss the swelling, &c.
itch. 423
Therapeutics. Sulphur is unquestionably one of the most im- portant remedies in this disorder, particularly at the commencement. In the milder, uncomplicated forms of the malady, and in the purulent variety, especially when confined to the fingers and wrists, it is indeed specific.
A dose of the said remedy, at a low potency, may, in such instances, be administered night and morning for a week or ten days, but dis- continued as soon as signs of improvement set in. In some rather obstinate acute cases, that is, when, after ten days to a fortnight or three weeks, but little improvement has been effected, we shall find the treatment facilitated by the simultaneous employment of the remedy externally, applying the Tinctura sulphuris as a lotion night and morning. A very speedy or a sudden suppression of the eruption is, on the other hand, not to be regarded as a cure, but on the contrary, as a driving in or repercussion of the eruption.
Against other varieties of the disorder, and in neglected cases, Sul- phur is not a sufficient remedy; therefore it becomes necessary to have recourse to Mercurius, Carlo v., Hepar s., Sepia, Feratrum, Lycopod., &c. as follows : Mercurius, when the eruption is accompanied by in_ tolerable itching, especially on becoming warm in bed ; looks dry and cracking, but consists of minute vesicles resembling papillae, when not narrowly examined, which are slightly inflamed, and bleed easily when scratched [scabies papuliformis). These little elevations or vesicles are sometimes intermixed with pustules, which, on breaking, form scabs. It is sometimes necessary to administer Sulphur or Acidum sulphuricum in alternation with Mercurius, in this form of the com- plaint, at intervals of four or five days, until an improvement or change in the symptoms result.
In the event of an amelioration, it is found useful to cease to ad- minister the medicine as long as it continues ; but if the improvement soon comes to a close, or a change occurs in the character of the eruption, another remedy must be prescribed. If the affection has retained the papular-looking form, and Mercurius alone has previously been administered, Hepar s. may be selected ; but if both Sulphur and Mercurius have been employed, Carlo v. may be advantageously alter- nated with Hepar ; and should any symptom remain thereafter, Sepia or Feratrum will generally speedily remove them.
In other cases of scabies papuliformis, and particularly where the papular appearance is more strongly marked than in the preceding, Mezereum and Silicea are very serviceable.
424 CUTANEOUS DISEASES.
In the pustular or humid variety {scabies purulenta), distinguished by distinct^ prominent, yellow pustules, having a moderately inflamed base, which are usually met with on the hands , and feet, and subsequently, if unchecked, on the back, shoulders, arms, and thighs, about the axillae, and near the knee and elbow-joints, — Stilphur, as has been already stated, is the principal remedy ; in inve- terate or neglected cases, considerable benefit will nevertheless be fre- quently obtained by giving Lycopodium in alternation with it. Should improvement ensue, and the eruption assume a drier aspect, Mercurius and Carlo v. will, in most instances, serve to complete the cure. But if no beneficial effect is produced after two or three repetitions of these remedies, at intervals of four or five days, Graphites may be exhibited at short intervals for three or four successive times, lengthening the intervals at each repetition of the dose ; and if no favorable alteration be brought about soon thereafter, Mercurius may be administered in the same manner. Should extensive incrustation ensue on the breaking and discharging of pustules, &c, Acid, sulphuricum is gene- rally of great service.
When the pustules are large, they coalesce and form irregular blotches, which sometimes ulcerate to a greater or less extent; in such cases Clematis and Rhus will be found serviceable. When, on the other hand, the pustules assume a prominent and globular form, of a yellowish or blueish colour, Lachesis has been found to be the most appropriate remedy.
In Scabies lymphatica, or watery itch, characterized by transparent vesicles of considerable size, without an inflamed base, much the same treatment may be pursued as has been described for the dry or papuliform variety ; but in some cases the alternate use of Sulphur, Rhus, and Arsenicum is requisite. When Scabies has been materially altered in its character by the abuse of Stclphur in allopathic practice, Mercurius, Sepia, Rhus, and Staphysagria, or Acid, nitricum, Dulcamara, Calcarea, and Pulsatilla, etc. have been used with success. Kreosote externally {largely diluted) and internally, has been recommended in some obstinate cases of Scabies, and Sulphur, Arsenicum, and Carbov. in cases which have been suppressed or repercussed by powerful ex- ternal applications. When furunculi make their appearance during the course of, or on the disappearance" of scabies, Silicea generally removes them very speedily and effectually.
* Boeninghausen's Manual of Homoeopathic Therapeutics.
whitlow, 4:2o
WHITLOW.
Paronychia. Panaris.
By this term is understood an abscess more or less deeply seated, fbrme<2 near the end of the finger, attended with severe pain and considerable swelling; it has a great disposition to reappear in individuals who have once suffered frjom its attacks, which clearly demonstrates the advantage of treating it as a constitutional, and not as a merely local affection ; in so doing we may have recourse to the following medicines : Mercurms, Hepar sulphuris, Rhus, Sul/phur, and Silicea.
Therapeutics. We may generally commence the treatment by Mercurius. But should the swelling not decrease after a few doses of Mercurius, or the pain become intense, recourse must be had to the alternate administration of Silicea and Hepar s.*
Rhus is more particularly indicated, where there is a considerable degree of erysipelatous inflammation.
Lachesis : — In cases where the affected part is of a dark red or blueish hue, and the pains extremely violent, this remedy may be administered, followed by Arsenicum and Carlo v., if an angry-looking, black, and painfully-burning sore form on the affected finger, f
But we must have recourse to the alternate administration of Sulphur and Silicea at intervals of about eight days, or so, in cases where a constant tendency to a recurrence of the complaint exists. These remedies, particularly the latter, are the most appro- priate in those severe cases in which the matter forms between the periosteum and bone, and when the latter has become diseased in consequence.
Magnetis Polus Arcticus. The application of the north pole of the magnet, for a minute or two, to the finger, will often afford speedy relief, when the pain is so intense as to be almost insup- portable. A poultice is also somewhat soothing under such circum- stances.
* These two remedies are, moreover, exceedingly serviceable in forwarding suppuration, and are therefore equally useful in bringing the abscess speedily to maturity, and causing the discharge of the pus, when there is no longer any possibility of effecting resolution ; but when the matter is deeply seated, and evacuation is not speedily obtained, the lancet must be employed.
f Hering's Hausartz.
42(> CUTANEOUS DISEASES.
IRRITATION OR ITCHING OF THE SKIN.
go.
This affection is usually an accompaniment of other diseases, and is to be treated accordingly ; however, in some cases, it declares itself in an idiopathic form, and is generally caused by scarcely perceptible colourless elevations under the cuticle, — which, however, are some- times of a considerable size, soft and smooth, but without desquama- tion, or any peculiar eruptive appearance.
Therapeutics. Against this extremely distressing irritation, Sulphur is frequently the specific remedy, particularly when exacer- bation ensues in the evening, or when the body is warm in bed ; but in other and more ordinary cases, the following remedies will be found serviceable : Ignatia amara, Pulsatilla, Mercurius, Rhus toxicodendron, Hepar sulphuris, Nux vomica, or Arsenicum album.
Ignatia amara: — When the irritation is most severe, after going to bed, and resembles flea-bites all over the body ; and after scratching, which relieves, shifts readily from one part to another,
Pulsatilla when the irritation comes on in the warmth of the bed, and is aggravated by scratching.
Mercurius when the irritation continues through the whole night, and Pulsatilla proves insufficient ; also in cases when the parts affected bleed readily after scratching. {Sulphur is sometimes useful, every four or five days, in alternation with Mercurius in such cases.)
Rhus toxicodendron, when itching is accompanied by a violent burning sensation, followed by
Hepar sulphuris, if necessary to complete the cure.
Nux vomica alternately wdth Arsenicum, when the irritation or itching appears on undressing.
In obstinate cases of almost all kinds, Sulphur, followed by Carlo v., will be found serviceable. Lycopodmm, Graphites, Silicea, &c, may be called for in particular cases. Opium is often useful in the case of old people.
In Prurigo scroti, Sulphur, Acidum nitricum, Dulcamara, and Rhodo- dendron have chiefly been recommended. Prurigo pudendi : Sulphur, Sepia, Conium, Calcarea, Natrum m., and Sulphur. Prurigo ani : Sepia, Acidum nitricum, Thuja, Mercurius, Sulphur, as also Kali c, Baryta c, and Zincum.
RINGWORM. 427
RINGWORM (HERPETIC OR VESICULAR).
Herpes circinnatus. Herpes serpigo.
This affection generally occurs in children. It has been considered contagious from the circumstance of several children of one family, or at the same school, being sometimes attacked at the same time; but there is every reason to believe that this opinion is erroneous, from the fact of none of the other species of herpes being communi- cable by contact. When not complicated with another disease it is not attended with any general constitutional derangement. The dis- order is characterized by an eruption of small rings or circular bands, the vesicles only occupying the circumference ; these are small, and have a red-coloured base of greater or less intensity. About the third or fifth day the vesicles become turbid, and then discharge, when little brownish scabs form over them. The portions of skin within the circlets are usually healthy at first ; but for the most part subsequently become rough, of a reddish hue, and scale off as the vesicular eruption dies away. The duration of the eruption frequently does not extend beyond a week or two, but when there is a series of con- secutive rings on the face, neck, arms, and shoulders, as frequently happens in warm climates (where the affection moreover assumes a more serious and obstinate character), or during hot weather in this country, it is necessarily protracted considerably beyond this period.
Therapeutics. In the majority of cases the affection yields readily under the action of Sepia, of which from two to three globules may be given in a little water, and the dose repeated on the fourth day, if required by any appearance of tardiness in the subsidence of the eruption, or should there be any indications of the formation of fresh rings.
In some obstinate cases the alternate use of Rhus and Sulp/i. every four or five days is found necessary. Calcarea, Natr., Nair. m.> Clem., and Magn., have been recommended in others.* All kinds of outward applications must be avoided.
* Bceiiinghaiisen's Manual of Homoeopathic Therapeutics.
428 CUTANEOUS DISEASES.
RINGWORM OF THE SCALP. PUSTULAR RINGWORM.
Porrigo scutulata. Tinea capitis. Tinea annularis. Favus confertus.
This disease is still more popularly known, than the above by the term of ringworm (or ringworm of the scalp). It is unquestionably of a highly contagious nature, being readily communicated among children who make use of the same comb and brush, or even towel, and is of long and uncertain continuance, — indeed there are few cutaneous affections which have more frequently baffled the unwearied efforts of practitioners than this; and it would have been well had less been attempted by those of the old school in the way of treatment ; for in but too many instances the so-called cure has proved worse than the disease.
Pustular ringworm commonly attacks children from the age of two years to the period of puberty ; it is not confined to the scalp, but also appears on the neck, trunk, and extremities ; when confined to the trunk, it proves by no means so obstinate and rebellious a disease as when located in the hairy scalp.
Diagnosis. The affection is characterized at the commencement, by the appearance of isolated, red-coloured, irregular, circular patches, on which appear numerous small yellowish points or pustules, which do not rise above the level of the skin, and are generally traversed in the centre by a hair. These pustules, which are much more thickly studded in the circumference, than the centre of the circular patches, soon break and form thin scabs,* which frequently unite with the adjacent patches, and assume a regular and extensive and irregular appearance, but commonly retain a somewhat circular shape. The incrustations become thick and hard by accumulation, and are detached from time to time in small pieces, which bear a close resemblance to crumbling mortar. When the scabs have been removed or torn off, the surface which they had occupied looks red and glossy, but is studded with slightly elevated pimples, in some of which minute globules of matter subsequently become apparent.
By these repeated evolutions of the eruption, the incrustations become thicker, the areas of the primary patches extend, and new
* Sometimes cup-shaped or concave (characteristic of favus), and at first of a tawny, but subsequently of a light yellow or whitish colour ; when they crack and break up, they be- come reduced to a powder, which looks like pulverized sulphur.
RINGWORM. 429
ones are formed, so that the corresponding edges become blended, and frequently the whole head thus becomes affected. The circular character of the original groups is still indicated, however, by the appearance of partially-formed arcs in the circumference of the larger incrustations. As the patches or clusters extend, the hair covering them usually becomes lighter in colour, breaks off short, and as the process of scabbing is repeated, it is thrown out by the roots, and finally, there remains only a narrow chaplet of hair round the head. If the hair-follicles are destroyed, the baldness remains permanent.
Causes. The disease is chiefly propagated by contagion, but appears to originate spontaneously in children of scrofulous, flabby, or feeble and emaciated habit, if they be ill-fed, ill-lodged, uncleanly, and deprived of a wholesome degree of exercise.
Therapeutics. It cannot be denied that, even under homoeo- pathic treatment, the disease frequently proves extremely obstinate ; but in many cases the difficulty experienced in effecting a cure, arises from the previous treatment which the patient has undergone, or from culpable conduct on the part of the parents, or others, in allowing the disorder to pursue its course for a lengthened period, unchecked and utterly neglected, ere proper assistance is sought.
The following are the principal remedies employed in the homoeo- pathic treatment :
Rhus, Arsenicum, Staphysagria, Hepar s., Lycopodium, Dulcamara, Bryonia, Phosphorus, Graphites, Baryta c, Calcarea, Oleander, Sulphur, &c.
The medicines must be selected according to the various changes which take place during the continuance of the disease; but as it would be wholly impossible, in so general a work, to give appropriate directions for the treatment of every case, we can merely enumerate a few of the leading indications for some of the more important remedies, referring, at the same time, to others, as being worthy of attention in cases which do not yield to the ordinary remedies.
While the patches exhibit an irritable and inflammatory aspect, Rhus will usually be found the most appropriate remedy : the head should at the same time be regularly and gently sponged with tepid water twdce a day. Should a dry exfoliation and scabbing then ensue, Sulphur may be had recourse to; but if, on the other hand, an offensive discharge break out, attended by violent itching, without
430 CUTANEOUS DISEASES.
much redness, Staphysagria may be administered, and then again Rhus. If, notwithstanding the administration of these remedies, very little favorable progress be made, or if, on the contrary, the affection become rather worse, and the exudation take on an acrimonious character, and productive of an extension of the disorder, or of the formation of ulcers, Arsenicum should be exhibited : after the action of which, Rhus will frequently produce a satisfactory effect. These remedies may also be occasionally administered externally with good effect, by dissolving a few globules of the remedy selected in a little water, and applying the liquid once or twice a day to the affected parts.
When the foregoing means are insufficient to effect a cure, which is unfortunately not a rare circumstance, particularly when strumous or debilitated subjects are afflicted with the disease, the following remedies must be used :
Hepar s., when the eruption is not confined to the head, but also appears upon the forehead, face, and neck ; when, moreover, the eyes and eyelids become inflamed and weakened, and soreness or ulceration breaks out on or behind the ears. In the latter case Baryta c, Graphites, and Oleander are also useful.
Dulcamara, when the glands of the throat and neck are enlarged and indurated (or Bryonia, when there is inflammation and tenderness of these glands) ; after which Staphysagria may be administered, and then one or more of the remedies mentioned at the commence- ment, followed by Baryta c.
If these medicines prove ineffectual, Sulphur, Graphites, Calcarea, Lycopodium, Phosphorus, or Oleander may answer the purpose required, and must be selected according to circumstances. In some cases the alternate use of two or more -medicaments will be found advantageous, such as Sulphur and Calcarea, — Sulphur, Rhus, and Graphites, — Graphites and Lycopodium — Graphites and Phosphorus, and so on. A dry, inert, and scaly appearance of the eruption chiefly requires Calcarea, or Sepia, Silicea, and Sulphur, but also Hepar s., Phosphorus, Rfais, Arsenicum, or Oleander. A humid or moist-looking eruption : Lycopodium, Graphites, and Rhus, or Staphysagria, Arsenicum, Sulphur, Sepia ; and also Baryta c, Calcarea c, dcuta virosa, and Oleander, &c.
In the other varieties of scald-head, such as the Porrigo lupinosa,*
* Characterized by small, dry, circular scabs, of a yellowish-white colour, having raised margins, and a central depression, like that on the seeds of the lupine. The incrustations are deeply set in the skin, to which their edges are firmly adherent.
RINGWORM. 431
Porrigo furfurans* Porrigo favosa^ &c, the same class of remedies are required as above prescribed; whilst against Porrigo decalvans (characterized chiefly by patches of baldness), Graphites, Phosphorus, Baryta, Lycopodmm, and Zincum have been found the most serviceable ; but Sulphur, Calcarea, Silicea, &c, and most of the other aforesaid remedies may be found indicated in particular cases. With regard to the administration of the medicines, it may be stated, that at the commencement of the disorder, a dose may be given daily, or every second day, until symptoms of improvement make their appearance, the medicine must then be discontinued, whilst the case progresses favorably, and only renewed, when the amelioration ceases, or the disorder threatens to extend itself. When no signs of improvement become perceptible, or when, on the contrary, the malady evidently seems to be getting gradually worse, notwithstanding the exhibition of two or three doses of a particular remedy, another must be selected according to the indications.
In cases of old standing, the intervals between the exhibitions of the medicine must generally be lengthened, or a dose may be given daily for a week, and then a period of ten to twelve days, and even upwards, allowed to elapse before the medicine is repeated, or another remedy substituted.
Undeviating attention to cleanliness must be observed throughout the entire course of the complaint, and the homoeopathic diet rules must be strictly adhered to in the majority of cases.J The hair ought generally to be removed early in the disease.
* This variety commences with the eruption of small pustules, containing a straw-coloured fluid, which soon discharge, dry, and form thin laminated crusts, with scale-like exfolia- tions. The affection is confined to the scalp, and is attended with considerable itching and soreness, although there is but slight excoriation ; the hair partially falls off, and, occa- sionally, becomes subsequently somewhat lighter in colour.
f Distinguished by the eruption of large, soft, straw-coloured pustules, generally somewhat flattened, possessing an irregular margin, and surrounded by a slight inflammatory redness. They are met with on other parts of the body as well as the scalp, and are accompanied by much itching. On breaking, these pustules discharge a viscid matter, which hardens into semitransparent, greenish-yellow scales. The disease extends to the face, and even- tually the ulceration spreads over the entire head, and, from the continued discharge, the hair and moist scabs become matted together. Pediculi are generated in large numbers, and aggravate the excessive irritation. The incrustations thicken into irregular masses, bearing some resemblance to a honeycomb. The acrid exudation from the ulcerated patches on the scalp exhales an offensive and pungent vapour.
t Adults, affected with this disorder, or indeed with any other cutaneous disease, ought wholly to abstain from fish and salt meat. Children ought to be placed under similar restrictions, and should not be allowed to partake of heating farinaceous food, such as oat- meal (in the form of porridge or stirabout, gruel), maize, &c.
432 CUTANEOUS DISEASES.
INTERTRIGO.
This affection consists of a galling or excoriation of the skin, accompanied with inflammatory redness and moisture, around the anus, between the nates, at the inner and upper part of the thighs, the groin, or other parts of the body, such as the axillae, &c. Riding, much walking in the heat of summer, and the irritation of the urine, are the most frequent exciting causes. It is, very frequently, readily relieved by Graphites or Lycopodium, externally and internally, at low potencies. Arnica, and also Nux v., Pulsatilla, Sepia, Sulphur, Arsenicum, and Chamomilla have also been recommended in particular cases : the selection being made according to the temperament and complexion of the patient, as also the state of the digestion, sexual functions, &c. (See also Excoriations in Children.)
PSORIASIS.
This cutaneous disorder is distinguished by a rough and scaly condition of the epidermis, sometimes in isolated spots or patches of an irregular form, at other times continuous, but almost always attended with clefts or fissures in the skin. It is usually accom- panied by constitutional derangement, and recedes or recurs at particular seasons of the year.
The cure of this disorder is generally difficult and tedious, espe- cially when it occurs in the inveterate form {psoriasis inveterata), characterized by nearly universal scaliness, with a harsh, dry, thick- ened and rigid state of the skin, which is at the same time red and deeply cracked), or when it is chiefly confined to the palm of the hand {psoriasis palmaris). In the simple form (psoriasis simplex), Lycopodium at a low potency, in repeated doses, frequently effects a cure in from four to eight weeks, even when the disorder is of lopg standing ; Rhus and Bryonia are also of considerable value in this variety. In other cases, Sulph., Sepia, Calc, Graphites, Clematis, and Ledum may be called for by the nature of the case. In Psoriasis inveterata, Arsenicum is of more or less utility, as also JRhus and Sepia;
PEMPHIGUS. 433
but it is often requisite to have recourse to Sulphur, Antim. c, Amman, c, Graphites, or Calc, etc., to complete the cure.
Against Psoriasis palmaris, Sulphur, Sepia, and Acid, muriaticum, or Zincum have hitherto been principally employed. When there is a discharge from the rhagades of an offensive smell, Rhus, Graphites, Lycopod., Mercurius, or Hepar, &c, are often of important service. And in Psoriasis facialis, — Sulph., Calc., Aurum, Graph., Lycopod. ; or Sepia, Cicuta, Ledum, Oleander, &c, claim a preference.
The diet, in this affection, as, indeed, in all other cutaneous maladies, should be simple and unstimulating. Fruits, and also vegetables, are often hurtful when the eruption is in an aggravated form, and ought, therefore, to be avoided under such circum- stances.
PEMPHIGUS. Febris bullosa, Pompholyx.
Pemphigus consists of an eruption of yellowish and transparent bullae or blebs on various parts of the body, varying in size from a lentil, or a split pea, to a walnut, commonly presenting an inflamed base, and generally assuming the shape of an almond. Fever is a frequent accompanying symptom ; but some authors maintain that the disorder occurs in two different forms, viz., the acute and chronic, and that fever is only peculiar to the former, and invariably absent from the latter ; whilst others, again, create a further distinction by giving the name of Pemphigus to the affection, when the vesicles exhibit an inflammatory base, and are preceded or accompanied by fever, and denominating it Pompholyx when exempt from these additional symptoms.
The disease occasionally comes on without precursory signs ; but may also be ushered in by sickness, general uneasiness, precordial oppression, headache, lassitude, painful stiffness in the joints, and violent itching of the skin ; or otherwise it commences with irregular chills, followed by dryness and burning heat of the skin, as also thirst, anorexia, and great rapidity of pulse. The eruption generally declares itself at first by one or more circular or oval red spots or patches, which are slightly prominent, and frequently bear a close similitude to the first signs of smallpox. These patches soon take on a dusky hue, and are preceded or attended by some degree of pain and heat
28
434 CUTANEOUS DISEASES.
in the affected parts. From the effusion of transparent serum beneath the epidermis, it becomes raised in the form of vesications presenting the appearance of blisters arising from a scald, or pro- duced by the application of cantharides to the skin. The develop- ment of these blebs sometimes ensues so speedily after the evolution of the erythematous patches, that some authors have been induced to conclude that pemphigus was never preceded by any redness of the cutaneous surface. The eruption gradually extends over the greater part of the body, but rarely affects the hairy scalp or the genital organs. The vesicles increase rapidly in size, and in some places become confluent. The skin between the bullae presents a natu- ral appearance, except when the latter approximate closely, in which case a more or less marked erythematous blush pervades the interstices. When the vesicles have attained their maturity, and burst of them- selves, they form incrustations of a whitish, or a pale brown colour ; but if the epidermis be detached by friction soon after the bullae have broken up, painful excoriations generally result. The duration of pemphigus with fever (acute pemphigus) varies from one to four weeks, according as the eruption may have been simultaneous or con- secutive. Pemphigus without fever, again (or chronic pemphigus), in which the development of the bullae is always successive, generally occupies a period of several months, and even much longer, if unchecked, in some cases. When accompanied by nervous fever the disorder is to be regarded as of serious character ; as also when it is very extensive, frequently renewed, and associated with inflammation of the bladder, &c.
Therapeutics. When the eruption is preceded or accompanied by inflammatory fever, the employment of Aconitum becomes more or less requisite ; but as soon as the fever and restlessness have been consi- derably allayed Cantharides (3 — 6) or Rhus (3 — 6) must be selected. The former is more especially useful when the bullae present a close analogy to the vesication produced by a blistering plaster, when the irritation is intense and consists of a violent burning itching, or when the disorder is attended with dysuria, haematuria, cystitis or, in the case of females, with inflammation of the vagina. This remedy may at the same time be advantageously applied" externally by means of a camel's hair brush. Rhus is an invaluable remedy in the majority of cases of Pemphigus, although it occasionally fails to relieve the troublesome pruritus so readily as Cantharides. Should nervous fever
SHINGLES. 435
be associated with the eruption, Rhus will be rendered still more requisite. When the blebs are copiously developed on the face, and there is severe headache, thirst, synochal fever with dry hot skin, tossing about, disturbed sleep, and even delirium, as is prone to be the case in young subjects, Belladonna should be prescribed. (See also Heat-spots in children.) After the employment of Belladonna, Lachesis or Rhus are generally required to complete the cure in pemphigus febrilis.
SHINGLES.
Zona. Herpes zoster. Cingulum. Ignis sacer5 fyc.
The term Zona or Herpes zoster, has been given to a cutaneous disorder characterized by the formation of several clusters of vesicles, which usually appear on one side of the body in the shape of a semi- circular band or belt, most commonly at the waist, but sometimes across the shoulder, and occasionally on the neck, face, and scalp, or other parts of the body. The eruption is occasionally preceded, for a few days, by languor, thirst, and loss of appetite, fits of shiver- ing, headache, sickness, restlessness, brownish or whitish coating on the tongue, accelerated pulse, heat and tingling in the skin. More commonly, however, the disorder appears without any precursory symptoms, and the attention of the affected party is primarily drawn to the region where the eruption is about to be developed by a sense of pricking and smarting, or burning heat and sharp pain. On examining the parts several bright red, irregular blotches, more or less widely separated, are observed, and upon each of which, numbers of minute white silvery-looking vesicles show themselves, and ere long increase to the size of a lentil or pea. The vesicles are at first trans- parent, being filled with a clear limpid fluid, but about the fourth day they assume a milky, or yellowish, or sanguinolent colour, and the fluid contained becomes sero-purulent, or even converted into true pus. Soon after this, they often become somewhat confluent, and flatten or subside, leaving a very faint outline behind them, or what is still more frequently the case, they dry up and form small yellowish or brownish scabs.
Some of the vesicles, again, burst on the second, or between that and the fourth day, and discharge a small quantity of limpid serum ; the epidermis being detached, suppuration of the vascular rete
436 CUTANEOUS DISEASES.
of the corion takes place for a few days in consequence of the expo- sure. While the vesicles of the first groups are acquiring an opalescent aspect, new clusters begin to appear in succession for three or four days, and pursue the same course. From the eighth or twelfth, to about the twenty-first day, all the incrustations of zona are detached, leaving the surface of the skin in a tender state, and covered with marks of a deep-red colour, which gradually disappear. Where the vesicles have been confluent, and the inflammation severe, the eruption is frequently of longer duration than above stated, and the skin, from occasionally becoming ulcerated below the incrusta- tions, which in such cases are rendered very adherent, heals slowly, and presents numerous pits or cicatrices for a considerable time afterwards.
The causes of herpes zoster are obscure. It is most common in summer and autumn. It is not contagious, and does not appear to have ever been seen as an epidemic. The disorder is, on an average, not of a serious character, especially when occurring in children and adults, but in the aged, it is liable to be followed by sloughing and gangrenous ulceration, and is always distressing from the pains which accompany it.
Therapeutics. When the disease is preceded by considerable constitutional disturbance, with severe pain, restlessness, deep-seated darting pains in the chest, heat of skin and quickness of pulse, a dose or two of Aconitum afford speedy relief. Spare diet must at the same time be enjoined. Should the febrile symptoms, pain, and restlessness not completely yield to Aconitum, Sulphur may be pre- scribed, succeeded by a repetition of Aconitum, or by Aconittim and Cqffea in alternation if there be less pain but continued restlessness. When the primary symptoms have been removed, or when the attack has commenced without any precursory symptoms, Rhus toxicodendron generally forms the most useful remedy, and is, in most cases, suffi- cient to conduct the disease to a happy issue— even in those occurring in individuals of an advanced age ; it is sometimes requisite, how- ever, to exhibit Sulphur or Graphites after, or in alternation with Rhus. The patients should, in all cases, be cautioned against lying on the affected side, as gangrene is liable to be induced by so doing, parti- cularly in bad habits and elderly subjects. If sloughing and gan- grenous ulceration supervene, notwithstanding all our precautions, Arsenicum must be had recourse to, succeeded or alternated with
ULCERS. 437
Lachesis and Cinchona, should a favorable reaction not follow the employment of Arsenicum alone. Sulphur, and sometimes Acidum nitricum usually form the most appropriate remedies to forward the process of healthy granulation and cicatrization. The parts may be dressed with dry lint. Nourishing and easily digestible food must be allowed in such cases, and even wine and water, or a little pure wine if required, as is sometimes the case in old and debilitated patients. Mercurius has been recommended as likely to be useful in zona, and may occasionally, along with Hepar, prove serviceable when the inflammation has run high, and the fluid contained in the vesicles has become converted into true pus : Antimonium tartaricum when at the very commencement there is considerable gastric disturbance with nausea and vomiting ; and Arsenicum when the cutaneous pains consist of a severe burning, and are accompanied by uncontrollable restlessness, dry heat of skin, and great thirst.
ULCERS.
Ulcera.
An ulcer, or sore of continuance, may be the result of a wound, bruise, burn, or abscess ; it may also arise from a bad condition of body, particularly when combined with sedentary habits, and gross or otherwise unwholesome living. In the latter case, its formation is preceded by a greater or less degree of pain, heat, redness, and swelling of the part. In many instances a little vesicle or pustule appears, which, on bursting, exposes a gap or breach in the skin. Sometimes there is at the commencement a single small excavation ; in other cases, several contiguous ulcerated spots are observed, which speedily become blended together, and form a sore of considerable magnitude.
When no effort at cicatrization or healing is taking place, the ulcer always presents an excavation or hollow, the margins of which are red, sharp, sometimes thick, prominent, rounded, or callous, and often jagged and irregular. The surface of the ulcer, at the same time, presents a dirty white or yellowish colour, and is usually covered with, and discharges a thin watery humour or sanies, frequently tinged with blood, and sometimes so acrid as to inflame and corrode the skin. While the process of ulceration is extending, the edge of the adjacent skin is inflamed and painful ; but as soon as a tendency
438 CUTANEOUS DISEASES.
to heal sets in, this ceases, and healthy granulations form, which present a florid colour, are of a firm consistence, and have a pointed shape, resembling minute cones. The matter secreted is altered to a bland, thick, and whitish or cream-like fluid (healthy pus) not adherent to the granulating surface. These granulations do not rise higher than the surrounding skin, and when they have risen to the level of it, those at the margin of the ulcer become covered with a smooth, thin, blueish film, which is at first semi-transparent, but soon changes to opaque on being converted into new skin.
Therapeutics. In the treatment of ulcers in general, the follow- ing are some of the most important remedies : Arsenicum, Carlo v., Lachesis, Mercurius, Sulphur, SiUcea, Sepia, Lgcojoodium.
Arsenicum is chiefly useful when the ulcer presents a livid aspect, or looks bloody, and bleeds at the slightest touch, and, instead of healthy pus, secretes an ichorous discharge mixed with blood ; the edges of the sore are at the same time hard and irregular, and the patient complains of great pain, particularly of an intense burning description.
Garbo v. is indicated under similar circumstances, and is there- fore very useful in alternation with the former remedy, especially when the discharge from the ulcer is of a very offensive nature, and the burning pains are much exacerbated towards evening and during the night. When the ulcer is large, or seems disposed to extend rapidly, or when it is surrounded by numerous small ulcerations or pustules ; further, when there is considerable swelling and discolora- tion of the surrounding parts, the leg presenting a mottled, dark- blue or purple appearance, — Lachesis forms a most important and eminently useful remedy.
Mercurius will usually be found very serviceable when the ulcer is deep, and secretes a thin and offensive discharge; but should healthy granulation not supervene on the filling up of the cavity under the action of Mercurius, Sulphur or Silicea may be prescribed, or both these remedies alternately. When the discharge continues thin and offensive, notwithstanding the employment of Mercurius, Assqfcetida may be administered, provided Arsenicum, or some other remedy does not merit a preference.
Sulphur is almost indispensable in nearly every case of long standing, and is sufficient of itself to effect a cure in many chronic cases. It is more particularly indicated, however, when excessive
ulcees. 439
itching, burning, or gnawing and smarting pains are experienced in the sore, which bleeds much when dressed, presents no distinct appearance of granulation, secretes a thick, yellow, unhealthy pus, or a fetid sanies, and has its irregular, elevated margins frequently sur- rounded by groups of pimples, w7hich add to the irritation created by the sore ; further, where there is cedematous swelling, and a reddish- brown discoloration of the limb, wThen the ulcer is seated in the inferior extremities.
Silicea is of nearly equal importance wTith Sulphir, in the treat- ment of chronic ulcers. It is accordingly of the utmost service in many cases, when administered in alternation w<ith that remedy, and, in those of a very obstinate character, with Sepia and Acidum mtricum. The secretion of a thick and discoloured pus is a useful indication for Silicea; at the same time, when the discharge consists of a thin, acrid, and offensive sanies, this remedy is of like utility, particularly in sores with imperfect granulation, or the repeated formation of large and flabby vegetations. When the pus is of a citron-yellow colour, the margins of the ulcer callous or inverted, and an intoler- able itching, sometimes with a pain of a burning description, is experienced at night in bed, — Lycopodium may be given with advantage. In superficial chronic ulcers, Lycopodiwm, is, moreover, one of the most useful medicaments.
In administering the remedies, it is frequently sufficient to give a dose every eight or ten days ; in other cases, it is found necessary to dissolve a few globules, or a drop or twro of the tincture in a pint or so of pure water, to which a tablespoonful of spirits of wine has been added, and order a tablespoonful to be taken daily.
When the ulcer is inflamed or extremely painful, a soothing effect is often derived from the application of linen dipped in warm water ; and if the ulcer be seated in the leg, the affected limb should be kept at rest, and not allowed to remain in a depending position. The application of lint dipped in, and kept constantly wet with cold water, is another simple, but highly useful form of dressing, and is frequently of greater efficacy than the preceding, especially when the ulcer presents a sharp, jagged, and undermined appearance, with no distinct formation of granulations, but exhibits a surface consisting of a whitish spongy substance, covered with a thin and acrid dis- charge, and bleeds on being dressed.
When, on the other hand, the granulations are sufficiently developed, but of a pale colour, and often large and flabby, with a smooth and
440 CUTANEOUS DISEASES.
glossy surface, the edges of the surrounding skin being at the same time thick, prominent, and rounded, the pus thin and watery, inter- mixed with flakes of coagulating lymph, which adheres closely to the surface of the sore, but the pain is trifling, and the sore comparatively insensible, — considerable assistance will generally be derived from the employment of a moderately tight and properly applied bandage. The promotion of healthy granulation and cicatrization is further mate- rially forwarded by the external employment of the same remedy which we are prescribing internally (in the same manner as described under the heading of Chilblains) ; but in other cases it will be found suffi- cient to keep the dressings constantly wet with cold water : wre must, however, never omit the internal administration of the appropriate remedy ; as, otherwise, the sore will be liable to break out again and again, at longer or shorter intervals, though apparently healed up in a satisfactory manner, under the employment of the unmedicated cold dressing alone.* In the treatment of healthy or healing ulcers, dry lint may be applied to the wound, and the dressing changed only once in forty-eight hours, when the secretion of pus is scanty and insuffi- cient to moisten the lint in a shorter period.
Ulcers attended with or arising from a varicose state of the veins, are usually very obstinate and difficult to heal, particularly when it is inconvenient or impossible for the patient to be kept at rest. Under such circumstances, it is essential that a properly fitting bandage or laced stocking should be worn. The best remedies calculated to effect a permanent cure are, Arnica, Pulsatilla, Lachesis, Sulphur, and Silicea; also Arsenicum, Carlo v., and Acid, pkospkoricum. The two first-named, when given alternately about once a week, early in the disorder, are occasionally sufficient to effect a cure, but for the most part it is necessary to have recourse to the others, either to complete the cure or to prevent a relapse. The indications for their selection are, in this form of ulcer, much the same as already given in the treatment of ulcers in general. Acidum phosphoricum is extremely useful in cases of more or less lymphatic ulceration, particularly when the patient has previously been injuriously affected by the employment of Mercury under allopathic treatment.
Acidum nitricum will prove of essential service after Acid, jokos. if required.
* In chronic, indolent ulcers on the inferior extremities, such as are frequently met with in elderly persons, the treatment ought to be solely internal at the commencement, and the doses administered at intervals of a week and upwards.
ULCERS. 441
Sepia, Arsenicum, Petroleum, Silicea, and Sulphur are most serviceable^ when proud flesh forms on the ulcers.
Against the following varieties of ulcers most of the subjoined medicines have been found of the greatest utility :*
Phagedenic : Arsenicum, Silicea, Mezereum, Hepar s., Sulphur ; also Conium, Acid, nitricum, and Ranunculus.
Scrofulous: Sulphur, Silicea, Calcarea, Lycopod., Carlo v., Arseni- cum, Acid, muriaticum, Baryta acetica, and Belladonna.
Putrid ulcers, or those occurring in Cachectic, Scorbutic subjects: Sulphur, Silicea, Arsenicum, Carlo v., Hepar s., Acidum muriaticum, Pul- satilla, and, in some instances, Ammon. c. et m.
Gangrenous : Arsenicum, Lachesis, Cinchona, Silicea, Belladonna, and Conium ; also Rhus toxicodendron, Secale cornutum, and Squilla.
Carcinomatous : Arsenicum, Lachesis, Conium, Sulphur, Silicea., Diadema aranea, Mercurins ; also Aurum, Staphysagria, and Hepar s.
Fistulous: Sulplmr, Silicea, Calcarea, Lycopodium, Pulsatilla, and Antiwmiium. In fungous ulcers : Sulphur, Silicea, Calcarea, Graphites* Sepia, Staphysagria, Petroleum, Antimonium, lodium, Thuja, and Acid, nitric. ; and in Fungus Jmmatodes : Phosphorus, Thuja, and Acid. nitr.
Mercurial: Hepar s., Acidum nitricum,, Acidum phosphoricum, Aurum, Carlo vegetalilis, Sulphur, Silicea, Belladonna, Thuja, Sarsaparilla, and Acid, fluoricum (especially about the ankle, with more or less impli- cation of the bones.)
Syphilitic : Mercurius chiefly, but also Acid, nitricum, to promote healthy granulation, when the former is insufficient, or to combat mercurial complication, when the patient has previously been sub- jected to injurious doses of that remedy. In other cases Lachesis, Sulphur, and Thuja, &c, are requisite to establish the cure. (See Syphilis.)
Indolent (with thick, smooth, prominent, and rounded margins, a flat bottom, smooth, shining granulations, which are liable to be repeatedly and suddenly absorbed soon after their formation, leaving the sore as much increased in size as it had previously diminished. The pus is thin and aqueous, and contains flakes of lymph which adhere tenaciously to the surface of the sore) : Sepia, Ac. phosph., Lye, Carlo v., Ars., Lack, Sulph., Silic, chiefly.
* Characteristic indications for many of the remedies quoted will be found in Boening- hausen's Manual of Homoeopathic Therapeutics.
442 CUTANEOUS DISEASES.
Inflamed : Aeon., Ars., Merc, Hep., Sil., and also, Mez., Puis., Ant., Bella., or Silic, Sulph.
Insensible: Euphorbium, Ars.
Irritable (painful, bleeding readily, with thin ichorous discharge, and imperfect or indistinct granulations) : Ars., Assa., Lye., Hepar, Carlo v., Merc., Phosph., Silic., Mez., Acid, m., Lack., Puis., Acid, nitr., Con., Sulph., Bella., Thuja, Staph.
Itching: Sulph., Silic, Ac. phosph., chiefly, but also Bye, Sep., Graph., Ars., Alum., Puis., Staph., Bov., Ban.
Itching at the edges only : Tart.
— at night only or chiefly : Bye, Staph.
Burning : Ars., Carlo v., or Bye, Sep., Sil., Clem., Graph., Mez., Hep., Acid. %., Acid, m., Bhus, Puis., Nux, Bov., Cham., Canth., Plumb., Ban., Lam.
Burning pain during the night only: Bye, Bhus, Staph., Hepar.
— pain or heat at the edges : Acid. m.
— pain when touched : Bach., Lye
Creeping or crawling sensations in the ulcers: Bhus, Clem., Cham., Con.
Excoriation, with pains resembling a recent : Mez., Bhus, Hep., Puis., Bella., &c.
Gnawing pain, with: Staph., Mere, Phosph., Bye, Bar., Kali, Bui., Sulph., &c.
Jerking pains, with: Staph., Cham., Clem., Ac. m., Ac. s., Am., Buta, &c.
Piercing or boring pain, with : Sulph., Silic, China.
Throbbing pain, with : Sulph., Clem., Hep., Merc, China, Bryon., &c.
Shooting, darting, pricking pains, with : Ac. nitr., Merc, Silic, Hep., Pills., Sulph., Mix, chiefly ; but also Staph., Sep., Bye, Ars., Mez., Clem., Graph., China, Petr., Bam., Ban.
Shooting pain at night only or principally : Bhus.
— pains at the edges, and only when touched : Clem.
— or pricking pains as if from splinters : Acid. nitr. Smarting : Silic, Graph., Staph., Bam., Bhus, Puis., Cham., Bry.
— or soreness at night only : Bhus.
Tearing, rending pain in the ulcers: Bye, Sulph., Sep., Graph., Staph., Canth.
Tearing, during the night only or chiefly : Lycopodium. Tensive pain in the ulcers : Sulph., Con.
ULCERS. 443
Ulcers which present a blueish or livid appearance : Ars., Lack., Silicea, chiefly ; but also Con., Sulph., Here, Assa., Aur. Ulcers with blueish margins : Assa.
— which have a greenish aspect : Ars.
Ulceus which have a whitish appearance : Mere., Sabin., Ars.
— smooth : Ac. phosph., Lach., Sil., San.
— superficial : Ac. ph., Ac. nitr., Merc.
— tumid : Lycop., Con., Bella.
— with indurated edges : Ars., Sil. ; and also Merc., Sulph., Sep., Assa., Thuja, Puis., Petr., Lye, Bryon., Sec.
Ulcers with inverted edges: Lycopodium, Ars.
— with pale edges : Nux v.
— with elevated edges : Ars., Sil., Sulph., chiefly ; but also Merc, Lye, Sep., Puis., Thuja, Assa., Petr., &c.
Ulcers wdth jagged edges : Mere, Thuja, Staph., Hep., Acid, ph., Sulph., Sil., Lach.
Ulcers surrounded by papilla: Sulph., Lach., Sep., Ars., Puis., Rhus, Sil., Lye, &c«
Ulcers with unhealthy pus.
Pus, serous, aqueous, sanious: Mere, Acid, nitr., Sulph., Sil., Ars., Carlo v., Lye, Graph., Clem., Ruta, Assa., Rhus, Ran., &c.
Pus, albuminous : Ars., Amm., Sulph., Sil., Sep., Cale, Lye, Puis., chiefly.
Pus, brownish : Ars., Carb. v., Sil., Bry., Sec.
— excessive secretion of: Sep., Puis., Sil., Ac. ph., Lye, Chin., Arg., Canth., Staph., Calen., Scill., Mere, Phosph., Sec.
Pus, gelatinous : Arg., Mere, Sep., Sil., chiefly.
— gray : Ambr., Lye, Mere, Sil., &c.
— yellow : Puis., Lye, Ars., Kreos., Natr., Nitr., Thuja, JDule, Aur., Sep., Sil., Clem., &c.
Pus, acrid, ichorous : Ars., Mere, Sil., Rhus, Staph., Sep., Sulph., Graph., Clem., Kreos., Acid, nitr., Natr., Ac. sulph., Hep., Lye, Ran., &c*
Pus, sanguineous : Ars., Assa., Hep., Merc. ; and Sulph., Sep., Lach., Sil., Lye, Rhus, Kali, Car bo v., Sec.
Pus, scanty secretion, or suppression of: Lach., Mere, Sil., Cale; and Carbo v., Clem., Sassa., Phosph., Petr., Staph., Magn., Led., Bar., Graph., &c.
Pus, fefyd: Sulph., Ac. phosph., Hep.; and Carbo v., Ac. nitr., Aur., Ac. m., Kreos., Staph., See com., Con., Sil., Sec.
DISEASES OF THE URINARY AND GENITAL ORGANS.
INFLAMMATION OF THE KIDNEYS. NepJmtis.
Diagnosis. Pressing, pungent pain in the renal region, shooting along the urethra to the bladder, dysuria, strangury, and ischuria (when both kidneys are affected), hot and high-coloured or red urine ; drawing up, swelling, and pain of the testis on the affected side ; numbness and spasms of the foot on the same side ; nausea, vomit- ing, colic, and tenesmus : lying on the part affected and motion aggravate the pains.
Causes. Excessive use of stimulants ; shocks of the body, falls, or strains, external injuries ; long lying on the back, abuse of diu- retics or cantharides, suppressed hemorrhoids or menstruation, metastases or calculi.
Therapeutics. The principal remedies in this affection are, Aconitum, Cantharides ', Nux vomica, Pulsatilla, Belladonna, ffepar sul- jphuris, Cannabis, Merctirius, Arnica montana.
Aconite. In the inflammatory stage of this affection, this re- medy should be administered in repeated doses, in the same manner as in Inflammatory Fever ; after which, in the majority of cases,-—
Cantharides will be found most efficacious in prosecuting the treatment, and may indeed be had recourse to at the very commence- ment of the attack, even when the accompanying fever is consider- able, particularly when the urine passes off in drops, or is tinged with blood, or when micturition is exceedingly painful, with burning pain in the urethra, and when there are the general symptoms of
INFLAMMATION OF THE KIDNEYS. 445
shooting, cutting, and tearing pains in the loins and region of the kidneys, or even in cases of complete strangury.
R Canth. Tinct. 6, gtt. iv. Aq. pur. Jiv. Dosis. 3SS ter quaterve vel ssepius quotidie, pro re nata.
The proved value of this medicine, when used homceopathically, in the cure of this painful disorder, is another of the many exempli- fications of the truth of the homoeopathic law : its power of causing diseases of the urinary organs, even when applied in the form of blister, being so well known, that, in all medical works, it has been noted as an exciting cause of this affection.
Cannabis is of nearly equal importance to Cantharides in ne- phritis. It is especially called for when a dragging pain, or an obtuse aching or pressive pain, or a sensation as if from excoriation is expe- rienced, extending from the region of the kidneys down towards the groin, accompanied by painful and difficult urination.
Form of prescription, the same as Cantharides.
Nux vomica : —When the affection can be traced to a suppression of a hemorrhoidal discharge, determination of blood to the abdomen, excess of wine or stimulants, and sedentary habits, and where we find constipation, feeling of faintness, nausea, vomiting, distension of the abdomen, and drawing up of the testis and of the spermatic cord. (Cocculus and Arsenicum are sometimes required after Nux v.)
Pulsatilla, In females of phlegmatic temperament, when the complaint is connected with irregular or suppressed menstruation.
The dose of the two latter remedies may consist of a few globules or a drop, (sixth dilution or potency), repeated every twelve hours, while necessary.
Belladonna : When shooting pains are experienced in the kidneys, extending to the bladder, — and further, when nephritis is accompanied with colic and cardialgia, heat and distension in the region of the kidneys, scanty micturition, the urine presenting an orange yellow, or sometimes a bright red colour, and depositing red or whitish thick sediment ; anxiety, restlessness, and periodical aggravation — constipation.
Form of prescription, same as Cantharides.
Hepar sulphuris is useful, when we have reason to apprehend the formation of an abscess or the commencement of suppuration : here the diagnosis is difficult, and the professional student must be
446 URINARY AND GENITAL ORGANS.
careful not to mistake the apparent alleviation of suffering for the subjugation of the disease. The following symptoms may serve as a guide in these cases : cessation of the acute pain, a sensation of throbbing and a feeling of weight in the region of the kidneys ; alternate chills and slight flushes of heat, and copious perspiration.
R Pulv. Hep. Sulph. 3, gr. iv. Divide in partes sequal. octo, quarum sumat unam tertiis horis.
Mercurius is also valuable in this stage, but more particularly when diarrhoea and tenesmus are present.
Colchicum. When, in addition to the usual symptoms of this disease, there is excessive nausea with tympanitic distension of the abdo- men, and painful and scanty emission of bright red urine.
Form of prescription, same as Cantharides.
When the disease has assumed a chronic form, and induration of the kidneys has taken place, Mercurius will often be found useful, followed by Aurum, unless some marked indication calls for the employment of another medicine.
In Nephritis arising from contusions or violent concussions of the body, Arnica is the principal remedy.
In cases arising from the abuse of Cantharides in blistering we may exhibit a drop or two of the saturated solution of Camphor, and every hour rub the inside of the thighs with the same preparation, twice a day, until relief is attained.
Observation. This disease sometimes arises from the presence of calculi in the kidneys ; in which case the symptoms of fever do not occur, until a considerable time after severe pain has been expe- rienced;— further a numbness of the thigh, and a retraction of the testicle of the affected side, are considered as distinguishing marks of the existence of a calculus in the kidney or ureter :— here the use of Nociatiana rustica has repeatedly been found a useful palliative, admi- nistered every half hour. But one or more of the subjoined medica- ments may be found more appropriate, and of a more permanent be- nefit: Zycop., Sassa., Cannah., Mez., Bella., Calc. In conclusion, the fol- lowing remedies (the utility of which in various forms of nephritis or nephralgia, either chronic or otherwise, clinical observation has con^ firmed) may be pointed out, as meriting the attention of the profes- sional student : Calcarea Carhonica, Lycopodium, Capsicum, Colchicum, Phosphorus, Sepia, Uva ursi, Kali carbonicum et nitricum, wad Graphites.
Patients suffering from Nephritis should strictly avoid wine, malt liquor, and spirits.
INFLAMMATION OF THE BLADDER. 447
In the event of suppuration, the following, in addition to Hepar s-., have been recommended : Arsenicum, Sulphur, Silicea, Kali nitrimim, and Sarsaparilla.
INFLAMMATION OF THE BLADDER.
Burning pain in the region of the vesica, with tension, heat, pain when touched, and external tumefaction; frequent and painful dis- charge of urine, or suppression, and generally tenesmus ; fever, and sometimes vomiting, as in Nephritis. The causes of this complaint closely resemble those of Nephritis, but it occurs more frequently in parturition than the latter affection.
Therapeutics. We should have recourse to Aconitum, as in Nephritis, when a considerable degree of inflammatory fever is pre- sent, followed by —
Cantharides, which here, as in the above-mentioned disease, is the leading remedy.
Nux vomica : When the affection is attributable to habitual indulgence in wine or spirituous liquors, this remedy, timely admi- nistered, will, in many instances, check its further progress ; and also, when it results from suppressed hemorrhoids, or other habitual discharges, or from dyspeptic derangements. It may be followed, if required, by Sulphur and Calcarea. The two last-named remedies are well adapted to the treatment of the chronic form of the complaint.
Pulsatilla, is valuable in checking the development of the affection, when arising from suppressed menstruation ; and is, more- over, serviceable in all cases, from whatever cause arising, when occurring in individuals of phlegmatic temperament, with the follow- ing symptoms: frequent desire to urinate, painful and scanty emission of slimy or sanguinolent urine, which deposits a purulent- looking sediment ; burning and cutting pains in the hypogastrium, with external heat and tumefaction ; suppression of urine.
Hyoscyamus : — When there is difficult urination, but the disease is not far advanced, particularly when we have reason to suspect, that this symptom arises from spasmodic constriction of the neck of the bladder, or when in fact it is more of a spasmodic than inflam- matory character. Digitalis is serviceable when, in addition to the
448 URINARY AND GENITAL ORGANS.
ischuria, a constrictive pain is felt in the bladder ; and Arsenicum and Carlo v. have been found very efficacious in allaying the burning in the urethra during urination, when Sulphur, Calcarea, or any of the foregoing remedies have not succeeded in arresting it. Arsenicum is, further, of great service when* there is intense thirst, and a distress- ing degree of anxiety and restlessness.
Form of prescription of the first-named remedies, the same as in Nephritis : of Hyoscyamus, Digitalis ', Sulphur, Calcarea, Arsenicum and Carlo v., the same as Nux v. and Pulsatilla. Hellelorus niger, as also Veratrum and Capsicum^ have been favorably spoken of in cases which come on gradually, but subsequently become very severe, attended with frequent urging to urinate, and spasmodic pains, during which only a small quantity of wrater is passed ; to these symptoms are added, continual inclination to vomit, aversion to all kinds of food, excessive distension of the abdomen. When the disease has arisen from the application of Cantharides as a blister in allopathic practice. Camphor must be resorted to as described under Nephritis. And when it arises from the presence of stone or gravel, the same remedies as those mentioned at the termination of the preceding chapter, are the most useful. Arsenicum all., Nux v., Sulph., Sepia, Silicea, and Kali nitricum are the remedies on which our chief reliance may be placed when suppuration sets in. And Helle- horus niger, Capsicum, Staphysagria, Lycopodium, or Baryta, when BlenorrJma supervenes.
Chronic Inflammation of the Bladder is accompanied by an extremely irritable state of that organ, together with a profuse secretion of mucus which is discharged along with the urine. From the latter circumstance the designation of Catarrhus vesicae has been given to this form of the disease. The remedies which are most serviceable in the treatment of chronic cystitis are,. Dulcamara, Pulsatilla, Sulphur ; or Merc, Calc, Nux, Phosph., Can,, Kali, Antimon. c, etc.
RETENTION OF URINE. 449
RETENTION OF URINE.
Ischuria.
When an obstruction to the flow of urine takes place, the fluid accumulates and distends the bladder to such an extent, that it rises up above the pubis, and forms a perceptible swelling in the hypo- gastric region; the entire abdomen becomes tumid and tender to the touch, and a considerable degree of fever is present ; the inclination to pass water is frequent and urging, but utterly ineffectual, and accompanied by intense pain .
Ischury is always to be held as a dangerous affection when it con- tinues for any length of time, for if relief be not administered, inflam- mation and consequent mortification ensues, the urine finds an outlet into the abdomen, and death soon follows.
The causes of retention of urine are, usually, inflammation or stricture of the urethra, enlargement of the hemorrhoidal veins; suddenly suppressed hemorrhoids, either by extirpation or other- wise ; over-distension, spasm of the neck of the bladder, inflammation or hernia of the bladder, paralysis of the bladder, absorption of can- tharides applied externally, or taken internally, excess in vinous or spirituous liquors, the pressure of the rectum, from a lodgement of indurated faeces, or of the uterus, tumours, etc. on the neck of the bladder; swelling or ulcer of the prostate gland, calculi, or particles of gravel lodging at the neck of the bladder, or in the urethra.
Therapeutics. The following remedies may be quoted as those which are best adapted to overcome all ordinary cases of ischury :
Aconitum, Carnphora, Cdntharides, Sulphury Calc. c, Nux v., Carl. v.? and
Aconitum is peculiarly efficacious when there is considerable fever, with burning heat in the region of the bladder, outwardly percep- tible to the touch. In the case of children, where, in addition to the foregoing symptoms, there is also distension of the abdomen, with suppression both of faeces and urine, this medicine is, moreover, one of our most important remedies. In urgent cases, a dose of this remedy may be exhibited every half hour or so, until the symptoms yield.
29
450 URINARY A^D GENITAL ORGANS.
Camphora forms a valuable general remedy where no occasional cause of the disorder can be detected, but it is also of great service where the complaint ef idently arises from spasmodic action,, Burning heat in the abdomen and urethra, with shivering coldness of the sur- face, and shivering succeeded by a hot fit, do not contraindicate the employment of Camphora, but as soon as the incipient symptoms of fever become more developed, Aconitum must be had recourse to. In administering Camphora, we shall frequently find it sufficient, particu- larly with children or very sensitive subjects, to make the patient smell the camphorated spirit; in other cases a drop or two of the first attenuation, or of the common spirits of camphor, may be given on a piece of sugar, and repeated twice or thrice in a space of a quarter of an hour. The attempted cure of hemorrhoids by the knife or ligature forms a not unfrequent source of urinary complaints, and of ischuria amongst others. When retention of urine has arisen from such a cause, or from excessive enlargement of the hemorrhoidal veins, the urine should be drawn off by the catheter, and the pain relieved by the administration of Sulphtr, in alternation with Aconite. Should these not permanently relieve, and the pain consist of a severe burning description, Carho v. and Arsenicum must be prescribed. Nux v. is extremely useful when the patient has been addicted to the habitual use of spirituous liquors ; and is, moreover, one of the most service- able medicaments, in conjunction with Sulphur, Pulsatilla, Carb. v., Arsenicum, etc., according to the characteristic features of the case, in effecting a radical cure where that is practicable. When ischury has been caused by over-distension, from want of opportunity of empty- ing the bladder while travelling, etc., the catheter should be intro- duced to draw off the accumulated urine, and the contractility of the bladder restored by means of Kyoscyamus, Arnica, Dulcamara, or Arseni- cum. The repeated application of cold water to the hypogastric region may also prove beneficial in this respect. When surgical assistance is not at hand, or wThen, particularly in the case of females, the intro- duction of the catheter is objected to from feelings of delicacy, Aconi- tum or Camphora ought to be tried first, and will very frequently supersede the necessity of resorting to mechanical interference, and, moreover, materially tend to ward off any evil effects which might otherwise arise in consequence of the prolonged retention. The application of hot fomentations to the pubic region, and the use of the hip-bath, or large injections of tepid water are sometimes sufficient to promote the expulsion of the urine. Retention of urine depending
DYSURIA. 451
upon spasm of the neck of the bladder frequently yields to the use of Camphora, but other remedies, such as Aconitum, etc. may be required in particular cases. When the disorder is occasioned by distension of the rectum from alvine concretions, or flatus pressing upon the neck of the bladder, the effectual removal of the primary disorder must be obtained by means of Opium, Nux v., Pulsatilla, Plumb, c, Sulphur, and, where required, Aconitum. The employment of unmedi- cated enemata, and of the catheter, may frequently be found requisite as auxiliary means of relief.
If ischuria arise from distension of the uterus in consequence of an accumulation of the menstrual fluid, or from gas or flatus, retroversio uteriy tumours (polypi), etc., pressing against the neck of the bladder or the urethra, — Sepia, Puis., Bella., Nux v., Sulph., Phosphorus, Lycopodium, — Staphysagria, Calcarea, Belladonna, Cantharides, etc., are the remedies by which a radical cure is most likely to be accomplished. In the instance of retention of urine from hernia of the bladder, the urine should be taken away by means of the catheter, the protruded bladder reduced, and a truss applied ; if the hernia be irreducible, the swelling should be supported by a suspensory bandage, but we may frequently succeed in effecting the reduction, and of materially guarding against relapses by the aid of such remedies as Nux v., Aconitum, Opium, Sul- phur, Plumbum, etc. (See Hernia.)
If inflammation or enlargement of the prostate be the evident cause, Aconitum, Pulsatilla, and Thuja will be found useful. If para- lysis of the bladder, Hyoscyamus, Arsenicum, Dulcamara, or other remedies, according to the original disorder which has been produc- tive of the paralytic affection. And when inflammation of the bladder or kidneys, or inflammation or stricture of the urethra, have given rise to the retention, see Cystitis, Gonorrhcea, and Stricture.
Calculi lodging in the urethra, and occasioning obstructed micturi- tion, require to be extracted or cut out.
DIFFICULTY IN DISCHARGING THE URINE. Dysuria. Stranguria.
Dysury, or difficulty in discharging water, may arise from various causes, such as inflammation of the urethra arising from gonorrhcea, or the employment of acrid injections, inflammation of the kidneys or bladder, spasm in the neck of the bladder, enlargement of the
452 URINARY AND GENITAL ORGANS.
hemorrhoidal veins, a collection of hardened faeces in the rectum ; excess in drinking intoxicating beverages, tumour or other diseases of the prostate gland, the suppression of an eruption or of some habitual discharge, or the prolonged application of cold, particularly in gouty habits, the lodgement of particles of gravel at the neck of the bladder or in the urethra, and the abuse of cantharides, either externally or internally, etc. etc.
Dysury is commonly attended with frequent inclination to urinate, smarting pain, heat and difficulty in voiding the water, and a sense of fulness in the region of the bladder. When there are painful or uneasy urgings, and the urine passes off only in drops or in minute quantities, the disorder is usually termed strangury. When the disease is induced by the presence of a calculus in the kidney or urethra,— nausea or vomiting, and a sharp pain in the lumbar region, as also in that of the kidney or urethra, accompany the before-men- tioned symptoms. When from a similar cause, having its seat in the bladder, or when produced by gravel lodged in the urethra, an acute pain is experienced at the extremity of the penis, especially during the emission of the last drops of urine, and the stream of urine is either spiral or bifurcated. Should scirrhous enlargement of the prostate have given rise to the complaint, a hard, painless tumour may be detected by the introduction of the finger into the rectum, or it may even be felt on pressing the hand against the perinaeum.
Therapeutics. As this disease is almost always symptomatic, the treatment must be directed against the primary affection. We shall accordingly confine ourselves in this place to a brief description of the indications of the remedies which have been employed with the greatest success in ordinary cases. When there is frequent inclination to make water, with great pain and difficulty in voiding it, the discharge being, at the same time, very small in quantity, often passed only in drops, and presenting a dark-red, muddy ap- pearance, the symptoms will generally yield, or at all events become materially relieved by the employment of Acomtv/m* When a sense of fulness in the hypogastric region is complained of, together with a cutting, burning, or aching pain, Pulsatilla may be prescribed with advantage ; and Belladonna when a darting or pricking pain extend- ing from the lumbar region to the bladder, agitation and colic are encountered. Hepar s. has been found productive of permanent benefit when Bella, gave but temporary relief. If the calls to make
DYSURIA. 453
water be extremely urgent, and the urine is passed in a very small stream, is acrid, dark-coloured, soon becomes cloudy, and exhales an offensive odour, Mercurius may be prescribed. Eepar s. is frequently useful after, or in alternation with Mere. For dysuria, with almost in- cessant inclination to make water, Petroselinum is often very serviceable ; and when the performance of the act of urination is at the same time extremely difficult, the urine invariably passing only in single drops, attended with severe burning pain in the region of the bladder and in the urethra, Cantharides can, with difficulty, be dispensed with. The several causes of the disorder must always be attended to, and will, where known, prove of great assistance in selecting the homoeopathic remedy. We shall accordingly find that when excess in drinking (either vinous or spirituous liquors) has given rise to it : Nuxv., Opium, or Sulphur and Pulsatilla are the most applicable. When disease of the prostate gland, and when enlargement of the hemorrhoidal veins, or suppressed hemorrhoids: Nux v., Pulsatilla, Sulphur, or Aconitum, Carbo v., Lachesis, Arsenicum, Lycopodium, Calcarea, Mer- curius. (See art. Hemorrhoids.) Again, when the disease has been excited by a fall or a blow on the back or region of the bladder, Arnica, and when it has arisen in consequence of a fright, Aconitum, are, for the most part, the most serviceable remedies. The abuse of Cantharides applied externally or taken internally is not an unfrequent source of the complaint, and is chiefly to be removed by Spirits of Camphor, which is, moreover, the principal remedy, particularly at the commencement of the cure, when other poisons have occasioned an attack of dysuria. Aconitum and Pulsatilla are sometimes required after Camphor. When a chill or the prolonged application of cold has induced the disease, a preference must be given to Aconite, Bella- donna, or Dulcamara, or to Nux v., Pulsatilla, Mercurius, Sulphur, Cal- carea, or Sarsaparilla. And when inflammation of the prostate gland* forms the primary cause, Pulsatilla and Thuja often prove of essential service. The age and sex of the patient is also a frequent guide to the selection of particular remedies. Thus, in old men, Lycopodium
* At the commencement of Prostatitis, Belladonna may be prescribed with advantage, when the pain is increased by the slightest pressure over the seat of the gland, and when there is considerable fulness or swelling in the region of the neck of the bladder. Cannabis is also worthy of attention under similar circumstances. If the pains are less severe, con- sisting more of an obtuse aching description, Mercurius is useful. WThen prostatitis occurs as a sequela of suppressed gonorrhoea, Pulsatilla and Lycopodium have been particularly recommended. In chronic inflammation of the prostate, and consecutive induration, Thuja h Merc, Carbo v., Calc. c, and Conium form the principal remedies.
454 URINARY AND GENITAL ORGANS.
and Opium are almost always called for at one period or other of the treatment. In ataxic females or pregnant women, Pulsatilla, Cal- carea, Acid, jokosp/wricum, or Sulphur, Conium, Ntccc v. ; and in children, Aconitwm, Belladonna, Nux v., Pulsatilla are the medicaments which have hitherto been most frequently used with the best results. In acute cases the diet must be sparing, and sometimes consist ex- clusively of demulcent drinks, such as gruel, &c, especially if the pain is very severe. Warm fomentations and injections of tepid water sometimes give considerable relief. In all cases salt should be partaken of in great moderation, and acids altogether eschewed. In chronic cases considerable relief is often obtained from drinking copiously of cold water throughout the day. Exposure to currents of air ought always to be avoided by those who are subject to urinary complaints. (See Nephritis, Cystitis, and also the indications which have been given for the remedies employed in Hematuria.)
SUPPRESSION OF URINE.
A partial and occasionally even a complete suppression of urine fre- quently takes place in fever. It also occurs in dropsy, and in inflamma- tion of various organs, such as the kidneys, &c. ; and finally, it may arise from loss of secreting power in the kidneys. The term is now, for the most part, confined to the latter form of the complaint ; and it is our intention in this place to restrict ourselves to that variety. The disease commonly takes place in individuals beyond the meridian of life ; but it is occasionally met with at a less mature age, and is some- times encountered even in children. Gouty habits appear to be most liable to be seized with it, and particularly after being much exposed to cold and wet, or on the suppression of an eruption, or some accus- tomed discharge, such as hemorrhoids, &c. Generally speaking^ there is no desire to make water, nor is there pain or tumefaction above the pubes indicating an accumulation of urine, the defective secretion of which will be farther confirmed by the introduction of the catheter. Nausea, constipation, and an occasional sense of sink- ing, usually accompany the disorder. Sometimes a series of other distressing symptoms, such as frequent and severe fits of vomiting, hiccough, pain in the back, intense headache and restlessness are present from the commencement. The pulse continues for some
SUPPRESSION OP URINE. 455
time normal $ when it becomes slower it indicates danger. The skin is generally natural, but profuse sweating sometimes supervenes, and the perspiration has, in some instances, been found to exhale a strong urinous odour.
Suppression of urine leads sooner or later to serious consequences, if the secretion be not restored, and is frequently very speedily fatal, in consequence, apparently, of inducing cerebral disease, and termi- nating in coma.
Therapeutics. The homoeopathic remedies which, in most instances, may be employed with success in restoring the func- tions of the kidneys are : Aconitum, Camphora, Cantharides, Nux v., Puk.y Belladonna, Opium, Lycopodium, Sulphur > &c. Their leading indications in suppression, or diminished secretion of urine, are similar to those which have been given under the heads of Dysuria and Ischuria. Attention should in every case be directed to the causes which have apparently been the means of developing the disorder, and the selection of the remedies made in accordance there- with. Thus, when the suppression or retropulsion of an eruption has called forth the disorder, Sulphur will form an almost indispens- able remedy. The same remedy, together with Nux v., Pulsatilla, Calcarea or Sepia, is equally useful where some habitual discharge, such as the hemorrhoidal, menstrual, &c, has been checked. The affection, as already observed, is prone to occur in gouty habits, conjoined with free living, or excessive indulgence in spirituous liquors. In these cases Nux v. will prove of great service, especially when we meet with nausea, or frequent and violent vomiting, head- ache, or heat in the face and head after meals, constipation, nocturnal restlessness, or unrefreshing sleep with frightful dreams. Opium, Lyco- podium, Lachesis, or Sulphur may, in some cases, be found necessary, when Nux v. is inadequate to effect a radical cure. When exposure to cold and wet has given rise to the disorder Dulcamara may be found useful at the commencement, particularly when there is a copious and offensive secretion from the skin. Acidum nitricum and Colocynth may be of some utility where the perspiration is profuse and exhales an urinous odour. In all cases, any signs of an approach of cerebral disease ought to be studiously watched, and, when detected, imme- diately combated by the appropriate remedies. (See Phrenitis.) The following remedies may also be enumerated as worthy of atten- tion in this disease : Cannabis, Alumina, Kreosotum, Bryonia, Carlo v.,
456 URINARY AND GENITAL ORGANS.
Evphorlium, Staphysagria, Clematis, Digitalis, Squilla, Colchicum, Graphites, Rhus, &c For the treatment of suppression of urine in consequence of Nephritis, Cystitis, or Hydrops, see those diseases.
STRICTURE OF THE URETHRA.
A stricture of the urethra may be defined to be a diminution, or such an alteration of a portion of the tube as renders it, at the affected part, much narrower than what it is in the normal state, or even completely obstructed. The formation of the disease appears, m most instances, to depend upon a thickening of parts of the canal, the result of inflammatory action. The first, or at all events one of the earliest signs of stricture of the urethra is the retention of a few drops of urine in the passage after the patient has performed the act of micturition; but these drops are soon involuntarily emitted; while another small quantity, accumulated between the cervix of the bladder and the stricture, may be expelled by the effect of pressure below the urethra. The next, and sometimes the first derangement observed is, that there is a frequent inclination to void water, the patient being under the necessity of emptying the bladder repeatedly m the course of the night. As the obstruction increases, the urine cannot be passed without pain and effort, and the stream becomes forked, spiral, or scattered. In the advanced stage of the disease the urine comes away by drops, and is sometimes mixed with purulent matter or glairy mucus. In addition to these symptoms, the patient is distressed with pain about the glans penis, and occasionally in the loins, and is, moreover, often attacked with severe paroxysms of intermittent fever. Exposure to cold, violent exercise, excess in venery, and the pleasures of the table aggravate all the symptoms, and cause entire stoppage of urine, The thin, glairy, or gleety dis- charge, which commonly attends, has frequently led to the mistake that the case is one of gonorrhoea secondaria, or gleet ; but the existence of the symptoms we have above enumerated, together with the unequivocal proof which is to be derived from the introduction of an appropriate bougie, remove all uncertainty. The most common seat of the stricture is just behind the bulb ; and that which is per- haps next in frequency is about four and a half inches within the canal; then three and a half; and sometimes close to the external orifice of the urethra.
The evils which are liable to result from old and aggravated cases
STRICTURE OF THE URETHRA. 457
of stricture are thickening of the bladder, with deprivation of its usual power of expansion, or inflammation accompanied with dis- charge of a sort of viscid secretion, bearing a resemblance to pus ; retention of urine, and dilatation and ulceration of the urethra between the bladder and the first and principal stricture. When the urethra ulcerates, and abscesses form and burst, channels are pro- duced, through which the urine escapes into the surrounding cellular membrane, nxA fistula in joerinteo are constituted.
Therapeutics. In the incipient stage of stricture of the urethra a cure may often be effected by appropriate medicines ; even in a more advanced stage a cure is sometimes practicable, or at all events such a degree of improvement capable of being brought about that the after treatment by mechanical means, where requisite, is thereby materially facilitated. The following are the principal medicines, from the employment of which results of a satisfactory nature are frequently to be obtained: Cannabis, Petroselinum, Can- tharides, Camphora, Mercurius, Aconitum, Sulphur; and, in some instances, with induration, and more or less contraction and thick- ening of the urethra: Clematis, Dulc, Digit., Petr., Sulph., or, Acid, nitr,, Silicea, Calcarea, Lycopodium, Pulsatilla, &c. A few of the leading indications for the selection of some of these remedies will be found in the chapters on Dysuria, Hematuria, Gonorrhoea. If the symptoms are invariably exacerbated by exposure to cold, Dulca- mara may be prescribed with advantage ; and when excess in wine or spirituous liquors causes serious aggravation, and occasionally com- plete retention of urine, Nux v. is a useful palliative. (See Reten- tion of Urine.)
In old inveterate cases, and particularly in permanent bad cartila- ginous strictures, recourse must be had to the ordinary mechanical means. In cases where it seems requisite from the commencement to conduct the treatment on the principle of mechanically dilating the contracted part of the urethra by means of bougies or elastic gum-catheters, but where the urethra is so irritable that the patient cannot bear the introduction of the instrument, or where copious hemorrhage follows its employment, Aconitum or Arnica may be pre- scribed with advantage. These remedies are, moreover, often of great utility in warding off inflammatory action in the testes from the use of bougies.
Where the medical treatment no longer offers any reasonable
458 URINARY AND GENITAL ORGANS.
prospect of success, and the stricture is so complete or extensive as entirely to arrest the introduction of the bougie, a surgical operation becomes necessary, which consists in the perforation of the stricture, with a stilet; or the plan of cutting down to the stricture, and then cutting through the diseased part of the tube must be resorted to.
URINARY ABSCESS AND FISTULA.
Fistula injoerinceo.
Fistulae in perinaeo are ulcerated openings in the perinaeum, which not unfrequently take place in consequence of the natural passage for the urine becoming completely impervious from stricture. The urethra becomes ulcerated immediately behind the seat of the obstruction, and the urine escapes into the cellular membrane ; the injected parts swell and inflame ; suppuration speedily supervenes ; the abscess bursts, and the fistulous opening, forming an outlet for the urine, is produced. In some instances no urine is discharged from the aperture until two or three days have elapsed, but in others, it flows from the first, intermixed with fetid pus. The secretion of pus then diminishes, and the urine passes out of the new channel in large quantities. Several external openings are occasionally formed, in place of one. Fistulae, of a similar nature to the foregoing, may be produced in the groin, scrotum, and even at the base of the penis near the pubis ; and in some rare cases they form a communication between the rectum and the part of the urethra behind the obstruc- tion. Retention of urine is no longer prone to occur when fistulae in perinaeo are established.
Therapeutics. It is recommended by most surgeons to open the abscess which forms the swelling in the perinseum early. The cure of the fistula necessarily depends upon that which has given rise to it, viz., the strictures themselves : when these are removed, either by the ulcerative process which preceded the production of the fistulae, or by other means, the urine resumes its natural course, and the fistulous aperture closes. If it should not do so, we must seek to effect this object by the employment of homoeopathic medi- cines ; and of these the following will generally answer best : Silicea, Sulphur, Calcarea, and, sometimes Mercurius, Arsenicum, Lachesis, or Cantharides. The introduction of a gum-catheter into the bladder,
INCONTINENCE OF URINE. 459
and the confinement of the patient to bed for a few days, is in some eases sufficient ; but where this is impracticable from the stricture remaining entire, and refusing to yield to the usual remedial agents, a staff may be passed down the urethra as far as the stricture, the canal laid open, a catheter conveyed into the bladder, and kept there until cicatrization is accomplished.
INCONTINENCE OF URINE.
Involuntary flow of urine usually proceeds from relaxation, or a paralytic affection of the bladder ; or from irritation or compression of the bladder, in consequence of the secretion of acrid urine, the pre- sence of gravel, or a diseased state of the organ itself.
Therapeutics. When the incontinence proceeds from relaxation brought on by a too free use of vinous or spirituous liquors, consider- able relief, if not a radical cure, will, in most instances, be effected by the employment of Nux v. In other cases having a similar origin, Opium, Lachesis, Sulphur, Calcarea, and sometimes Acid, muriaticum, must be had recourse to subsequent to, or in alternation with Nux #. If masturbation or excess of venery have induced a relaxed condition of the sphincter of the bladder, Nux v., followed by Sulphur and Cal- carea, will generally be found the more efficacious remedies ; but the auxiliation of Acid, muriaticum, China, and Acidum phosphoricum will often be required. The use of the flesh -brush and frequent sponging writh cold water is also of some service in such cases. The inconti- nence of urine which proceeds from paralysis of the vesica, or is attendant on more general paralytic derangement, has been cured by Cicuta and Magn. aust. The aid of one or more of the following medi- caments, Aconitum, Belladonna, Hyoscyamus, Cocculus, Nux v., Opium, Natrum m., Arsenicum, Sulphur, Bryonia, Dulcamara, Bauroceracus, Sepia .or Silicea, etc., will, however, be necessary in many cases. The employment of electro-magnetism, cold bathing, and of friction at the upper part of the sacrum should not be neglected in inveterate cases of paralytic enuresis. Against spasmodic incontinency, Camphor a, Belladonna, Hyoscyamus, Ignatia, Natrum m., Nux, Pulsatilla, Conium, Cina, and Rhus ; or Bycopod., Sulph., Bach., Baryt. c, Ruta, etc. should claim most attention, and be selected according to the peculiarities of the case, and with due regard to the collateral symptoms. If
460 URINARY AND GENITAL ORGANS.
inflammation about the neck of the bladder and urethra give rise to the disease, Aconitum and Cantharides should chiefly be employed. (See also Cystitis and Gonorrhoea.) When the secretion of acrid or highly acidulated urine produces an involuntary flow of urine, con- siderable relief will be obtained by drinking freely of cold water, or of barley-water or linseed-tea. Amongst the homoeopathic remedies from wThich the most appropriate selection may be made, to effect a radical cure of such cases, the following may be quoted. Mercurius, Hepar s., Kreosotum, Lauroceracus, Arsenicum, Graphites, Iodium, Vera- trum, or Tartarus emet., etc. If the presence of gravel or sand create irritation and consequent involuntary expulsion of urine as soon as it is secreted, the exhibition of Calcarea, Nux v., Cannabis, Uva, Phospho- rus, or Petroleum is often attended with the most satisfactory results. In all cases where there is much pain and irritation, recourse may be had to the simple diluents above alluded to, together with the employment of Aconitum and Sulphur in alternation, and the injection of tepid water into the bladder.
Against nocturnal enuresis, Ammonium carbonicum is often efficacious ; as likewise Belladonna, especially when the weakness proceeds from cere- bral irritation ; Kreosotum when the emission takes place only during deep, almost comatose sleep, and Cina when the existence of worms in the alimentary canal appears to be the irritating cause. (See the other remedies given under the article Invermination.) In other instances of this frequently most troublesome form of the complaint, Pulsatilla, Sepia, Sulphur, Silicea, Carl, v., Arsenicum, or Hepar, Graph., Cole. Am., China, Con., Petrol., Natr., Rut., or Mags, oust., etc., may be indicated.
In the case of children, if the emission of urine take place only at an early hour in the morning, the nurse ought to be ordered to get into the habit of raising the child from bed before the time of the usual occurrence of the mishap.
DIABETES.
By this term is understood an immoderate secretion of urine, con- taining a large proportion of saccharine matter. Sometimes, however, the quality of sweetness is absent, and the usual urinary taste alone perceived. The complaint has, consequently, been divided into two species, of which the former has received the appellation of Diabetes
DIABETES. 461
mellitus, and the latter that of Diabetes insipidus. The mellitic variety- is by far the more dangerous and fatal. Diabetes, for the most part, comes on slowly and insidiously, insatiable thirst and voracious appe- tite, the usual attendant symptoms throughout the disorder, being frequently the only striking symptoms at the commencement. In other cases, the patient complains of great lassitude, and a tendency to perspire after any trivial exertion ; the appetite, although keen, is generally accompanied by deranged digestion. Pain, sometimes of a very severe disposition, is often complained of in the lumbar region, and a sense of distressing weakness is generally experienced in the said part of the body. As the disease progresses, especially in the diabetes mellitus, rapid emaciation of the whole body ensues ; the thirst continues excessive, but the quantity of urine voided exceeds in quantity that of the fluid and aliment introduced ; there is a feeling of complete prostration; the pulse becomes quick and weak; the breathing exceedingly laborious, and dropsical infiltration takes place in the inferior extremities. The disease affects men more frequently than women, and it frequently attends sympathetically in a milder form on hysteria, hypochondriasis, dyspepsia, and asthma. Those who are in the decline of life, or have a shattered constitution arising from intemperance, as hard drinking, excessive venery, or from the prolonged abuse of diuretics or aperients, or other powerful depleting measures, such as repeated venesections, etc., seem to be most subject to its attacks. Many instances, however, have occurred in which no obvious cause could be assigned. The duration of the disease has varied from five or six weeks to many months, and even several years before terminating fatally.
Therapeutics. The very different opinions as to the proximate cause of the disorder, and the contradictory pathological conclusions, which have been drawn by allopathic writers, have led them to promulgate and adopt the most opposite and conflicting varieties of treatment. In homoeopathic writings, again, we meet with com- paratively fewT detailed descriptions of treatment, and authentic radical cures, particularly of the mellitic form of the complaint. This is, undoubtedly, in a great measure to be attributed to the rarity of the disease, for the very minute attention which is necessarily paid to symptoms by the homoeopathic practitioner, in order to enable him to reap the peculiar advantages of his materia medica without, at the same time, neglecting to pay due attention to every
462 URINARY AND GENITAL ORGANS.
additional circumstance which may facilitate his choice of the appro- priate remedy, such as the history of the case, and a careful discrimina- tion between cause and effect, — must materially tend to overcome the difficulties which surround the allopathist, and render the disease in his hands one of so intractable a nature. The medicines which have been chiefly recommended by the limited number of homoeopathic authors who, hitherto, have casually written on or referred to Diabetes mellitus, are Acidum phosphorictim, Mercurius, Sulphor, Natrum m., Carlo vegetabilis, Ledum; and, further, Acid, muriatictcm, Asclepias vincetoocicum, Ammon. c, Arsenicum, Alumina, Graphites, Ambra, Baryta c, Bella., Con., Magn., Terebinth., and Meph., &c. Of these the following have, as yet, been principally employed : Mercurius solubilis, Veratrum, Kali carbonieum, and Acidum mtiriaticum. Their indications are mainly as follows :*
" Merc. sol. is indicated when there is a constant desire to urinate, night and day, swollen moist prepuce and glans penis, both of them painful; drawing, squeezing sensation in the testicles, a cutting, tearing pain in the left kidney, painful swelling of the gums, white coated tongue, constant dryness in the mouth, a bad fetid breath, constant hunger, insatiable thirst, burning, acrid, scraping eructations, burning pain in the epigastric region, wakefulness, owing to the desire to urinate ; slow, languid pulse, sunken countenance, general weakness and debility, swelling of glands, &c.
"Veratrum: — Great alteration of the countenance as of a dead person ; swelling of the gums, looseness of the teeth, sticky dryness of the mouth and fauces, which cannot be removed by any liquids, great nausea and thirst, painful hunger, drawing pain in the umbilical region, excessive flow of urine, even involuntary, soreness of prepuce, extreme general prostration and weakness, especially of the extremi- ties, trembling of the whole body, inclination to faint, weak, almost imperceptible pulse.
" Kali carb. : — Jerking pains in both renal regions, especially on sitting down, and protracted ; dull stitches in the left ; frequent and violent desire to urinate, especially troublesome at night, the urine of a pale green colour; burning sensation in the urethra during evacuations ; sharp drawing pains through the penis; pains on motion in the inguinal region ; feeling of cold in the intestines, as if water were being dropped upon them; burning heat in the stomach,
■* Homoeop. Exam, vol iv. No, 12, p. 525.
H/EMATURIA. 463
languor, swollen and ulcerated gums, dry mouth, fetid breath, violent thirst, especially in the evening and at night, very pale and sunken countenance, sunken eyes, irritable surly state of mind, easily alarmed, uneasiness and wakefulness, great prostration, feeling of emptiness in the whole body, drawing pains in the back, frequently proceeding from the sacrum.
"Acidum muriaticum is preferable to all other remedies in cases where there is an entire absence of thirst, and where the urine has a milky appearance ; also in cases of drunkards, where it has proved very efficacious."
When diabetes is symptomatic of dyspepsia, asthma, hysteria, &c, see the remedies which have been enumerated under these different heads.
The diet in diabetes ought to be wholesome, and contain the greatest amount of nutriment in a small bulk ; animal food ought to be preferred ; vegetables, especially potatoes, and fruits are to be inhibited. All kinds of liquids wrhich exert a specific or direct effect upon the kidneys should be strictly avoided. Milk should, in gene- ral, be also abstained from.
HEMATURIA. Mictus cruentus.
The passing of blood with urine may arise from various causes, amongst which the following are the most frequent : falls, bruises, blows, violent exertion, such as leaping and hard riding, — the lodge- ment of a small stone in the kidney or ureter, or by inflammation of the kidney ; it may also be occasioned by irregular menstruation, hemorrhoidal disturbances, habitual and excessive indulgence in spirituous drinks, the frequent use of certain vegetables, such as asparagus &c, excess in venery, and by the frequent external and internal employment of Cantharides. The blood voided is, in most instances, intermixed with the urine, but when it originates from the lacerating effects of an irregular stone, it is generally discharged in streaks and coaguli, and deposits a dark brown-coloured sediment, bearing a resemblance to coffee-grounds. The act of urination is generally performed with some difficulty, and accompanied with tenesmus. When the blood proceeds from the kidney, the urine first expelled looks muddy and high-coloured, is usually very copious, and
464 URINARY AND GENITAL ORGANS.
attended with acute pain in the back, anxiety, numbness in the thighs, drawing up of the testes, constipation, and other abdominal derangements. When from the ureter, the symptoms are nearly the same as the foregoing, with the exception that the pains extend from the lumbar region along the course of the ureter down into the pelvis, with strangury, and perhaps also nausea and vomiting. In hemorrhage coming from the vesica urinaria, we commonly meet with spasm, dysury, occasionally severe burning and other pains in the hypogastrium perinaeum, penis, and anus, during and subsequent to the act of micturition. To these are added, especially when the difficulty of making water is considerable, great anxiety, cold sweats, shivering chills, debility, and fits of syncope. The blood is not so intimately combined with the urine as in the immediately preceding cases, generally deposits a coherent sediment, and is sometimes emit- ted in a free state.
The voiding of sanguineous urine is always to be regarded in a serious light, especially when it is commingled with purulent matter. The prognosis must, however, be regulated by a variety of circum- stances, such as the active or passive nature of the discharge, the age and constitution of the patient, the duration and recurrences of the affection, the collateral symptoms, and the occasional causes, &c.
Therapeutics. Cantharis forms one of the more generally use- ful remedies in this disease. It may be had recourse to in almost all cases where we are uncertain as to the exciting cause of the disorder, and especially where there is considerable difficulty in making water, with scalding in the urethra during the act of micturition, or violent cutting and spasmodic pains in the hypogastric region, the blood discharged being either pure and passed in drops, or copiously inter- mixed with the urine, or in streaks or coagulated. Even when the existence of purulent matter is detected in the sanguinolent urine, the employment of Cantharides may be attended with beneficial results. But the assistance of such remedies as Pulsatilla, Clematis, Mercurius, Hepar s., Cannabis, Sdbina, or Uva %rsi is commonly essential in the latter case.
When, on the other hand, the disorder has evidently originated in the employment of Spanish fly itself, in the form of a blister, in allo- pathic practice, or in large doses internally, a drop or two of Spirits of Camphor must be given, and repeated every two or three hours until relief is afforded. Should any sequelae, such as burning in the urethra,
HEMATURIA. 465
etc. etc., remain after the employment of Camphor, Carlo v. and Arseni- cum will usually cause them to yield. Next to Cantharides, Mezereum has been recommended as one of the principal remedies in the homoeo- pathic treatment of hasmaturia, more particularly where the blood passed does not appear to be in large quantity, and the accompanying pains not very severe; further, when the blood is rarely or never coagulated.
When the disorder has resulted from external violence, it usually gives way readily under the use of Arnica ; but if the patient be of a plethoric habit, it will be found highly advantageous, if not impera- tive, to exhibit Aconitum in alternation with Arnica.
To pursue the description of treatment required in those cases where the occasional or predisposing cause is known, we shall find that Nux vomica forms an eminently useful remedy, when the habitual over-indulgence in spirituous or vinous liquors, or suddenly suppressed or checked hemorrhoids have given rise to it, and painful aching in the back with smarting in the urethra are complained of. After Nux v., Sulphur may generally be prescribed with much benefit ; and this remedy, again, may in turn be succeeded by Calcarea with advantage, particularly when the blood is discharged in small clots. Pulsatilla is very serviceable in females affected with ataxic menstrua- tion, but it has been found of equal value in the male subject when the disease was attended with a constrictive and cutting pain around the umbilicus, extending with great violence to the lumbar region ; or, where spasmodic pains were experienced in the inferior extre- mities, particularly the right knee, and from thence upwards to the groin, with spasmodic retraction of the scrotum and penis, and burning pain at the orifice of the urethra. Sulphur and Calcarea may often^ as in the case of Nux v., follow Pulsatilla wdth good effect.
Cases apparently arising from venereal excesses usually require Cinchona in the first instance, and subsequently Nux, Sulphur, Calcarea9 or Phosphorus. Mercurius, also, is sometimes of much value here^ par- ticularly when the blood is often discharged during sleep, along with seminal emissions. Hepar s. may succeed Mercurius, should the latter produce merely temporary melioration. At other times Ledum, or Mezereum, may be found better indicated. When the voiding of bloody urine arises from the presence of calculi, Nux v., Cannab., Calc, Petrol,, Phosph., Canth., Lycopod., Sass., Canth., Ac. nitr., Nux m., and Zincum have chiefly been recommended. When the pain is excessive, Aconitum, and in some cases Arnica, may exert a soothing influence.
30
466 URINARY AND GENITAL ORGANS.
Squilla, Zincum, Conium, and Millefolium have also been favorably- spoken of, as being useful in particular cases of this affection. Water or barley-water should, in most cases, be drunk in considerable quan- tities. When hematuria occurs merely as a secondary disorder, in connexion with Nephritis or Cystitis, see these diseases.
DISCHARGE OF BLOOD FROM THE URETHRA.
Urethrorrhagia* Hamorrhagia methm. Styrnatosis.
This complaint, like the preceding, is frequently met with in con- nexion with other disorders. It may, however, exist in an idiopathic form either in consequence of mechanical injury, or venereal excess, in either of which cases the same remedies must be had recourse to as those given for the treatment of hematuria arising from similar causes. When it occurs as a secondary malady, in connexion with hemorrhoids, menstrual irregularity, etc., Nux v., Pulsatilla, Sulphur, etc., are the most appropriate medicaments, and may be selected according to the indications described above. Should the affection be encountered as a secondary symptom of gonorrhoea, it will com- monly yield to Cantharides, but Cannabis or Sulphur may sometimes be required to complete the cure.
INFLAMMATION OF THE URETHRA, CLAP. Urethretis. Gonorrhoea. Blenorrhcea.
Under the above heads we purpose to treat of inflammation of the mucous membrane of the urethra resulting from impure connexion, attended with a discharge of puriform matter. The affection com- monly commences a week or ten days after the risk of taking it has been incurred ; but in some cases it begins in two or three days, and in others no perceptible symptoms become developed for two or three weeks. The disease varies in severity according to the extent and intensity of the inflammation. In ordinary cases the latter only extends an inch and a half along the urethra, or two inches from its orifice ; but in severe forms it occupies the entire course of the canal, and even affects the mucous membrane of the bladder. The earliest symptom of a clap consists of a sense of titillation or
INFLAMMATION OF THE URETHRA. 467
itching at the orifice of the urethra, which sometimes extends over the whole of the glans penis, and is accompanied by a frequent inclination to make water. In a short time some uneasiness is experienced on passing the urine, and the orifice of the urethra is observed to be red and swollen, and perhaps a small quantity of discharge is observed. The act of urination now becomes more and more painful, sometimes almost insupportable, while the stream becomes diminished and broken, notwithstanding the increased ex- pulsive efforts exerted by the patient. A somewhat copious dis- charge of thick, white, or yellowish puriform matter soon takes place from the urethra. As the inflammation advances, or when it has been intense from the commencement, the discharge becomes greenish, acrid, and sometimes mixed with blood. The glans and prepuce frequently become red and tumefied ; involuntary and painful erections often occur, particularly during the night, and there is sometimes considerable restlessness, headache, and other symptoms of fever. This, the acute, stage of the disease generally goes on increasing, or at least continues with unaltered violence for eight or ten days, but is sometimes prolonged to three weeks and even upwards, if unchecked, or aggravated by the thoughtlessness of the patient, in committing errors in diet, indulging in the use of ardent spirits, exposing himself to cold or the excitement of sexual intercourse. When the acute stage begins to subside, its decline is marked by a diminution of the pain and scalding sensation in making water, and in a month or six weeks none of the symptoms may remain. It very often happens, however, that instead of undergoing a spontaneous cure of this description, the acute symptoms disappear, but a dis- charge of puriform fluid continues for a considerable period, the affection assuming the form of chronic inflammation.
The above are the symptoms of gonorrhoea as it is usually met with. But it occasionally appears in a much more serious and dis- tressing form, in which not only the whole course of the urethra, but even the bladder itself, becomes implicated in the inflammation. When this happens, the sufferings of the patient become materially aggravated ; the calibre of the tube is much contracted, in conse- quence of the tumefied state of the mucous membrane, and the urine is passed with the greatest difficulty and only in drops, accompanied by excruciating pain in the urethra, hips, loins, and hypogastrium ; the involuntary erections are frequent and attended with excessive sufferings, especially when combined with distortion of the penis
468 URINARY AND GENITAL ORGANS.
(chordee) from the effusion of coagulated lymph into the corpus spongiosum urethrae. In the worst cases, small indurations may often be felt in the course of the urethra, and sometimes Cowper's glands and the prostate partake of the inflammation, in which event a sense of heat, weight, and fulness is experienced in the perinseum, with pain in the hypogastrium, dysuria, and tenesmus, particularly when the disease has spread to the bladder or its cervix. Abscess, fistula, and permanent disease of the prostate, or stricture of the urethra are the occasional results of the last-mentioned state of matters. Phimosis, orchitis, bubo, not unfrequently take place, from the extension of the inflammation to the prepuce, testes, and glands of the groin during the course of gonorrhoea. Gleet, or the existence of a serous or muco-purulent, pale green, or colourless discharge from the urethra, is not an unfrequent occurrence after an attack of acute inflammation. It is commonly attributed to chronic inflammatory action. The most trifling error in diet, and particularly the use of spirits, wines, and pungent condiments, is generally followed by frequent inclination to void water, a degree of ardor urinae, and increased oozing of matter. This state often continues for years, and grows more and more aggravated, until at length a permanent stricture is formed, or thickening of the bladder, disease of the prostate, or even of the kidneys, becomes established.
In women the symptoms are, generally speaking, not so distressing as in men. Sometimes, however, the inflammatory action affects the mucous membrane of the vagina, and even that of the uterus itself. The discharge takes place from the secreting surfaces of the labia* nymphae, and clitoris, as well as from the lining of the meatus urinarius and vagina in severe cases.
Treatment of Gonorrhoea. The disease sometimes proves very intractable even in homoeopathic practice ; but if the treatment is commenced sufficiently early it terminates much less frequently in the secondary form of the malady, and the other serious conse- quences we have detailed, than it does under allopathic treatment. The remedies which have hitherto been chiefly employed by homceo- pathists are Copaiba, Petroselinum, Cannabis, Aconitum, Sulphur, Can- iharides, Capsicum, Silicea, Z^cqpodium, Acidum mtricum, Sepia, &c.
In the milder forms of the affection, or in cases occurring in healthy subjects, a cure is generally very easily and speedily accom- plished when the patient applies before the second stage has set in.
INFLAMMATION OF THE URETHRA. 469
We have repeatedly succeeded in arresting the disease at its outset (i. e. when the orifice of the urethra looks fuller and redder, and a disagreeable itching is felt in the tube, together with frequent desire to make water, and some pain on voiding it) by means of the alternate employment of Aconite and Cannabis, at intervals of at first six, and subsequently twelve to twenty-four hours. So soon, however, as the discharge begins, and ardor urinae is experienced, Copaiba 3 — 6 often proves a very useful if not a specific remedy ; but should there be a perpetual urgency to make water, Petroselinum 0 may be prescribed in preference to Copaiba. Cannabis is preferable to either Copaiba or Petroselinum, when the inflammation runs somewhat higher, and the pain and difficulty in passing water are consequently more intense. A drop of the first, second, or third dilution may be taken every six or eight hours. In gonorrhoea with phimosis, or extension of the inflammation to the prepuce, Mercurius is the most important remedy ; but it is sometimes necessary to prescribe a dose or two of Aconitum,, in the first place, when the inflammatory action is excessive, and the glans, as well as the preputium very much tumefied. (See Phimosis.) Mercurius is, further, of considerable efficacy at the commencement of the second stage of the disease, when there remains a muco- purulent discharge, of a white or greenish yellow colour, and some degree of pain in passing the last drops of water ; or when there is swelling and induration of the lymphatic glands of the penis. SiUcea or Hepar s. is sometimes required after Merc, in the latter case ; and Capsicum is often useful in removing any ardor urinae that may remain. Sulphur is still more frequently required than Mercurius after the inflammatory stage is over, and particularly when the discharge has become serous, and a feeling of uneasiness alone remains in the urethra when voiding urine. In painless gonorrhoea accompanied wdth swelling we have generally given Merc, Sulphur, or Silicea, at the sixth potency : a few globules night and morning for four successive days. We now come to the treatment of the severer forms of gonorrhoea. Here the employment of Aconitum, Cannabis, and Cantharides is especially called for. The curative power of these remedies in such cases is frequently very striking, and the rapidity with wThich they afford relief highly satisfactory. Aconitum is more or less useful in most cases of gonorrhoea occurring in young and vigorous subjects, and attended with headache, restlessness, and other febrile symptoms ; but it is almost indispensable where the inflammation is severe and extensive, the pain during micturition
470 URINARY AND GENITAL ORGANS.
excruciating, the glans, or indeed the entire penis, much swollen, and the sufferings greatly exacerbated by frequent or almost constant erections (priapismus). In such cases a drop or two of Aconitum at the third or sixth dilution may be added to an ounce of water, and a dessert-spoonful given every six hours. Relief is generally obtained after the first dose, and it is rarely necessary to continue the medicine after it has been taken for the third time. Cantharides is generally required after Aconitum. It may be given from six to eight hours after the second or third dose of the latter, when the intensity of the pain and any febrile irritation which may have been present have yielded, but the dysuria, ardor urinse, and chordee still continue distressing, Cantharides may be exhibited without the previous employment of Aconite, when there is no marked degree of constitutional disturbance, but the scalding during micturition and the chordee are very severe, and the discharge is greenish and tinged with blood. It may be prescribed at the sixth dilution, and the dose repeated in from six to twelve hours according to circumstances. Cannabis is sometimes required after Cantharides, especially when the dysury proves obstinate; and when Cannabis effects little or no improvement, Petroselinum may be administered. We have occasionally found the alternate employment of Petrosel., CantL, and Cannabis requisite before the continuous urging inclination to pass water and the torture during micturition could be subdued. Mercurius or Sulphur are not unfrequently useful in completing the cure, when the before- mentioned remedies have removed the active inflammatory symptoms.
Treatment of the Second Stage op Gonorrhoea. When the disorder has reached the chronic stage before the patient seeks advice, we must generally expect to encounter more difficulty in effecting a cure, than during the first or inflammatory stage ; the more so, if the patient has previously drugged himself with large and long-continued doses of cubebs or of balsam of copaiba, or has fruit- lessly persevered for some length of time in the employment of astringent injections. In a number of cases, early benefit has been derived from the use of Capsicum, Mercurius, Sulphur, and Acid. nitr. Capsicum has chiefly been recommended when the discharge is whitish and purulent, and ardor urinae is still experienced when making water. Ferrum, Pulsatilla, and also Nux v. have been stated to be useful when Capsicum failed to remove the symptoms quoted. Sulph. and Merc. are considered the most useful, in general cases, when the patient
INFLAMMATION OF THE URETHRA. 473
has previously been under a course of copaiba or cubebs. Acid, nitric. is often very serviceable in gonorrhoea as soon as the inflammatory stage is over ; but generally requires to be followed by Sulph. if the pain has subsided, but the discharge continues. When the inflam- mation had evidently extended far down the urethra, we have found much advantage in the use of Cantharides and Cannabis, and in some cases from Nux v., when the discharge wras serous and scanty the desire to pass water frequent and urgent, the act of urination painful and difficult, the stream of urine broken or forked; in short, when the symptoms presented the appearance of the formation of stricture or a tendency thereto. In addition to the above medicines, Acid, nitricum may be mentioned as a useful remedy in gonorrhoea secundaria or gleet; also Sepia, Zycqpodium, Cubeba, SiUcea, Calcarea, Thuja, Natrum m., and Dulcamara. When, in consequence of errors in diet, the use of wines, spirits, acids, &c., an increased discharge takes place, accompanied by frequent desire to urinate, and some scalding pain, Nux v., or one or more of the other remedies enumerated above, as Cannabis, Sec, must be resorted to. Tussilago petasites (in the dose of two teaspoonfuls of the expressed juice of the plant, or of the water containing the plant in a macerated condition) has recently been recommended as a most efficacious remedy in recent as well as chronic gonorrhoeas. If aggravation follows the first dose or two of the medicine, it must be given in a weaker or more diluted form. A case of ophthalmia which had existed for two years, and had made its appearance after a suddenly suppressed clap, was cured by the employment of this remedy.*
When there is a complication of gonorrhoea and chancre, or when the discharge from the urethra is found to proceed from chancres within the tube, Mercurius should be prescribed. (See also Syphilis.) And when there are condylomata on or in the vicinity of the genital organs, or there is reason to suppose that 1>he discharge from the urethra is of sycosic origin, Thuja and Acidum nitric, or Cinnab., Merc, and Sulph, are the principal remedies with which the cure is to be accomplished. (See Sycosis.) Against symptomatic buboes Carbo animalis is considered as one of the most efficacious remedies. Silicea and Mercurius may also be named as likely to be useful in some cases. (See art. Bubo.)
If cystitis ensue in consequence of the extension of the inflam- mation to the mucous membrane of the bladder, Cantharides and * Rosenberg, Gr. u. st. N. Arch., 1— -2. 80.
472 URINARY AND GENITAL ORGANS.
Cannabis will claim the principal attention. (See Cystitis.) % When swelled testicle results from the sudden suppression of a clap, Clematis, Sulphur, and Pulsatilla form the most appropriate remedies. (See Orchitis.) And when rheumatism or ophthalmia are produced, the medicaments enumerated in the respective chapters on these affec- tions must be employed. It sometimes happens that pains in the region of the prostate are complained of for a considerable length of time after an attack of gonorrhoea, which prove particularly trouble- some during erections, and occasionally incapacitate the individual affected for riding on horseback. Their removal is, in general, ac- complished without difficulty by means of Pulsatilla, Thuja, Sulphur, Lgcopodium, or Capsicum. (See Prostatitis.)
During the treatment of gonorrhoea, wine, spirits, and malt liquors ought to be abstained from. Pure cold water is the best diluent, and may be freely partaken of. Active exercise should be shunned during the inflammatory stage ; when it cannot be wholly avoided a suspensory bandage should be worn. If the inflammation be extensive or the parts much swollen, confinement to the recumbent posture becomes requisite.
INFLAMMATION OF THE GLANS PENIS.
Balanitis. Balano-blenorrhcea.
Inflammation of the glans penis may either occur simultaneously with inflammation of the urethra after impure connexion ; or it may arise from mechanical injury, or from the inadvertent application of poison to the part, as sometimes happens when the patient has been occupied in handling poisonous plants.
When the disorder takes its rise from extension of the inflam- mation of the urethra over the whole of the glans, and also the prepuce, Mercurius is, in general, the most appropriate remedy. Sometimes it may be found necessary to give a dose or two of Aconitum before Mercurius ; and in other cases Cannabis may be more prominently indicated than either of the said remedies. (See Inflammation of the Urethra, and also Phimosis.) Acidmm nitricum is useful when small, superficial ulcerations form on the glans in neglected or protracted cases. If the affection has been caused by a bruise, or has arisen from friction during coitus, Ar- nica should be administered, and alternated every eight hours with
INFLAMMATION OF THE TESTIS. 473
Aconitum, should the inflammation and swelling be excessive. In the event of these remedies failing to relieve the symptoms, Rhus toxicodendron must be employed. Belladonna and Bryonia, sometimes in alternation with Aconitum, have been recommended as the best adapted to the treatment of those cases which have originated in the accidental application of poison. Cannabis, Cantharides, Cuprum, or Ledum are considered by some homoeopathists as the most deserving of attention, when no cause can be traced or assigned as having given rise to this inflammation. If the disorder be of syphilitic or sycosic origin, the remedies which we have mentioned in the chapters on these two diseases must be resorted to.
INFLAMMATION OF THE TESTIS.
Swelled Testicle. Orchitis. Hernia humeralis
This affection is liable to arise from external injury ; but it is much more frequently encountered as a sympathetic disease from irritation of the^urethra. The inflammation and swelling come on suddenly, and as abruptly subside, or pass from one testis to the other. At the commencement of the attack, the testicle is tumefied, soft, and sensitive to the touch ; after a short period it becomes hard and excessively painful. The spermatic cord is also rendered very tender, and thickened, whilst its veins are occasionally found in a varicose state. Pain in the loins, colic, sickness, more or less fever, depression of spirits, and occasionally a difficulty of making water, are other not unfrequent concomitants of the disorder.
Therapeutics. If the accompanying fever run high, a few doses of Aconitum must be exhibited. On the reduction of the fever, and diminution of local heat, Pulsatilla is one of the most efficacious remedies when irritation of the urethra, and especially that arising from suppressed gonorrhoea, has given rise to the affection. Sulphur and Clematis erecta are sometimes required to complete the cure after the employment of Pulsatilla ; in many cases, indeed, these remedies are preferable to Pulsatilla, even at the beginning of the disease. When the swelling has resulted from external injury Arnica, externally and internally, rarely fails to afford speedy relief. It may be preceded by Aconite if called for, and succeeded by Pulsatilla or by Conium if the pain and swelling do not readily diminish under the action of
474 URINARY AND GENITAL ORGANS.
Arnica.* In those cases where Aconite has been found necessary, the application of lint dipped in cold water and kept constantly moist, is frequently productive of great relief. Should induration in the epididymis remain, Aurum, Clematis, and Sulphur will be found the more generally useful. In other instances, and especially in indura- tions of long standing, we may, in addition to the above, bear the following remedies in mind : Rhododendron crysanthum, Merc, Graph., Lycopod., Agnus castus, Staph., Spong., or Zincwm. Against orchitis as a metastasis of Parotitis, Pulsatilla, Merc, and Nux v. have been strongly recommended ; and in that from the abuse of Mercury, Cinchona, Aurum, Acidum nitr., and Sulphur have proved of great efficacy.
SARCOCELE.
This is an affection of the body of the testis, in which its sub- stance is, for the most part, converted into a hard fleshy substance, hence the name. In the mild form of the complaint the tumour is smoother, and produces little or no pain or uneasiness beyond what is occasioned by its weight. This benign condition of matters some- times goes on without material alteration for a considerable period ; but in other cases it very speedily acquires a more serious character, by becoming unequal and knotty, increased in bulk, and attended with acute shooting pains extending up the loins and back. When it assumes a malignant character, it ulcerates and forms a large, foul, offensive phagedenic ulcer with indurated edges ; or extremely pain- ful fungi burst forth from the ulcerated surface, subject to repeated occurrences of hemorrhage. Occasionally an accumulation of fluid in the tunica vaginalis takes place coeval with the enlargement and induration of the testis, producing that mixed variety of the disorder denominated hydro-sarcocele.
Sometimes the disease appears to be merely local, particularly when an external injury has given rise to its formation, and the patient is of a good habit of body. But when it proceeds from, or happens to become developed in a tainted constitution, the abdomi- nal viscera and system at large become implicated, severe constitu- tional irritation supervenes, and a termination is sooner or later put to the patient's existence.
* See art. Contusions.
VARICOCELE. 475
Therapeutics. In the mild form of the complaint, of in the first stage, resolution may be effected by means of one or more, of the following remedies : Aurum, Clematis, Lycopod/ium, Agnus castus, Graphites, Rhododendron, and Sulphur. When the scrotum presents a livid colour, and its veins are varicose, Lachesis will be found very useful. In more advanced stages, or when the tumour acquires a malignant character, Arsenicum, Lachesis, Clematis, Arenia diadema, Carl, v., or Thuja may, in some instances, enable us to arrest the fatal progress of the disorder, but in the majority of such cases extir- pation is the only resource.
VARICOCELE.
Varicocele, Cirsocele, or varicose enlargement of the sper- matic veins, usually commences close to the testis, and extends upwards to the abdominal ring. The tumefaction of the vessels is commonly greater the nearer they approach the testis. The swelling is knotty and unequal, bearing some resemblance to coiled-up earth- worms ; it is sensitive to the touch, creates a feeling of weight in the scrotum, also in the loins, and often a degree of numbness in the thigh. Prolonged retainment of the erect posture, exercise or over- exertion of any kind produce an aggravation of symptoms. Cirsocele is to be distinguished from hernia as follows : after placing the patient in the horizontal posture proceed to reduce the swelling by compression of the scrotum ; then press the fingers against the upper part of the abdominal ring, and request the patient to get on his legs ; if it be a cirsocele, the swelling will reappear with increased size, from the obstruction which is offered to the return of blood into the abdomen by the pressure ; but if a hernia, the recurrence of the tumour cannot take place as long as the pressure at the ring is continued. Blows upon the groin, the violent pressure of a hernial truss over the spermatic cord tumours resting on and interrupting the circulation in the vena cava inferior, excesses, &c, are considered as the most common exciting causes of the malady.
Therapeutics. The radical cure of cirsocele is frequently attended wTith great difficulty ; and in many cases it is only prac- ticable to give palliative relief. Pulsatilla, Lachesis, and Arnica are the more generally useful remedies. In most cases we may com-
476 URINARY AND GENITAL ORGANS.
mence with Pulsatilla, and desire the patient to support the testis with a suspensory bandage. Lachesis is frequently of considerable service after the previous employment of Pulsatilla, but particularly when the vessels present an extremely livid appearance. When external injury, such as a blow, or the pressure arising from the pad of a truss, has given rise to the affection, Arnica, in the form of lotion (one part of the tincture to ten of water), should be applied.
If, from long standing, or violent exercise, the vessels have become more than usually tumid and painful, a dose of Aconitum may be pre- scribed, the part frequently bathed with cold water, and the patient confined to the recumbent posture. Nux v. is of service where there is constipation, and neither Pulsatilla nor Lachesis correspond to this particular symptom. (See art. Constipation.) Sulphur will often prove useful after Nux* Arsenicum and Carlo v. may be selected when severe, burning pains are complained of in the tumour. And in inveterate cases: Sulphur, Graphites, Lycqpodium, Carlo v., Sepia, &c. are the remedies from which we can expect to derive the most assistance ; but where the symptoms do not yield to any of these or others which may have appeared better indicated, and the tumour is large, extremely painful, and threatens to waste away the testis by its pressure, the varicose veins should be removed, and inflammation subdued by the antiphlogistic measures given under the head of Wounds.
HYDROCELE.
By the term hydrocele is meant a tumour arising from a preter- natural accumulation of serous fluid, having its seat in the mem- branes of the scrotum [Anasarca integumentorum), or the coats of the testis and its vessels {Hydrocele tunica vaginalis). The former is com- mon to the whole bag and enveloping cellular tissue ; it is generally accompanied with anasarca in other parts, or ascites, and when pressed upon retains the impression of the finger. The latter is a purely local affection, and is that to which the name of hydrocele is by many writers restricted. It presents the appearance of a pyriform swelling of the scrotum ; is elastic, free from pain, and rarely occurs on both sides, but more commonly on the left than the right. The tumour is primarily manifested at the inferior part of the testis, and gradually ascends towards the abdominal ring. In some cases the
HYDROCELE. 477
accession of the disorder is sudden, and the swelling increases to a painful degree of distension ; but more frequently it takes place very slowly, and occasionally continues for many years with little disturb- ance. The tumour is usually hard at its posterior surface, where the testis is for the most part situated. As it enlarges, and particularly in its early stage, it is transparent, so that a shade of light pervades the whole tumour when a candle is held on the opposite side ; and on compressing it with the fingers fluctuation is perceptible,— by which circumstance, together with the absence of pain and the smoothness of the surface, it is distinguishable from hernia of the omentum or intestines, sarcocele, fungus haematodes, or schirrus of the testis.
Therapeutics. As anasarcous swelling of the scrotum is gene- rally met with in conjunction with anasarca or ascites, we refer the reader to these different headings for particulars, and shall merely add that when there appears to be no marked participation of the whole habit in the disorder, it will frequently yield readily to the employment of Hetteborus, Arsenicum., or China, &c. The radical cure of hydrocele of the tunica vaginalis is in many cases attended with considerable difficulty. In those of recent origin, or occurring in very young subjects, Pulsatilla will often be found an effectual remedy. In more inveterate cases, Hepar sulphuris, Graphites, Sulphur, Nux v., Arnica, Conium, &c, externally as well as internally, become requisite, the latter two especially when a contusion has given rise to the affection. Mercurius, Cinchona, and Digitalis have been em- ployed with success in several cases. And in strumous habits, Silicea has been stated to be of greater efficacy than almost any other remedy. In all cases it ought to be the earnest and untiring aim of the practitioner to effect a cure by means of appropriate medicine, in place of resorting to the hazardous experiment of effecting a cure by the operation of injection. When the tumour, from its great bulk, has become of painful annoyance to the patient, palliative relief may, if absolutely necessary, be afforded by the evacuation of the accu- mulated fluid by means of a trocar. After which process, the parts may be dressed with lint dipped in cold water, and a dose or two of Arnica given internally, prior to the selection of any other remedy, according to the nature of the case, the constitution and tempera- ment of the patient.
478 URINARY AND GENITAL ORGANS.
Diffused Hydrocele of the Spermatic Cord {Hydrocele funiculi spermatid) consists of a collection of watery fluid in or about the cellular membrane surrounding the spermatic cord. The tumour occupies the course of the cord, is soft, colourless, and unaccom- panied by pain. It seems to diminish on the application of pressure, but speedily resumes its usual size, either in the recumbent or erect posture, as soon as the pressure is discontinued. It is often no longer than the portion of the cord which occupies the groin, but sometimes it extends as far as the testis, and produces excessive distension of the scrotum. When the swelling attains a large size, it is productive of great inconvenience, and the patient complains of uneasiness in the lumbar region.
The treatment of this form of hydrocele is closely analogous to the preceding. When the swelling is small, a suspensory bandage should be worn ; and if it appears to have originated from the pressure of an ill-made or badly-fitting truss applied to obviate hernia, the occa- sional cause \inust necessarily be remedied, otherwise all attempts at a cure will prove abortive. When the disease is associated with anasarca in other parts, or when morbid states of the abdominal viscera, such as indurations, &c, become manifest, remedies must be selected to embrace the whole deranged habit. (See Anasarca, Enteritis, &c.) In some desperate cases, it may be found neces- sary to lay open the tumour by an incision extending from the abdo- minal ring to the testis.
Encysted Hydrocele of the Spermatic cord. {Hydrocele cystata funiculi spermatid.) In this variety of the complaint the fluid is contained in one (rarely two) distinct cell or cyst. The tumour is of an oblong shape, and is placed between the abdominal ring and testis. It is always free from pain, possesses a good deal of trans- parency, and is commonly very tense. Itt differs from hydrocele of the tunica vaginalis, by not extending below the testis, feeling like a distended bladder, and throughout exempt from hardness. The testis is, however, always to be felt below or behind it ; whereas in hydrocele of the vaginal tunic, when of considerable magnitude, the testicle cannot be discovered. It is distinguished from hernia by its size and form remaining unaltered in the horizontal posture, and by not becoming enlarged or receiving any impulse from sneezing or cough- ing ; further, by its incapability of being returned into the cavity of the abdomen, and its being unattended with any derangement of the
VENEREAL DISEASE. 479
intestinal tract. A perceptible fluctuation and the absence of pitting on pressure determine its features from those of anasarcous hydrocele. The homoeopathic treatment required is the same as that described for hydrocele of the vaginal coat.
VENEREAL DISEASE. Syphilis, Lues Venerea.
The symptoms produced by the venereal disease are. generally divided into primary and secondary ; by the term primary is under- stood the ulceration, sometimes followed by a swelling of the ab- sorbent glands, which results from the direct application of a peculiar virus to the parts.
When the ulceration is situated on the organs of generation it is denominated a chancre, and the glandular swelling receives the appel- lation of bubo. The ulcer may be on the prepuce, the glans penis, at the angle formed by the junction of the two former, at the fraenum, the orifice of the urethra, the body of the penis, or even on the scrotum or perinaeum. In the female, the ulcers are commonly formed about the labia, nymphae, clitoris, and sometimes within the orifice of the urethra or the vagina. The first symptoms of a chancre generally set in from three to six days after coition, and are commonly announced by a feeling of itching, which upon examination is found to proceed from a small pimple or pustule having an inflamed base, which feels hard to the touch ; soon afterwards, an elevated point is observed on the minute cone, from an opening in which a limpid fluid is discharged, and succeeded by a more or less rapid development of ulceration. The primary venereal sore varies much, however, both in appearance and intensity in different individuals, these several forms seeming in a great measure to depend on the habit of body, age, and temperament of the patient. The most common varieties are the Hunterian chancre, the superficial ulcer with raised edges,the phagedenic, and the sloughing ulcer. The Hunterian chancre commences in the manner we have already described. As soon as this sore is formed, it exhibits a tendency to assume the circular form, becomes deep and spreading, is covered with a tenacious and adherent matter, and has a hard, cartilaginous base and margin ; it is met with on all the parts of the genital and urinary organs we have alluded to. When on the glans
480 URINARY AND GENITAL ORGANS.
it is usually less painful, and less inflamed than when it is on the prepuce or fraenum, but more inclined to hemorrhage. The super- ficial ulcer has its margins considerably elevated, and sometimes spongy, but is not attended with induration ; it is sometimes accompanied by two or three sores of the same character, and has its seat very often on the outside of the prepuce, but is as frequently met with, attended by its superficial satellites, on the corona glandis, under the prepuce, or around its orifice. When located at the side of the fraenum it usually destroys that fold of reflected integument.
The phagedenic sore is destitute of any marked degree of sur- rounding hardness, has no granulations, but presents a livid-coloured circumference, and is liable to spread most rapidly and alarmingly, particularly when injudiciously treated by irritating external appli- cations, or by excessive doses of Mercury. Lastly, the sloughing ulcer is distinguished by displaying itself, at the commencement, as a black spot, which extends, then casts off, and discloses a phagedenic or corroded surface. The ulcer which remains after the slough has come away is of a painful character, and has a dark blue or livid crimson margin. A bad habit of body, combined with intemperance, insufficient or unwholesome diet, and a residence in an unhealthy neighbourhood, or the effects of improper treatment, and particularly the abuse of Mercury r, or the employment of powerful and irritating local applications, are apparently the principal causes which give rise to the formation of this serious description of sore, which, if not checked, or if perse veringly maltreated, will frequently go on slough- ing and ulcerating until nearly the whole of the external sexual organs are destroyed.
The cleft of the nates, the groin, the perinaeum and the labia pudendi are frequent seats of the sloughing ulcer.
Secondary Symptoms. These most frequently consist in an ulcerated state of the fauces, mouth, and Schneiderian membrane. In bad constitutions,* and especially where improper treatment has been employed, such as excessive doses of Mercury (one of the most fruit- ful sources of many of the so-called secondary symptoms in general), considerable portions of the velum palati and tonsils, as also the epiglottis, the cartilages of the larynx, and eventually even the bones
* Ricord is of the opinion that secondary symptoms never arise from contagion, but are derived from hereditary taint. (Traite Pratique des Maladies Veneriennes.)
SYPHILIS. 481
of the nose become affected, and are sometimes destroyed ; affections of the skin (syphilida) of various kinds, assuming the form of papulae, pustulae, squamae, tuberculae, etc., also occur, sometimes preceded by febrile symptoms. The syphilitic eruptions chiefly shew themselves upon the external organs of generation, about the verge of the anus, on the face, especially the forehead and angles of the mouth ; but sometimes also on the back, and indeed the whole body. They have very often a peculiar hue, varying in shade from a violet red to an earthy yellow, but commonly distinguished by the denomination " coppery," and have usually a tendency to ulcerate. Other symptoms of constitutional infection almost constantly accompany the syphilitic eruptions, such as pains in the bones, ulcers in the throat, etc.
Constitutional lues often affects the iris, producing inflammation and ulceration. The periosteum and bones are frequently the principal seat of the constitutional symptoms, particularly the bones of the cranium, the inferior maxillary, the clavicle, sternum, distal end of the radius, and the tibia, in addition to those of the nose, as already observed. When the disease settles in the bones, or when the bones have become involved by the employment of Mercury in large doses, the patient is tormented with nocturnal pains of a more or less excru- ciating character.
Treatment of the Primary Symptoms of Lues.
Bicord,* in opposition to Hahnemann, considers a chancre, at its commencement, as a purely local disease, and therefore recommends that it should be treated as such, and destroyed by the application of a cautery within three to five days after the contraction of the infec- tion. He states that he never knew of a case, so treated, which ter- minated in the absorption of the virus into the system, followed by symptoms of general poisoning. We have not, as yet, been so fortu- nate as to have had any cases submitted to our observation at so early a period of their career, and cannot therefore offer any testimony in favour of the latter part of M. Ricord^s assertion, if that were needed, seeing that it is founded on extensive practical experience. We have, however, had opportunity of treating a considerable number of cases at a somewhat more advanced stage, and propose to give the following, brief outline of the treatment we pursued : —
* Traite Pratique des Maladies Veneriennes.
31
482 URINARY AND GENITAL ORGANS.
The remedies we employed were Mercurius vivus, Merc, corrosivus, Acidum nitricum, Hepar s., Acid, phosph., Zycqpodium, Sulphur, Silicea, Arsenicum, Carlo v., Lachesis, Thuja, and Sepia. In the selection of these we were guided by the state and appearance of the sore, and varied the potencies according to the habit of body of the patient. Where Mercury had not been previously employed, we prescribed it for all sores which presented an indurated base and margin, whether they secreted and were covered with a tenacious or a thin offensive matter, and we should certainly most unwillingly dispense with this valuable remedy in such cases, notwithstanding the bad repute it has acquired, from the frightful effects which have so frequently arisen from its abuse in the hands of our allopathic brethren. Such results can never take place in homoeopathic practice, assuredly not, in the hands of any one at all deserving of the name of a homoeopathic practitioner. Where the health of the patient was remarkably good, and the sore neither of long duration, nor had in any way been aggra- vated by previous treatment, we have repeatedly succeeded in effecting a cure in from ten to fourteen days, by means of Mercurius vivus 6.* A few globules (about a dozen) night and morning, for five or six days, and subsequently, on the ulcer assuming a healing aspect, every second or third day. In other cases, especially in torpid constitutions, it was found requisite to have recourse to the third, second and first triturations, and to the second and third of Mercu- rius corrosivus, giving J to \ a grain daily until a copious discharge of healthy pus supervened, or the excavation began to be filled up with healthy granulations. As soon as either the one or the other of these changes took place, a pause of three or four days was made. At the expiration of that period, a few more doses were generally suffi- cient to effect a cure in the last-named instance; but in the former, if no signs of granulation made their appearance, (which however, was rarely the case), a dose or two of Sulphur 6 produced a favor- able effect. If, on the other hand, granulations appeared, but instead of being firm and florid, they were pale, flabby, and prominent, Acidum nitr. 3 answered better. Again, when, after the previous employment of \ Mercury, the sore improved somewhat, became less cartilaginous at the base, and finally filled up with florid but too elevated granulations, and remained hard at the edges, was very painful and irritable, bleeding rather freely at the slightest touch, and
* The highest potencies of Mercurius (200 and upwards), are said to have recently been employed in Germany, with unequivocal benefit in the treatment of chancre.
SYPHILIS. 483
secreting a thin, acrid, offensive discharge, Arsenicum brought about a healthy and otherwise favorable action. Nevertheless, a few doses of Sulphur or Acid, niir. were sometimes required to complete the cure, after the employment of Arsenicum, especially when the ulcer had spread rapidly, and attained a large size at the commencement. From four to six or eight weeks generally elapsed before a cure was established in these cases.
When there was excessive pain, swelling, and inflammation, and these symptoms did not yield to the employment of Mercurius,— Sulphur and Aconitum, in alternation, every twelve hours, gave relief. In other cases, the exposure of the part to the vapour of hot water, together with spare diet and the recumbent position, were sufficient to allay the excessive irritation. The dressing, when the ulcer was neither very irritable nor extremely painful, consisted of a small piece of lint. Great cleanliness is requisite in all kinds of sores ; and when the chancre is located under the prepuce, and the latter is much swollen and inflamed, water should be throwTn up between the prepuce and glans by means of an appropriate syringe.
The remedies which we employed against the ulcer with raised edges were Acid, nitricum, Hepar s., Sulphur, Arsenicum, Silicea, Carlo v., Lycopodium, Acid, phosph., Sepia and Mercurius. Most of the cases treated had already existed from six to eight weeks, and upwards, and had been subjected to a smart Mercurial course, both outwardly and inwardly. Acid, nitricum and Hepar s. were consequently very generally required. To the former the preference was given when the gums were severely affected, and when aching pains were complained of in the bones ; the sore itself not painful, yet disposed to bleed easily and profusely, presenting no signs of central granu- lation, and having the margins elevated and spongy-looking ; or when there was a tendency to the production of condylomata (sycosic complication), with secretion of a thin sanious discharge. The dose consisted of one drop of the third dilution, at first, night and morning, then daily, and subsequently every other day, according to the results. Sulphur 6 and Thuja were sometimes required after Acid. nitr. had effected all the benefit it seemed capable of. The former when cicatrization proceeded slowly and imperfectly; and the latter (both outwardly and inwardly), when excrescences continued to form and to discharge profusely. Hepar sulphuris proved particularly useful wrhen the mouth and gums exhibited unequivocal signs of mercurial action, and when the sore was painful, irritable,
484 URINARY AND GENITAL ORGANS.
and had assumed a disposition to spread rapidly. A quarter of a grain of the third or second, and in some instances the first, tritura- tion, were given night and morning, at the commencement of the course, for four days ; then daily, for a like period, and subsequently every second or third day. Silicea, and at other times Acid, nitric, were sometimes called for to complete the cure, after Repar s. had subdued the more prominent symptoms of mercurial aggravation, and given a healthy character to the sore. Sulphur, as has already been observed, is sometimes of much utility in promoting healthy granulation in the Hunterian chancre, and is also of great service in sores which present a red or bluish margin, and display a tendency to take on a bad character ; but it is especially in the treatment of the superficial ulcer with raised margins that we have derived the most satisfactory results from its employment. When a sore of that character occurred in a strumous habit, or in persons of lymphatic or bilious temperament, who were subject to hemorrhoidal attacks and obstinate constipa- tion— when, moreover, the edges of the sore were spongy, very sensitive, and prone to bleed rather copiously, however gently the prepuce might be drawn back — and, finally, when the secretion from the ulcer was thin and ichorous, or thick, yellow, and rather copious, but the centre of the ulcer flat and presenting no signs of incarnation, we never failed to derive the most satisfactory results from the employment of Sulphur 6, ten or twelve globules daily for from six to eight days, and then at longer intervals, if we perceived that the medicine had made a favorable alteration in the appearance of the sore. It was rarely that any other remedy was required to complete the cure when Sulphur was indicated as above. Arsenicum, Carlo v., and Silicea were found very useful when the ulcers had been ren- dered irritable by a free use of stimulating applications under allopathic treatment. Arsen. or Carlo was equally beneficial when the margins of the sore were jagged, sharp, and undermined ; the discharge thin, acrid, and offensive ; the ulcer painful and liable to bleed somewhat copiously when slightly touched. Carlo v. received a preference to Arsenicum when the patient bore evidence of having been under a cpurse of Mercury, the breath emitting the peculiar fetor, and the gums looking inflamed, spongy, and ulcerated. Silicea was sometimes requisite after the two preceding medicines, when they had produced great improvement, but seemed inadequate to effect cicatrization. When the sore was inflamed as well as painful and irritable, and the discharge discoloured, or thin and bloody, the
SYPHILIS. 485
granulations indistinct or altogether absent, Silicea was of vast service. These medicines were prescribed at the sixth potency, and in the same manner as Sulphur. Nux v. and Pulsatilla were occasionally em- ployed with advantage when the appearance of the sore was altered by intemperance in eating and drinking. Mercurins, from the reasons already specified, was rarely an available remedy in this form of chancre; but in two instances in which it had not previously been employed, or at all events in unusual moderation, it was productive of unequi- vocal benefit at the sixth potency. The sores in the cases in question occurred in subjects of lymphatic temperament and of plethoric habit, and displayed an active, spreading character ; the secretion being at the same time acrid, ichorous, and rather copious.
In some very obstinate cases of superficial chancre, where the sore assumed all the characteristics of an indolent ulcer, the margins being thick, rounded, and prominent, without the slightest ap- pearance of granulation, or if any granulations formed, they presented a pale and flabby appearance, Lycopodium and Phosphoric acid proved very serviceable. The former particularly in persons of lymphatic temperament and mild disposition, with tendency to habitual con- stipation ; the latter in spare, debilitated subjects, who had been addicted to excessive indulgence in venery. When neither of these were sufficient to establish a cure, Sepia and Sulphur brought about the desired result. These, then, were the principal remedies which we employed with unequivocal benefit in the treatment of the Hunterian and superficial chancres ; and in not one instance did the slightest appearance of constitutional or secondary symptoms super- vene. Considerable advantage accrued from the simultaneous ex- ternal employment of the appropriate remedy in some cases, when the sores were of a very indolent character. As regards the treatment of the two other kinds of primary sores, viz. the phagedenic and the sloughing, we cannot say much, having had only three cases of the former, and none of the latter under our observation ; but we have every reason to conclude that the homoeopathic remedies would, when timely resorted to, readily succeed in arresting the progress of the disease. In the three cases of phagedenic sores above alluded to, two of them had previously been injudiciously treated by over- doses of Mercury, and had been further aggravated by the employment of irritating external applications. Hepar s. 3, Lachesis 6, and Acid, nitr. 3, soon brought on a healthy action in these, and effected a cure. The remaining case, which bordered closely on the sloughing
486 URINARY AND GENITAL ORGANS.
ulcer, yielded to Arsenicum 6 and Silicea 6. We found a striking change for the better in the appearance of the sores, from the internal use of Arsenicum and Lachesis, — the livid red or blueish margins soon assuming a healthier colour after their employment. The other remedies exerted perhaps a more favorable influence over the process of granulation. Against the true sloughing ulcer, Arsenicum must, doubtless, be an] efficient remedy; it corresponds, both in its pathogenetic properties and those which have been derived from clinical observation, so closely to the local and constitutional symp- toms of the disease. Lachesis, — and Silicea, Bella., China, Mezereum, Hepar, or Acid, nitr., might also be found useful, if not indispensable, in many instances.
Simple excoriations on the glans, resulting from coitus, will gene- rally heal readily without any treatment whatever, if attention be paid to cleanliness. A weak lotion of Arnica (one part in sixteen or twenty) will frequently hasten recovery. Cases which from neglect, and particularly want of cleanliness, have become converted into small, flat, superficial sores, require Acidum nitricum or Acid, phosph. ; the latter we found more useful when the spots or sores were of larger size. The diet, in all primary sores, must be regulated by circumstances. In young plethoric subjects affected either with the Hunterian or with the superficial chancre with raised margins, the diet must be low, and if the sore be very painful and inflamed, the reclin- ing posture is often necessary. The drink must consist of nothing but water, toast-, barley-, or rice-water, weak black tea, and cocoa. In somewhat debilitated subjects, or in all cases where the sore is neither in an inflamed state nor very painful, the diet need not be sparing; but stimulants, such as wine, or spirits, are rarely, if ever, called for, and are often, if not always, objectionable under homoeopa- thic treatment. In the phagedenic sore, absolute rest in the recum- bent posture is imperative. If there be great prostration of strength, the diet should not be too sparing, and yet not more generous than the state of the digestive functions will admit of. Wine may be called for, where the patient has been long accustomed to the daily use of spirituous liquors, or where the constitution is extremely debilitated, and no reaction is found to take place from the employ- ment of the appropriate, or homoeopathic remedy.
Btiho. This term was formerly exclusively employed, as its name implies, to denote a swelling in the groin, arising from the passage of
SYPHILIS. 487
venereal matter or poison through the inguinal glands; and yet if the patient have a primary venereal sore on one of his fingers, he may have a bubo immediately above the elbow, or in the axilla. Buboes have been divided into venereal, sympathetic^ and- constitutional. The venereal bubo is supposed to arise, as above observed, from the direct irritation which the venereal poison offers to the lymphatic gland or glands as it passes through this portion of the absorbent system into the blood. But the matter of syphilis may be taken up into the circulation without exciting any inflammation in the glands of the groin, or similar glands in other parts of the body. The occurrence of a bubo in consequence of ulcers on the external parts is, in reality, comparatively rare in healthy subjects, particularly when the primary sore is properly treated ; and we are confident that, in many cases, the injudicious and too free use of irritating local applications, such as sulphate of copper, nitrate of silver, and the red precipitate, in allopathic practice, is a frequent source of this glandular implication. The purely sympathetic, or non-venereal bubo is generally preceded and accompanied by some degree of derangement of the health. At times it may be induced by causes apparently the most trivial, such as the wearing of a tight boot, the effects of a sprain or bruise, &c. A boil or sore on the foot, leg, thigh, or nates, an inflamed or painful corn, a bunion on the great toe, are frequent causes of inflammation and enlargement of the inguinal glands. By the constitutional bubo, we here allude to scrofulous swelling of the lymphatic glands of the axilla, or of the groin, especially the latter. Getting the feet wet, or sitting on a damp seat, in a gig, or on the top of a coach, frequently develops this form of bubo.
Therapeutics. It is sometimes difficult if not impossible to arrive at the true character of a bubo ; the patient, from false deli- cacy, often refusing to admit that he has previously been affected writh chancre. In homoeopathic practice, this is of no material consequence ; the appearance and condition of the swelling, and the state of the general health forming a sufficient group of symptoms to enable us, in doubtful cases, to select the appropriate remedies. The correct history of the case is, however, by no means unimportant, as it facilitates the choice of the remedy. If a bubo be a venereal one, and the chancre is in existence with it, we should not deviate from the treatment called for by the aspect of the primary sore.
488 TJRTNARY AND GENITAL ORGANS.
But if the sore assumes a somewhat improved appearance, or remains perfectly unaltered, and the bubo, on the other hand, becomes con- siderably aggravated, we ought to give the latter our chief attention, and prescribe according to the features which it presents. The following is the mode of treatment we have ourselves pursued. Whenever the swellings were either small, or of considerable size, but neither excessively inflamed nor particularly painful, we pre- scribed Mercurius at the third trituration, quarter of a grain night and morning, until signs of improvement made their appearance. In those cases again in which the swelling was large and painful, and accompanied by intense inflammation, the integuments pre- senting a deep red hue extending over a considerable surface, the redness disappearing on pressure, but returning immediately after the finger was removed, Belladonna 6, every six to twTelve hours, was found to be of the greatest efficacy. When suppuration threatened, or became established, Silicea 6, every twelve hours, formed an ad- mirable remedy, having either the effect of producing absorption of the matter, and causing the tumour to subside, or of quickly for- warding the suppurative process and the discharge of the pus from the cellular membrane surrounding the gland. The former more desirable result generally took place when the preceding inflamma- tion had not been intense. Hepar <?., third trituration, we preferred to Silicea, if the patient had previously been subjected to a course of Mercury, Staphysagria 6 was substituted for Hepar $., when the mouth and gums were much inflamed or ulcerated. When the bubo took on an indolent and indurated condition, or had remained in that state for several months prior to the adoption of the homoeopathic treatment, Card. v. was often very serviceable, having frequently the effect either of dispersing the tumour, or of causing it to suppurate. Silicea was, however, of nearly equal efficacy in such cases, and at all events rarely failed to do good, when Carlo v. or a. produced only a slight degree of amendment. A swollen, spongy, or ulcerated state of the gums was an additional indication for Carlo v. Sulphur, or Aurum, and Acid, nitricum proved useful in some obstinate cases. Should the matter of a suppurated bubo exhibit a decided tendency to spread, before advice has been sought it may sometimes be necessary to have the swelling opened by the lancet. After the pus has been discharged, and the bubo has become converted into a sore, the treatment must be conducted according to the character and appearance of the ulcer. (See Ulcers, as also the treatment described for primary sores on
SYPHILIS. 489
the glans, &c.) Silicea and Sulphur are two of the most valuable remedies in all cases where the parts do not show a disposition to heal ; but Acid, nitr., Aurum, Carl, v., Assafcetida, or Staphysagria will sometimes be called for, particularly in cases which have evi- dently been aggravated by the previous use of Mercury in excessive quantities.
Against sympathetic lulo, Belladonna, Hepar, Silicea, Sulphur, Carlo a., &c, are the more important medicaments. The indica- tions for Belladonna have already been given above. Hepar s. may follow Belladonna if suppuration threatens ; or if, after the removal of the excessive inflammation, the gland remains in a tumefied state. Silicea is one of the most useful remedies in sympathetic bubo, either at the very commencement, even when there is a considerable degree of inflammation, or at a more advanced stage of the affection, when suppuration threatens or is already established. When a bunion on the great toe, or an inflamed bursa in any other part has given rise to the bubo, there will be additional reason for prescribing Silicea, as that remedy wdll in such a case be homoeopathic to the originating cause as well as its sequel. In bubo arising from suddenly suppressed perspiration in the feet, this medicine is, moreover, a most important medicament. Sulphur is also an efficient remedy in sympathetic buboes, particularly when they occur in individuals wTho are subject to hemorrhoids, or to boils on the lower extremities or nates ; or when the inflammation and enlargement of the inguinal gland or glands has arisen after the suppression of an old sore on the foot, leg, or thigh. Carlo a, has been recommended as an effective remedy in sympathetic bubo, from the circumstance that even when suppuration seems unavoid- able, it has generally either the effect of causing the tumour to subside, or quickly suppurate and discharge. We have found Silicea to answer the purpose better.
In the treatment of scrofulous bubo, Mercurius and Dulcamara are very serviceable when the swelling is of recent origin, and has become developed after getting the feet wet,* or after sitting on a damp seat. A dose or two of Belladonna will sometimes be required, especially if the inflammation runs high. In cases of longer standing Silicea and Sulphur are generally of greater efficacy. Silicea, as has already been remarked, is a valuable remedy in suppurated buboes; in chronic
* Silicea is, however, to be preferred to either of these remedies when checked perspira- tion occurs in persons who have long been affected with sweating of the feet.
490 URINARY AND GENITAL ORGANS.
cases it is particularly required where the swelling is indurated and painless. Sulphur is frequently of much utility when the tumour is hard, but painful to the touch, and the integuments somewhat inflamed, or very liable to become so after any slight exertion. Calc. c, Clematis, and Carlo v. et a. are also deserving of notice in scrofulous buboes. [Calc, after the previous employment of Sulph. ; and Clematis, Carlo v. or a. after Silicea, in obstinate, indolent, and indurated swellings.) Iodium, Acid, nitr., Arsenic., Aurum, Staph., or Spongia, &c, have likewise been recommended in scrofulous buboes. Silicea and Sulphur are two of the principal remedies to promote granulation and cicatrization when these buboes have become con- verted into ulcers. (See Venereal Buboes, and also Scrofula.)
Treatment of Secondary Symptoms.
Sore Throat. This form of secondary symptoms, so-called, arises in most cases, as a sequel of the abuse of Mercury, either internally or locally, in the treatment of a primary sore. It, consequently, for the most part, yields most readily to the use of anti-mercurial remedies, such as Hepar s., Acid. nitr. : Bella., Lach., Sulph., Silic, Thuja, Staph. — Arsenic, Alumina, Lycopodium. When the mouth and gums likewise are inflamed or ulcerated, one or more of the same remedies, together with Carlo vegetalilis, Aurum, Natrum m., Iod., and China must be had recourse to, according to circumstances. We are generally in the habit of commencing with Hepar s., third trituration, when the patient complains chiefly of pain, dryness, and scraping in the throat, writh some degree of inflammation and swelling of the tonsils, but little or no true ulceration. When, on the other hand, on examining the throat, the tonsils are observed to be somewhat enlarged, the fauces considerably inflamed and ulcerated, the ulcer or ulcers, superficial, and of a gray colour, we commence with Acid, nitr. 3 — 6 in preference. Belladonna and Lachesis are very useful when the inflammation and swelling are more severe, and the ulcers extremely painful and irritable. After these remedies have subdued the excessive inflammation, Acidum nitr. and Sulphur are generally of great value, and often sufficient to complete the cure. In other cases Carl, v., Aurum, Silicea, or Arsenicum, &c, are required. (See also the treatment of Primary Ulcers.) In those cases where we have no reason to suspect that Mercury has not given rise to, or
SYPHILIS. 491
aggravated the symptoms, Mercurms is an important remedy,* parti- cularly when the ulcer or ulcers are covered with a tenacious and adherent matter, and the surface considerably excavated. Acid, nitricum and Thuja have been recommended after Mercurius or Sulphir. Silicea, or Arsenicum, Lachesis, or Carlo v., may sometimes be found better indicated than either of the preceding remedies. Lycopodium 6 — 9 is considered by Rummelt to be a remedy which can with difficulty be dispensed with in secondary syphilis. He gave it with, striking advantage in a case of sore throat, which had long resisted various kinds of treatment (not homoeopathic) ; the tonsils were covered with ulcers, having a gray-coloured base. He also found it of great efficacy in several cases where the fauces and tongue were covered writh an herpetic-looking eruption, bearing some resemblance to the wrinkled skin on the hands of washerwomen, and attended with a burning sensation on partaking of warm food, or after smoking.
Against aching pains in the bones, Acid, nitr., Aurum, and Lachesis, are of great service; and in venereal nodes or other diseases of the bones, the same remedies, together with Acid, phosph., Assafmt, Sulph., Calc, Silic, Dulc, or Mercurius, when the affection has not actually been produced or materially aggravated, as is but too often the case, by the abuse of that mineral. (See Oz^ena, and Diseases of the Bones.)
Against syphilitic Ophthalmia {Iritis) Acidum nitric, is often a most effective remedy, particularly when severe nocturnal pains in the bones are complained of at the same time, and the patient has pre- viously undergone a course of Mercury. (See Iritis.)
The treatment of secondary symptoms in the form of eruptions must be regulated according to the different species of cutaneous disease to which they bear the greatest resemblance, together with the character of the other constitutional symptoms which usually attend. When the eruption partakes of the papular form (Lichen, Strophulus, Prurigo), Aconitum, Sulphur, Acid, nitr., Hepar s.,
* Hartmann recommends the Mercurius prmcipitatus ruber in syphilitic ulceration of the throat, one grain of the first trituration night and morning, for from six to eight days ; at the expiration of which period, or sooner, if signs of medicinal action become earlier developed, he discontinues the prescription, and only repeats, as before, in the event of a cessation taking place in the improvement which may have resulted from the employment of this preparation.— Ueber die Anwrendungsder Homceop. Arzn., Aeon., Bryon., Merc, p. 109. f Allg. Horn. Zeit. vol. vii, p. 117.
492 URINARY AND GENITAL ORGANS.
Sepia, JDulc, Con., Thuja, Cicuta, Lycopod., Ac. muriat., Bryonia, Puis. The two last named, together with Lycopod. and Sulphur, particularly when there is considerable derangement of the digestive function. When the secondary symptoms are associated with the tubercular or with the pustular form (Sycosis, Acne rosacea, Impetigo, Favus, Ecthyma), Acid, nitr., Thuja, Aurum, Lachesis, Carlo v. et a., Sulph., Lycopod., Calc, Cic, Arsenic, Rhus, Staph., &c. And when they have taken on the form of squama (Scaly Syphilis, Lepra, Psoriasis, Pityriasis, Pellagra, Acrodynia), Sulphur, Lycopod., Lachesis, Thuja, Arsenic, — Calc, Cicuta, Led., Graph., Sep., Natr. Carbo a. etv., Clem., Petr., Phosph., Olean., Ahim., Zinc, &c. Secondary venereal ulceration of the skin is frequently preceded by an eruption, possessing one of the before-mentioned characters, and sometimes in the form of bulla (venereal rupia). These ulcers present no uniform or con- stant aspect, sometimes assuming a circular shape, with an irregular, foul, ash-coloured surface; at others displaying the peculiarity of healing in the centre and extending at the circumference, the edges being sharp, and the unhealed part presenting the same colour and appearance as in the before-mentioned instance. The tawny hue, and the shape and situation of the ulcers are considered as the cha- racteristic signs of their venereal origin. In syphilitic eruptions of most kinds Mercurius is more or less useful, but as it so very frequently happens that that remedy has been most injudiciously and abusively employed before the patient seeks the aid of homoeopathic treat- ment, it is seldom that we can desire that benefit from its use which might otherwise be the case. The remedies which have principally been recommended against the venereal ulceration of the skin, whether complicated or not with mercurial erythema, or eczema, or other symptoms of mercurial poisoning, are, Acid, nitr., Sulph., Silicea, Hepar s., Laches., Thuja, Aurum, Carbo v., Acidumfuor., and also Aconitum and Belladonna, chiefly as intermediate remedies when there is excessive febrile irritation. The treatment of phagedenic ulcera- tions, such as occur in the advanced stages of syphilis wTill chiefly consist in the employment of the same remedies as those we have named as the most suitable for primary phagedenic sores. When secondary symptoms exhibit themselves, especially in the form of venereal whitlow, with formation of a very offensive matter under the nails, and exfoliation of the latter, Mercurius, Carbo v., and Silicea are the most useful medicaments. (See Whitlow.) And when rhagades,
SYPHILIS. 493
or ragged ulcerated fissures, are the more prominent features of the affection, the medicines to be employed are Merc, Sulph., Lycopod., Acid, nitr., Hepar <?., Calc, Agnus <?., and Graphites.
\ilis in Infants, The venereal poison is not unfrequently com- municated to the foetus in utero through the medium of the blood of the mother. The child is also said occasionally to contract the disease at the time of birth from the direct application of the virus of a chancre with which the mother happens to be affected. In the former instance the child is born with the disease. The symptoms of syphilis in the new-born child, or soon after birth, are copper-coloured blotches, and scaly eruption over the greater portion of the body, pustules and superficial ulcerations about the anus and nates, and sometimes on the organs of generation, rhagades, warts, hard and soft swellings about the head; also ulcerations and fissures at the corners of the mouth, and in the lining membrane of the fauces, and in some instances on the eyelids. In addition to these symptoms there is often an obstruction of the nostrils with a thick, yellow secretion, so that the child cannot breathe freely ; the cuticle peels off extensively ; the child becomes excessively emaciated, and if not speedily relieved it becomes hectic and soon perishes.
Therapeutics. The disease has been found to yield readily to Mercurius v. 6 ; but the homoeopathic practitioner is often prevented from having recourse to this remedy by discovering unequivocal indications that the child has previously been subjected to a course of some mercurial preparations, under allopathic treatment. Under such circumstances it is generally requisite, particularly when the mouth, gums, and throat are severely affected, to prescribe Hepar s. or Acidum nitr. When the mischief done is more extensive, and the hard as well as the soft parts have become implicated, Aurum may be prescribed in the first place, and subsequently Hepar s. and Acid. nitr. in alternation. Should there be great difficulty in swallowing, Bella- donna will generally afford relief, should Acid. nitr. fail to do so. If the mercurial affection does not form a prominent feature, as is frequently the case when the preparation employed has been Calomel in comparatively small doses, we may then administer either Mer- curius sol. or Merc, corros. at the sixth or twelfth potency, one globule daily or every other day, for four to six days, carefully watching the effect produced, and discontinuing the medicine as soon as we perceive
494 URINARY AND GENITAL ORGANS.
traces of its action on the local symptoms or on the system generally. When the child exhibits great sensibility to external impressions, or when it is frequently seized with spasms or tremors, is very restless and sleepless, and averse to take nourishment, the extremities being, at the same time cold, the countenance earth-like, and the nose pointed ; when, moreover, there is a lingering, debilitating fever, with excessive thirst, and small, hard, accelerated pulse, China should be prescribed. After the employment of China, Ferrum has been found beneficial, when administered at a low potency. In other cases Acid.phosph, will claim a preference to Ferrum, particularly if the tendency to colliquative sweats does not subside under the employment of China, Sulphur, Silicea, and also Calcarea, Lycopodium, and Lachesis are also deserving of notice in such circumstances. If the eyes and eyelids are principally affected, or subsequently become so, Mercurius corros. should form the principal remedy, unless Mercury in some form or other has already been used, in which case one or more of the followT- ing must be selected : Belladonna, Acid, nitr,, Hepar s,, Sulphur, Calc, Aurum, Graphites, Thuja, Cannabis, (See Ophthalmia.)
Against affections of the periosteum, nodes, or other diseases of the bones, Assafatida is one of the most useful medicaments ; and the next in importance are perhaps Mezereum and Acidum phosphoricum ; but Silicea, Sulphur, and Calcarea must also be borne in mind. (See Diseases of the Bones, and Secondary Symptoms.) When phagedenic sores appear on the genital organs or other parts of the body : Lachesis, Arsenicum, Silicea, or Mezereum, &c, will be required. (See Primary Sores.) The mother or nurse of the affected child should simultaneously be placed under treatment. It is by some thought sufficient to operate on the child through the milk of the nurse, but we are in favour of the preceding plan, with the observance of due caution in the exhibition of medicine to the child.
phimosis.
'Phimosis is understood to signify that contracted state of the extre- mity of the prepuce which prevents its being retracted so as to expose the glans penis. It is most commonly produced by inflam- mation and swelling, or thickening of the prepuce. Sometimes it occurs as a congenital affection. The treatment must be conducted
PARAPHIMOSIS. 495
according to the nature of the exciting cause. If friction, or any- other mechanical injury has given rise to it, Arnica should be em- ployed. In other cases, originating in a similar cause, Calen&ala officin., R7ms, or Pulsatilla may be required.
If from syphilis, Mercurms, Acid. nitr.3 and Thuja chiefly. Division of the prepuce may sometimes be rendered necessary in syphilitic phimosis, when the escape of the pus is entirely prevented by the extent and severity of the inflammatory swelling. When it proceeds from uncleanliness, Aconitum may first be prescribed, if there be much inflammation, and then Mercurius. Tepid water should at the same time be injected between the prepuce and glans by means of a small syringe. Should the prepuce present a puffy or bladder-like appear- ance, Rhus may be employed with advantage. Circumcision is gene- rally employed in surgical practice against congenital phimosis, When phimosis arises from the irritation caused by excrescences, \ and Acid. nitr. must be resorted to. (See Sycosis.)
PARAPHIMOSIS.
What is denominated paraphimosis is that state of the prepuce in which it is drawn behind the corona glandis, and is incapable of being again brought forward. In young subjects it is rarely attended with serious results, but when it takes place in adults, the prepuce often becomes intensely inflamed and ulcerated, and the glans penis destroyed by mortification.
In recent cases, the reduction is often affected by compressing the glans, and simultaneously drawing the prepuce forward. When requisite, the process may be facilitated by previously immersing the penis in cold water, or applying it to the part. In more advanced cases, when the prepuce is considerably swollen, if will "be necessary to administer a dose or two of Aconitum^ and sometimes Mercurius, in order to subdue the inflammation, before the parts can be handled. Warm fomentations are also useful. The division of the stricture is necessary if all other means fail. When suppuration ensues, either prior or subsequent to the reduction, Mercurius, Eepar $., and Cap- sicum have been recommended. And when induration remains, Lachesis, Should mortification threaten, the employment of Arseni- cum or Lachesis may avert its development.
496 URINARY AND GENITAL ORGANS.
HERPES PREPUTIALS.
Herpes preputialis. This disease is occasionally confounded with syphilis, from the close resemblance which it sometimes bears to that affection. It consists of an eruption of vesicles which appears on various parts of the body, and not unfrequently on the penis, especially at the prepuce, and has therefore received the appellation of Herpes preputialis. When the foreskin is the seat of the disorder a sensation of heat and itching is ascertained on the outer or inner, or even on both surfaces of the said part, and in the space of a day or two one or more small patches of a vivid red colour make their appearance, on each of which five or six small globular vesicles arise, containing a serous and transparent fluid. The heat and itching now increase, and on the third or fourth day the fluid grows turbid, and is converted into pus. The vesicles then burst, and the dis- charged fluid dries and forms small, thin, scaly incrustations. When the eruptions break out on the inner surface of the prepuce, the epithe- lium becomes detached after the rupture of the vesicles, and exposes the inflamed vascular rete of the chorion. It is the superficial sore thus produced which is sometimes mistaken for a primary venereal ulcer. The absence of the raised or of the indurated edges, and of the small, gray-coloured secretion, covering the base of the venereal sores, forms the leading determination. In the early stage of herpes preputialis the disease is distinguished by the evolution of a cluster of small vesicles. When the vesicles are developed on the outer surface of the prepuce, the fluid they contain is either reabsorbed, or desiccates on the fifth or sixth day ; in the latter event it is altered into minute dry scabs, which, provided the parts have not been irritated by friction, are thrown off about the eighth or tenth day, and the cure is then, for the time being, complete. It is not a contagious complaint, but is prone to occur repeatedly in the same individual. The friction of the clothes during prolonged exercise, and the contact of deranged vaginal secretions aggravate and often develop the affection in those who are predisposed to it. The use of mercurial preparations in a deranged state of the digestive functions, and the previous occurrence of one or more syphilitic attacks, have all been considered as predisposing causes.
sycosis. 497
Therapeutics. In most cases the disease may be left to itself, particularly when the vesicles are situated on the exterior of the fore- skin. But it is always necessary to protect the part from friction, as the cure is invariably delayed when the drying up of the vesicles is retarded. When the inner surface of the prepuce forms the seat of the disease, the vesicles or excoriations ought to be protected by the introduction of a small portion of lint between the glans penis and the prepuce. Cold water may also be freely employed. When the affection proves unusually obstinate, or is reproduced again and again, Acid. p/wspL, Aumm, Hepar s., and Mtmmhave been strongly recommended. The state of the digestion ought to be attended to at the same time. When a chronic inflammation of the urethra exists simultaneously, Canth., Petrol., Petroselinwm, Dulc, SuVph, Gale, Silk., Sep., or Lycqpod. will chiefly claim attention.
SYCOSIS.
By the above term we allude to the disease described by Hahne- mann * as having occurred very extensively during the last war, from 1809 to 1814, and which manifests itself externally in the form of excrescences on the genital organs a few days, or even weeks, after impure connexion. " These excrescences are occasionally dry, resembling warts, but much more frequently soft, spongy, secreting a fetid fluid, bleeding easily, and similar to cockscombs or cauliflowers; they appear in men upon the glans penis, at the margin and the inner surface of the prepuce, also on the scrotum, perineum and nates ; in women, on the vulva and adjacent parts. They are often accompanied by a gonorrhoeal discharge, which is thick and purulent from the commencement, with little pain during urination, but with hard tumefaction of the penis, or lymphatic swellings on the dorsum penis, very sensitive to the touch. The disease was considered by the majority of allopathic practitioners, as simply a symptom or modification of syphilis, and was accordingly treated by them with Mercury, and by violent external application, cautery, excision, liga- tures, &c. The immediate and natural sequel of this method was, that, generally, the condylomata reappeared after the expiration of a
* Die chronischen Krankheiten, ihre eigentliche Natur und homoeopatische Heilung. lster Th., 2te viel vermehrte Auflage, p. 104.
32
498 URINARY AND GENITAL ORGANS.
longer or shorter time, and were again subjected to the same treat- ment ; or if the means employed, succeeded in destroying them, the sycosis deprived of its local or vicarious symptom, showed itself in another and more aggravated manner, in the form of secondary symptoms; the external means employed, and the Mercury (which is unappropriate to the disease), given internally, being inadequate to destroy, in the slightest degree, the sycosic miasm with which the system was impregnated. In addition to the injurious constitutional disturbance produced by the Mercury, particularly when given in large doses, and in the shape of the most acrid and irritating pre- parations—analogous excrescences broke out upon other parts of the body ; in some cases -consisting of spongy elevations, whitish, sensible, and flat, having their seat in the mouth, on the lips, tongue, and fauces ; in others, large, prominent, brownish-looking tubercles, situated in the armpits, on the neck and scalp, &c. ; or, again, other symptoms were developed, of which I need only mention here, retraction of the flexor tendons, particularly those of the fingers."
Therapeutics. Hahnemann was the first who recommended and employed Thuja occidentalis in sycosis. When the disease is in its primary form, accompanied or not by a gonorrhceal discharge, and not complicated with syphilis, or occurring in a strumous habit, a few drops of a low potency, or a few globules of the third or sixth dilution, speedily succeed in effecting a radical cure ; in obstinate cases, in addition to internal administration, the condylomata may be touched daily with the diluted tincture of Thuja.
In some cases the cure is materially facilitated by the use of Acid, nvtricum. in alternation with Thuja.* Where there is a complication of syphilis with sycosis, Mercurius and Sulphur in alternation, at low potencies (third trituration), are very efficacious.
Against the secondary symptoms of sycosis, Thuja and Acidum nitricum are still to be held as the most important remedies ; but when they are found inadequate to destroy the disease, either in con- sequence of complications with secondary syphilis, or some other dyscrasia, Sulphur, Ac. phosph., Euphrasia, Cinnab., Sabina, Staph., or Lycopodium. Of these, Sulphur has commonly been found the most
* The aid of Acid, nitric, is almost, indispensable in all cases in which the patient has formerly been placed under a course of Mercury during one or more syphilitic attacks, or some other affection.
sycosis. 499
appropriate to administer when the constitutional symptoms, such as sore throat, with enlargement of the tonsils and ulceration, hoarse- ness, stains on the skin, scaly spots, or eruptions assuming the character of psoriasis or lepra, have undergone little or no improve- ment under the employment of Thuja and Acid. nitr. ; it will, further, claim a preference when there is, at the same time, general derange- ment of the system, and especially when the patient is affected with" symptoms of abdominal plethora, with hemorrhoids, and constipa- tion ; or when shooting pains are experienced in the joints, and the flexor tendons of the fingers are in a state of contraction ; tongue dry, red, rough, and fissured, lips much tumefied. Zycqpodium may follow Sulphur with advantage, when there is superficial, wThite ulcer- ation of the tonsils ; and the tongue is fissured, or is, together with the inner surface of the lips and the fauces, covered with a scaly, herpetic-looking eruption. Siaphysagria, when the gums are much affected, somewhat ulcerated, swollen, soft, or spongy, and the glans penis covered with soft, moist excrescences. Sabina has been of great service when the condylomata were large, moist, and painful even when not touched. Acid, johosphoricum will deserve attention when the sycosic excrescences are of long standing, or when the patient has previously been treated with Mercury in large doses, and Acid, nitr., Thuja, Sulphur, and Staphysagria have either failed to do good, or have only effected partial improvement. Cinnabar has been strongly recommended as a valuable remedy in inveterate or second- ary sycosis. Hahnemann considered Mercury as inappropriate to sycosis, and as peculiarly hurtful when given in over-doses. When administered in the small doses employed by homceopathists, it appears to be of great efficacy in some obstinate cases. A compli- cation with syphilis, or secondary symptoms, in the form of enlarge- ment of the tongue, swelling and ulceration of the tonsils (provided these latter symptoms have not arisen from the abuse of Mercury), condylomata, &c, will justify us in anticipating a beneficial action from the use of Cinnabar. Sometimes the sore throat arising from sycosis may bear so close a resemblance to that of secondary syphilis, that it will be difficult to found a diagnosis thereupon ; but the history of the commencement of the disorder, along with the existence of tubercular or wart-like excrescences in the vicinity of the anus, genital organs, or other parts of the body, will enable us to discriminate the sycosic from the syphilitic origin. In sycosic bu- boes, Thuja and Acid, nitricum are the principal remedies, but cases
500 URINARY AND GENITAL ORGANS.
may often occur in which Staphgsagria, Sulphur, or Mercurius will be required. (See Bubo,)
We shall conclude this portion of the work by giving a short statement of Dr. Goullon^s mode of treating Syphilis,* together with an extract from the more extensive and interesting observations of Dr. Attomyr,t on the treatment of Venereal Diseases.
Dr. Goullon employed Mercurius solub. and Merc, sublim. corros. chiefly* in the treatment of chancres in general. The former in the dose of T\, | of a grain, twice a day ; and the latter, to which he gave the preference, as follows ;
& Merc, corros. gr. ss — j ; Aq. unc. viij ; Spir. vin. q. s.
A tablespoonful morning ancLevening, (diminishing the quantity when vomiting followed the first dose or two).
When the sores were foul and confluent, attended with fetid discharge, also local application of the same remedy. The greater the degree of improvement effected, the less frequently was the medicine ordered to be taken. In the majority of cases scarcely gr. ij were necessary to establish a cure without risk of a relapse or the occurrence of secondary symptoms. Where syphilis and scabies were encountered in the same subject, the cure of the former was commenced first. The worst complication was found to be secondary syphilis in the form of eruptions, &c., and scrofula. Baths of Merc. corros. (33 -ij) produced striking benefit here ; but when the patients had previously undergone a course of Mercury, the medicament which, more frequently than any other, though not always, did the most good, was Acid. nitr. in repeated doses.
In sore throat, Lycopodmm ; in ostitis, or exostitis, Silicea ; and in tetters and herpetic sores, Sarsaparilla (ptisan) proved the most serviceable.
Dr. Attomyr observes that " With respect to the treatment of the various forms of the venereal disease, we have in general nothing farther to add, except that in this disease as in all others, the ho- moeopathic law of cure by similarity of symptoms is applicable, and here too proves its validity.
cc Before entering specially upon the homoeopathic treatment of the venereal disease, it will be necessary to premise some few remarks,
* Allg. Horn. Zeit., No. 17, 30ster Band, p. 258. t Ruoff's Repertorium, hy A. H. Okie, M.D.
TREATMENT OE VENEREAL DISEASES. 501
which deserve consideration when viewed in reference to my therapeutical results.
6i Syphilitic patients, with very few exceptions, are young unmar- ried men, who either board at the hotels or sit at table with their relations, or probably superiors. In either case it is unfortunate for the observance of the homoeopathic diet, and indeed much worse here than it would have been in Germany or any other Austrian province* for in Hungary far greater quantities of condiments and acids are used with food than in other places. To this must be added the fact that patients conceal their disorders, and in order not to excite suspi- cion, dare not venture on the slightest aberration from their accustomed diet. In consequence of these uncertain dietetic circumstances, I resolved in treating such patients, to administer larger doses than usual.
" I am still of the opinion, that the lower dilutions recall reaction quicker, but that their effects are less intensive and permanent than the higher. Four grains of calomel in the space of a few hours ope- rate violently, and excite diarrhoea, while the same four grains, if taken in minute portions, result in an indisposition, which continues several days, and in a more intense commotion of the organism. I moreover concluded from these premises that the larger doses could be repeated more frequently, which would seem essential on account of the necessarily frequent dietetical errors. Within the period of two years I treated 156 patients labouring under the venereal disease. Every physician knows how it is with office practice, how difficult to learn anything or obtain any certain experience in this manner. Gene- rally one half of this class of patients stay away, so that it is impos- sible for us to decide with certainty upon the termination of their disorders. The one remains away because the effects of the treat- ment did not fulfil his anticipations, the other (and among syphilitic patients the majority) because he is approaching convalescence, and is desirous of avoiding the burdensome thanksgiving for his cure. This last occurred so frequently to me that during the treatment of an interesting case, I was always fearful, as I was led to expect that as the cure progressed, my patient would remain away, and I be unable to arrive at any certainty with regard to the termination of the case.
"I requested a patient with eleven chancres (seven of which > of the size of a lupine-seed, were situated on the scrotum), after all were
502 URINARY AND GENITAL ORGANS.
healed, but two of them still presented cicatricular depressions, to return in eight days, and let me see if the two scars had also disap- peared. My patient, however, did not return, notwithstanding I had clearly given him to understand that I had no reference to his return- ing thanks, but merely as a subject of scientific interest. This plan was so often adopted towards my patients, that they ironically termed me the < gratis Doctor/ for which I in return, during the last three months of my residence in Presburg, punished them very sensibly, although I am sorry that punishment in many instances fell upon those who were innocent. So it happened that of the 156 patients treated, I cannot cite more than 84 who persevered until perfectly cured, and most of these, at my request, returned, and were examined by me fourteen days after their convalescence. " Were cured of
|
Chancres |
34 |
|
Gonorrhoea .. |
24 |
|
Gleet . |
9 |
|
Balano-blenorrhcea . |
2 |
|
Bubo . |
10 |
|
Hernia humoralis . |
2 |
|
Nodes and eruptions |
2 |
" I have observed the following five varieties of chancre :
ci First form. — The edges more or less jagged, elevated, slightly painful, but sensitive when rubbed by the linen, with a copper- coloured circumference. The base of the sore is indurated, lard-like, the ichor adheres so firmly to it, that it cannot be removed by wash- ing. The ichor is of a light yellow colour, viscid, glutinous, resem- bling pus, sometimes acrid, offensive ; it makes spots on the linen as if from melted tallow. The sore extends far more in depth than in breadth. This form appears on all parts of the glans, and also on the prepuce, but more frequently on the posterior part of the glans, near its junction with the prepuce.
" Second form. — The sores are superficial, not only do not extend in depth, but are perceptibly elevated above the surface. The edges are never jagged, always sharply circumscribed, painless. The sore looks clean, of a flesh-red colour, almost spongy, it is never necessary
TREATMENT OF VENEREAL DISEASES. 503
to clean it, as the ichor does not adhere. The ichor is somewhat thinner than in the first form, usually more copious and mixed with blood. This form heals sooner than the first, appears almost exclu- sively on the prepuce, and there are always several sores present at the same time.
" Third form. — The sores of the second form gradually become elevated so much above the surface of the prepuce, that they resemble more a horizontal section of a wart than an ulcer. This form dis- charges very profusely. The ichor is more offensive than in the two preceding forms, but still not so bad as it is in those which follow. It is unusual for all the chancres of the second form to become con- verted at the same time into those of the third, therefore these two forms are usually co-existent. This variety frequently heals very quickly. I have never seen true condylomatous forms of disease arise from this. In my case-book I have given the compound name of f chancre wart5 to this form, which term, on account of its brevity, I will still retain.
" Fourth form. — The corona of the glans is almost one ulcerated surface. This frequently extends to the posterior part of the glans ; occasionally, at the same time, to the prepuce also. The sore is quite superficial, here and there lard-like, but the greater part red and thinly coated with matter, which can be readily washed off. The ichor, which is very profuse, is somewhat less consistent in this than in the varieties already described, and is of a very fetid odour, which apparently depends upon the simultaneously increased secretion of smegma. The sore appears as if the skin had been torn off. This form either heals as such by contracting from the edges towards particular points, forming several chancres, which are nearly sepa- rated or only united by linear excoriations; or the above described lard-like spots extend more in depth, and chancres of the first form appear. This fourth variety of chancre has a tendency to appear in company with gonorrhoea.
" Fifth form. — A chancre which in its incipient state has the appearance of the first form, in a few days becomes covered with a scab which presents the appearance of a psoric sore. The scab absorbs the fluid secreted beneath it, and thus becomes thicker and does not fall off until the sore beneath it has healed. This variety appears either
504 URINAUY AND GENITAL ORGANS.
on the common integument of the penis or directly on the verge of the prepuce, which becomes swollen, looks as if excoriated, burns severely while and after urinating, when walking is disturbed by the pressure of the linen, to which it slightly adheres. This variety I term the 'psoric chancre/ and conjecture that it arises from a com- plication of syphilis and psora, which conjecture is strengthened not only by the appearance of the sore, but also by the violent pruritus and the favorable results attending the administration of Sulphur. This form generally appears simultaneous with one of the varieties already described.
In the treatment of these different forms of chancre, I have by degrees been obliged to resort to the following eleven remedies :
Mercurius sokibilis, Merc, dulcis, Merc, sublimatus corrosivus, Acidum nitric, Thuja, Hejpar sulphur., Corallia rubra, Acid, phosphor., Sulphur, Causticum, Staphysagria.
In the first variety of chancre, Merc, solub. is the chief remedy, it is not, however, adapted to half the cases. Thuja comes next to the quicksilver in this variety. The patient usually took a few doses of Mercur., then a few doses of Thuja, and when its beneficial influence appeared to cease, the Mercury was resumed. In addition to these, I administered Merc, dulcis, Sublim. corrosiv. and Causticum in several obstinate cases, and I believe I have observed considerable improve- ment in this form after each of these remedies.
In the second form Acidum nitric, is the chief remedy. When this form is purely pronounced without complication, particularly with the third form, the Nitric acid acts very promptly, and in twenty days, at the extent, the disease is cured. I have, however, cured, or evidently assisted the cure of several of these cases with Mercur. and Thuja.
In the third form Thuja appears preferable to Acid, nitric, although the latter as well as Mercurius solub. is a very effectual remedy in this variety. In one case, Acid, phosph. acted very strikingly. Staphysa- gria in another in the same prompt manner.
In the fourth form, preference must be given to Corallia rubra. Although this remedy is capable of curing a chancre of this variety in fourteen or at the extent, eighteen days, yet still it does not appear to be able to prevent this form from becoming converted into the first, by which the treatment is considerably prolonged. Nitric acid may be ranked with Corallia in the treatment of this form, and in several cases in which rapid improvement did not succeed the admi-
TREATMENT OE VENEREAL DISEASES. 505
nistration of Corallia; and where the pruritus was very vehement, I gave Sulphur, which cured the disease in toto.
" In the fifth form, which was the most rare, Sulphur was the chief remedy. Hepar sulphur, operated favorably in this form, when com- plication with bubo existed.
" At first I gave Merc, solub. in doses of a drop of the fourth dilu- tion, and when this was all gone I resorted to* the fifth. At the beginning of the treatment I repeated the medicine every six or seven days, and afterwards every three or four days. I have, however, cured several chancres with X000 and 4000. Nitric acid and Thuja were given in similar doses, but also with effect in the thirtieth dilution. Of Corallia I gave about a grain of the third trituration. Sulphur and the liver of sulphur I always administered in the X000, also Causticum, Staphysagria and Phosphoric acid, and the two other preparations of Mercury in the third potence. One month was about the average time required to cure a chancre, several healed in fourteen days, in which cases I must remark that these patients were individuals who were able to follow strictly the homoeopathic dietetic regulations. In several cases, six weeks or more were consumed in the cure of the chancres, for which the patients themselves were in fault, as several confessed to me that they were not able to refrain from coition during the treatment.
" The articles of diet wThich I forbade were —
" 1. Acids : as vinegar and lemon-juice.
" 2. Spirituous drinks : wine, whiskey, beer, liquor, and all alcoholic drinks ; beer I would have allowed, had it not been adulterated with bitter plants.
"3. Spices, or rather medicines which have crept from the apothe- cary^ shop into the kitchen, as coffee, tea, pepper, cinnamon, vanilla, the cayenne pepper (Capsicum annum) which is used in Hungary, cloves, caraway, and aniseed.
"I also advised my patients to avoid the use of pomatum, medicated dentifrice, and perfumery of every description. Smoking I did not forbid, because no one would have obeyed me in this particular.
" One of the most important directions during the treatment of chancre relates to mental and particularly bodily quietude. The patient should go out as little as possible, walk very slowly, not wear tight pantaloons, or remain long standing, and on no account drive or • take horse exercise. My attention was directed to this latter circumstance several years ago, by the experienced Dr. Mueller,
506 URINARY AND GENITAL ORGANS.
attached to the medical staff in Pesth. As I treated but few venereal patients after that period, this circumstance was forgotten. In Pres- burg, I treated a young man more than seven weeks for a large deep chancre, which did not lose at all its lard-like base, and although it did not extend either in breadth or depth, it evinced no disposition to heal. The patient was too well acquainted with the superiority of homoeopathy to* adopt the advice of trying allopathic treatment. While we were discussing the probable cause which impeded the cure, my patient inquired whether it was not probable that daily horse exercise could be an injury ; Dr. Mueller's advice now struck me. I forbad riding on horseback, and in the course of eleven days the chancre was healed, the patient having remained in his room in his drawers, generally reclining upon the sofa. Corporeal rest is decidedly the best prophylactic against the formation of buboes. I must mention still another serious obstacle which greatly impedes the cure of all venereal diseases. I refer to the excessive anxiety of those youths who are infected for the first time ; they fancy that they see themselves walking about without their olfactory organs, and covered with eruptions and sores.
" At first I applied charpie to the sores ; but as this became deranged and formed lumps, I preferred fine, clean, washed linen (not new). I subsequently abandoned this also, as every foreign body adheres to the sore as soon as it commences healing and discharging, and on removing, irritates the chancre, and in general incommodes more than the secretions of the sore.
"\ have treated patients with several chancres conjoined with phimosis, without having seen the sores more than once, as the phi- mosis occurred a few days afterwards and continued to the conclu- sion of the treatment. When the prepuce could be retracted, the chancres were either completely cured or very nearly so.
" When washing the sores, care must be taken not to press too violently upon them. Many patients gave themselves much trouble in endeavouring to wash off the lard- like matter forming the base of the chancre. Patients should be informed that this is futile and injurious. It is entirely impossible to clean the base of the sore, as this must be removed by the process of suppuration, produced by the action of the appropriate remedy. Chancres of the first form generally discharge copiously, and for a long time, so that the pa- tient's linen appears as much soiled as in gonorrhoea. When I perceive this increased discharge make its appearance, I always con-
TREATMENT OF VENEREAL DISEASES. 507
tinue the remedy which produced it, because this increased suppu- ration of the sore is the most natural remedy to cleanse and heal it. The period of increased discharge frequently occupies two thirds of the whole time employed in the cure. I have, however, frequently seen perfectly healthy sores, which were much diminished in size and superficial, remain in statu quo without healing completely. This apparently depends upon the conduct of the patient, on whom the cure has advanced thus far.
" If doubt arises respecting the nature of sores on the genitals, whether they are really chancres or not, it is advisable to wait several days before administering our remedy. If in the course of six or eight days the sores are not healed, but have become larger, deeper, and the base lard-like, there can then be no doubt ; the patient may talk as much as he pleases about the fidelity of his sweetheart.
" In concluding this subject I have still to remark, that in the cases of three patients afflicted with chancres I observed vermin, which are not uncommon in syphilis, and by us termed 'Filz lause/ (Pediculus pubis.) One of these patients, who was somewhat of a scrofulous diathesis, was troubled with them in two instances. I need scarcely remark that these patients observed the utmost clean- liness; as I do not at all consider these vermin as the result of filthi- ness, it is not improbable that they are produced per generationem aequivocam, in the same manner as in the itch, either by the dis- charge from the chancre, or in transpiration of the patient, and con- sequently may be ranked as the product of the venereal disease.
" Buboes. Swelling of the inguinal glands, consequent upon syphilis, are more dreaded by patients than any other form of this disease. It is well known how under allopathic treatment they are plastered, cauterized and incised again and again. I have treated eight patients with venereal buboes, without the necessity of one of them being confined to bed for a single day. A day or two before the spontaneous rupture of the swelling, the patient experienced a slight tensive pain when walking, but not any other inconvenience either before or after that circumstance occurred. The buboes usually broke while patients were walking, and had they not expe- rienced the sensation produced by the moisture, they would not have been aware of its occurrence. I have witnessed neither sinuses, fistulous openings, callous edges, nor partial remaining indurations, &c., in any of these cases, although I never made use of cataplasms
508 URINARY AND GENITAL ORGANS.
to prevent induration, leeches for inflammation, or of the knife or caustics in opening them.
"There is no doubt that buboes, which appear simultaneously with chancres, or immediately after their suppression with external remedies, partake of the venereal character. Scrofulous glandular affec- tions are usually readily recognisable from the general diathesis, and the disorders of the glands in other parts of the body which are com- monly present. But there are also buboes which appear sooner or later after coition without any other symptom of venereal infection. Whether these glandular swellings are to be considered as venereal has not yet been determined by adequate experience. I have seen two such cases. The one an arthritic man, aged thirty-eighty the other a young man of three-and-twenty. Both cases were preceded by frequent coition, and in the case of the first individual, it was inordinate. In the first case the bubo, which was confined to one side, was cured by resolution under the use of Stdphur and Nitric acid, the second by suppuration by Nitric acid alone. In the latter case there were two buboes of the size of a hen's egg, one on each side.
" Buboes are treated homceopathically by the same remedy that is indicated for the particular variety of chancre which they accompany. The medicament that cures the chancre frequently operates so power- fully upon the bubo, that the latter suppurates and heals before the chancre is completely cured, so that in this case the bubo does not alter the peculiar treatment adapted to the chancre. Sometimes, however, the bubo remains after the chancre has healed, and in this particular case does it first become necessary to adapt our therapeu- tical efforts to the bubo itself.
" I made use of five remedies in the cure of buboes. Merc, solubilis, Acid, nitric, Sulp/mr, Hepar sulph., Cole, and Silicea. The first two remedies I gave in drop doses of the fourth dilution, at intervals of four or six days, the last three in the thirtieth dilution, every eight days.
" Mercurms and Acid, nitric, operated better during the inflamma- tory state of the swellings, previous to their opening. After this had occurred, I administered JklpL, SiUcea, and the liver of sulphur with good effect.
" I have frequently seen swellings of the inguinal glands arise in patients afflicted jyith very painful gonorrhoeas, in which much violent exercise was taken, particularly in individuals infected for the first time. In such cases I recommend the observance of strict corporeal
TREATMENT OE VENEREAL DISEASES. 509
rest for a few days, and proceeded in the treatment of the gonorrhoea without reference to the inguinal swellings, and I have never seen them pass into suppuration or induration, or remain after the cure of the gonorrhoea.
" Condylomata. The cases of this affection, which have come under my notice, are too few in number for me to determine whether this form of the venereal disease belongs to the syphilitic, or whether it depends on one of the various cachexies of Hahnemannian sycosis. The first view is favored by the fact of the concomitant presence of chancre and condylomata, as well as the degeneration of many chan- cres' into condylomatous structures ; while the circumstance that this form of disease frequently appears entirely alone without any admix- ture with the other forms of venereal, and has the peculiarity which is foreign to chancre of occupying the anus at the same time, or selecting this part alone as its seat, favours the Hahnemannian views of sycosis. Be this as it may, the distinction is of no practical utility. The symptoms of this disease direct the physician to the appropriate remedy, no matter whether he considers the first or last view as correct — a superiority possessed by homoeopathy in the treatment of this as well as other diseases, which is not acknow- ledged only because it is desirable to arrogate the appearance of science.
" In the case of a patient with two large condylomatous ex- crescences on the anus, who had been previously treated by caustics, neither Thuja, Nitric acid, Acid, phosphor., Zycopod., Sulphur, Psorin, nor Sycosin were of any benefit. Staphysagria X000, repeated every five days, removed the disease almost entirely in the course of two weeks, so that I gave the patient a few doses more of the latter remedy, in hopes that the disease would be completely overcome in a short time ; the pa- tient, however, did not return ; I therefore cannot say how the case terminated, although it is very probable that the patient was cured.
"The condylomatous case, which I have mentioned as cured, was that of a patient with three condylomatous excrescences, which had been cauterized, but were reproduced. 1 gave him Thuja X10, seven days after Sulphur X, seven days later Acid, nitric. A, gutt. una, for two successive days, all without effect. The Thuja was now repeated but . in the fourth dilution, a drop every third day, after which the excrescences were diminished one half in size. The repetition of Thuja of the fourth dilution entirely cured the disease.
" Throughout this work I have avoided the recital of cases, for in
510 URINARY AND GENITAL ORGANS.
this disease one case very much resembles all of the others. In sycosis I have made an exception in order to be able to introduce the remark that Thuja, which in this case was the proper curative when first administered, was not attended with any success, and did not prove beneficial until administered in a lower dilution after two other remedies had been given. I am perfectly willing that this favor- able result should be ascribed to the lower dilution, but must remark that in at least ten cases of intermittent fever, in which Ipecacuanha proved fruitless, and several other remedies given subsequent to it, likewise proved inefficient, that Ipecac, then administered in the same dilution and dose, was attended with the most favorable result.
" Gonorrhoea. — This form of the venereal disease is of all others the most troublesome, as well for the patient as his physician. To the patient, as it is the cause of much pain, sleepless nights, fever and other analogous symptoms, which may result in inflammation and induration of the testicles, stricture of the urethra, &c, either owing to the misconduct of the patient or to the preposterous and violent allopathic treatment. Gonorrhoea is a troublesome disease to the physician, owing to its tendency to become chronic, and in the form of a gleet to continue long and obstinately. It appears to be the general character of diseases of mucous membranes to run their course sluggishly. We frequently see catarrhs, in themselves unim- portant, continue for several weeks. This is also the case with various mucous diseases of the nose, ear, vagina, &c, which are rendered chronic as soon as an increased mucous secretion appears.
The usual time required to cure an acute gonorrhoea was one month. Several were cured in fourteen days; a few cases degene- rated into gleet.
"I experienced the best effect in the treatment of this disease from the exhibition of Cannabis in the fourth dilution, in drop doses, which were repeated at intervals of five or six days. I occasionally repeated the remedy for two or three days in succession, and then waited seven or eight days.
"Pulsatilla was given with effect also in drop doses of the fourth dilution, where general corporeal agitation, very diminished appetite, evening chill, increased thirst, &c, were present. In three or four days, this febrile state was usually allayed, and I then again continued the Cannabis.
" A few globules of the 30th dilution of Cantharides were always
TREATMENT OF VENEREAL DISEASES. 511
effectual in very painful erections, violent burning and strangury. In one case hematuria supervened, which was not relieved by Can- tharides but by Mezereum.
" Mercur. solub. 4 gutt. una, effected a rapid cure in a case of gonor- rhoea attended with a greenish discharge. In this case, however, several sores were present, which indicated the application of Mercury. The gonorrhoea was cured before the chancres.
" At first, before I had effectually tried the efficacy of Cannabis, I tried Blenorrhin, in doses of several globules of the thirtieth dilution. A gonorrhoea in which Capaiva 'proved inefficient, was cured in two weeks by two doses of Blenorrhin. In several other cases, this remedy effected considerable improvement, although it did not produce a complete cure. But as Cannabis with an intercurrent dose of Pulsa- tilla, Cantharides, or in cases of very frequent urination, Petroselinum, acted very favorably in a majority of cases. I made no farther trials with Blenorrhin in acute gonorrhoea, although I made use of it in gleet.
" Gleet. Nine cases of this disease were cured with Blenorrhin 30th, Sulphur 30th, and Cannabis 4th gutt. una. I repeated Cannabis every five, and the other two remedies every eight days. I am unable to mention any particular indications for the employment of any of these remedies. Generally Sulphur, given at first, produced considerable improvement, diminished the discharge perceptibly, but excited slight burning in the urethra, after which I usually gave Cannabis with effect. I observed this frequently. I have, however, perfectly cured painless gleets with Cannabis aided by Sulphur or Blenorrhin.
" As regards the dietetic treatment in gonorrhoea, all violent exer- cise must be avoided. If the testicles are sympathetically affected, the patient must wear a suspensory bandage, or at least support the testicles with a handkerchief. • Beer should not be taken during the existence of acute or chronic gonorrhoea.
" I saw discharges unattended with pain, reproduced in several patients who indulged freely in wine immediately after their gonor- rhoeas had been cured ; it, however, soon disappeared ; the very severe burning can be much diminished by the patient's drinking water very freely, by which means the urine is increased in quantity and rendered less acrid. This innocent palliative produces great relief to the patient, and should therefore never be neglected.
512 URINARY AND GENITAL ORGANS.
66 Inflammation of the testicles. I treated but two cases. One was in company with a gonorrhoea, or rather gonorrhoea con- joined with swelled testicle. The patient being afflicted with gonor- rhoea, went out a hunting in cold damp weather, and returned with violent pain in the testes. The disease increased during the night, and both testicles wrere swollen, hard, not bearing the slightest touch, the scrotum red and tense, some fever which continued until the evening of the succeeding day. There was scarcely any discharge from the urethra. Two doses of Clematis, 12th dilution, three glo- bules repeated every three days, cured the disease, after which the gonorrhceal discharge reappeared. Swelling of the epididymis of one of the testes, which still remained, was removed by Aurum iv dis- solved in water.
ee The second case was a relapse, which had previously been sub- jected to allopathic treatment. It was relieved by China IV000, and Aurum IV000. China was administered three times, Aurum twice.
" The patient should remain in bed and have the testes properly supported.
" Gonorrhoea glandis. Incorrectly so termed. It could with more propriety be called inflammation of the glans penis. I treated two cases. One case was conjoined with gleet. The glans was very red and swollen, small fissures appeared on various parts of it, and in a few days, a very offensive mucous secretion succeeded, which increased very much in a short time, and affected the prepuce also. Corallia 3, one grain repeated in four days cured the balano-blenor- rhoea, and Cannabis and Sulphur the gleet. The second case was connected with chancre, was not so violent, and was cured by the use of Mercury.
" A few years ago I cured several of these cases with Thuja X000.
" Nodes. The patient had been afflicted three years before with a chancre which was cauterized. After taking a violent cold from exposure to moisture, the patient had a gouty attack. It was treated without effect ; a depot formed on the tibia, which wa& attended with such violent boring and rending pains, particularly at night, that he was deprived of all nocturnal rest, and obliged to quit his bed. He then underwent a course of ' Dzondischer' pills, which rather in- creased than relieved his malady. After the administration of half a grain of Eepar sulpha Calc. 3d trituration, he was able to sleep several
TREATMENT OF VENEREAL DISEASES. 513
hours in the morning. Two additional doses of Hepar, given at intervals of eight days, removed the pain almost entirely, the patient ate, drank, and slept as in health, though the swelling was not per- ceptibly diminished ; this, however, disappeared entirely on adminis- tering three doses of Acid, nitric, x, at intervals of from eight to ten days.
"The other patient had two osseous swellings of the size of a pigeon's egg on the head, and an eruption over the whole body, for the relief of wrhich he had taken several hundred baths, and as many mercurial pills. The patient was cured after eighteen months' treat- ment which was repeatedly interrupted. Of course he took very many homoeopathic medicines, so that I am unable to mention the results obtained by any particular one, especially as during the latter period I treated him only by letter.
" Complications.
" Chancre and Bubo. — The treatment of this form of compli- cation has been described under Bubo.
" Chancre and Gonorrhoea. — If the gonorrhoea is very painful, the treatment of the chancre, which otherwise is preferable, must be suspended, and Cantharides or some other appropriate remedy be exhibited. This also holds good if profuse and continued hematuria supervenes,
" Chancre and Condylomata. — In this case, the treatment can be united, as Thwja and Nitric acid are particularly indicated in both forms.
" Gonorrhoea and Hernia humoralis. — Here of course the latter must be treated without delay.
" The other complications are not of importance, and the treat- ment of them is obvious.
" Syphilis secundaria. Secondary Syphilis.
" Aurum. — Nasal speech, stinking ichor and small pieces of bone discharged from the nose, ulcers on the palate, the tonsils are cor- roded by ulcers, offensive discharge from the ears, with violent boring pains in them, painful periosteal swelling, on the hairy scalp, forearm and tibia, on the head itching nodes, rending pains in the bones of the extremities.
"Aurum. — Inveterate syphilis, the nasal, frontal and superior maxillary bones swollen and reddened, with sticking pains in them,
33
514 URINARY AND GENITAL ORGANS.
bloody, fetid discharge from the nostrils, the margins of the eyelids reddened at their inner canthi; if the head is not kept warm, head- ache as if a draught of air passed through it.
" Acichm nitric—On the head isolated, humid pustules ; the face full of maturated pustules, with broad red margins, which after some days form crusts; on the right ala nasi, a condylomatous protube- rance of the size of a bean, covered with a scab ; tonsils red and swollen ; there was formerly a raw spot on the anus between the legs ; pruriency and humidity of the integuments.
cc Hepar suVphuris, Rhus.
"Sepia. — Inveterate syphilis, with ulcers of the glans and pre- puce. After Mercur., Acidum nitric, and Thuja had been given without perceptible improvement.
"Thuja, with the aid of Graphit. and Sepia., were given, copious discharge of pure mucus from the urethra in a subject who had pre- viously taken much Mercury, slight burning when urinating, the bulbous portion of the urethra painful internally, the orifice of the urethra red, swollen, the inner surface of the prepuce red, pain in the region of the bladder, ulceration of the base of the glans, scro- tum painful, many nocturnal pollutions, headache, melancholy, inclined to suicide."
DISEASES OF PARTICULAR ORGANS AND REGIONS, OR OF THE SYSTEM IN GENERAL.
GOUT.
Arthritis.
This disease, particularly when it has assumed the chronic* form, requires a long and discriminative course of treatment. The chief danger arises from its liability to transfer its seat from the part first attacked to some of the principal internal organs, such as the head or stomach ; in such instances, it assumes a peculiar critical character.
From some peculiar predisposition, gout is often hereditary ; until therefore this constitutional tendency is eradicated by a proper mode of treatment, where practicable, it is useless to expect a permanent cure.
Diagnosis. Pains in the joints, with inflammatory or chronic cold swelling, and symptoms of deranged digestion.
These signs, however, may only partially declare themselves, or be marked by some other chronic malady; indeed there is scarcely any disease of that character, with which gout may not be complicated.
Prior to the attack, we generally find symptoms of general derange- ment of the digestive functions, with a slight access of fever : the veins of the feet become swollen, and a sense of numbness, cramps* or twitching is present, with a deficiency of perspiration. When the attack comes on, which most frequently occurs in the evening, or during the night, it is generally attended with a feeling of dislocation in the joints of the feet, and burning or severe scalding pain in the part attacked, more or less intense ; after a time these sensations dis- appear, leaving the part red and tumefied : the fit occurs again at intervals, generally diminishing in intensity ; in many instances con- siderable fever is present.
516 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Among the exciting causes of gout may be numbered the follow- ing : a luxurious mode of life ; stimulating diet or drinks ; a sudden check of perspiration ; mental emotions ; sedulous application to studious pursuits, and neglect of proper exercise in the open air ; and the use of aperient medicines and tonics. In plethoric habits, the gout shows a considerable inclination to shift its seat to the head, and in dyspeptic individuals to the stomach and intestines.
Therapeutics. In general cases of this affection, the principal medicaments are Aconite, Pulsatilla, Nux vomica, and Bryonia, etc.
Aconite, in plethoric or corpulent habits, where there is consider- able inflammatory fever, with hard and quick pulse.
Pulsatilla, where the pains are of a shifting nature, exacerbated towards evening or in led, with a paralytic or torpid sensation in the part affected, and more particularly, when the dyspeptic symptoms, given under this medicine (see Indigestion or Dyspepsia) present themselves, and when the pain is relieved by uncovering the affected limb.
When, on the contrary, the pain is increased by uncovering, and relieved by warmth, and the patient is weak, depressed and ex* hausted, Arsenicum will be found of material service in affording relief. Pains worse at night, with restlessness and constant necessity to change the position of the extremities, pale and anxious or haggard countenance, are generally relieved by Ferrum, or Ferrum and Rhus in alternation ; and, in other cases, by Cinchona, especially when there is sensibility to the touch, and aggravation of the sufferings from the most trivial pressure or blow.
Nux vomica, when the pains are worse towards the morning ; para- lytic and torpid sensations, with cramps and throbbings in the muscles : and moreover, when, in addition to other dyspeptic symptoms, we find constipation and hemorrhoids, or an inclination to that affection, and an irritable or choleric temperament : furthermore, when indulgence in wine or fermented liquors has been the inducing cause.
Bryonia, where the pains are increased by the slightest motion; aggravation of suffering at night; coldness and shivering, with gene- ral perspiration or fever. For the dyspeptic symptoms present, see article Indigestion.
Each of the medicines here mentioned may successfully follow Aconitq, when the febrile symptoms have been in some measure sub- dued by the administration of that medicament.
RHEUMATISM. 517
In chronic cases, the applicability of the following medicines should be consulted : Argentum, Lyeopodinm, Aurum, Sulphur, Calcarea car- bonica, Colocynth, Hepar sulphuris, Colchimm, Phosphoms, Conium macu- latum, Daphne, Kali, Guaiacum, lodium, Rhododendron*, Clematis viticella, and Manganum. Also, as intermediate remedies, — Arnica, Ledum palustre, and Sabina.
In Arthritis vaga the following remedies have been recom- mended in addition to Pulsatilla: Nux v., Arnica, Manganum, Nux moschata : and also Rhododendron, Plumbum, Daphne, and Assafoetida.
Arthritic Nodosities, or Nodes : Lycopodium, Aurum, Ledum, Graphites, Calcarea, Rhododendron, Calcarea, Silicea, Sepia, Berber is, and Staphysagria in alternation ; as also Agnus, Antimonium, Bryonia, Phos- phorus, Sabina, Zincum. Arthritic contractions are sometimes benefited by Sulphur, Bryonia, Rhus, Guaiacum ; or Colocynth, Silicea, Calcarea, etc. Arthritis occurring in individuals, whose occupations compel them to work in the water, is chiefly to be relieved by Calcarea, Pulsatilla, Sarsaparilla, and Sulphur ; and in some cases by Arsenicum, Dulcamara, Antimonium, Nux moschata, and Rhus. Nux v. is one of the most important remedies against the precursory symptoms of gout ; and Belladonna against recent metastasis. In Chiragra : Nux, Bry., Lye, Cocc, Ant, Agn., Rhod., Sulph., Lach., Led., etc., are the most generally appropriate remedies. And in Podagra: Arnica, Sabina, Ledum; but in many cases the following are equally important : Bry., Sulph., Calc, Cocc, Am. c. et m., Amhr., Lyc> etc.
rheumatism, rheumatic fever.
Febris rheumatica. Rheumatismus.
Diagnosis, Pains in the muscular or membranous structure, generally with swelling of the adjacent cellular tissue, with slight red- ness and increased generation of heat, caused by taking cold,
This disease is of twTo kinds, the Acute and Chronic : the former is accompanied by fever, preceded by restlessness; heat alternating with chills ; thirst ; coldness of the limbs and extremities ; constipation and accelerated pulse, followed by pains in the large joints, generally shifting their situation, leaving redness, swelling, and tenderness of the parts affected ; it is also frequently attended with excessive per-
518 DISEASES OE PARTICULAR ORGANS AND REGIONS.
spiration and weakness. In the latter, or Chronic Rheumatism, the swelling of the parts, except in very severe cases, is commonly less perceptible ; sometimes there is present a feeling of general stiffness or numbness, with little or no fever.
Other symptoms incidental to this complaint, we shall notice more particularly under the head of the different medicaments most effica- cious in the treatment. The principal exciting causes are damp, chill, or a sudden check of perspiration. People who have resided long in a tropical climate, or have been subject to continual exposure to cold or wet, are very liable to suffer from rheumatism in the chronic form.
Therapeutics. In the treatment of this affection, the following medicaments have been found particularly useful : Aconitum, Bella- donna, Bryonia, Chamomilla, Nux vomica, Mercurius, Pulsatilla, Rhus toxicodendron, etc.
Aconitum, when we find high fever, dry heat, thirst, and redness of the cheeks ; excessive shooting or tearing pains, extremely violent at night ; occasionally redness or shining swelling of the parts affected ; aggravation of pains by the touch ; excessive irascibility of temper.
Belladonna is useful when the pains are of a shooting or burning description, principally in the joints, aggravated by movement, and worse at night; when the parts attacked are much swollen, rigid, very red, and shining, and particularly when there is fever, with determination of blood to the head, throbbing of the vessels of that part, and redness of the face; heat of skin, thirst, accelerated pulse and sleeplessness, aggravation of the pains on movement.
Bryonia may follow Aconite, or the preceding medicine, writh great benefit, or be administered independently. The following are its more prominent indications : severe shooting pains, much increased by motion of the affected part, or by a cold draught of air ; swelling of the joints of the upper and lower extremities ; fever ; headache, gastric derangement, and constipation ; pains aggravated at night, or particularly on the slightest irritation ; irascibility and perverseness of temper; the pains seem situated more in the muscles, and particu- larly about the joints, than in the bones. Bryonia is, like Belladonna, particularly indicated in rheumatic fever, wrhen the pains are exces- sively increased by the slightest movement, but the accompanying fever less of a synochal type than that which calls for Bella.
Chamomilla, when we find dragging or tearing pains, with a
RHEUMATISM . 519
sensation of numbness of of paralysis in the parts affected, feverish- ness; great agitation and tossing; desire to remain lying down; perspiration; exacerbation of suffering at night, with temporary relief from sitting up in bed, or frequent changing of posture ; dragging rheumatic pains in the gums or upper and lower extremities, with nocturnal exacerbations, or excessive aggravation of pain from the slightest movement. Aching pains all over on waking in the morning, and chilliness during the day.
Nux vomica : — Sensation of numbness, paralysis, or tightness in the parts affected, with cramps and palpitation of the muscles ; pains of a dragging description, chiefly confined to the joints, trunk of the body, back, loins, and chest, aggravated by cold • gastric derange- ment ; constipation; irritability of temper. In rheumatism in the muscles of the neck, with stiffness and drawing of the head to one side, and nocturnal exacerbations ; as also in rheumatism having its seat in the gums, muscles of the chest, abdomen, and back, with flatulence and constipation, Nux is one of the best remedies. (Coccu- lus and Ignatia are sometimes called for, when Nux brings only temporary relief.)
Mercurius is indicated in cases where the pains are increased by the warmth of the bed or exposure to damp or cold air, aggravated at night, and especially towards morning ; also where there is considerable puffy swelling of the parts affected. This medicine is particularly useful when the pains seem seated in the bones or joints ; profuse perspiration without alleviation of suffering, is also a good indication for its employment ; rheumatic fever with continual alternations of chills and heats, or internal heat, with fugitive chills in the affected parts. (Lachesis is often efficacious when Mercurius fails to relieve the fore- going symptoms.)
Pulsatilla is useful in shifting rheumatic pains, particularly if attended with a sense of torpor or paralysis in the parts upon which the patient has been lying, relieved by exposure to cool air, and worse at night or in the evening; rheumatic fever, with predominating chills, and pains in the long bones. (Camphora is often of great ser- vice in pains which disappear in one place to reappear in another, such as from the feet to the arms, and so on, when Pulsatilla or Rhus, etc., produce merely palliative amendment.)
Rhus toxicodendron is indicated by a sensation of torpor, dull- ness, and crawling, with feeling of numbness, or creeping in the affected parts, especially those on which the patient lies: paralytic
520 DISEASES OE PARTICULAR ORGANS AND REGIONS.
weakness or trembling of the extremities, when attempting to move them ; a sensation of bruising or of laceration, as if the flesh were torn from the bones, or as of scraping of the bones ; pains worse during rest, re- lieved by motion ; inflammatory or shining redness in the joints, with stiffness, and sometimes a darting pain when handled. This remedy is particularly useful when rheumatism or rheumatic fever has arisen after a thorough wTetting, or when the sufferings are aggravated in cold or damp weather, and when in rheumatic fever the pains set in especially during the chills, and the chilliness alternates with heat throughout the course of the disease, except during the night, when heat prevails, and gives rise to a constant inclination to stretch the limbs. This medicament may sometimes follow Bryonia with con- siderable advantage. Ferrum is sometimes useful in alternation with Rhus, particularly when the pains are relieved by frequently shifting the position of the limbs ; or after, or in alternation with Pulsatilla, when the pains fly about from one part to another, and are of a lanci- nating description.
Arsenicum is a most valuable remedy when the pains are of a tearing^ dragging, lancinating, burning character, accompanied by anxiety and uncontrollable restlessness and sleeplessness, with great heat of skin and excessive thirst, small accelerated pulse and swelling of the extremities. In rheumatic metastasis to internal organs, espe- cially the heart, Arsenicum is one of the most important remedies. Accessions of sweat, w7ith mitigation of suffering, is a characteristic indication for Arsenicum,
Col chi cum : — Rheumatism, with gastric derangement and slight fever, during the prevalence of cold, damp weather; or rheumatic fever (continua remittens), exacerbated in the afternoon, with general dry heat, palpitation of the heart, thirst, and fugitive sweats; shooting, tearing pains in the affected parts, becoming almost insupportable at night, subsiding towards morning, and then suddenly fixing upon some other part of the body, which in its turn becomes painful and inflamed^ whilst the previously affected part loses its former redness, but remains in a tumefied state for a few hours.
China is of much service at the commencement of an attack of rheumatic fever, when the following symptoms are met with: noc- turnal, pressive, aching pains in the head, with excessive general restlessness, which disturbs sleep ; fugitive chills in the back, and tendency to sweat on covering up the parts, or on the slightest excess of clothing ; the chilliness gradually extends over the whole body, but
RHEUMATISM. 521
consists more of an internal than an external feeling of chilliness, with exception of the hands and feet, which are as cold as ice ; by degrees partial heat supervenes, with exacerbation of headache, and distension of the vessels, dragging, tearing pains in the back, sacrum, thighs, and knees, with weakness in the affected parts, and aggrava- tion or renewal of suffering on touching or handling them ; sometimes symptoms of gastric or bilious derangement make their appearance at the same time, as bitter tase, with yellow furred tongue, bitter eruc- tations, nausea, and even vomiting, and excessive thirst.*
Ranunculus bulbosus. This remedy is also of considerable efficacy in rheumatic fever, and is indicated by some of the charac- teristic symptoms which call for the employment of China, such as aggravation or renewal of the tearing, shooting pain by the touch, or by movement or alteration of posture. The fever partakes of the type of a continua remittens, becomes exacerbated towards evening, and is attended with a strong full pulse. The pains are of a fugitive character, and are, in addition to the above peculiarity, which is common to China, generally aggravated by cool air. Semilateral heat, with coldness of the hands and feet, is likewise an indication for Ranuncukts bulb. in. rheumatic fever. f
Rhododendron chrysanthum. Rheumatic fever (of the character of synochus), in which the chilliness alternates with heat, accompanied with pressive headache from within outwards, and drawing in the limbs ; dry heat in the trunk during the night, with restlessness and sleeplessness, followed by slight general heat towards morning, on mitigation of pain. The nocturnal drawing, or dragging and tearing pains occupy the periosteum chiefly, are aggravated by bad, changeable weather, and by rest.
Sulphur : — Drawing, pricking, or drawing, tearing pains in the extremities and joints., with slight swelling of the latter ; mitigation of pain from external warmth, and aggravation from cold ; exacerbation or accession of pain when at rest, and amelioration on movement; but chiefly when the pains are of a fixed character. Rheumatic fever, with alternate heats and chills, anxietas praecordii, and pains in the head and neck, and severe pricking in the sacral region ; the headache increases, by its violence, the great tendency to restless- ness and disturbed sleep, and admits of no rest in any position. The accompanying fever is a continua remittens, with exacerbations in the evening, or after retiring to rest, consisting of shivering chills^ * Hartniann's Therapie. f Ibid.
522 DISEASES OF PARTICULAR ORGANS AND REGIONS.
which it is impossible to allay by warmth, and which terminates in heat after an hour or two ; towards morning, sweat of an acid odour. Commonly, there is complete absence of appetite, or desire for acid food only, with great thirst, parched mouth (or sensation of dryness), sour eructations, distension of the scrobiculus and abdomen, and sensibility to the touch ; costiveness.*
Arnica is characteristically indicated when the extremities are affected with tensive, tearing pains, or pains as if caused by a bruise, attended with debility, redness, and swelling, exacerbation from the slightest movement, and yet it is found impossible to retain the limbs long in one posture, in consequence of the unremitting pain and the restlessness which arises from so doing. In pains of a simi- lar description affecting the thorax, particularly the posterior portion, this remedy is still more efficacious, with the contradistinction that they are mitigated by movement $ chilliness and heat exist at the same time, i. e., whilst one part feels warm to the touch, another feels cold.f
Lachesis has been found of great efficacy in rheumatic fevers, and especially in those occurring after the abuse of mercury. It is chiefly indicated by pain and stiffness, with swelling of the affected part, sensibility to the touch, and exacerbation of the pains during move- ment, towards evening and at night ; sweat, which brings no relief.
Mezereum is equally efficacious in rheumatic fever after a course of mercury in large doses, when the pains occupy the long bones, and are principally of a drawing and tensive description.
Carbo v.: — Drawing tearing pains in the thorax, with paralytic sensation, and obstructed respiration ; also when excessive flatulency is present.
Euphorbium. Tearing, or pressive, aching, shooting pains, ex- acerbated during rest, ameliorated by movement.
Obstinate cases of rheumatism frequently require a long, careful, and discriminative treatment. In some cases much benefit will be obtained from repeated doses of Sulphur ; in others, Calcarea, par- ticularly when the pains are increased at every change of the weather. Hejpar sulphuris and Lachesis alternately have been recommended in the severest kinds of acute rheumatism. Colocgnth is frequently useful against the stiffness which remains ; or N%xy Cocculus, and Ignatia, when there is stiffness of the entire frame, with threatening rheumatic paralysis. In the event of a sudden metastasis to the chest, attended * Hartmann's Therapie. f Ibid.
RHEUMATISM. 523
with oppressed respiration, palpitation of the heart, and excessive agitation, Aconitum should be immediately administered in repeated doses until relief is obtained ; but should the improvement only prove temporary, Sulphur and Pulsatilla have been recommended to be given in alternation. Belladonna and Bryonia may also be of service in dangerous results of this kind. When the heart becomes implicated in acute rheumatism or rheumatic fever {Endocarditis or Pericarditis rheumatica), Belladonna, in repeated doses, is frequently, in addition to Arsenicum, a most useful remedy if timely administered ; and may, in some cases, be advantageously employed in alternation with Aconitum, and followed by Spigelia 1 — 3 and Digitalis I — 3, or Cannabis or Bryonia, according to circumstances.
These remedies, together with Cannabis, Arsenicum^ Lachesis, in some instances, are the most valuable in the treatment of idiopathic Endo- carditis, Carditis, or Pericarditis, which see.
Against rheumatism with Fever {rheumatic fever), Aconitum, Bella- donna, Bryonia, and Chamomilla are the most appropriate medicaments when the accompanying fever runs high or is of a synochal type ; and Merc, Rhus, Nux v., Puis., Cocc, Calc, Chin., Ars., Ran., Rhod., Bide, Indig., Am., and Sulph., when it is of a sub-inflammatory type.
Against Non-febrile rheumatism : Argent, m., Assa. (when the pains proceed from below upwards, as, for instance, from the hand to the arm and shoulder),* Clem., Hep., Lach., Lye, Phosph., Veratr., Nux, Puis., Thija, Sang, can., Tgn., Merc, Bulc, Sulph. chiefly.
For rheumatism in the Joints, with or without swelling {articular rhetimatism), Aeon., Bry., Bella., Rhus, Ant., Clem., Am., Led., Lye, Hep. s., Sulph., Calc, Sep., Argent, metal, (without fever).
For rheumatism in the upper extremities: 1st, The Shoulder: Aeon., Bry., Puis., Rhus, — Kali, Magn., Assa., Card, v., Sil., Thuja, Nux, Staph., Hep., Sec. 2d, The arm : Assa., Cocc, Led., Puis., Sab., Veratr., Guaj., Chin., Ant. c, Bella., Bry., Kali, M. arct., Sec. 3d, The Fore- arm : Rhus, Merc, Staph., Calc, Nux v., Sulph., Sep., Sil., Hep., Lye, Ran. bulb., Ran. seel., Sec. Lower extremities : 1st, The Hip or Hip- joint : Bry., Calc, Led., Rhus, Ant., Coloc, Chin., Bulc, Tgn., M. austr., Merc, Nux v., Puis., Veratr., Phosph., Am., Bella., Sec. 2d, The Thigh : Merc, Guaj., China., Bella., Bry., Calc, Carb. a., Clem., Coloc, Ign., Puis., Sulph., Am., Carb. v., Cocc, Nux v., Rhus, Thuja, Sec. 3d, The Leg : Calc, Lye, Puis., Sep., Sil., Staph., — Ant. e, Am., Ars.y
* Allg. Horn. Zeit. No. 21, 31ster Bd.
524 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Cham., Chin:, Coloc, Guaj., Led., Mag. arct., Mag. ami., Phosph., Thuja, Veratr., Merc, Nux v., Ran. seel., &c.
Against rheumatism in the Thorax (pectoral and intercostal muscles particularly) : Am., Phosph., Ban. bulb., Spig., Sulph., — Ars., Bella., Carb. v., Hep., Merc., Ran. seel., Sep., Sil., Bry., Calc., Chin., Bulc, Led., Lye., Cocc., Nux v., Rims, Staph., Veratr., &c. In the Heart: Aeon., Lach. ; and Ars., Bry., Bella., Puis., Spig., Sulph., Calc., Cham., Chin., Merc, Nux., Thuja, Tabin., Carb. v., Rhus, Phosph., &c. Back : 1st, The Shoulder-blades (scapulae) : China, Merc, Rhus, Sep., — Aeon., Am., Bry., Coloc, Phosph., Ac ph., Ran. bulb., Rhod., Staph., Assa., Bella., Calc, Cocc, Nux v., Sulph., Veratr., &c. 2d, The Dorsum : Am., Ars., Bella., Cocc, Nix, Puis., Sulph., .Calc, Lye, Sep., Sil., — Assa., Bry., Cham., Bulc, Hep., Ign., Lach., Led., Mag. aust., Phosph., Ac ph., Rhod., Spig., Staph., Thuja, China, Coff., Guaj., Merc, Rhus, Veratr. (See Lumbago). 3d, The Sacrum : Nux v., Puis., Rhus, Sep., Sulph., — Ars., Bella., Carb., Bulc, Hep., Mag. aust., Ac ph., Staph., Thuja, Am., Bry., Calc, Cham., China, Cocc, Ign., Lye, Phosph., Veratr., &c. _ For rheumatism in the Head; Spigelia is one of the most effective reme- dies ; in other cases, Aeon., Bella., Bry., Lye, Acid, nitr., Merc, Ipecac, Ign., Coloc, Sulph., Led., Lach., China, Phosph., or Cham., followed if required, by Nux. v. and Puis, at intervals of twelve hours. In rheumatism arising from the abuse of Mercury, Sulph., Carbo v., Sass., Lycop., Guaj., China, — Acid, n., Hep., Lach., Bella., Calc, Ac. ph., Puis., Bulc, are the most useful in general cases. In that which has been produced by the excessive and injudicious employment of Cinchona : Puis., Ars., Carb. v., Merc, Sulph., Sep., Veratr., and Calc. And in Gonorrhceal rheumatism, Clem., Sass., Thuja, Puis, Tussilago petas., Baph., Lye, and Sulph., may be considered the most appropriate medicines.
For Chronic Rheumatism the following are the principal reme- dies : Veratrum, Phosphorus, Carbo v., Sulph., Lycop., Hepar, Lach., Clem., Indigo, Valeriana. When the pains are aggravated or excited by the slightest chill, — Aconite, Calc, Bry., Bulc, Merc, Sulph., Acid. phosph., will generally be found the best remedies from which to select. When the attacks are excited by unfavorable weather, — Calc, Rhtis, Bulc, Rhod., Verat., or Lycop., Carbo v., Lach., Hepar, Mang., Nux m. ; and when every change of weather brings on a relapse, — Calc, Silicea, Sulph,, Bulc,Merc, Lach., Rhus, an&Veratnim are usually the mostuseful.
For rheumatism arising from a chill in the water, or from cold, moist weather, — Calcdrea, Nux m., Sarsaparilla, or Stdph., Bulc, Carbo v.
LUMBAGO. 525
Rheumatism with paralytic weakness,— Arnica, Fernim; China, &c, or Electro-magnetism, when painful jerkings are experienced in the part.
Against unsettled or shifting rheumatic pains, in addition to Pulsatilla: Rfais, Arnica, Bryonia, Nux m., and in some instances, Mod., Dap/me, Mang., Plumb., or Crocus, Valeriana, and Assafcetida, are the most appropriate medicines.
Rheumatism from congelation, — Arsenicum, Bryonia, Nux moschata, chiefly.
LUMBAGO.
Diagnosis. Violent pain, of a rheumatic character, in the lumbar region, either periodical or permanent, frequently accompanied with a considerable degree of fever.
Therapeutics. The medicines most valuable in its treatment are, Aconite, Bryonia, Nux vomica, Rhus toxicodendron, Belladonna, Pulsatilla, and Mercurius.
Aconite may be given at the commencement, if much fever declare itself.
Bryonia where the pains in the back are of a severe aching or lancinating description, constraining the individual to walk in a stoop- ing position ; aggravated by the slightest motion, or draught of cold air, and attended with a general sensation of chilliness.
Nux vomica is particularly indicated when the pains resemble those produced hy a bruise, or by excessive fatigue : also when they are much increased by motion and turning in bed at night, and attended with considerable weakness ; and moreover, when irritability of temper and constipation are present. Nux v. is often of great service after Bryonia in acute lumbago. In chronic cases it is a remedy of no mean importance.
Rhus toxicodendron : Dragging or shooting pain in the dorsal and lumbar region ; severe aching or pain as if from the effects of a bruise or a sprain in the loins ; a feeling of stiffness or tension in the affected parts on attempting to move, but aggravation of the pains when in a state of rest, or when pressure is made on the seat of the sufferings. It is also a useful remedy in chronic cases.
526 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Belladonna, where the pains are deeply seated, causing a sensation of heaviness, gnawing, or stiffness ; it may follow Aconite with considerable benefit, when slight inflammatory symptoms are present.
Pulsatilla, when the pains, resembling those mentioned under Nux vomica are moreover attended with a sensation of tension or constriction at the affected parts ; it is particularly indicated, as re- marked in other parts of this work, for females, or individuals of mild, sensitive, or phlegmatic temperaments.
Mercurius, when the pains are much of the same description as those given under Nux vomica, but considerably aggravated at night, incapacitating the sufferer from taking rest, (See also art. Rheumatism.)
INFLAMMATION OF THE PSOAS MUSCLE. Psoitis.
Diagnosis. Pain in the renal region, hip, and downwards to the leg. The limb can neither be stretched or drawn upwards without pain; in walking there is a hobbling in the gait, with the body inclined forward ; turning in bed, or lifting any weight increases the pain. Occasionally, but seldom, we find a swelling of the psoas muscle and in the region of the groin. The affection, in some measure, resembles Nephritis, from which, however, it is dis- tinguishable by the absence of disturbances of the urinary system, &c.
This disease is generally more painful than dangerous; it may, however, prove fatal from matter forming and discharging itself into the cavity of the abdomen, but more frequently abscesses open in the groins, anus, perinaeum, or thighs ; it may also produce caries.
Therapeutics. The remedies given under Lumbago and Rheu- matism (which see), are equally useful in most cases of this disorder ; however, as there is generally a greater degree of fever present than in that affection, Aconitum, followed by Belladonna, should generally form the commencement of our treatment.
The following may be mentioned in addition :
Colocynth, when there is a feeling of contraction in the psoas muscles when walking, and the disease is more of a chronic nature.
When rigors are complained of, followed by a sensation of throb-
SCIATICA. 527
bing, and increase of pain in the affected part, and we have reason to apprehend incipient suppuration, we may give Staphysagria in repeated doses, followed by Silicea or Hepar, to bring the abscess to a head as quickly as possible, and thereby relieve the sufferings of the patient.
In by far the greater number of cases of Psoas or Lumbar abscess, however, we have no premonitory symptoms which might lead us to anticipate such a disease, and are but too often unaware of the existence of the disorder, until an external tumour is formed. (See Chronic abscess.)
When the bones have become affected, or when an abscess has arisen from diseased vertebrae, Silicea may be productive of all the benefit we can look for in so serious a case.
Staphysagria may follow the above when a discharge of a peculiarly offensive sanies takes place,
A%irum, Assafoetida, Argentum, Plumbum, or Sulphur may also prove of service in the latter form of lumbar abscess.
SCIATICA.
Diagnosis. Pain in the region of the hip-joint, which frequently extends to the knee and foot, following the course of the sciatic nerve. It often interferes with the motion of the foot, causing stiffness and contraction.
Therapeutics. The principal remedies in ordinary cases, are Aconitum, Arsenicum, Chamomilla, Ignatia, Nux vomica, Pulsatilla, Colo- cynth, and Rhus toxicodendron.
Aconitum. When considerable constitutional disturbance at- tended with fever is present.
Arsenicum. When burning pains are complained of, or some- times a sensation of coldness in the affected part— acute dragging pains in the hips, with great restlessness, obliging the patient to move the limb frequently in order to obtain relief, occasional inter- missions of suffering or periodical returns ; great weakness and incli- nation to lie down— mitigation from the application of external heat. It is also useful in those cases of marasmus or emaciation which arise from a long continuance of want of rest> the result of pain, and from derangement of the digestive system.
528 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Chamomilla is more particularly indicated when the pains are frequent at night, attended with excessive sensibility and irritability of fibre : sensation of torpor in the affected parts.
Ignatia. When the pains are of an incisive nature, particularly on moving the limb, and more especially when they occur in indi- viduals of a mild melancholic temperament, or in those who are sub- ject to alternations of extremely high and low spirits.
Nux vomica. When the pain becomes aggravated towards morn- ing, and is attended with a sensation of stiffness and contraction so as to interfere with the motion of the foot, and also a sensation of paralysis or torpor and chilliness in the parts affected, — particularly in individuals of an irritable temperament.
Pulsatilla. When the pains are aggravated towards evening, and during the night, or when the patient is seated, but somewhat relieved in the open air ; this remedy is best adapted for persons of mild disposition and leucophlegmatic temperament.
Colocynth is an important remedy in this distressing disease. It has been found of the greatest service in cases where the right leg was affected, and the pains liable to be excited, or much aggravated by a fit of anger or indignation.
Rhus. This medicament is more peculiarly indicated when the pains are aggravated by rest, relieved by motion, or by warmth: with disposition to melancholy or an unaccountable feeling of dread.
Veratmm, Btaphysagria, Manganum, Mezereum, Hepar s., Sepia, Phos- phorus, Buta, Kali c., Conium, Sec, may also be found useful in parti- cular cases of this complaint, or Neuralgia, generally, which see. (See also the remedies described for the treatment of rheumatic pains, art. Rheumatism.)
PAIN IN THE HIP. HIP-GOUT. RHEUMATISM IN THE HIP.
Coxalgia, Coxagra. Ischias.
Diagnosis. A pain in the hip-joint dependent upon a true gouty inflammation, almost universally of an acute description; the pain is extremely violent, and extends from the hip-joint to the neighbouring aponeurosis, the periosteum, and the adjacent ligaments : it conse- quently, sometimes reaches upwards to the back, or downwards to the thigh, rendering motion excessively painful, either in walking, rising up, sitting down, or turning in bed. When the pain is not deeply seated, there is generally absence of either swelling or redness.
HIP DISEASES. 529
This species of gout usually assumes the irritable character, runs its course quickly, and forms an active local inflammation, which very rapidly terminates in suppuration, when unchecked. It occurs more frequently in the male than in the female subject.
When suppuration supervenes, the pain becomes more obtuse, pressing, and throbbing; the inflammatory fever assumes the suppu- rative character (febris suppuratoria), indicated by shivering and shud- dering, alternating with heat, to which a number of other sufferings become united, such as swelling, pains in the knee, limping, luxatio spontanea, &c.
Therapeutics. The following remedies have been found most effective in the treatment : Mercurius, Rhus toxicodendron, Aconitum, Belladonna, Chamomilla, Pulsatilla, ffepar sulphuris, Colocynth, Ar- senicum, &c.
Mercurius is a useful remedy when the disease is attended with halting in the gait, and sharp, cutting, tearing, and burning pains, which are materially aggravated at night and during every move- ment, and are usually attended with profuse nocturnal sweating ; also where exudation threatens, or has already taken place.
Rhus toxicodendron. When darting, tearing, or dragging pains are experienced in the hip-joint, attended with tension and stiffness in the muscles, aggravated, or chiefly felt, during rest. Also painful sensibility of the joint when rising from the sitting posture.
Aconitum. When the affection is attended with marked febrile symptoms, or inconsiderable inflammation of the joint itself exists from the commencement.
Belladonna is particularly indicated in the inflammatory stage when attended with a marked redness of the skin, and considerable pain on the slightest movement, with lameness ; in such instances it may advantageously precede Mercurius.
Chamomilla is of great efficacy in recent cases, with exacerbation of pain, at night in bed.
Pulsatilla is occasionally found serviceable in mild cases of this disorder, partaking of a rheumatic character, when the patient complains of wrenching pains in the hip-joint, which are aggravated towards night, and even when in a state of rest. (Acid. nitr. is sometimes useful after Puis.)
34
530 DISEASES OE PARTICULAR ORGANS AND REGIONS.
Hepar sulphuris is chiefly useful in case of exudation, and may in such instances follow Mercurius with some advantage.
Colocynth is a useful remedy in subacute or chronic cases, when the pain is constant, and of a squeezing description, accompanied by a sensation as if the entire joint were tightly and painfully bound ; also when the attacks are liable to be brought on or aggravated by a fit of passion, indignation, or mortification.
Arsenicum deserves a preference to other remedies when the pain extends or shoots along the interior of the affected limb like a hot stream (increased by every movement, and, especially, hj every change of temperature) ; great prostration of strength, disappearing in the intervals between the paroxysms ; paleness of the face, oppression at the chest, or even attacks of faintness from the slightest exertion. (Hygea, xvi, 67-74.)
The following remedies have also been found useful in many cases : Sulphur, Silicea, Graphites, Bryonia alba, Calcarea carbonica, Digitalis, Argentum, Acidum nitricum, Kreosotum, Assafatida, Aurum foliatum, Can- tharides, Lachesis, Chamomilla, Staphysagria, Nux vomica, Acidum phos- phoricum, Sepia, and Calcarea phosphorata. (See also the following article on Hip-disease, and that on Rheumatism, where indica- tions for some of the above-mentioned will be found.)
hip-disease.
Morbus coxarius.
Diagnosis. Chronic inflammation of the bones composing the hip-joint (particularly the acetabulum), frequently commencing only with pain or uneasiness in the knee of the limb attacked, or a slight weakness of the part affected, attended with limping; afterwards emaciation, and elongation of the limb itself takes place, and as the complaint progresses, a severe fixed pain is felt behind the trochanter major, increased by pressure on the front of the acetabulum, extend- ing down to the knee, ankle, and foot, which is accompanied with feverish symptoms, restlessness, and flattening of that part of the nates which is generally fullest and roundest, depression of the crest of the ileum, and distortion of the spine.
This complaint is most frequently met with in children, but no age, sex, or condition of life is exempt from its attacks ; it is peculiarly
HIP-DISEASE. 531
insidious in its approach, the pain and uneasiness in the knee above- mentioned being frequently the first symptom denoting its presence; hence it is not unfrequently mistaken for some complaint of that joint, — a deplorable oversight, since it is only in the incipient period of the disease that a favorable prognosis can be given ; if no appro- priate relief be timely administered, matter forms within the joint ; the acetabulum, and sometimes the head of the femur, becomes destroyed by caries, luxation upwards and outwards takes place, and the limb, which had previously been preternaturally elongated, now becomes contracted and shortened ; the sufferer is then either de- stroyed by excessive constitutional irritation, or recovers with an anchylosed joint.
Causes. An inherent constitutional taint, such as scrofula, is no doubt the principal predisposing cause ; but it is generally attributed to external violence, or exposure to damp or cold, as lying down on damp grass in summer, &c.
Therapeutics. Mercurius, Belladonna, and Rhus are our prin- cipal remedial agents, at the commencement of the disease ; and Calcarea, Colocynth, Sulphur, Silicea, Calcarea pkosphorata, Pulsatilla, Sepia, and Stcvphgsagria in more advanced stages, or after the previous employment of the first-named medicines.
Mercurius : — This remedy is of itself sometimes found to act as a specific in the early and curable stage of the disease ; it is more particularly indicated when the patient is of a scrofulous diathesis and sallow complexion, and when no pain is complained of, but the disease is insidiously advancing.
Belladonna is more especially called for in the inflammatory stage, when the patient suffers considerable pain.
In some cases it may be found advantageous to alternate these remedies according to the symptoms that present themselves.
Rhus toxicodendron : — In the first stage of the disorder, with darting or dragging or tearing pains in the hip-joint, increased by suddenly pressing the head of the femur into its socket, accompanied with tension or stiffness of the muscles, most painful when in a state of rest ; and severe pain on arising from a sitting posture.
Colocynth has been found of much value in this disorder, either after Belladonna and Mercurius, or in preference to those medicines when, from the commencement, the hip-joint is described to feel as
532 DISEASES OF PARTICULAR ORGANS AND REGIONS.
if firmly and painfully bound by an iron clasp, with pain extending down the limb, and stiffness in the knee-joint.
Sulphur is generally required in chronic cases, particularly when arising from a scrofulous or psoric metastasis.
Calcarea carhonica has been recommended as particularly worthy of attention at the commencement of the second stage of the disorder.
In cases of abscess or caries in this disease, Silicea and Calcarea phosphorata may be employed with advantage.
The following remedies are likewise deserving of attention in the treatment of this serious malady : Calcarea, Bryonia, Hepar s., Acidum phosphoricum, Phosphorus (in the stage of shortening), and Lachesis.
Affections of the Knee. In affections of the knee-joint, Silicea forms one of the most important remedies, particularly when the disease begins in the synovial membrane. Acid, nitricum, Aurum, Ac. phosphoricum, Lycopodium, Lachesis, Sulphur, or Calcarea, have, in addition to Silicea, been found useful in inflammation of the synovial membrane of the joints, in consequence of the effects of Mercury ; and Rhus, Bryonia, Lycopodium, Nux v., China, or Sulphur, when the complaint occurs as a result of gout or rheumatism. Sulphur and Calcarea have chiefly been recommended in lymphatic or scrofulous enlargement of the knee ; but also the following, in some cases : Silicea, Lycopodium, Arsenicum, Iodium, and Arnica.
In the event of suppuration : Silicea, Mercurius, Hepar s. ; and in that of serous infiltration : Silicea and Sulphur ; or Calcarea, Mercu- rius, and Iodium. In glazed or shining, white, soft or doughy swell- ings of the knee, Pulsatilla is an excellent remedy, and is indeed more or less useful as a general remedy in soft, colourless swellings of the knee, whether painful or otherwise. Sometimes the alternate employment of Iodium and Pulsatilla is required, especially in strur mous habits. When the swelling is red, and very painful, Bryonia is more appropriate, (or Bryonia and Iodium in alternation, in scrofulous subjects).
DETERMINATION OF BLOOD TO THE ABDOMEN. 533
DETERMINATION OF BLOOD TO THE ABDOMEN.
Congestio viscerum abdominis. Congestio ad abdomen.
This derangement is characterized by a disagreeable or painful sensation of weight, heat, and burning, with hardness and tension in the lower portion of the abdomen*
Nux vomica is one of the most frequent sources of relief in those who lead a sedentary, life, or are much addicted to over-indulgence in the pleasures of the table, particularly when the following symptoms are complained of: hardness., tension, and fixed pain in the abdomen, sense of great weakness or prostration, rendering it difficult or almost impossible to walk about; constipation, with pain in the loins, spirits oppressed and irritable.
Sulphur will frequently be found serviceable in completing the cure after the above, or it may be selected in preference in cases of long standing, when we meet with the following indications : dull pains, and a disagreeable sensation of distension in the abdomen, constipation, tendency to obstinate hemorrhoidal attacks, extreme dejection.
Carbo vegetabilis, may be selected when the symptoms are accompanied with excessive flatulency, and will frequently be found of great service in some obstinate cases, when alternated with the two preceding remedies.
Arsenicum will also be found useful, especially when there is a disposition to diarrhoea with extreme weakness ; or —
Capsicum, when these symptoms occur in individuals of a lymph- atic temperament.
Sepia is often of much utility in the case of females, particularly when the symptoms are analogous to those enumerated under Sulphur.
In particular cases, the following will also be found useful : Pulsa- tilla, Lycopodium, Belladonna, Mercurius, Bryonia, Chamomilla, Rhus toxicodendron, Veratrum. By consulting the articles on Dyspepsia, and Hemorrhoids, the reader will find further assistance in the selection of the above remedies.
Daily exercise in the open air, together with a careful attention to regimen, must be observed by those who are afflicted with this disease.
534 DISEASES OF PARTICULAR ORGANS AND REGIONS.
ACUTE INFLAMMATION OF THE EYES.
Ophthalmia.
Diagnosis. Superficial, bright scarlet redness, pain, and heat of the eye, generally with marked sensibility to the action of light ; either with dryness or an increased secretion of ophthalmic humours. When severe, accompanied by cephalalgia, febrile symptoms, and increased intolerance of light, particularly when the entire eyeball {Ophthalmitis), or the sclerotic coat {Sclerotitis) is affected, in which latter case, moreover, the redness presents a pink appearance.
This affection may arise from a variety of causes, such as exposure to extreme light, the strong heat of a fire, particularly after coming out of an extremely cold atmosphere, external injuries, or cold.
Therapeutics. The following remedies are those which are more generally required in the treatment of this affection, according to the form in which it presents itself, namely : Aconitum, Belladonna, Nux vomica, Cinchona, Digitalis, Euphrasia, Ignatia, Arnica Montana, Pulsatilla, Mercurius, and Sulphur.
Aconitum : — Valuable at the commencement of the treatment, in general cases of non-catarrhal inflammation; but even in simple inflammation of the conjunctiva or simple catarrhal ophthalmia, should the inflammation be considerable and attended with fever.
Belladonna may follow Aconitum, if great sensibility to light remains. Also in Acute, Arthritic, Rheumatic and even Scrofulous ophthalmia, when the following symptoms present themselves : red- ness in the conjunctiva, margin of the eyelids, and corner of the eyes, with a swollen and tumid appearance ; or redness of the sclero- tica, with intolerance of; and pain increased by, light ; great sensi- bility of the eyes and eyelids ; aching pains above and around the orbits, or pains which penetrate deeply into the orbits and head, with aggravation on moving the eyes ; flashes of light, sparks, or darkness before the eyes, with extreme dimness of vision towards evening ; objects appearing reversed or double j moreover, when there are the following catarrhal symptoms : severe cold in the head, with acrid discharge, causing excoriation, and sometimes an eruption of pimples under the nose, and on or about the lips ; periodical return of short, dry, barking, spasmodic cough, aggravated towards night, and
&
ACUTE INFLAMMATION OF THE EYES. 535
severe headache. (Mercurius and Hepar &, are often required to com- plete the cure after the employment of Belladonna.)
Nux vomica : — In catarrhal, arthritic, or rheumatic inflammation of the eye, when there are burning, pressive, or aching pains, a feeling as of sand in the eye, with stiffness, smarting, tickling, and itching ; foul tongue, and other symptoms of disordered stomach ; slight fever in the morning and towards evening ; irritable temper ; pressure on the eyes and eyeballs on attempting to open them ; redness of the canthi ; the eye streaked, bloodshot, and swollen, with adhesion of the eyelids; sensibility to light ; briny lachrymation ; affection worse towards morning. Nux v. and Pulsatilla are two of the most useful remedies in simple inflammation of the conjunctiva, particularly at the commencement of the attack ; but Sulphur is often required to complete the cure.
Cinchona. When the inflammation is less intense, but the motion of the eye painful, accompanied by the sensation before noted as of sand in the eye, with the distinction that an exacerbation takes place towards evening ; when the pains are of a burning or pressive nature, with headache in the forehead, as if arising from a suppression of the nasal secretion.
Arsenicum, chiefly in catarrhal and scrofulous ophthalmia, when there exists a violent burning pain or pains of so severe a description as almost to drive the patient distracted ; specks and ulcers on the cornea.
Euphrasia. For the employment of this medicine, the particular indications are, white of the eye much inflamed and of a pink or rose colour (Sclerotitis) ; painful pressure and smarting in the eyes ; profuse and acrid flow of tears, excited or increased by exposure to cold ; copious secretion of mucus, sometimes sanguinolent ; or bright red- ness of the conjunctiva, with distension of the veins ; minute pustules on different parts of the conjunctiva ; white opaque specks on the cornea; excessive intolerance of light (scrofulous inflammation of the conjunctiva) ; severe cold in the head with profuse fluent nasal discharge; violent headache, aggravation of the symptoms towards evening.
Ignatia may be administered with advantage when there is pressure in the eyes, a profuse flow of tears, great intolerance of light, but with little or no perceptible redness of the eyeball ; severe coryza ; in catarrhal^ rheumatic, or scrofulous inflammation.
Pulsatilla. Aching or burning and smarting irritation in the
536 DISEASES OF PARTICULAR ORGANS AND REGIONS.
eye, as if from the insertion of sand under the lids, with scarlet red- ness of the eyes and eyelids, and copious secretion of mucus, disordered stomach, foul tongue, and chilliness towards evening, followed by febrile heat ; or pricking, shooting, piercing pains in the eye, with bright redness of the eyes, and profuse lachrymation, especially on looking at the light, or on going into the open air, and generally ot a scalding or acrid nature ; or, on the other hand, excessive dryness of the eyelids, especially in the evening, with nocturnal agglutination ; photophobia; swelling of the eyelids; aggravation of the symptoms towards evening; sensitiveness with disposition to weep. (Ferrum is occasionally very serviceable after Pulsatilla, especially in scrofulous ophthalmy ; at other times Sulphur is preferable.)
Mercurius. In many cases of catarrhal, rheumatic, and scrofulous ophthalmia, as also in iritis, this medicine is frequently to be employed with advantage. Its ordinary indications are lancinating pains, or painful and irritating pressure, as if from sand, especially on reading, or otherwise fatiguing the eyes, but also when at rest in bed; prick- ing and itching in the eyes, particularly in the open air; rose-coloured redness of the eye (sclerotitis), with injection of the veins ; profuse lachrymation ; great sensibility to light, but especially that of the fire or a candle; vesicles and pustules on the sclerotica; ulcers ori the cornea; pustules and scabs round the eyes, and at the margins of the eyelids ; cloudiness of the sight ; violent pains in the orbit and fore- head ; renewal of the inflammation on the slightest exposure to cold. (ffepar s. or Sulphur are frequently required after Mercurius.)
Sulphur is an important remedy in inflammations of the eye of all kinds, whether catarrhal, rheumatic, or scrofulous, when of an obstinate or inveterate character. It is, however, more particularly indicated by the following symptoms : pressure, smarting, and burning, as if from sand ; itching in the eyes or eyelids ; dimness of sight, with dusky appearance of specks, vesicles, or pustules and ulcers on the cornea; pustules or granular elevations in the eyelids, and scabs round the orbits ; inflammation of the iris, with irregularity of the pupil; copious lachrymation, and excessive photophobia, and aggravation or suffering on moving the eyes ; painful dryness of the eyes, especially within doors; contraction of the eyelids; imperfect vision, with scintillations ; cephalalgia, and violent pains in the orbit, &c.
Chronic cases of this affection frequently require a long and careful course of constitutional treatment to effect a perfect cure; one of our best remedial agents for this end is Hepar stilphuris, which is also
DISEASES OF THE EYE. 537
of great service in acute attacks after Bella, or Merc, in individuals predisposed to this affection. Among the other medicines which may be consulted with advantage in catarrhal, rheumatic, or even scrofulous ophthalmia are, Sulphur, Calcarea carhonica, or Graphites, Sepia, Spigelia, Acidum sulphuricum, Petroleum, Lachesis, Acidum nitri- cum, Ferrum metallicum, Colocynth, &c.
If inflammation arise from '"external injury, caused by a blow, or the entrance of any foreign body into the eye, we should employ Aconitum, which is eminently superior to Arnica in lesions of the ball of the eye; in severe cases it may be used externally as well as internally. Should Aconite not suffice to effect a cure, Sulphur must be had recourse to, followed, if called for, by Calcarea, or any other remedy which may appear better indicated. When the lids have been injured Arnica is more appropriate ; and when both the ball and the lids have suffered, Aconite and Arnica should be employed alternately ; or a dose or two of Aconite given first, and subsequently a lotion of Arnica applied. Finally, the following medicaments may be pointed out as being eminently useful, or worthy of attentionin the varieties of ophthalmia enumerated.
For Catarrhal ophthalmia, in addition to those above men- tioned : Chamomilla, Hepar sulphuris, Lycopodium.
Rheumatic [Sclerotitis) : Bryonia, Chamomilla, Rhus,oxi& Veratrum; Lycopodium, Spigelia,* in addition to those described under the heading of Inflammation of the eye.
Scrofulous: Arsenicum, Conium, Hepar s., Sulphur, and Calcarea; also Dulcamara, Ferrum, Graphites, Sepia, Petroleum; or Aurum, Baryta c. et m., Lycopodium, Cannabis, Chamomilla, Bigitalis, Iodium, Mercurius corrosivus,f Magnesia, Natrum m., in conjunction with the remedies alluded to, as suitable to this variety of the disease, at the commence- ment of this article.
Syphilitic: Mercurius and Acid, nitricum chiefly; in some cases Aurum, Lachesis, Sulphur, Bella., &c.
Sycosic : Thtija, Acid, nitricum, and sometimes Mercurius.
Gonorrhceal : Pulsatilla, chiefly. Tussilago petasitis ? Arnica (in Hypopyum) . Sulphur is still more serviceable than Am. in hypopyum.
* Spigelia is specific in a large number of cases of arthritic and rheumatic ophthalmia. Aconitum is sometimes required in the first place. Sulphur, preceded by, or alternated with Aeon, is of nearly equal efficacy in some instances. Rummell, Allg. hom. Zeit. No. 21, 32 Bd.
f This remedy has been found exceedingly efficacious in the acute form of scrofulous ophthalmia, with ulceration of the cornea and disposition to staphyloma, hypopyon, &c. — Hygea, XIX Band, 1 Heft.
538 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Abuse of Mercury under allopathic treatment : Hepar sulphuris, Acid, nitricum, Sulphur, Pulsatilla; and in some cases Belladonna^ Lachesis, Staphysagria, Lycopodium, Thuja, or Cinchona.
Fungus hjimatodes : Thuja, Carlo a., and Phosphorus.*
Iritis arthritic a : Cocculus, Staphysagria, Conium, Lycopodium, Calcarea, Nux v., Bryonia, Spigelia.
Iritis mercurialis : Hepar s., Acidum nitricwm, Lachesis.
In Ulceration of the Cornea, the following remedies have hitherto been employed with the most satisfactory results : Acidum nitr., Arsenicum, Euphrasia, Sulphur, Lachesis, Calcarea, Belladonna, Mercurius, Hepar sulphuris, Silicea, and Natrum m.
Specks on the Cornea, or opacity of the same : Belladonna, Euphrasia, Sulphur, Calcarea, Hepdr sulphuris, Pulsatilla ; as also Arseni- cum, Acid, nitricum, Cannabis, Magnesia, Aurum, Lycopodium, Silicea, Sepia.
Cataract: The remedies which have chiefly been described as efficacious in this affection of the eye are, Sulphur, Silicea, Cannabis, Conium, Magnesia, Phosphorus, &c.f
Strabismus: In addition to the ordinary simple mechanical remedies, great assistance has been derived from, and in some instances the cure has been solely effected by Belladonna, and Hyoscya- mus, when the affection had not been of too long standing.
Fistula lachrymalts. The following remedies have been employed with success in this affection: Petroleum, Silicea, Slannum, Calcarea, Ptdsatilla, Sulphur, Lachesis, and Acid, fluor. ?%
* For the description of an interesting cure of fungus hsematodes in the eye, vide * Brit. Journ. of Homoeopathy/ No. 2.
f After surgical operations on the eye, Aconitum is a most valuable remedy. In many instances it alone is sufficient to conduct the consecutive effects to a happy issue. It ought to be given immediately after the operation, and repeated as soon as any abnormal symptoms threaten to break out. In individuals of mild and easy disposition Aconite does not always answer ; severe shooting pains in the temples, as also in the eyes, are, in such cases, generally more readily subdued by Ignatia. When intense pains supervene, accompanied by vomiting, Bryonia is useful. When the' pains are of a jerking or twitching description, attended with vomiting and lienteria, Asarum, — and when they are burning, accompanied by diarrhoea, Arsenicum are of great service. Crocus relieved throbbing and jerking pains in the eyes ; Thuja shooting pains proceeding from the temples, with entire loss of appe- tite. W7hen depression failed, but the lens broke in pieces under the operation, Senega pro- moted the absorption of the particles. When, on the completion of the cure, the sight was impaired by a false perception of colours, and particularly when 'every object appeared to be covered with blood, Strontiana completely succeeded in restoring matters to a normal state. —Dr. Wurzler. Allg. Horn. Zeit., No. i, 21 Band.
% There are very few instances in which I have failed to cure Fistula lachrymalis by means of homoeopathic remedies administered internally. In the majority of cases, and par-
DISEASES OE THE EYE. 539
Weeping or Watery eye involuntary flow of tears). When this affection proceeds from an obstruction of the lachrymal duct, it must be treated by the remedies above enumerated ; but when it merely consists in a relaxed condition of the glandular apparatus of the eye, with a superabundant secretion of tears [epiphora)^ the subjoined remedies have been found successful : Euphrasia, Spigelia, Paris. In other cases a selection may be made from amongst the following : Puis., Bromiwm (especially the right eye), Sulph., Euphorb., Clematis* Sepia, Merc, Ferrum, Ledum, Graphites, Phosph., Lycopod., Silicea, Acid, sulph., Thuja, Veratrum, Petrol,, Rhus, Sabad., Digitalis, Nux v., &c.
Aegylops (Anchylops). Against this sore, which has its seat immediately under the internal angle of the eye, Acidum nitricum has chiefly been employed. (See also Fistula lachrymalis, of which this affection is now commonly considered to be a mere modification or only a certain stage.)
Bloodshot eye. This derangement may arise from a blow or fall, the act of retching, vomiting, or violent coughing, crying, &c. It presents a bright scarlet appearance in most instances at the com- mencement, but usually assumes a livid hue at a subsequent period. The affection generally disappears of itself; but as it is occasionally liable to prove exceedingly obstinate, absorption is materially facili- tated, and the unsightliness removed by the internal and external employment of Arnica. (See External Injuries.) Belladonna, Lachesis, Nux v., or Chamomilla may be required in certain cases.
Against hemorrhage from the eyes, the following have hitherto been employed with the most success : Belladonna, Carlo vegetabilis, Chamomilla, and Nux v.
Short-sight, Near-sightedness {Myopia). The medicines which have been employed with the greatest effect in this affection are: Pulsatilla^ Sulphur, Carbo v,, Acid, phosph., Phosphorus, Conium, Acidvmi nitricum, Ammonium c, Anacardium, and Petroleum. Of these Pulsa- tilla and Sulphur have proved the most serviceable in the affection when occurring as a sequel of ophthalmia ; — Acidum phosph., when resulting from typhus, or from a debilitating loss of fluids, — and Carbo v., Acidum nitricum, and Sulphur, when attributable to the effects of mercurial action.
ticularly when on the right side, Petroleum proved efficacious. I could never enforce a cure with lower potencies when X (the 30th) failed. In addition to Petrol., Calcarea was sometimes useful, especially when given alternately with the former ; in other cases, Ruta and Staphysagria, or Stannum and Pulsatilla. In some instances, Silicea did good — Con- stantine Hering. Arch., 3ter Bd., Istes Heft, p. 122.
540 DISEASES OE PARTICULAR ORGANS AND REGIONS.
Against sudden attacks of blindness : Aconitum, followed by Mer- curius, Sulphur, and Silicea. Against blindness towards evening, Bella- donna is the principal remedy, but in some cases, Veratmm will answer better. Should neither of these effect much improvement, Hyoscyamus may be administered.
HORDEOLUM.
Stye*
Diagnosis. This is a little hard tumour appearing like a small dark-red boil, generally in the corner of the eye, or upon the eyelids, attended with severe inflammation, and frequently causing fever, con- siderable pain and suffering. It suppurates slowly and imperfectly, and has no tendency to burst spontaneously.
Therapeutics. The two most valuable medicines in the treatment of this affection are Pulsatilla and Aconitum.
Pulsatilla will, in most cases, suffice to remove the stye, if given on its first appearance.
Aconitum. When inflammation runs high, attended with great pain, fever, and restlessness.
In some instances, Staphysagria may be found useful to complete the cure, particularly when the swelling degenerates into a hard white tumour. In obstinate cases, Sep., Calc. ; and in some scrofulous habits, Arsenicum, Sulphur, Lycopodium, &c, may be required.
Lippitudo (Blear-eyedness) : Aconitum, Euphrasia, Mercuritis, Pulsa- tilla, chiefly, but possibly also : Sulph., Calc, Kali, Lycopod., Sep., Staph., Silic, Phosph., Magn. c. et m., Cham. Carl, v., Cic. or Sass. &c.
Against Blepharitis {{inflammation of the eyelids) : Aconitum, Bella- donna, Hepar, Pulsatilla, Nux v., Chamomilla, and Euphrasia have chiefly been employed with the most success in the acute form of the com- plaint ; and Arsenicum, Sulphur, Calcarea, Antimonium, Cinchona, &c, in the chronic variety.
In Inflammation of the margins of the eyelids, or meibo- mian glands {ophthalmia tarsi) : Belladonna, Mercurius, Hepar, Eu- phrasia, Nux v., Pulsatilla, Chamomilla, &c.
DISEASES OF THE EYE AND EYELIDS. 541
Catarrhal inflammation of the eyelids (inflammation of the conjunctiva palpebrarum) : Arsenicum, Mercurius, Hepar, chiefly.
When the external surface of the eyelid is inflamed, Aconitum, Bel- ladonna, Hepar sulphuris, and Sulphur are more particularly called for.
ECTROPIUM.
This affection consists in a retraction or e version of the eyelids, owing to which circumstance their conjunctival tunic or internal sur- face is turned outwards.
There are two species of the disorder : one occasioned by turgescence and relaxation of the lining of the eyelids, produced by violent inflam- mation ; the other is caused by contractions of the skin covering the eyelids, or of that in the vicinity, induced by the cicatrices of con- fluent smallpox, burns, or wounds. In the former variety the morbid swelling not only pushes the margins of the eyelids from the ball, but renders them everted ; in the latter the edges are primarily displaced to some distance from the eye, and afterwards turned entirely outward, along with the whole of the affected eyelid.
In both varieties the eyeball, from being exposed, and submitted to constant irritation, is rendered dry and inflamed, the tears escape over the cheeks, vision is impaired, and sometimes ulceration or opacity of the cornea supervenes. The conjunctiva, from the same circumstance, becomes thickened, fleshy, and finally indurated.
Therapeutics. When ectropium arises from turgescence and relaxation of the palpebral lining, Mercurius and Hepar sulphuris are often sufficient to effect a cure ; but in other cases, Arsenicum, Sulphur, or Calcarea are required, particularly when the affection is met with, as it commonly is, in debilitated, unhealthy subjects. — Belladonna, Euphrasia, China, &c, have also been found useful. When contrac- tion of the skin has produced the complaint, the cure may be said to be only attainable by means of an operation.
542 DISEASES OF PARTICULAR ORGANS AND REGIONS.
ENTROPIUM.
In this complaint the eyelashes and the margin of the eyelids are inverted towards the ball of the eye, and cause great pain and inflam- mation. When it has existed for a considerable time, the cornea is rendered opaque, prominent, and indurated, or ulceration and even complete loss of vision result. Relaxation of the skin of the eyelids, in consequence of previous chronic inflammation, disease of the mei- bomian glands, and the cicatrices of ulcerations, or wounds on the palpebral conjunctiva, form the general exciting causes of the dis- order.
Therapeutics. Pulsatilla is one of the most serviceable medi- cines in entropium, and is frequently sufficient to effect a cure. In other cases, Borax has been found useful. Belladonna, Mercurius, Hepar s., Euphrasia, and occasionally Nux v. and Chamomilla may also prove efficacious, particularly where the malady has originated in dis- ease of the meibomian glands. When the contraction of cicatrices has given rise to the affection, it is to be remedied by cutting out as large a portion of the skin of the affected eyelid, opposite the centre of the entropium, as will be adequate, on the approximation of the lips of the wound, by means of adhesive plaster or a small suture, to replace the tarsus and ciliae in their normal position.
Swelling of the lips {scrofulous) : Belladonna and Mercurius are two of the most useful remedies in this affection, when there is simultaneous retraction of the lip. If ulceration and incrustations accompany the disorder, Belladonna, Mercurius, Hepar, Sulphur, Staphy- sagria, Silicea, and Sepia. If there be tumefaction simply, Aurum, Mercurius, Bryonia, Belladonna, Hepar, Lachesis, Sulphur, and Calcarea. (See Scrofula.)
Scirrhus. Against indurations of this serious character, either in the face or lips, Belladonna, Conium, Sulphur, Silicea, Carlo a. et v., Phosphorus, Staphysagria, and Magnesia m. are chiefly to be recom- mended; and the following against carcinomatous ulcerations (both
INFLAMMATION OF THE EAR. 543
internally and externally) ; Arsenicum, Lachesis, Clematis, Conium, Sul- phur, Silicea, Acidum nitricum, Aranea, Carlo v. et a,, &c.
Warts on the face. Kali, Sepia, Dulcamara, Thuja, Acidum nitricum, and Sulphur are,, generally, the most useful. The employment of the knife or of caustic in such cases is highly improper, and often attended with the worst effects. Against these excrescences on other parts of the body, such as the hands, Sec, Sulphur and Calcarea form two of the best remedies in cases of* long standing ; Lycopodium, when large, and intersected with deep clefts ; when moist, Thuja, Acid. nit. and Sabina (externally and internally) ; — Natrum, Sepia, and Rhus have also proved useful in some cases.
INFLAMMATION OF THE EARS AND EARACHE.
Otitis. Otalgia.
Otitis. Diagpntosis. Violent, frequently insupportable, pain in the ear, with sensibility, and even inflammation of the meatus audi- torius externus, and greater or less fever.
The pain when excessive, communicating with the whole head, may bring on delirium, or even inflammation of the brain.
Otalgia may either exist as the effect of otitis, or, if neglected, may pass on to inflammation ; in many cases again, it may arise by sympathy from toothache, or declare itself as a purely neuralgic affection.
Therapeutics. The medicaments applicable to the majority of cases of these troublesome and painful disorders are Mercurius, Pulsa- tilla, Belladonna, Nux vomica, Arnica, Dulcamara, and Chamomilla, Hepar, Cinchona, Sulphur, Sec
Mercurius : When the pain is attended with a sensation of cold- ness in the ears, and exacerbation of suffering in the warmth of the bed ; shooting or tensive pains in the internal ear, extending to the cheeks and teeth; inflammation and induration of the ear, with soreness of the orifice, and discharge ; swelling of the glands. When Mercurius affords only partial relief, a dose of Hepar s. will often subdue the remaining symptoms ; but if a purulent discharge continue, accom- panied by humming in the ear, and pricking pains, Sulphur will gene- rally be found requisite.
544 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Pulsatilla is a most valuable remedy in this affection. It is particularly indicated when the external ear is much affected, and appears inflamed and swollen ; attended with heat, shooting and tensive excoriating pain internally ; moisture in the ear, or somewhat copious discharge. This medicament is particularly useful for females, and individuals of chilly habit.
Belladonna, wThen there is determination of blood to the head, with redness of the face, digging, boring, tearing or shooting pains extending to the throat, fever, and extreme sensibility to the slightest noise j when the pains are more severe internally; also when the brain partakes of the irritation or inflammation, and delirium is present. (Hepar is sometimes required after Belladonna to complete the cure in obstinate cases ; and particularly when the inflammation has ended in suppuration.)
Nux vomica : — When the pains are of a tearing, shooting nature, extending to the forehead, temples, and bones of the face, worse towards morning ; dryness of the ear ; particularly when the affection occurs in persons of a lively, choleric disposition.
Assafcetida : —Burning, shooting pain, occurring in paroxysms, and proceeding from within outwards.
Arnica :■ — In individuals of nervous, excitable temperament, sub- ject to be attacked from slight causes ; also, when great sensibility to noise is present. (Cinchona is often useful after Arnica, especially when the pains are aggravated by lying on, or touching the affected ear. In other cases, Sulphur will be found more efficacious, particularly when the sensibility is excessive.)
Dulcamara, wrhen the affection has arisen from a chill or wetting, will, in many cases, prove sufficient for its removal ; it is also indi- cated when the pains increase at night, and are attended with nausea.
Chamomilla : — When there are stabbing pains in the ear, as from knives; great sensibility to noise, or even to music, extreme sensi- tiveness, susceptibility, and irritability.
In external inflammation of the ear, Pulsatilla forms one of the most generally useful medicaments. Sulphur is also of frequent efficacy, especially after the previous employment of Pulsatilla; Calcarea is sometimes required after Sulphur. When the inflammation runs high, or threatens to extend to the face or scalp, Belladonna usually becomes requisite. Merctirius, Magnesia, and Boras sodce, have also been recom- mended in this form of otitis. Against chronic inflammation, or
INFLAMMATION OF THE EARS AND EARACHE. 545
scrofulous ulceration of the external ear, Merc, Hep., Puis., Lye. Sulph., Ahem., Kreos., Kali, Phosph., Stan., Cale., Baryta, etc.-, are the most useful.
Against hemming or buzzing in the ears, Nuxv. will be found service- able in recent cases, when the annoyance is worse in the morning ; Pulsatilla when in the evening ; Dulcamara when at night, or Mercu- rius when accompanied by sweating. China, Carlo v., and Acidum nitricum, Hepar, Lack., etc., when the affection occurs in individuals who have taken mercury in large quantities. In chronic cases, Aurum, Petroleum, Sulph., Baryta c., Natr. m., Lye., Phosph., Sep., Con., etc., have been found useful; the last-named remedy particularly, when there is great sensibility to cold, and a tendency to suffer from rheu- matic pains in the limbs.
Otorrhcea. When this disorder results from acute inflammation of the ear, Pulsatilla, Sulphur, and Mercurius are the principal remedies. In chronic otorrhcea occurring after repercussed scabies, Cale. c., in repeated doses, has been found very efficacious.*
Catarrhal, or mucous otorrhcea : Belladonna, Mercurius, Pulsatilla, and Sulphur chiefly.
Purulent otorrhcea : — Mercurius, Pulsatilla, Sulphur, Belladonna, and Hepar, — or, Silicea, Calcarea, Acid, nitricum, Assafmtida, Lachesis, Petroleum, etc. When the discharge is offensive, Hepar, Aurum, Carlo v., Sulphur, and Silicea.
Sanguineous otorrhcea : Mercurius, Pulsatilla, and Silicea, — also Lacheds, Cicuta, etc. When the disorder has arisen from the abuse of mercury ; Hepar s., Acid, nitricum, Aurum, Assafmtida, Sulphur, and Silicea, have proved the most useful: and when over-doses of sulphur appear to have given rise to it, Pulsatilla and Mercurius.
When we have reason to apprehend caries of the ossicula auditoria ; Silicea, Sulphur, Aurum, and Natrum m., are the remedies from which we may hope to obtain the most assistance.
Against the effects of suppressed otorrhcea : Belladonna, Pulsatilla,
* Dr. Maly. Hygea, XX Bd., 2tes Heft.
35
546 DISEASES OF PARTICULAR ORGANS AND REGIONS.
and Mercurius ; and, in some cases, Nux v., Bryonia, or Dulcamara may be selected, according to circumstances. Belladonna and Bryonia chiefly when there is fever, headache, or unequivocal signs of cerebral irritation : Mercurius, Belladonna and Pulsatilla followed, if required, by Sulphur, Calcarea, and Hepar, when the glands of the neck or the parotids become tumefied. When orchitis results: Pulsatilla and Nux v., or Mercurius.
In Dysecoia, or deafness, the following remedies have chiefly been employed with the most success : Pulsatilla, Mercurius, Sulphur, Calcarea, Causticum, Graphites, Ledum, Acid* nitricum, Phosphorus, Petro- leum, Ammonium c, etc.
For Congestive deafness: Belladonna, Hyoscyamus, Sulphur, Silicea, Mercurius, Graphites, Phosphorus, etc., have more particularly been recommended.
Nervous deafness: — Causticum, Petroleum, Phosphorus, Acid. phosph., etc.
Catarrhal, or rheumatic deafness : Mercurius, Pulsatilla, Arsenicum, Belladonna, Ledum; or, Sulphur, Calcarea, Hepar, Lachesis, Acid, nitricum, Chamomilla, and Coffea.
Deafness from the repercussion of eruptions: Sulphur and Antimo- nium; or, Causticum, Graphites, etc. When deafness occurs as a sequel of measles, Pulsatilla is one of the most useful remedies ; in other cases, Carlo v. will be found requisite.
When it results from Scarlatina: Belladonna and Hepar; and when it is produced by Smallpox : Mercurius and Sulphur.
Deafness from the abuse of Mercury is generally capable of being removed, or materially relieved by Acidum nitricum, Staphysagria, Assafcetida, or Aurum; Hepar s., Petroleum or Sulphur. When the disorder is attributable to hypertrophy of the amygdalae, Aurum, Mercurius, Acid, nitricum, and Staphysagria have principally been recom- mended. When it comes on as a sequel of fevers, or other disorders, particularly of a nervous character, Phosphorus, Phosphoric acid, Vera- trum, and Arnica; and when it occurs as a result of a suddenly checked
BLEEDING OF THE NOSE. 547
discharge from the nose or eaxs,Hepar, Lachesis, and Ledum; and also, Belladonna, Mercurius, and Pulsatilla, have generally been found the most appropriate.
BLEEDING OF THE NOSE.
Epistaxis.
Bleeding of the nose often appears at the termination of many diseases, such as fevers, epilepsy, etc., and is, in such instances, salutary ; it also frequently relieves or cures headache, vertigo, etc., and ought therefore not to be interfered with, unless it be excessive, last too long, recur too frequently, or take place under a debilitated state of the system. The attack is occasionally preceded by a degree of quickness of the pulse, flushing of the face, throbbing in the tem- poral arteries, confusion or dimness of sight, heat and itching in the nostrils, and other signs of congestion.
The remedies usually required are, Aconitum, Arnica Montana, Bella- donna, Bryonia, Cinchona, Pulsatilla, Mercurius, Rhus toxicodendron, Secale cornutum ; or, Carlo vegetabilis, Graphites, Magnes artificials, Ammonium muriaticum, Ferrum, Kali, Sepia, Sulphur, Calcarea, Acidum nitricum, Baryta, Bovista, Crocus, Conium, Cina, &c.
When the bleeding is excessive, Aeon., Am., Bellad., Cin., Merc., Puis., Rhus, or Sec, are the most useful.
When the hemorrhage arises from congestion in the head, a preference may be given to Aeon., Bellad., Cin., Crocus, Con., or to Graph., Rhus, Chamom., Alum, &c.
When from being overheated, or in consequence of indulging to excess in spirituous Uguors, &c, Nux vomica, or Aeon., Bellad., Bryonia, Thuja.
Epistaxis in females, who have too scanty catamenia : Puis., Graph., Caust, Sep., or Sec. In those, on the contrary, who have too copious a menstrual discharge : Aeon., Calc, Croc, Sabina.
In debilitated subjects, or those who have previously been exhausted by loss of humours : China chiefly, or Ferrum, Sec, and Ac nitr.
In consequence of physical exertion : Rhus, or Arnica principally.
In consequence of a blow or contusion : Arnica.
Bleeding from the nose in children, arising from worms : Cina or Merc
Accompanying every attack of coryza : Pulsatilla or Arsenicum.
548 DISEASES OF PARTICULAR ORGANS AND REGIONS.
When nasal hemorrhage is liable to occur from the most trivial cause : Sulphur, Silicea, Sepia, Calcarea, and Carlo v., and in some cases, Graphites and Lycopodium, are the best remedies to eradicate the con- stitutional tendency.
The following are characteristic indications for some of .the above remedies :
Aconitum. Prolonged or violent bleeding at the nose, in plethoric subjects, with a considerable degree of fever, flushing of the face, pulsation of the temporal and carotid arteries, or general fulness of the vessels of the head.
Belladonna is frequently of the greatest service, after, or in alternation with, the above remedy, but also when there is bleeding from the nose at night, which awakens the patient from sleep, and some- times returns in the morning ; bleeding from the nose from being overheated. (See Bryonia and Rhus.)
Bryonia, bleeding from the nose, chiefly in the morning, or at night during sleep, causing the patient to awake ; or when it arises from suppressed menstruation : or from overheating during warm weather ; obstinate or irritable disposition.
Mercurius, bleeding of the nose during sleep, or while coughing, with speedy coagulation, so that the blood hangs in clots at the nostrils : or when the affection is preceded by a sensation of tightness round the head, as if it were bound.
Carbo v. — Bleeding at the nose during the night, with ebullition of blood ; violent nasal hemorrhage in the morning while in bed, followed by pain in the chest ; discharge of a few drops of blood from the nose every forenoon ; excessive bleeding from the nose several times a day, particularly after stooping, or after every exertion, preceded and followed by great paleness of the face. (See Rhus.)
Graphites : Bleeding of the nose towards night, with heat in the face, preceded by determination of blood to the head in the after part of the day, particularly in females who have scanty catamenia. (See Pulsatilla and Causticum.)
Pulsatilla : — Hemorrhage from the nose every afternoon, even- ing, or before midnight, especially in females with suppressed or scanty catamenia, or in those of a mild and placid disposition.
Calcarea : — Violent bleeding at the nose, chiefly in plethoric, lymphatic persons ; or in females in whom the menstrual flux returns too early, and is excessively copious.
Magnes artificialis. Bleeding from the nose, particularly in
BLEEDING OF THE NOSE. 549
the afternoon, preceded by aching and weight or pressure at the fore- head ; protracted bleeding, after blowing the nose.
Arnica, in addition to being the principal medicine in violent nasal hemorrhage from external injury, or from great physical exer- tion, is, moreover, an important remedy in all cases in wThich the hemorrhage is preceded by itching in the nose and forehead ; and when the nose feels hot, and the blood discharged is red and liquid.
Rhus : — Bleeding of the nose from physical exertion, such as lifting a heavy weight, or, when blowing the nose, spitting, &c., or nasal he- morrhage which becomes aggravated or renewed on stooping, or during the night.
Ferrum : — Nasal hemorrhage in debilitated subjects, with excessive paleness of the face. (Especially after China.)
Sepia : — Frequent attacks of hemorrhage from the nose, with pale or sallow complexion, especially in females with obstructed catamenia. Sulphur, either alone or in alternation with Sepia, and sometimes Carlo vegetabilis, Graphites, and Lycopodium, is of great service in removing a susceptibility to this affection. (See also the remedies enumerated under Nasal hemorrhage from the most trivial cause?)
Nux v., — bleeding of the nose, especially in the morning, from being overheated, or after drinking wine, &c, or in habitual drunkards. (Lachesis and Calearea carbonica are sometimes requisite here, in addi- tion to Nux v.)
Dulcamara: — Bleeding at the nose after getting the feet wet ; flow of hot, clear blood from the nose.
Crocus : — Discharge of dark -coloured, thick or viscous blood from the nose, particularly in females who menstruate too copiously, some- times followed by fainting.
Moschus : Frequently serviceable when the nasal hemorrhage occurs in nervous, hysterical females.
Ammonium c, bleeding from the nose after a meal.
Silicea, nasal hemorrhage in scrofulous subjects.
When the hemorrhage is of an active kind, the patient should be placed in the erect posture, and kept cool and quiet for some time afterwards. The diet in all cases must be low and unstimulating.
When there is reason to fear suffocation from the bleeding con- tinuing inwardly, and getting into the throat, as is liable to happen in extremely debilitated subjects, in whom little or no reaction appears to follow the administration of the remedies, the anterior and pos- terior outlets from the nose may be plugged ; the latter by passing
550 DISEASES OF PARTICULAR ORGANS AND REGIONS.
threads up the nostrils, and bringing them out at the mouth, then securing pieces of sponge, or small rolls of lint to the ends ; after this, the threads should be drawn back, and tied sufficiently tight so as to bring the plugs somewhat firmly against the orifices.
Sprinkling or dashing cold water on the face, exposing the face to a current of cold air ; placing the feet or hands in warm water ; apply- ing a wet cloth round the abdomen, and even dipping the head into a pail of iced water, or salt and water, are among the best of the po- pular means, or occasional auxiliary modes of stopping an excessive or prolonged discharge of blood from the nose.
"With regard to the administration of the remedies, the repetition of the dose, if called for, must depend upon the greater or less degree of the severity of the attack. We ought to be in no hurry to repeat in the majority of cases. (See also what has been said on this matter in the Introduction.)
SWELLING OF THE NOSE.
The remedies for this as well as all other maladies must be selected according to the cause, where known. Thus, if the affection has arisen from a contusion, Arnica (externally and internally) must be prescribed.
If the disorder is encountered in scrofulous subjects, one or more of the following must be had recourse to : Aurum or Assafcetida ; or Sulph%ir, followed by Calcarea ; or Belladonna, followed by Mercurius and Hepar s. When the disease has been excited by the abuse of mercury : Hepar s., Acidum nitricum, Aurum, Belladonna, or Sulphur will be found the most efficacious. When attributable to the habitual use of spirituous liqtwrs : Calcarea, Arsenicum, Nux v., Pulsatilla, Sulphur ; or Bachesis, Bellad., Merc, Hepar s. Finally, Bellad., Merc, and Hepar have been found most serviceable in cases where the tumefaction was red and very painful ; in similar cases of an obstinate character ; Bryonia, Sulphur, Calcarea, and Bhus have proved efficacious. When there are, moreover, incrustations in the nose, Silicea, Sepia, Carlo v., and Natrum m., are the most appropriate remedies. Redness of the point of the nose, Calc, Carlo animalis, or Rhus toxicodendron* Coppery redness, Arsenicum and Cannalis, Sec.
Acne rosacea : Bach., Bhus, Cic, Bed., Buta, Sepia ; or, Ars, Calc, Kreos., Aiw., Carlo v. et a., Canth., Hepk, Cau., Thuja, Acid, nit., &c.
SWELLING OF THE NOSE. 551
Against swelling of the interior of the nose (Schneiderian mem- brane), Teucrium marum verum especially; but also Staph., Phosph., Cole, Sep., Sil., Sulph. These remedies, together with Stannum, Au- rum, and Kreosotum have likewise been employed with success against nasal polypi.
In Caries of the bones of the nose, whether of a scrofulous or mercurial origin, Aurum is. the most important remedy. When of syphilitic origin, Mercurius is to be preferred, provided the patient has not already been placed under an injurious course of that powerful medicine, in which case the affection is as likely to have arisen from the remedy as from the disease, and will consequently require to be combated by anti-mercurial medicines, among which Aurum will in this instance form the most valuable remedial agent ; the other ge- neral antidotes to the injurious effects of mercury on the constitution, such as Hepar s., Acidum nitr., Sulphur, and Calcarea ; or, Lachesis, Carl, v., Staphysagria, Lycopodmm^ Assafcetida, Acid, phosph., Silicea, &c, may, in some cases, become necessary, particularly when the system generally has become impaired by the cause in question. (See Ostitis.)
Ozjena. This disorder consists of an ulcer, having its site in the nose, from which a fetid purulent matter is discharged.
It usually commences with slight inflammation and tumefaction about the alae nasi, accompanied with sneezing, increased flow of mucus, with which the nostril becomes obstructed, and sometimes slight hemorrhage. The ulceration soon spreads from the Schnei- derian membrane to the nasal cartilages, the mucus gradually assumes the nature of pus, and if the disease be not checked, the bones become implicated, and caries results ; a thin, acrid, offensive matter or sanies is then constantly discharged, and often excoriates the lips and throat, and the sense of smelling becomes abolished ; eventually the ossa spongiosa inferior, and also the vomer, and in the worst cases, — particularly when -there is complication with scrofulous and venereal or mercurial disease, — even the palate and superior maxillary bones exfoliate, the bridge of the nose falls in, and leaves a frightful deformity of countenance.
Therapeutics. The remedies which have chiefly been employed in this malignant disease are, Teucrium marum verum, Pulsatilla,
552 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Sulphur, Calcarea ; or Magnes. m., Bryonia, Belladonna, Lachesis, Ly co- podium, Natrum m., Causticum, in the first stage, with mucous obstruc- tion ; Mercurius and Aurum in the second, with discharge of pus, and also affection of the bones ; followed, if required, in Oz-<ena scro- fulosa, by Sulphur, Silicea, Acidum nitricum, Phosphorus, Conium, or Potassa lich. In Syphilitic Oz^ena, Mercurius forms the principal remedy ; but if the patient has already been subjected to an injurious course of that medicine, Aurum is to be preferred, and succeeded, if requisite, by Acidum nitricum, Hepar s., Assafcetida, Lachesis, Conium, or Thuja.
In disease in the Antrum Highmorianum, the following have been recommended : Teucrium marum verum, Arsenicum, Lycopodium, Sulphur, Silex, Aurum, Mercurius, Hepar s., Mezereum, Staphysagria, Carl, v., Antimonium c, Kali hydr., Phosphorus ; and Spigelia, Nux, China, Phosphorus, as palliatives when the pains are very severe.*
Cancer Nasi ; — Arsenicum, Carlo v., Aurum, Sepia, Silicea, Sulphur, and Calcarea are the remedies which have principally been pointed out as the most appropriate to combat this serious and frightful malady.
CANKER OF THE MOUTH. SCURVY IN THE MOUTH. Cancrum Oris. Gangrena Oris. Stomacace.
This affection consists of a fetor in the mouth, with a viscid, bloody discharge from the gums, which are at the same time hot, red, tumid, spongy, very sensitive, retracted from the teeth, and subse- quently, ulcerated along their margins. Sometimes there are also glandular swellings, salivation, or ptyalism ; and usually looseness of the teeth, impeded mastication and deglutition, great debility, and slow fever.
Therapeutics. Mercurius is the most useful remedy here, and may generally form the first prescription in almost every case of the kind, as it will rarely fail to prove serviceable, if not sufficient to
* Goullon considers Arsenicum and Lycopodium as almost specific in this disease. He recommends Arsenicum to be given when the pains are excessively severe, of a throb- bing and splitting, or bursting description, when at their height. Lycopodium when there is a thick and yellow discharge.— A. H. Z. 2, 24.
CANKER OF THE MOUTH. 553
effect a perfect cure. When, however, we have reason to conclude that the symptoms above described have in reality been created by the injurious employment of mercury, under allopathic treatment, it will be necessary to have recourse to the appropriate antidotes to that powerful mineral, amongst which Carlo v. will be found of pri- mary importance ; should the improvement effected by Carl. v. be only of a partial character, the treatment must be followed up by Hepar s. and Acidum nitricum alternately ; or by Staphysagria, if fun- gous excrescences form on the gums. Carlo v. is, moreover, of great service when the disorder has arisen from unwholesome food, the daily use of kitchen salt in excess, or the prolonged use of salt meat ;* when the gums smell most offensively, and bleed during mastication ; the teeth loose, mouth hot, tongue much excoriated, and moved with difficulty.
After the employment of Carlo v. we may have recourse to Arseni- cum, if the ulceration continues extensive, and the patient complains of luming pains in the gums, with great prostration of strength ; or Arsenicum and China in alternation, if, in addition to the foregoing symptoms, the gums present a black, spongy, and somewhat gan- grenous appearance.
Nux v. is an admirable remedy in this disorder, particularly when it occurs in meagre, dark-complexioned subjects, of bilious tempera- ment and choleric disposition, who lead a sedentary life ; the gums presenting a putrid aspect, and so much swollen as completely to cover the teeth ; countenance pale and sunken.
Capsicum has been found useful, under nearly similar circum- stances, the affected party being, moreover, of a plethoric habit and phlegmatic temperament.
Dulcamara may be used with advantage after Mercurius, when the glands of the throat are implicated in the derangement ; or it may be selected in preference to Mercurius, when the disease is prone to be excited by the least exposure to cold, during damp, or cold, raw, wet weather.
Nat rum m. is frequently a valuable remedy in completing the cure after the administration of Carlo v.3 Acid, nitr., Hepar, &c. It is more especially indicated when the ulcers are indolent, and do not put on a healing aspect ; the gums being at the same time much
* Constantine Hering recommends a drop of Spiritus cetheris nitrosi once or twice a day in the event of Carlo v. or Arsenicum failing to bring about a favorable action in such cases.
554 DISEASES OF PARTICULAR ORGANS AND REGIONS.
swollen, very sensitive to heat or cold, and disposed to bleed at the slightest touch ; moreover, when painful vesicles or blisters are observed on the tongue, inner surface of the lips, and cheeks, which impede speech, and, together with the irritable gums, render the act of mastication a work of labour and excessive torture. When, not- withstanding the employment of the last-mentioned remedy, the complaint seems disposed to linger, Sulphur may be prescribed, and followed or alternated with Acidum sulp/mricum, Sepia, or any of the other medicines already treated of, if required by the bent of the succeeding changes in the features of the case, &c. Silicea, Sub-boras soda, Helleb. and Iodium may also prove useful in some cases.
Lemon-juice, which is well known as a most valuable remedy in scurvy, is equally useful as a domestic remedy in stomacace ; but its use must be discontinued during the employment of the above medicaments.
Sage is equally useful in some varieties of the disorder. Rinsing the mouth with brandy has also been found of service.
The use of wholesome, easily-digested food, with a due proportion of vegetables, must be enjoined in order to expedite the cure.
SCURVY.
Scorbutus.
This disorder is characterized by excessive debility, pale and bloated countenance: oedematous swelling of the inferior extremities- hemorrhages ; livid spots on the skin, or foul ulcers ; offensive urine, and extremely fetid stools. The gums are spongy, or otherwise diseased, as described in the preceding article.
It chiefly affects sailors, or others who from circumstances are deprived of fresh provisions and an adequate quantity of ascescent food, and are exposed to cold and moisture, together with fatigue. Intemperance, want of exercise, impure air, uncleanliness, with de- pressing emotions, further tend to predispose to the disease, when com- bined with unwholesome food, or the aforesaid alimentary deficiency.
In the cure, as also the prevention of this malady, it is requisite, in the first place, to remove the probable causes of its invasion, where that is practicable; and to supply the patient, if possible, with
scurvy. 555
wholesome diet, fresh vegetables, and those fruits which furnish citric acid, such as lemon, the juice of which made into a drink forms an invaluable remedy. Sour kraut, and other substances which have undergone the acetous fermentation, cider, spruce-beer, and the like, as also vinegar, have been likewise recommended.
The homoeopathic medicines which may be prescribed with the most advantage against the ulcers and diseased gums are, Carlo v.> Nux v., Arsenicum, Mercurius, Staphysagria, and Sulphur; or also Acid. oiitr., Cistus, Nat. m., Ammonium c. et m., Dulcamara, Kreosotum, Acid, mur., Sepia, &c. (See the preceding article, and also that on Ulcers.)
The use of lemon- or lime-juice and other acids must be discon- tinued during the employment of the above remedies.
Gumboil (Parulis). Silicea, Staphysagria, and Calcarea, but par- ticularly the first, are the principal remedies against this affection. When there is much inflammation and considerable swelling, Bella- donna may be prescribed, followed by Mercurius and Hepar sulph., if little relief is obtained from its use. Nux v., Pulsatilla, and Sulphur are sometimes very useful. In swelling of the jaw, with suppuration, whether in consequence of carious teeth, or the unskilful abstraction of a tooth, Silicea is the most important remedy. In gumboil from irritation, arising from the cutting of the wisdom-teeth, Aconitum and Calcarea are useful ; as also Belladonna, Arnica, and Chamo?mlla, par- ticularly when there is considerable inflammation with swelling of the face, &c.
Against hemorrhage from the gums Staphysagria is one of the principal remedies. Mercurius is also a good remedy in such cases, especially when the gums are painful, swollen, spongy, and jagged at the margins ; but when the foregoing abnormal state of the gums has evidently originated in the abuse of Mercury, they must be com- bated by such remedies as Carlo v., China, or Hepar s., Acid, nitr., &c. Acidum phosph. is another important remedy in bleeding from the gums, especially when it is readily excited by touching or rub- bing the gums, and when the gums feel as if excoriated. Alumina, Sepia, Natrum m., Silicea, Lycopodium, Kali c, Acid, sulph., Rhus, Amir a, and Buta may also be enumerated as useful remedies in affections of the gums, such as ulceration, &c, with tendency to bleeding from the most trivial cause. In the case of morbid growths or excrescences on the gums, Staphysagria is deserving of notice.
556 DISEASES OE PARTICULAR ORGANS AND REGIONS,
INFLAMMATION OF THE TONGUE.
, Glossitis.
Diagnosis. Tumefaction, with heat and redness of the tongue, the swelling is sometimes so great as to fill the whole cavity of the mouth, rendering swallowing impossible, and threatening suffocation ; unless resolution takes place, it may terminate in induration, suppu- ration, or gangrene.
Causes. Besides a general strumous habit, local injuries, acrid substances, rheumatism, catarrh, and metastasis.
Therapeutics. The following medicines will be found most appropriate in the treatment of this affection, according to the ex- citing cause : Arnica Montana, Vrtica urens, Mercurius, Aconitum, Bella- donna, 'P%dsatilla, Lachesis, and Arsenicum.
Arnica, in cases of lesion of the tongue from the points of decayed teeth, &c, or of burns or scalds. (Acid. pkospL is occasionally required after, or may, in severe cases, be given in preference to Arnica : in other instances, Silicea and Sulphur will be required to complete the cure.)
Urtica urens has been recommended in preference to Arnica in burns and scalds of the tongue and mouth.
Mercurius is almost specific when glossitis presents itself in the form of a disease of the tongue, attended with excessive inflammatory swelling or induration.
Aconitum may, with advantage, precede the above remedy, should the inflammation be very intense.
Belladonna. When the affection does not speedily yield to Mercurius, or when the inflammation is of an erysipelatous or active phlegmonous nature. After the inflammation has abated we may, in many cases, return to Mercurius.
Pulsatilla has been found useful in cases arising from sup- pressed hemorrhoidal and arthritic affections.
Against indications of threatening gangrene, Arsenicum and Lachesis are the principal remedies. They may both be given, and repeated according to results.
In some rare cases when, from great tumefaction of the tongue, suffocation threatens, it may be found necessary to have recourse
OFFENSIVE BREATH. 557
to longitudinal incisions ; and after having thus warded off the more pressing danger, exhibit Cinchona, and then fall back upon the more specific remedies.
In some extreme cases of this nature, where the disease has made head before the arrival of professional assistance, it may be found necessary to resort to tracheotomy. This is, however, a dangerous mode of relief, from the risk of consequent tracheal inflammation ; but, when it should be found absolutely necessary, we may, by the exhibition of Arnica, two globules, internally, and also in the form of lotion, — in the proportion of four minims of the mother-tincture to a hundred of water, — materially diminish the danger of so serious a result.
Such cases will, however, rarely if ever, occur to the homoeopathic practitioner, if the disease be taken in time, and the remedies judi- ciously selected.
In cases of soreness or ulceration of the tongue, Merc, Nux v., Ars., Carlo v., Sulph., Ac. nilr., Acid, sulph., Natr. m., Acid, fluor., Silic, and Staph., are the most effective remedies.
Against Ranula, or the formation of an inflammatory or indolent tumour under the tongue, in consequence of obstruction of the salivary ducts from cold, inflammation or other irritating causes, Mer curias, Calc, and Thuja have chiefly been employed. In some cases, one or more of the following remedies may be requisite for the removal of the obstruction, after the tumour has burst, and left the usual obstinate ulcer behind : 'Petroleum, Sulph., Silicea, Puis., Stann., or Staphys., provided Mercurius or Calc. should not be more appropriate in this stage of the disease likewise. When the tumour is of an inflammatory nature Merc, and Silicea may generally be resorted to.
OFFENSIVE BREATH.
The most frequent cause of this unpleasant affection are, uncleanli- ness, leaving particles of food in the teeth; an accumulation of tartar; carious teeth; a diseased state of the gums; aphthae in the mouth ; derangement of the stomach ; or an abuse of mercury.
Therapeutics. When there is reason to suppose that 4he first- named circumstances is the chief cause of the complaint, its removal
558 DISEASES OF PARTICULAR ORGANS AND REGIONS.
will be readily effected by proper attention, rinsing the mouth with tepid water, and brushing the teeth, with a moderately hard brush night and morning, as also after every meal.
When attributable to the second cause, a dentist of known skill and respectability ought to be consulted. Lastly, when the an- noyance can be traced to any of the remaining sources enumerated, the remedies given under these different headings should be had recourse to.
When, on the other hand, no apparent cause of the derangement can be assigned or detected, benefit will often be derived from one or more of the following medicines : Nux v., Silicea, Pulsatilla, Sulphur and Ckamomilla ; or Arnica, Bellad., Hyos., &c.
If the heaviness or fetor of the breath is chiefly perceptible in the morning, Nux v. and Silicea will frequently be found successful in affording relief. Arnica, Bellad., and Sulph. have also proved effectual in similar cases. If after a meal, Nux v. succeeded by Ckamomilla and Sulphur. If in the evening, or during the night, Pulsatilla or Stdphur^
Mercurius, Bryonia, Arsenicum, Hyoscyamus, Agaricus, Ambra, Carbo v. et a., Sepia, Lycopodium, &c, may also prove useful in particular cases. In young girls at the age of puberty, Aurum is often the most appropriate medicine ; but occasionally, Pulsatilla, Sepia, Bella- donna, or Hyoscyamus will be found preferable here. When the abuse of Mercury has evidently been the cause of the evil, Aurum, Carlo v., Lachesis, Sulphur, Hepar, Belladonna, or Acidum nitricum, &c, will be found the most suitable remedies.
CRAMP IN THE LEGS.
Veratrum, Nux vomica, Sulphur, Calcarea, Lycopodium, Acidum nitri- cum, Sepia, Camphora, Argilla, Colocynth, and Rhus are amongst the best remedies for cramps in the calves of the legs. Veratrum has been recommended as one of the most useful medicaments for eradicating the tendency to frequent returns of this painful and troublesome disorder, succeeded by Sulphur, and Colocynth, should it not suffice to effect a cure. Rhus, when the attacks occur during the day when* sitting, as well as at night, Sepia, Zycopodium, and Acid, nitr., when the affection is experienced chiefly in walking. Sulphur, after Nux v., or Rhus, wnen the attacks occur chiefly during the night. Calcarea when stretching out the limb brings on the cramp. Argilla, in cramps
DERBYSHIRE NECK. 559
which arise on crossing the legs, or even on descending stairs. Colo* cynth is frequently beneficial, when stiffness and pain are always expe- rienced in the limb for some time after the attack.
BRONCHOCELE. GOITRE.
Derbyshire neck.
This disfigurement arises from a tumefied state of the glandula thyroides. As the enlargement increases, it is productive of a con- siderable degree of obstruction to free inspiration, from the pressure which it exerts against the windpipe. The disorder is most frequently encountered amongst the inhabitants of mountainous districts. Women are more prone to be afflicted with it than men, and particu- larly those who have suffered from severe labours. An inherent con- stitutional taint seems to be the chief predisposing cause.
In the treatment of the affection, Spongia marina has generally been found the most useful remedy, administered in repeated doses. In cases of long standing, one or more of the following remedies may prove of service in materially diminishing the size of the tumour, if not sufficient to disperse it entirely. Calcarea, Carlo v., Staphysagria, Lycopodium, Iodkim, Ammonium e., and Natmm c. et m. Or : Ferrum, Sepia, Thuja, particularly when the superficial veins of the swelling are in a varicose and painful state, and Curbo v., or Lycopod. fail to effect any amendment. When, either from exposure to cold or otherwise, the thyroid gland has become slightly tumefied, and there is at the same time redness of the integuments over and around the swelling, attended with impeded deglutition, violent headache, cough, and a considerable degree of fever, a dose or two of Belladonna, at intervals of twelve hours, will act beneficially ; should the accompanying fever become intense, Aconitiim may be resorted to. If, on the other hand, there be no discoloration of the surrounding skin, and the fever be of a less active character, Mercurim should be prescribed. When symp- toms of suppuration have set in, Mercurius is still called for, and should then be administered every four to six hours, in order to forward the bursting of the abscess. Silicea is sometimes required, if the suppura- tive process proceeds very tardily.
When the tumefied gland does not disperse under the action of
560 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Bella, or Merc, or when it has already become indurated before medi- cal aid has been sought, Spongia, Natrum, Conium, Sulphur, and Calcarea are amongst the most useful remedial agents.
SWEATING EEET.
Some individuals are much troubled with a disagreeable, clammy sweating of the feet, to such an extent as to render it necessary to change the stockings several times daily. This evil is, moreover, a source of extreme annoyance to others, from the offensive odour which is usually exhaled at the same time. The utmost attention to cleanliness is insufficient to remedy the complaint ; and to attempt to suppress the secretion by cold water, or powerful astringents, is highly culpable, from the dangerous consequences which are liable to ensue from producing a sudden suppression.
Amongst the homoeopathic remedies, by which a safe and perma- nent cure has most frequently been brought about, Silicea and Rhus toxicodendron merit priority of notice. A few globules of the former may be taken every four days, for a fortnight or three weeks ; at the expiration of which period, a few days may be allowed to elapse, and if improvement then set in, the medicine may be continued, at inter- vals of increasing length, until the cure is effected. But should no melioration result, Silicea may be had recourse to in the same man- ner. After Silicea, Rhus may again be resorted to, if required. These two remedies are also the most appropriate to be administered against the deleterious consequences of a suddenly checked foot- sweat.
Other remedies may be required in obstinate cases of this com- plaint, or in those where a general derangement of the system coexists. The following may therefore be pointed out as worthy of being referred to in such cases: Mercurius, Baryta c, Graphites, Kali c, Cyclamen; or Sulphur, Calcarea, Bachesis, Blmmbum aceticum, Carlo v., Bycopodium, Sepia, Acid, nitr., &c.
SLEEPLESSNESS. 561
SLEEPLESSNESS.
Agrypnia.
Sleep is essential to renew the vital energy which has been ex- hausted during the day, as also to assist the function of nutrition. When, therefore, anything occurs to deprive us of this indispensable necessary for a protracted period, or, at all events, so materially to disturb it as to render it inadequate to fulfil its requisite purpose, the health will eventually give way under the deprivation.
The average duration of sleep is from six to eight hours ; but it is liable to variation from several causes. Some, from peculiarity of constitution, require less, others a little more. Habits of idleness, &c. tend to prolong it ; and it may here be remarked, that when not restrained within proper limits, sleep, instead of repairing, exhausts the strength ; and is, as well as the derangement of M'hich it is our object at present to treat, consequently, occasionally productive of serious diseases, such as madness and idiocy, — these distressing maladies having unquestionably been traced in some instances, to indolent habits of prolonging sleep beyond the period required for healthy recreation.
In almost all cases, sleeplessness is but symptomatic of some other disease, and can only be remedied by the removal of the abnormal source. It frequently, however, forms so prominent a feature as to render it necessary that we should treat it as an idiopathic disease, and direct our attention to the selection of medicines conformably.
Intense mental application, continued up to the period of going to rest; sedentary habits; the habitual use of coffee (often for the express purpose of warding off inclination to sleep), also weakness of the digestive functions, are frequent causes of sleeplessness. Under such circumstances, Nunc v. will generally be found the most appro- priate remedy ; but, unless the acquired habits above detailed are given up, or materially altered, no permanent benefit can be expected from the employment of the remedy referred to.
Overloading the stomach, particularly towards night, with the habitual employment of stimulating, or rich, indigestible food, form additional fertile sources of disturbed sleep, which can only be obvi- ated by the observance of a more simple mode of living. The
36
562 DISEASES OF PARTICULAR ORGANS AND REGIONS.
attainment of the desired relief may, however, be considerably for- warded by means of a dose or twTo of Pulsatilla.
Mental emotions often originate sleeplessness.
When excessive joy is the excitable cause, Coffea is a useful remedy. When the affection arises from dejection, caused by grief, unpleasant ideas, vexation, &c, Ignatia. If it be attributable to fear, or fright, or when the sleep is disturbed by fantastic or frightful visions, Opium, followed, if required, by Belladonna in the latter instance : and when anxious, annoying, or agitating events disturb or retard sleep, Aconitum.
Sleeplessness arising from nervous excitement in sensitive or irri- table subjects will often yield to Hyoscyamus ; or to Belladonna, wThen there exists a strong but ineffectual desire to obtain sleep. The latter medicine is further indicated when agitation or anguish, with frightful visions, timidity or terror, apprehension of real objects, &c. are complained of; or when the sleep is disturbed by frequent start- ing, and is attended with extreme sleeplessness early in the evening, or towards morning.
Moschus is a useful remedy in sleeplessness occurring in hyste- rical or hypochondriacal individuals, arising from nervous excite- ment. Acid.phosjQh. and Sepia are also occasionally useful in such cases.
Sleeplessness in old people can scarcely be considered a disease. But when it occurs in children, it almost invariably arises from some bodily ailment, which ought to be attended to and removed without delay, if practicable, as deprivation of sleep is more detrimental during infancy and childhood, than at any other period of life. (See Sleeplessness in Children, Part III.)
Coldness of the feet is a frequent cause of retarded or disturbed sleep. Daily exercise in the open air is here, as in most other cases, to be recommended ; also gentle and general friction, when there is, at the same time, chilliness or stiffness of the limbs. The application of a vessel containing hot water to the feet is the only mode of obtaining any refreshing sleep in some cases, when coldness of the feet is the disturbing cause.
This languid state of the circulation is often capable of being per- manently removed by means of homoeopathic remedies, combined with frequent bathing of the feet in cold water, and appropriate exer- cise. Ammonium m. and Carlo v. et a, ; as also Graphites, Kali c., Nux v., Bycopodium or Sulphur, &c, will generally be found the best adapted to the attainment of this object. When the digestion is in
SLEEPLESSNESS. 563
a deranged state, the remedies noted under Dyspepsia must be resorted to.
When, on the other hand, sleep is prevented or retarded by burning heat in the feet, — Lachesis, and, in other cases, Pulsatilla, Acid, phos- phoricum, Stannum, Lycopodium, Kali c, Sepia, or Secale c, &c. must be selected.
Sleeplessness from a harsh, dry, and imperspirable state of the skin, may be remedied, after the removal of the said cause, when not impracticable from too long continuance, &c, by means of Graphites, Natrum c, Silicea, Sepia, Acid, nitr., or Calcarea, &c.
Sleeplessness and other derangements resulting from tea, require the employment of the antidotes to that drug for their removal, Of these, Cinchona will usually prove the best ; should it not be adequate to effect the purpose required, Fermm will often succeed. (Cqffea is to be preferred in sleeplessness, or other more serious cases of indis- position arising from green tea; but it must be followed by the exhibition of Cinchona, if relief is not soon obtained.)
When coffee is the originating cause of the affection, Nux v., as has been already remarked, is the principal remedy ; on other occasions Chamomilla will be required, particularly when sleeplessness and other sufferings, such as headache, colic, &c. occur in nervous, highly excitable, and irritable subjects, who are extremely impatient under sufferings even of a description that would be deemed trivial by ordinary people. Ignatia, particularly in the case of mild, sensitive, or changeable dispositions. Cocculus, in nearly similar circumstances to those described under Chamomilla, with the distinction of a sensa- tion of emptiness or lightness in the head.
When sleep is prevented, disturbed, or accompanied by the symp- toms hereafter noted, the remedies mentioned will be more or less indicated, and must be selected according to the entire group of symptoms.
Aching pains in the body (sleep disturbed by) : Lye, Mang., Phosph. ac, Merc, — Am. m., Anac, Aur., Baryta c, Lach.
Anxiety (sleep disturbed or prevented by) : Ars., Bella., Ferr., Kali, Op., Petr., Bhus, Veratr., Calc, Carlo v., Cham., Merc., Hep., Phosph., Puis., Nux v., Sulph., &c.
Arms, heaviness in the (sleep disturbed by a feeling of), Biadema.
Agitated sleep : Nux v., Led., Ac. nitr., Oleand., Sulph., Zinc.
Arms, swelling, enlargement of the (sensation of) : Biadema.
564 DISEASES OV PARTICULAR ORGANS AND REGIONS.
Back, pain in the : Am. m.
Bulimy : Cinchona, Bry., Phosph., Sel., Sulph. Burning heat in the blood-vessels: Arsenicum.
Carphologia (during sleep) : Op., Bella., Hyos., Coce, Ars., Phosph.,
Phosph. ac, Rhus, Stram. Chest, pain in the (aching and oppression) : Alum., Am. e, Am. m. Coldness or shivering: Ahim., Amb., Am. m., Carlo v. et a., Graph., Kali,
Nux, Sulph., Merc, Arg., Ars., Daph., Staph., Calc, Acid, m., Arg., &c. Coldness, sensation of, during sleep : Ambra. Congestion in the chest during sleep : Puis. Colic : Lye, Plumb., Sep., Staph., Aeon., Amb., Am. c, Am. m., Kali,
Magn., Magn. s., Ac. nitr., Rhus, Ars., Aur., Merc, N. mos., Puis.,
Sulph., Ac. sulph., Per., &c. Convulsions : Cin., Cup., Hyos., Calc, Lye, Merc, Op., Puis., Sec Cramps (in the calves of the legs) : Anac, Kali c, Rhus, Sulph.,
Nux v., Lye, Bry., Carbo v., Cham., Magn., Magn. m., Sep., Staph.,
Veratr., &c. (See Jerking.) Cramps in the legs : Anac, Kali, &c. (See Cramps.) Creeping, crawling sensations (formication) : Sulph., Lye, Carbo v. Cries during sleep : Puis., Sulph., Bella., Bry., Calc, Cham., Cin.,
Coce, Lye, Sep., Sil., Stram., Croc, Gran., Ac nitr., &c.
Deglutition, during sleep : Calcarea.
Delirium, wandering during sleep : Nux v., Lach., Op., Puis., Sulph., Bella., Bry., Cham., Aur., Big., Camph., Coloc, Sec.
Breams. Dreams, sleep disturbed by Agitated, Anxious: Nux, v., Puis., Am., Graph., Magn., Phosph., Sulph., Thuja. — Alum., Ant. tart., Bar., Car., Carb. a. et v., Cham., China, Coce, Con., Coce, Big., Graph., Guaj., Hyos., Laur., Led., Lye, M. arct., M. austr.,Mang., Mez., Merc, Mur. ac, Natr., Natr. m., Nitr., Op., Petr., Ph. ac, Plat., Plumb., Ran. bulb., Ran. seel., Spig., Stann., Staph., Verb., Ac, Sulph., Veratr., Zinc, &c.
Amorous Dreams (sleep disturbed by) : Lack., Viol, trie, M. arct., Natr., Nux v., Staph., Op. — Alum., Bism., Calc, China, Coce, Hyos., Led., Lye, Magn., Merc, Natr. m., Phosph. ac, Rhod., Samb., Spig., Stann., Stram., Sulph., Thuj., Valer., Veratr., Canth., Lgn., Graph.) Oleand., Sep., Plat., Puis., Sabad., Par., &c.
SLEEPLESSNESS. 565
Animals, dreams of (sleep disturbed by) : Am., Merc, Bella., Phosph.,
Hyosc, Sil., Ac. sulph., Nux v., Sulph., Sec. Apprehension (attended with) : Arsenicum. Assassins (dreams of) : Belladonna, Silica, &c.
Bodies, mutilated : Am., Nux v., Con.
Business, Occupations, Events of the Day: Nux v., Bry., Puis.,
Sulph., Bella., Lye, Merc, Sil., Oic, Hep., Phosph., Rhus, Ac. nitr.,
Magn., Staph., Stan., &c. Business, of urgent : Nux
Cares, of: Arsenicum.
Complicated, confused dreams : Aeon., Alum., Bar., Bry., China,
Hell., M. arct., M. aust., Magn., Phosph., Puis., Sil., Valer., Cann.,
Cic, Stann., Sec. Contradictory, irritating : Asar., Aeon., Ambr., Amon., Anac, Ars.,
Calc, China, Cina, Big., Lye, Ign., Mag. m., Mur. ac, Natr., Nux v.,
Op., Phosph., Rheum, Rhus, Sil., Staph., Sulph., Bry., Calc, &c. Continued after waking : Aeon., Bry., Natr., Calc, Ign., Natr. c, Sec. Cruelties, dreams of: Nux v., Silica.
Dangers, of : Anac, Calc ph., Con., Hep., Kali, Nitr., Ran., Thuj.,
Sulph. Darkness, of: Arsenicum. Death, of: Ars., Magn., Thuja.— Anac, Am., Calc, Graph., Kali, Lye,
Magn. m., Phosph., Phosph. ac, Plat., Sassa., Ac sulph., Verb., Lach.,
Cocc, Con., Puis., &c. Death, dreams with fear of : Alum., Thuja. Demons, dreams of: Kali carhonicum, Natrum carbonicum. Disease, of: Nux vomica. — Calc, Cocc, Kreos., Kali.- — Amm. m., Bar.,
Hep., Phosph., Sil. — Anac, Bros., M. arct., Can., Scill., Zinc Disgusting dreams : Nux v. — Stilph., Magn. m., Natr. m., Zinc. —
Aurum, Anac, Chel., Kreos., Mur. ac, Phosph., Puis. Disagreeable, unpleasant : Nux v., China, Laur., Phosph., Natr. m.,
Rims, he. Dancing, of: Magnesia carbonica, Magnesia muriatica. Disappointments, Mortifications, of: Big., Mosch., Ign., Staph.,
Rheum, Sec.
Falling, of: Thuja, — Amm. m., Big., Aur., Bella.) Kreos., Hep., Magn. m., Merc, Sep., &c.
566 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Fantastic dreams : Calcarea, Natrum muriaticum, Opium. — Carb. a.,
Con., Graph., Kali, Lye, Natr. c, Sep., Sulph. — Bary. c, Carb. v., Lack.,
Nux v., Sil., Spong., Led., Amb., Puis., Sec. Festivities (dreams of) : Antimonium cruclum, Mgs., Ac. nitr., Sec. Fire, of: Hepar sulphuris, Magnesia carbonica, Magnesia murialica. —
Anac, Croc, Phosph. — Alum, Ars., Bella., Calc, Kreos., Laur., Mag.
austr., Spig., Sulph., Sulph. ac, &c. Floods, of: Magnesia carb., Mercurius, Natrum carb. Flying, of: Natrum sulphuricum. Frightful dreams (sleep disturbed by) : Nux v., Op., Cocc, Graph.,
Puis., Lye, Merc, Phosph., Ban. sc, Sass., Sep., Sulph., Calc, Bella.,
Ars., Lach., Ac nitr., &c. Furunculi: Pmnus spinosa, &c. (See Breams of Biseases.)
Haemoptysis (dreams of) : Mephites, &c. (See Breams of Biseases.) Hemorrhage: Phosphorus, Sec. (See Breams of Biseases.) Historical, dreams : Amm. c, Mercurius, &c.
Indecision, of: Arnica montana.
Ignominious, Humiliating dreams : Moschus, Asar., Alum., Am., Am., Con., Staph., &c.
Learned Subjects, of: Lgnatia, M. arct.
Linen (of foul) : Kreosotum.
Lively, Vivid : Phosphorus, Rhus toxicodendron, Sulphur, Silicea. — Nux v., Puis., Op., Lye, Calc, Anac, Am., Bella., Bry., Cic, Mag., Mar., Natr., Phosph. ac, Sabad., Sep., Stann., Ambra., Ars., Carb. v., Clem., Cham., Con., Lach., Croc, Graph., Bros., Mgs., Mag. arct., Magn., Mar., Mur., Mosch., Mur. ac, Natr. m., Petr., Bheum, Spig., Staph., Tart., Stram., Valer., Viol, tr., &c.
Losses, of: Mephites.
Marriage :
Meditation, Reflection (dreams with) : Bryonia, lgnatia, Nix vo- mica.—Lach., Anac, Sabad., Sabin., Thuja, Aeon., Am., Camph., Carb. a., Graph., M. arct., M. austr., Puis., Rhus, Sec.
Misfortunes, dreams of: Nux vomica, Pulsatilla, Bycopodium, Gra- phites, Thuja. — Amm. m., Am., Bella, Cham., China, Kali c, Phosph., Sassa., Sulph., Sulph. ac. — Alum., Anac, Ars., Cocc, Ign., Led., Merc, Ran. bulb., Staph., Sec.
Money, of : Cyclamen, Magnesia, Pulsatilla.
SLEEPLESSNESS. 567
Murders, or crimes: Bella., Lye, Natr. m., Nitr.ae, Rhus vernix, Silicea.
Perplexing dreams : Arsenicum, Graphites. (See Complicated, Con- fused Dreams?)
Pleasant, Agreeable : Calcarea, Natrum carhonicum, Opium, Pulsa- satilla, Sepia, Staphysagria, Viola tricolor. — Ant. c, Aw\, Carb. a., Graph., Kali, Lacli., Magn., Natr. m., Phosph., Phosph. ac, Plat., Sil., Alum., Amm. m., Carb. v., Croe,Magn., Ars., Bary., Bism., Cocc, Coff., Ign., Hyos., Magn. m., Merc, Ac. nitr., Olead., Spig., Thuj., Veratr., &c. &c.
Poetic : Lachesis, Calcarea, Spongia, Amm. c.
Poisoning, of : KreosoUcm, &c.
Projects, of: Anacardium.
Pursuits : Kreosotum.
Quarrels : Nux vomica, Am., Magn., Phosph., Stann., Alum., Aw., Calc, Hep., M. austr., Puis., Selen., Staph., &c.
Realities, dreams which appear to be : Natrum carbonicum, Natrum
muriaticum. Remembrance with, of things forgotten : Caladium. Remembrance, dreams of which one loses the : Bella., Hell., Cic,
Cocc, Lye, Selen., Spig., Tar ax., Veratr., Vil., Am., Aur., Bry., Con.,
Lack, Laur., M. arct., Men., Merc, Natrum m., Rims, Sabad., Stram.,
Sulph., &c. Repentance, dreams of: Arsenicum. Reproaches : Arnica. Revolts : Mercurius. Robbers : Magnesia carbonica, Merc, Magn. m., Alum., Aur., Kali, Sil.,
Natr. c, Plumb., Veratr.
Sad, Melancholy dreams : Rheum, Lye, Spong.
Serpents, or Reptiles (dreams of) : Kali carbonicum.
Shots : Hepar sulphuris, Mercurius.
Show: Kreosotum.
Spectres, or Frightful Visions : Alum., Bella., Calc, Ammon. c, Carb.
v., Ign., Kali c, Merc, Ac nitr., Puis., Sil., Stclph., Nux v. Storm, of a : Arnica, Arsenicum, Euphr., Natr.
Teeth, of the falling out of the : Nux vomica. Threats, of: Arsenicum,
568 DISEASES OE PARTICULAR ORGANS AND REGIONS.
Travels, Voyages, Journies : Magnesia carbonica, Natrum carlo-
nicum, Opium, Amm. m., Amm. c, Magn. m. Typhus Fever, of death from : Kali chloroticum.
Vermin, dreams of: Nux v., Acid, muriat., CAel., PAospA., Am. c
War, of: TAuja, Verb., Plat., Per.
Water, of : Ammon. muriat., Graph., Magn., Alum., Big., Kali, Magn. m.,
Merc, Pan. bulb., Sil., &c. Water, of, desire to void, (of inclination to urinate) : Kreosokim.
Sleep) disturbed or prevented by :
Excitement (nervous) ColcA., Merc, Coffea, Nux v., LacA., Amb., CampA., CantA., Caps., CAin., Hyos., MoscA., Puis., Sep., Lye, Laur., Ac. nitr., Mags, aust., Teuc, &c.
— vascular : Pry., Nuos v., Puis., Sep., Sil., Calc, Baryt. c, Natr. m., Carb. a., Merc, PAospA., Sabin., Sep., Am. c, Asar., PAus, Pan., Sec.
— by vascular, in the chest : Puis., Cyc
— vascular, in the head : Puis.
Abnormal states during sleep :
Eyes, open : Bella., Op., Bry., Veratr., SulpA., Coloc, PAospA. ac, Per., Sell., Tart., Samb.
— convulsed : Op., Hell., PAospA. ac
— fixed : Tart.
Face, puffiness of the :
— coldness of the: Belladonna.
— paleness of the : Belladonna.
— redness of the : Op., Arnica, Viola tricolor. Fatigue, feeling of, during sleep: Kreos., Antim., Ambra. Fear, during sleep : Carb. v., Puis., Cocc
— or dread of losing one's reason : Calc carb. Fright : Puis. Silica, SulpA., Veratr., Kali c, Am., Tab.
Gastric sufferings : CAam., Con., Hep., Kali, Ac. nitr., Sil., PAus, Graph, &c.
SLEEPLESSNESS. 569
Grinding of the teeth : Ars.
Hallucinations : Bella., Cham,, Sulph., Led., Merc, Phosph., Stram. Hands, coldness of the : Bella., Merc., Carl. v.
— heat in the : Lack., Staph.
Head, pain in the : Sulph., Merc., Lye, China, Calc, Carlo, v., Cham., Con., Hep., Haem., Kreos., Mag., Ac. nitr., Phosph., Phosph. ac, Puis., Sil., Mags, arc, Zinc, &c.
Head, congestion in the: Puis., Sil., Am, c
— heat in the : Silica, Camphora. Hearing, delusions of: Cham., Sep., Carl. v. Heart, pain in the : Baryta carl.
— • palpitation of the : Ars., Lye, Puis., Sulph., Merc, Acid, nitr.,
Calc, Baryt. c, Natr., Agar., Bide, Sec. Heat, general: Nux v., Puis., Lach., Cham., JDulc, Hep., Merc,
Magn. m., Calc, Petr., Phosph., Bry., Ars., Natr. m., Sep., Sil., Carl. a.
et v., Bry., Viol, tr., Alum., Am. c, Colch., Graph., Stilph., Sec. Heat, with anxiety : Puis., Natr. m.
— with dread of, or aversion to being uncovered : Magn
Ideas, sleep disturbed or prevented by flow of: Nux v., Puis., Coffea,
Lye, China. — Sulph., Calc, Staph., Sil., Graph,, Hep., Kal., Cocc,
Led., Salad., Bar., &c. Ideas, by fixed : Pulsatilla.
— gloomy, annoying : Graph., Rhus, Alumina. Inquietude, restlessness in the limbs, (sleep disturbed by) : Puis.,
Nux v., Sulph., Kreos., China. Itching, or tickling in the body: Nux v., Puis., Merc, Sulph., Thuj.,
Am. c, Am. m., Baryt. c, Cocc, Croc, Kreos., Mez., Berl., Sec.
Jactitation : Aeon., Ars., Bella., Cham.' — Coffea, Alum., Asa., Calc, Lach., Hep., Kreos., Plat., Guaj., Hell., Tart., Nix v., Op., Gran., Carl. a. et v., Merc, Puis., Rhod., Phosph., Sil., Jalap, Clem., Cin., &c.
Jaw, hanging of the, during sleep : Nux v., Op.
Jerking, Shocks, Starts or twitchings (sudden) : Ami., Ars., Bella., Cupr., Kali., Lye, Natr., Puis., Sil., Sulph., Tart., Thuj., Carl, v., Cham., Op., Lgn.,,Con., Staph., Sep., Mgs. arc, Merc c, Phosph., Cast., Sec.
Jerkings, or Convulsions in the eyes : Cocc, Puis. — — in the face : Op., Rheum.
570 DISEASES OE PARTICULAR ORGANS AND REGIONS.
Jerkings, or Convulsions in the fingers: Coce, Rheum, Ac. sulph., Anac, Ars.
— — in the feet : Phosph., &c.
— — : of the head: Coce, Magnetus polusArcticus
— — of the legs : Phosphorus.
— — of the mouth : Op., Anac, Puis.
— — of the tendons (subsultus tendinum) : Belladonna.
Joints, sleep disturbed by pain in the : Silicea.
Lamentations (during sleep) : Stan., Nux v., Alum., Phosph., Sulph. Lancinations, or shooting pains indifferent parts of the body:
Cann., Buph. Laughter (during sleep) : Alumina, Bycopod., Stram. Limbs, pains in the : Nux #., Lack., Sulph., Calc., Con., Ac. nitr.,
Am. c, Am. m., Anac, Berb., Card, v., Phosph. Loins, pains in the : Am. m., Berh., Kreos.
Mastication (while sleeping) : Calcarea.
Meditation, reflection, during sleep : Back., Anac, Bry., Ign.
Moaning, during sleep : Bach., Puis., Acid, m., Ipecac, Bella., Alum.,
Bry., Nux v., Cham., Op., Sulph., Lye, Veratr., Phosph., Ars., Am.,
Rheum, &c. Murmurs, or muttering during sleep : Op., Sulph. Mouth open, during sleep : Op., Merc, Rhus, Samb., Mgs.
Nightmare {Incubus. Bphialtes) : Nux v., Puis., Op., Sulph., — Silicea, Ruta, Valeriana, Aeon., Am. carb. — Bye, Magn. m., Natr. m., Bry., Hep., Con., Bella., Am. m., Kali, Alum., &c.
Oppression at the chest (during sleep, or at night and preventing sleep) : Arsen., Carb. v., Cham., Graph., Sulph., — Calc, Bye, Op., Aeon., Alum., Kali, Kali ch., Phosph., Ran., &c.
Pollutions, during sleep : Kali c, Kali h., Sulph., Bye, Ac phosph., Phosph., Con., Carb. v., Puis., Petr., Bed., Par., &c.
Quarrelling, during sleep : Ars.
Respiration, intermittent, during sleep : Opium. — rapid, accelerated : Aeon.
SLEEPLESSNESS, 571
Respiration, short : Aeon. Cham., Rhus, Mere.
— slow : Op., Cinchona.
— Wheezing, whistling : Nuxv.
Scrobiculus cordis, pain in the : Cede, c, Kali e.
Sighs, during sleep : Lack,, Merc.
Singing : Bella., Croc, Phosph. ac, Mgs. arc.
Sliding, or sinking down to the foot of the bed during sleep : Ars.,
Acid. m. Snoring loud, or stertorous breathing : Op., Cart, v., Stram., Nux v.,
Ign., Cham., Sulph., Sil., China., Rheum, Rhus, &c. Somnambulism : Op., Bry., Phosph. — Alum., Natr. m., Sil., Sulph. Soreness of the throat (pain in the) during sleep ; Ammon. m. Starts : A^nb., An., Bella., Cham., Cupr., Bros., Hep., Lye, Puis., Sil.,
Sulph., Tart., Thuja. — Nux v., Hep., Calc, Carl, v., Chin., Cocc, Castor,
Baph., Hyos., Aeon., Agn., Alum., Am. c., Ant. c., Merc., Magn., Ign.,
Bach., Kali, Plumb., &c. Starts, when touched : Stram.
— with gestures indicative of fright or terror : Stram. Stomach, pain in the : Bye, Con., Alum., Graph., Kali, Am. c, Acid.
nitr., Sulph., Sil., Rhus, Sen., &c.
Talking, during sleep : Puis., Sulph., Nux v., Ahim., Am., Ars., Bella., Calc, Camph., Carlo, a. et v., Cham., Kali, Magn., Magn. m., Merc, Muriat. ac, Natr. m., Nitr. acid., Phosph., Phosph. acid., Plumb., Sep., Sil., Stram., &c.
Toes, pains in the, during sleep : Am. carb. Trembling : Eiophorbium.
— internal : Natrum m.
Uncovering of the arms, &c, during sleep : Plat., Corr. mbra,
Magn. polus arcticus. Uneasiness, general, sensation of, during sleep : Ars., Merc Urine, emission of, during sleep : Am. carb., Am. muriat., Bach., Con.,
Graph., Hepar, Bella., Ars., Baph., lod., Cup., Coffea, Natr. m., Sulph.,
Calc, Carb., Op., Bye, Sep., Sil., Merc Petr., Mgs. aus., Cin., &c.
(See Enuresis.) Vertigo : Sulph., Calc, Am. c, Natr., Phosph., Spong., &c. Visions, during sleep : Bella., Cham,, Bed., Merc, Phosph., Phosph, ac>
Stram., Sulph, , &c.
572 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Visions, frightful : Bella., Sulph., Calc, Card, v., Merc, Sil.
— horrible : Card, anim., Sec. Voluptuous, sleep retarded or disturbed by: Calc. carl.
Weeping, during sleep: Puis., Sulph., Calc, Nux v., Alum., Am., Ars., Bella., Camp7i., Carlo a. et v., Cham,, IKali., Magn., Magn. m., Mgs., Merc, Mur. ac, Natr. m., Nitric acid., Phosph., Phosph. acid-, Plumb., Rhus, Salin., Sep., Sil., Stann., Tart., Zinc
Sleep, Lethargic, stupefying : Aeon., Ant., Bella., Calad., Camph., Graph., Bach., Nux v., Op., Puis., Hyos., Laur., Led., Mosch., Nux mosch., Phosph. ac, Plumb., Stram., Tart., Veratr., Mag. arc, &c.
Sleep, lethargic, alternately with sleeplessness : Bachesis.
Somnolency, or drowsiness in the open air : Tartarus.
— day and night : Baryta, c
— in the evening : Ant., Ars., Tart.
— in the forenoon ; Ant. crudum.
— in the morning : Mephites putorius. Sleep, broken, interrupted : Cocc, Ars., Big., Par., Zinc
— incomplete, imperfect, half asleep : Ars., Bella., Bry., Bach., Merc, Hepar., Cham., Cocc, Op., Acid, nitr., Cic, Euph., Sil., M. arc, Graph., Kali, &c.
Sleep, light: Nuxv., Bach., Ign., Sulph., Merc, Aeon., Alum., Ars., Sel., Sil., Calad., 01. an., Tart.
Sleep, protracted, too prolonged : Merc, Stdph., Plat., Puis., Hepar, Berl., Bar., 01. an., Phil., &c.
Sleep, profound : Ant. tart., Nux mosch., Op. — Ars., Bella., Ign.,Baur., Bed., Mgs., Phosph. ac, Puis., Bhod., Sec. corn., Seneg., Stram., Veratr., Aeon., Anac, Ant. c, Bar., Bry., Camph., Con., Croc, Cup., Hyos., Petr., Phosph., Ruta, Sep., Spig., Zinc, &c.
Sleep, unrefreshing : Bry., Con., Hepar, Op., Sulph. — Ami., Bism., Calc, Cann., Bach., Bye, Natr. m., Nitric acid, Petr., Selen., Sil., Staph., Ahim., Am. m., Anac, Carl, a et v., Cham., Kali, Mag. arc, Magn., Magn. m., Merc, Ban. lull., Sepia, Spig., Stann., Stram., Veratr., Sec.
Sleep, of too short duration : Nux v., Calc. carl.
— tendency to fall asleep when in the open air : Aeon., Tart., M. aust.
Sleep, tendency to fall asleep early in the morning : Nux v., Bach.,
SLEEPLESSNESS. 573
Puis., Sulph., Phosph. ac, SiL, Con., Croc, Calc, Carl. v., Bye, Plat., Sep., Kali, Hepar, China, Sec. Sleep, tendency to, during exercise : Aeon.
— during and after a meal : Nux v., Sulph., Aeon., Anac, Arum., Aur., Bor., China, PhospL, Phosph. ac, Verb., Natr. m., Graph., Kali, Calc., SiL, Zine., &c.
Sleepiness in the afternoon : Sulph., Puis., Bov., Bruc., Canth., Grat.,
Viol, tri., &c. (See Sleep, tendency to, after a meal.) Sleep, tendency to, during employment : Sulphur.
— when reading and writing : Natrum sulph.
— when sitting : Bruc., Ferr., Mg., Petr., Tart., Sec.
— during a storm : Silica.
— retarded: Calc, Carlo a. et v., China, Cj/e., Per., Graph., Hyos., Kali, Bach., Bye, Merc, Natr., 01. an., Phel., Phosph., Phosph. ac, Puis., Ban., Stann., Staph., Sulph., Nux v., Natr. m., Nitr. ac, Sep., &c.
Sleep, retarded, or difficult to be renewed after waking during the night : Natr. m.9 Sep., Sulph., Puis., Magn., Am. c, Ars., Berb., Bor., Per., Phosph., Ban., Ban. sc, Sec.
Sleeplessness, alternately with somnolency; Bachesis.
— after midnight : Nux v., Coffea, Ars., Cap., Kali carl., Sil. — Assaf., Aur., Cann., Bulc, Hepar, Magn., Natr., Ban. seel., Sep., Sulph. ac, Aeon., Am., Ant. c, Bry., Calc, Con., Bach., Graph., Merc, Mez., Nitr. ac, Phosph. ac, Plat., Rhus, Staph., Sec.
Sleeplessness, before midnight : Bry., Calc carl., Carl, v., Merc, Phosph., Puis., Rhus toxi., Sep. — Ars., Bella., Bar., Calad., Carl, a., . China, Graph., Hep., Ign., Kali., Bach., Bed., Bye, M. aitst., Mar., Mur. ac, Selen., Spil., Sig., Sulph., Nux v., Con., Alum., Am. m., Ant. tart., Am., Bar., Kreos., Nitr. acid., Natr. m., Stann., Staph., Veratr., Sec.
Sleeplessness, with desire or inclination to sleep : Bella., Cham., Phosph., Puis., Sep. — Ars., Bry., Calc, China, Can., Hep., Kali c, Merc, Natr., Nux v., Phosph. ac, Rhus, SiL, Sulph., Carl, v., Graph., Hyos., Bach., M. arct., Natr. m., Nitr. acid., Staph., Veratr., Selen, Sec.
Sleeplessness, arising from griping pains in the intestines : Bye, Plumb., Sep., Staph., Kali., Amir., Am. c, Am. m., Magn. c, Magn. s., Natr., Ac. nitr., Bhus, Phosph., Sec.
Waking, difficult and retarded : Nux v., Calc, Graph., Sepia. — Natr., Natr. m., Nitr. ac, Phosph. ac, Tab., Teuc, Alum., Mgs., Magn. m., Merc, Natr., Phosph., Phosph. ac, SiL, Sulph., Euphr., Anac, Am.,
574 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Asaf., Carl, v., Hep., Hyos,, Kali, Baur., Natr. m., Nitr. ac, Puis., Veratr., &c.
Waking too early : Nux vomica, Kali carbonicum, Natrum carbonicum, Banunculus bulbosus. — Ars., Atir., Caps., Bulc, Magn. c, Mur. ac, Sulph. ac,Assqf., Calc, Graph., Hep., Lack., Mang., Merc, Mez., Nitr., Nitr., ac, Plat., Ban. so., Bhocl., Sep., Sil., Staph., Thuja, &c.
Waking early 5 and always at the same hour : Selenmm.
— incomplete : Conium.
— with a start : Amb., Ars., Bella., Cham., Bros., Hep., Lye, Bids., Sulph., Bheum., Tart., Thuja, Bry., Graph., Carbo v., Calc, &c.
Waking at the slightest touch (generally with a sudden start or cry) :
Selenium. Waking at the slightest noise : Selenium.
— early^ from a feeling of coldness : Aciclum muriaticum, Fer. mg. Waking caused by violent shocks or jerks in the head and neck :
Magnetis polus arclicus. Waking caused by a feeling of suffocation or obstructed respiration :
Hepar, Ipecac, Sambucus nigra. Waking w-ith headache : Bachesis, Belladonna, Anacardium, Berb., Fer.
mg., Bheum. Waking with colic : Hmmatoxylum campechianum.
— congestion in the head : Berberis.
— congestion and heat in the legs : Mephites putorius.
— diarrhoea: Hcematoxylmm.
— dizziness or giddiness : Ars., China, Flat., Puis., Sol. m.
— erections : Bachesis,
— fear of gosts or spectres : Sulphur.
— hallucinations: Sulphur.
— hunger: Belladonna.
— vexatious thoughts or ideas : Alumina.
— lassitude in the arms : Ferrum magneticum.
- — lassitude general^ or fatigue. See Sleep, unrefreshing.
— pains in the limbs : Ntix vomica, Bachesis.
— pains as if beaten : Bachesis, Viola odorata.
— pains in the loins : Bachesis.
— a sensation of paralysis : Kreosotum.
— perspiration: Merc, Clem., Chel., Cic, Bros., Fer. mg., &c.
Waking with rigidity or stiffness in the limbs : Bachesis.
— stretchings and convulsive yawning : Nux v.
SLEEPLESSNESS. 575
Waking, with bitter taste : Bryonia, Rhus toxicodendron, &c.
— putrid taste : Rheum, Sec.
— tears, cries, &c. : Mercurius.
— thirst : Berberis.
— sore throat : Lachesis.
— trembling : RatanJiia, Sambucus.
— visions (visions are seen on waking) : JDulc, Sulph.
— weakness in the knees : Ferrum magneticum.
Yawning, incessant : Bry., Can., LJuph., Lye, Oleand., 01. an., Phett.,
Rhus, Staph., SulpJi., Viol, od., Zinc., Nux v., Puis., Ign., Amm., Ant.
tart., Am., Ars., Bry., Cina., Kreos., Che\., Croc, Laur., M. arct., Men.,
Mtor. ac, Natr. m., Oleand., Bar., Phosph., Ph. ac, Sabad., Sassqfr.,
Sep., Sil., Stann., Staph., Ahim., China, Card, v., Sulph., Merc, Veratr.,
Bella., Caps., Bar., Canth., Hep., Zinc, &c. Yawning, abortive : Lycopodium, Cham., Ruta, Aeon., Ign., Croc,
Phosph. Yawning, violent: Ignatia, Hepar, Platina, BJms, Agar., Mosch., Cor.,
Per. mg., Magn., Mgs. arc. Yawning, spasmodic : Platina, BJms. — Ignatia, Hepar, M. arc, Sep. —
Ang., Bry., Cap., M. aust., Mosch., Laur., Natr. m., Scill. Yawning, without feeling sleepy : Platina, Rhus. — Ign., Mag. arc,
M. aust., Sep., Bry., Hep., Lach., Scill., Ang., Natr. m., Mosch., Cham.,
Cup., SulpJi., StapJi., Alum., Amm. m., Sec. Yawning, frequent, in the afternoon : Canth., Ign., Plat.
— — morning : Nux v., Ign., Viol. od.
— while walking : EupJwrhium.
— — Natrum sulphuricum.
— Cutis anserina ; Lauroceresus, Paris quadrifolia.
— shaking, shivering, or shuddering : Laur., Kreos., Natr. s., Par., Sil.
Yawning, lachrymalian : MepJi., Violod., Staph., Kreos.
— with oppression or tightness at the chest : Stannum.
— stretching: StapJi., Nux v., CJiina, Guaj., Natr. s., 01. an., Ruta, Sabad., CantJi., Oniscus, Tart., &c.
Yawning, with tremor: Cina, Oleander.
— vertigo : Agaricus rmiscarius.
576 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Position during Sleep.
Arms above the head (during sleep) : Pulsatilla, Nux v., Plat., Calc,
Coloc. — Rheum, Ruta, Thuja, Veratr., Sulph. Arms across the abdomen : Pulsatilla, Coc, Mags*
Back, on the (dorsal) : Bryonia, Pulsatilla, Rhus. — Nux v., Sulph., Calc, Lye., Ign., Cic., Ferr. — Aeon., Ant. tart., Aur., China, Coloc., Dros.y Mgs., Mgs. arct., Phosph., Plat., Viol., &c.
Hands under the head : Nux^ v,, Ars., Bella., Plat., Coloc., Men. — Aeon., Amir., Ant. tart., Ign., Mgs., M. ausl., Puis., Rhus, Sabad., Spig., Viol. od.
Head inclined forwards, with the: Staph., Aeon., Puis., Cic., Cup., Viol. od.
Head inclined to one side : Cina, Spong., Tar ax.
— elevated^ high, with the : Sulphur.
— low, or buried under the bedclothes : Spong., Am., Sep., Nux v.
— thrown back, with the : Bella., Cina, Spong. — Cic, Hep., Hyos., Ign., Sep. — China, Nux v., Cap., Mgs., Stan., Viol. tr.
Knees, bent : Viola odorata, Ambr., Mgs.
Legs drawn up : Puis., Plat., Card, v., Stann. — Anac, Cham., Chin.,
Mang., Men., Rhod. Legs widely separated : Cham., Puis., Bella., Plat., Rhus. — Agar.,
China, Pule. Legs, one of the, bent, the other extended : Stannum.
— crossed : Rhodendron crysanthum.
— stretched out : Cham., Plat., Mgs., Puis., Viol. od.
Seated (in a sitting posture) : Sulph., Cina., Bye, Ars., Rhus. — China,
Hep., Phosph., Puis., Sabin., Spig. Forwards : Cic., Cap. Side, on the left : Baryta carbonica, Sabina.
Positions in which it is impossible to recline or sleep*
Back, on the ; Phosphorus.
Recumbent posture, inability to remain in the : Sulphur, Lycopodium.
Side : Aconitum, Sulphur.
— left (incapability of lying on the) : Lycopodium.
NIGHTMARE. 577
NIGHTMARE. Incubus. Ephialtes.
When this well-known and distressing disturbance occurs very frequently in an aggravated form, it becomes necessary to prescribe for it. The homoeopathic remedies which have chiefly been em- ployed against it to the best advantage are Aconitum, Nux #., and
Aconitum. When there is considerable febrile excitement, with quickness of pulse, thirst, palpitation of the heart, oppression at the chest, anxiety, and agitation.
Nux v. :— When nightmare is occasioned by sedentary habits, the habitual indulgence in spirituous or malt liquors, &c.
Pulsatilla : — When there is derangement in the digestive func- tions, arising from gross living, heavy suppers, &c.
Opium is a remedy of importance in all cases of a severe character; but particularly when, during the attack, the respiration is nearly suspended, or stertorous, the eyes only half closed, the mouth open, the countenance expressive of extreme anguish, and bedewed with cold perspiration ; subsultus tendinum. When any of the foregoing remedies, but especially Nux v. and Pulsatilla, are insufficient to effect a cure, Sulphur or Silicea may be resorted to in repeated doses. In other cases, one or more of the following may prove useful : Phos- phorus, Ruta, Valerian, Ammonium c, and Hepar. Every apparently exciting cause of the attacks must at the same time be avoided ; the diet should be light and wholesome ; suppers altogether abstained from, and a glass of cold water taken instead, on retiring to rest.
Daily exercise in the open air, the shower-bath, or sponging with cold water every evening, are useful preventives, or auxiliaries during treatment.
37
57S DISEASES OE PARTICULAR ORGANS AND REGIONS.
RUPTURE.
Hernia.
By this term is understood a swelling occasioned by the protrusion of some of the viscera from the cavity of the abdomen. In the ge- nerality of cases, the displaced intestines are included or contained in a bag, derived from the peritoneum, which they push before them in their descent. The situations in which the swelling most commonly makes its appearance are the groin, the navel, the scrotum, the labia pudendi, and the upper and anterior part of the thigh. It also occurs in the vagina, perinaeum, foramen ovale, and sciatic notch, and occa- sionally at every point of the fore part of the abdomen. The viscera which are most frequently protruded are the omentum and the small and large intestines, or a portion both of omentum and intestine. But the stomach, liver, spleen, bladder, uterus, and ovaria, &c, have been known to form component parts of hernial tumours. ,In con- sequence of the tumour escaping at the different situations above mentioned, it has received the appellations of inguinal,* umbilical,^ scrotal,^ pudendal,^ crural or femoral, vaginal, perineal, thyroideal,\ ischiatic and ventral, &c. Further, from containing different kinds of viscera, it has been designated epiplocele, when its contents consist of a piece of the omentum only ; enterocele, when of a fold or portion of intestine ; and entero-epiplocele, if both intestine and omentum con- tribute to form the swelling. A hernia or rupture, for the most part, appears suddenly after some violent corporeal exertion, and presents an indolent, and usually soft and elastic tumour, at some of the points or situations already referred to, but most frequently at the lower and lateral part of the abdomen (the groin), or towards the inner part of the bend of the thigh, or at the navel (descending from the abdominal ring in the first-mentioned instance ; from below Poupart's ligament in the second; and out of the umbilicus or navel in the third). The swelling is subject to a change of size : being smaller or quite im- perceptible when in the recumbent position ; larger or only apparent on assuming the erect posture, and particularly when taking a full
* Or a bubonocele. t Or an exomphalos. Omphalocele.
X Or an oscheocele. § Or a bubonocele.
(i Or hernia foraminis ovalis.
RUPTURE. 579
breath/ coughing^ or sneezing; also on walking or standing long after a hearty meal. It is frequently diminished, or caused to recede com- pletely when pressed upon, but returns as soon as the pressure is removed. Vomiting, constipation, colic, and other signs of a deranged state of the stomach and intestines, are frequent concomitants of rupture, arising from the abnormal situation of the viscera.
The nature of the contents of the hernial tumour are generally known by the following distinctions : if the case be an enterocele, the swelling is smooth, elastic, rendered tense by coughing, or by holding the breath ; is in general very easily returnable, and usually attended with a gurgling noise when ascending. An epiplocele, or omental hernia is, on the other hand, of a more uneven and doughy or flabby texture ; is neither made tense, nor receives any impulse from cough- ing; is more compressible, and, if large, or in the scrotum, is more oblong and heavier that enterocele ; it recedes very gradually, and its reduction is unattended by any gurgling noise.
An enter o-epvplocele, or a hernia composed both of intestine and omentum, has the characteristic marks less distinct than either of the preceding cases ; when reducible, it is known, in pressing back the contents, by the gurgling noise which attends the ascent of the in- testinal portion, while that of the omentum is reduced without noise, and with greater difficulty ; otherwise, the feeling communicated to the touch is often sufficient to render this variety distinguishable from the others.
Causes. The predisposing causes of hernia are : general relaxa- tion, or unusual largeness of the natural openings of the abdomen. When any such proclivity exists, particularly in children and the aged, the viscera are occasionally protruded by trivial circumstances, such as crying, coughing, sneezing, or even by the act of a somewhat full inspiration ; but in other cases, or where there is no marked predisposition, the protrusion only takes place under great bodily exertion, or in consequence of external injury. When rupture ensues in consequence of predisposition, or seems to take place sponta- neously, its formation is very gradual ; but when it results from ex- treme corporeal exertion, it appears very suddenly, and if the opening through which the bowels protrude be small, as is generally the case in such instances, there is much danger of strangulation.
Hernia is termed reducible when it can at airy time be readily
580 DISEASES OF PARTICULAR ORGANS AND REGIONS.
returned into the abdomen, and when, in an unreduced state, it is productive of no pain, or hinderance to theperformance of the intes- tinal functions ; irreducible, when it cannot be replaced, in consequence of its bulk, or from the contraction of adhesions ; and strangulated, when the protruded parts are not only incapable of being returned, but are moreover affected with constriction, pain, and inflammation, attended with nausea, frequent retching or vomiting, tension of the abdomen, obstruction of the bowels, quick, hard, pulse, and more or less fever. If the return of the intestine be not effected under such a state of matters, an aggravation of all the said symptoms at first ensues, and subsequently the vomiting is exchanged for a convulsive hiccough, with frequent bilious eructations ; after the abdominal ten- sion, fever and extreme restlessness have continued for a few hours in an increased degree, the patient suddenly becomes relieved from pain, the pulse low, feeble, and intermittent, the eyes dim and glassy, the belly ceases to be tumid and tense, and the skin, particularly that of the extremities, becomes cold and moist ; the hernial swelling disappears, and the integuments over the part often change to a livid hue, but invariably convey an emphysematous feel or crepitus to the touch, indicative of the establishment of gangrene : finally, spasmodic rigors and convulsive twitching in the tendons supervene, and death soon terminates the scene.
Therapeutics. When the disease has not been neglected, or is not of long standing, it may very generally, if not invariably, be cured by means of internal homoeopathic remedies.
In effecting the reduction of a hernia by the taxis, the patient should be laid upon his back, a pillow being placed under the chest and pelvis, so as to curve the trunk of the body, and thereby relax the abdominal muscles. If the case be one of inguinal or femoral hernia, the muscles, &c, of the thigh must also be relaxed, by placing the limb in a state of flexion, so as to be rotated inwards. Then gently compressing the tumour, we should push upwards and out- wards, in the case of inguinal hernia ; and first backwards and then upwards, in the case of femoral, if the tumour be small ; but first downwards, and then backwards and upwards, when it is large and reflected over Poupart's ligament.*
* In Umbilical hernia the pressure is to be made directly backwards.
RUPTUItE. 581
Even strangulated hernia is capable of being reduced by the taxis with facility, after the employment of the proper remedies, particularly Aconite and Nux vom. ; the operation, which is always more or less dangerous, being thereby avoided.
In almost every instance, but particularly when the rupture causes pain, and is tender to the touch, the appropriate medicine ought first to be prescribed, — since, if the remedy selected should not prove adequate to produce reduction, it will at all events have the effect of removing the irritability, and,' consequently, of rendering re- placement by the taxis comparatively easy, and free from the danger which would otherwise have attended any attempt at manual reposi- tion, preparatory to the dispersion of the irritation. In some cases, the application of w7arm fomentations to the part reduces the hernia, and the general relaxing effects of a warm bath are well known as being useful in facilitating reduction. The following treatment has been strongly recommended when the symptoms encountered are as described : —
Aconitum. When there is considerable fever, with quick, hard, full pulse, inflammation of the affected parts, with excessive sensibility to the touch ; violent burning pain in the abdomen ; hitter > bilious vomiting ; agonizing restlessness, and cold perspiration. A second dose to be given, if required, an hour after the first, or even a third after a similar interval. In the majority of cases, marked benefit has resulted after the administration of the first dose of Aconitum, under the circumstances mentioned ; but when no change for the better re- sulted after the third exhibition, or when the bilious eructations and vomiting become converted into an acid character, Sulphur must be prescribed, and if the patient fall asleep thereafter, he should be allowed to repose quietly.
When the tumour is not so painful or tender to the touch, and the vomiting less severe, but the respiration oppressed and laborious, and the strangulation has arisen from errors in diet, from exposure to cold, from being overheated, or from a violent fit of passion, etc., Nux v. is to be preferred, and may be repeated every two hours or so.
If no change results in about two hours after the second dose of Nux v., — Opium should be prescribed, or this remedy may be had recourse to from the first, and repeated every quarter of an hour, until improvement takes place, should there be hardness and disten- sion of the abdomen, putrid eructations, or even vomiting of faecal
582 DISEASES OE PARTICULAR ORGANS AND REGIONS.
matter. (Plumbum may be given after the third or fourth dose of Opium, if no decided change for the better become perceptible.)
When there is retching and vomiting, with cold moist skin and coldness of the extremities, — Veratrum should be administered and repeated in from half an hour to an hour or so ; and in the event of no favorable turn taking place after the second dose, — Belladonna should be prescribed.
When the case has been neglected, or we find, on visiting the pa- tient, the malady already advanced so far that the integuments over the rupture have assumed a livid hue, and there is reason to appre- hend the invasion of gangrene, the patient may yet be saved by the administration of Lachesis in repeated doses; if no relief follow in the space of about two hours, Arsenicum may be tried. Rhus has also been spoken of as being serviceable in extreme cases. The operation should not be delayed, when symptoms of a serious character do not speedily yield to the remedies indicated; but the latter should always be tried first, as no bad consequences will result from the delay under the precautions stated ; on the contrary, the subsequent manual treatment has been found to be thereby materially facilitated.
[The following practical remarks of M. Traub,* on the homoeo- pathic treatment of incarcerated hernia, appear to us to require no apology for their insertion here.]
Incarcerated Ruptures. {Hernia incarcerate.)
Incarcerated herniaebelong undeniably to those diseases, in the treat- ment of which, the old method appeared in one of its brightest lights ; having, in most cases of incarcerated ruptures treated in accordance with its dictates, succeeded in accomplishing the two desirable ends, viz. : the removal of the incarceration, and the reposition of the pro- lapsed parts, without resorting to an operation. According to my own calculation, this has always been the case in three out of four. But if we consider that the remedies which the old method employed for this purpose, wTere by no means of the most agreeable descrip- tion to the unfortunate patient, but that, on the contrary, he had to suffer excessively during the treatment, we may justly rank homoeo- pathy above her older sister, (even if we were to take it for granted
* Beitrage Zur Homceopathie, vom Landchirurgus Traub in Schonigen. — Allg. Horn. Zeit. No. 12, 31ster Bd.
RUPTURE. 583
that the former also succeeds only in three cases out of four) because she attains her object by far more gentle means.
But homoeopathy does more, though not so much as some exag- gerating panegyrists boast, yet decidedly more than some talented practitioners are disposed to admit. Dr. Lobethal, of Breslau, e. g., assures us in his contributions to the " Pharmako dynamik. nach homceopathischen principien," (Allgem. Homceop. Zeitung, 13 Band, 18 Nummer), where he describes the effects of Nux vomica with his customary exactness, that he has not observed, in incarcerated her- nial, the effects ascribed to and expected from this remedy, and he adds that the external treatment of hernia, appears to him, according to the character of the incarceration, to be more efficacious than the employment of Nux, Belladonna, and Aumm.
It were much to be regretted, if the prejudice caused and promul- gated by such unfavorable experience, wTere to induce practitioners never to have recourse to specific medicines in cases of incarcerated hernia, or, at all events, to do so with but little confidence. In order to prevent the possibility of this prejudice taking place, it is desirable that many such cures should be made known ; and this is the reason which- induces me to communicate the observations that I have hitherto had an opportunity of making, in my own practice, on the homoeopathic treatment of incarcerated hernia. From the time that I commenced to treat my patients on the principles of homoeopathy, but few incarcerated ruptures have occurred to me in which the homoeopathic medicines have failed to prove their specific power, (the proportion is as one to ten,) through which I have become con- vinced that homoeopathy has obtained a great triumph over the old method in the cure of this disorder also.
In treating incarcerated herniae with homoeopathic remedies, I consider it necessary that the patient should preserve, uninterrupt- edly, such a position that, after the incarceration has been removed^ the protruded parts shall either fall back into the cavity of the abdo- men by their own gravity, or be drawn back by the other intestines, and no manual efforts whatever be made to attempt the reduction.
To remove the incarceration, homoeopathy selects, as is well known, such medicines, which, if taken by a healthy person in an appropriate manner and in sufficient quantity, produce positive symptoms, very similar to those of Hernia incarcerata, with the view of lessening and removing the morbid muscular contraction by the reaction of the vital power, (according to the unchangeable law of nature, through
584 DISEASES OF PARTICULAR ORGANS AND REGIONS.
which the reacting vital power constantly strives to call forth a tone and activity opposed to that which has been positively excited in the organismus by some extraneous influence, and thus restores the equilibrium and the harmony of the vital functions).
In order to ensure the most favorable action of specific remedies, the patient should be kept as quiet as possible, and allowed to remain undisturbed, all manipulations made for the purpose of accomplishing reposition, having the effect of producing a primary, or so to speak, violent or forcible dilation of the contracting muscles, by which an increased contraction is caused through the reaction of the vital power, and in consequence of which the beneficial effects of the medicine employed is thereby materially obstructed. The same is the case with most remedies which are applied externally, wherefore, the external treatment of an incarcerated rupture is, in most cases wrhere homoeopathic remedies are employed, not only superfluous, but even detrimental.
If, in treating an incarcerated hernia, both homoeopathic medi- cines and external treatment are employed, and the reposition suc- ceeds, this result is no doubt to be looked upon rather as the effect of the latter than of the former, because the homoeopathic medicines are interrupted in the display of their positive effects, and the vital power cannot, under such circumstances, exert a beneficial reaction ; in this case Dr. Lobe thai is perfectly right when he says : The exter- nal treatment of a rupture appears to him to effect more than Nux9 Belladonna, and Aunim. But if, under the external treatment of a rupture, the reposition does not succeed, the bad effects of the incarceration will increase the more rapidly, and the necessity of an operation will be indicated the sooner ; moreover, the success of the latter will be rendered the more doubtful the greater the degree of external violence which may have been used, since the evil conse- quences of these rude interferences continue even after the ope- ration.
The homoeopathic materia medica possesses already a considerable number of remedies by which the symptoms of incarcerated hernia can be more or less simulated, but only a few of these have been employed up to the present time. In my own practice I found the greatest assistance from the following :
1. Nux VOMICA,
2. acidum sulphuricum,
3. Lycopodium,
4. Belladonna.
RUPTURE. 585
And, finally, I must mention one more remedy, which, although it does not offer in the series of symptoms that it is capable of pro- ducing, those which accompany the formation and incarceration of a hernia, can yet not be dispensed with as an appropriate intermediate or auxiliary remedy in certain forms of incarcerated ruptures, on account of the unlimited influence which it exercises upon the vascular, and chiefly upon the capillary system, and accordingly not only comprises among its symptoms the type of inflammatory fever, but also the type of acute local inflammation ; farther, on account of its effects upon the mind, which manifest themselves particularly in the form of inconsolable anguish, forebodings of death, and great disposition to be frightened, — states of mind which we not unfre- quently meet with in persons affected with incarcerated hernia : I allude to Aconitum Napellus.
The method I have hitherto adopted in the treatment of incar- cerated ruptures is as follows : —
Having convinced myself of the existence of an incarceration, I first place the patient in a comfortable reclining posture, the chest and the pelvis somewhat raised, in order that the abdominal muscles may be relaxed as much as possible; the "lower extremities being, at the same time, moderately drawn up. The patient having continued in this position for a few minutes, I proceed to the selection of the remedies.
In reference to the concomitant symptoms, we meet with three forms of incarcerated herniae, which present materially different marks of distinction.
First form of Incarceration.
The rupture has just occurred for the first time, or one that had formerly existed has reappeared, and has suddenly become incar- cerated, in which case the rupture is always small, the symptoms appear suddenly and with greater intensity ; they consist in a pinch- ing or squeezing and pressive sensation in the region of the rupture ; violent dragging pain with periodical tearing, and a sort of spas- modic constriction in the abdomen ; nausea, inclination to vomit, and actual vomiting of an acid mucus ; obstruction, with frequent inclination for stool ; most of these symptoms are increased by the slightest pressure on the rupture, as also by movement.
Nux vomica corresponds with the symptoms of this form of incar- ceration. I accordingly give 10 — 15 globules of one of the higher
586 DISEASES OF PARTICULAR ORGANS AND REGIONS.
potencies every half hour or every hour. Frequently a remission of the symptoms takes place after the first dose or two ; if, at the same time, a sensation of movement takes place in the rupture, or if a gurgling noise be heard, then a remission of the incarcerating mus- cular contraction, and a speedy replacement, without any external treatment, may be expected. Should this not be the case, but/ on the contrary, the sufferings return again with unabated vigour ; or if an oppressive soreness or pain as if from a wound, and a violent burning, prevail in the region of the rupture, and the superincumbent integuments become very sensitive to the slightest touch ; or if the heat in the affected parts increases, and thus betokens an increased de- termination of blood towards these parts ; or should the incarceration have been preceded by a fright, or some other mental affection, and the patient be in a state of general irritation or excitement, then I usually give one drop of Aconitum of the third to the sixth dilution, and, an hour afterwards, Nux vomica at a lower dilution than in the first instance, and in a liquid form in preference, (Nux vom.9 2. gtt. x — xv, Aq. destill. 5\j) a teaspoonful every half hour to an hour.
Second form of Incarceration*
The rupture becomes suddenly incarcerated and is generally small ; tearing, dragging pain, both in the rupture itself, and in the whole abdomen predominates ; the patient sometimes experiences fugitive stitches in the region of the rupture ; the pains undergo periodical remissions — disappearing almost entirely for a time, and then return- ing wTith increased violence ; the patient feels much exhausted during the remissions; he complains of a general sensation of cold; the abdo- men is much distended by flatus ; after a continued desire to vomit, the patient eventually vomits an acid-tasting fluid; and, notwith- standing a very urgent inclination for stool, no evacuation takes place.
In this form of incarceration likewise, Nux vomica is an excellent medicine, but Lycopod/bum vies with it in efficacy ; I generally admi- nister both these medicines alternately, at intervals of one to two hours. If, however, these symptoms appear in a crural rupture, if they take place in a woman, or has the incarceration in the latter case taken place during or immediately after the appearance of the menses, and if, moreover, the individual is of a mild, yielding, dispo- sition, Lycopodium is to be preferred. I give this medicine in the middle attenuations (10—15) either in globules or in the liquid
ILUPTURE. 587
form (Tinct. lycop. gtt. xv; Aq. destill. gj), a teaspoonful every half hour, or every hour. If throbbing, burning, and other symp- toms indicating Aconitum become predominant, I administer the latter as an intermediate remedy.
Third form of Incarceration.
The third form of incarcerated hernia, (which occurs chiefly in aged peif&ons, and in ruptures of long standing, that have, for the most part, been kept back by appropriate bandages, or have been continually protruding, and have attained a large size) is that in which the incarceration comes on insidiously and imperceptibly, and betrays itself at first only by a distressing, pinching, and constrictive sensation of the region of the rupture, by uneasiness and fulness in the abdomen, and by periodical sickness and constipation. The rupture is not very painful to the touch, the incarcerated part is also not so tense and hard as in the two preceding forms, but feels more doughy. This incarceration may often exist for days, without any perceptible increase in the concomitant symptoms ; gradually, how- ever, twitchings and pinchings, combined with periodic, transitory, tearing pains, supervene in the abdomen and groin; the sickness then becomes more lasting, a sweetish, saline, or bitter fluid is some- times eructated, and is not unfrequently followed by vomiting of a watery fluid, and subsequently of ingesta.
In this form also, two medicines concur, and the one is again Nux vomica, which competes here with Acidum suljj/mricum for the rank of priority. If the patient is of a sanguineo-choleric temperament, which, however, is but seldom the case, Nuos vomica, at a low dilution, must be given first ; and should the removal of the incarceration, not be effected within twelve hours Acidum sulp/mricum must be administered. If the incarceration takes place on the left side, and the patient is of a melancholic-phlegmatic temperament, Acid, sulp/m- ricum should be employed from the beginning. I have hitherto been in the habit of prescribing in the disorder in question, a drop of the tenth dilution of this medicine to be taken every hour.
By means of the foregoing treatment of incarcerated hernia, I say it with heartfelt joy, I have always more readily and more frequently succeeded in attaining the desired result, than was the case in my former practice, when I treated my patients in accordance with the principles of the old school. If my assistance was sought sufficiently early, it formed a rare exception to the rule, when an incarceration
588 DISEASES OE PARTICULAR ORGANS AND REGIONS.
of the first and second form was not removed within eight hours, and that of the third form within twenty-four hours. Still more rarely did it happen that the homoeopathic medicines entirely failed to remove the incarceration, and where it consequently became neces- sary to perform an operation.
It is very much to be regretted that homoeopathy cannot yet renounce the operation as the last resource in the treatment of incar- cerated hernia ; whether this will ever be possible, I Shall not investigate here ; we may, however, presume, with every appear- ance of certainty, that those cases in which the operation is now deemed indispensable, will become more and more scarce, the more closely that the re-provings of medicines already known, and the provings of others yet unknown, or untried, will be discovered to approach in similarity individual forms of this disease.
If the homoeopathic medicines do not remove the incarceration within a given space, to be determined by each individual case ; but if, on the contrary, symptoms of a more troublesome and dangerous character make their appearance ; if not only the rupture itself, but also the abdomen and the epigastric region become very sensible to the slightest touch ; if the existing pains and the tension of the abdomen become more intensely violent ; if nausea, the inclination to vomit, and the vomiting itself increase, and the patient vomit more liquid than he has taken, even during the prevalence of excessive thirst ; should traces of bile or of other intestinal contents be dis- covered in the matter ejected; if high fever, with a hard, full pulse supervene, and the patient become more and more restless, it is to be presumed that the medicines administered (although no others can be found that correspond better with the form of the disease under treatment,) are either not strictly homoeopathic to the case, or that they have been employed in an improper dose, or, finally, that the medicine appropriate to this individual case, is as yet unproved, and therefore unknown. Under such circumstances I never hesitate for a moment to propose an operation, and if the patient consents, to perform it as soon as possible.
FAINTING. 589
FAINTING. SWOONING.
Syncope.
Individuals of weak nerves and delicate constitutions, particularly of the female sex, are frequently subject to fainting fits, which, al- though rarely dangerous, yet when utterly neglected, or inappro- priately treated by violent or very debilitating means, are prone to become serious, and even fatal.
The usual causes are sudden transitions from cold to heat ; breath- ing vitiated atmospheres ; great fatigue ; loss of blood ; long fasting ; grief, fear, and other mental emotions.
When fainting occurs, the patient ought immediately to be removed to where a stream of pure fresh air can be obtained, and freed from all tight clothing about the neck, chest, and abdomen ; he should at the same time be placed in a comfortable position, with the head low. If the foregoing prove insufficient to effect restoration, sprinkle cold fresh water on the face and neck, and, if necessary, on the pit of the stomach. Should there still be no marked benefit produced, or if the patient becomes cold, a little spirits of camphor may be applied to the nose. When the fainting has arisen from fright, the best medi- cines for the consequences are Aconite or Opium, and sometimes Colo- cynth. (See Mental Emotions.) After great depletion, or other debilitating causes,— Cinchona, and, in some instances, Nux v., Card, v., and Veratrum; also a little wine in very small quantities at a time, or a little bread or biscuit, soaked in wine, and sometimes a little strong soup may be administered. Should the fainting arise from mental emotions, Ignatia and Chamomilla are the remedies in general cases. (See Mental Emotions.) When slight pain causes fainting, Hepar sulph. Fainting from violent pain, Aconite, Chamomilla, or Cocculus. If the affection is liable to result from even the most trivial degree of fatigue, Veratrum. When it is produced by excessive mental application, or in those who have been addicted to the use of ardent spirits, Nux vomica.
In other cases, the following remedies have been recommended where the corresponding symptoms are met with : —
Aconitum. When there is a palpitation of the heart, with deter- mination of blood to the head, humming in the ears ; or when the paroxysms come on usually on assuming the erect posttire, and are accom-
590 DISEASES OF PARTICULAR ORGANS AND REGIONS.
panied with shivering and flushing of the face, succeeded by deadly paleness.
Coffea may be prescribed after Aconitum in highly excitable or nervous subjects, when the fainting fit has arisen from fright, and the last-named medicine has not relieved much.
Hepar sulphuris, when the fit generally comes on towards evening, and is preceded by vertigo.
Lachesis, when the faintingfits are either preceded, accompanied, or followed by asthmatic symptoms, vertigo, paleness of the face, nausea, vomiting, convulsions, spasms of the jaw, rigidity of the body; bloated appearance of the face ; epistaxis ; aching pain or stitches in the fore part of the chest ; cold perspirations. (See Veratrum.)
Moschus : — Fainting fits, attended with spasms in the chest, or succeeded by headache, and occurring towards evening, during the night, or in the open air.
Veratrum, when the attacks are excited by the slightest fatigue ; or when they are often preceded by a feeling of extreme anguish and excessive dejection, or despair, and accompanied by spasmodic clenching of the teeth, and convulsive movements of the eyes and their lids.
Nux v. is a beneficial remedy when the fits take place particularly in the morning, after a meal, or after taking exercise; and there is nausea, with paleness of the face ; also, when the patient complains, on recovery, of pain in the stomach, sparks before the eyes, or dimness of sight, together with a feeling of anxiety ; and is, further, affected with anxiety, trembling, and congestion in the head, or oppression at the chest.
Acidum phosphoricum has been found useful after JSlux v., when that remedy has not removed or diminished the tendency to suffer from fainting fits after a meal.
When, as is frequently the case, the fits of swooning or fainting take place in hysterical females, the remedies which will commonly be found the most appropriate are, Ignatia, Nux moschata, Cocculus, Chamomilla, Nux v., Natrum m., or Arsenicum, Sec.
If the attacks are attended with asthmatic symptoms, Kreosotum and Berheris in addition to Nux v. When accompanied by headache, Lycopodium, Moschus, Graphites, Natrum m., Stram. ; loss of conscious- ness, Lycopodium, Oleander, Arnica, &c. Creeping or crawling in the limbs, Nux v., Borax. Humming, buzzing, or tingling in the ears, Aconitum, Nux v., Petroleum, &c. Paleness of the face, Berheris, Na-
PAINS IN THE LOINS. 591
trum m., Pulsatilla, &c, in addition to Nux v. Copious perspiration or sweating, Calcarea. Pain in the heart, Lachesis, &c. Benumbed limbs, Natr. m. Coldness or shivering, Aconitum, Calearea, Colocynth, &c. Vertigo, Sulphur, Arsenicum, Berberis, Lachesis, &c. Vomiting, Lachesis, Nux v., Pulsatilla, Kali e., &c.
In conclusion, it may be remarked that Caladium, in addition to Aeon., is useful in cases that are liable to come on after assuming the erect posture. Kreosotum and Spigelia, when occurring from, the heat of the room. Lycopodium and Silieea, when in the recumbent posture. Caladium, when engaged in meditation. Carlo v. Natrum m.9 Kreoso- tum, in addition to Nux v., when in the morning. When writing, Caladium.
Persons who are subject to fits of fainting or swooning should, if possible, strictly avoid all those frequent causes of fainting fits which have been alluded to at the commencement of this chapter ; as also, where practicable, any other cause known by experience to be pro- ductive of the attacks; otherwise the cure will be rendered difficult, or even hopeless.
PAINS IN THE LOINS. Notalgia.
As these pains are frequently purely symptomatic, the treatment must be directed against the disease from which they originate. Thus as Hemorrhoids, Leucorrhma, Metritis, Myelitis, &c, are frequent sources of the complaint. The reader is referred to the treatment of these affections in their respective chapters.
When the pains arise from the habitual indulgence in wine or spirituous liquors, coupled with confirmed sedentary habits, or late hours, an occasional dose of Nux v. will generally afford relief; and when a strain from lifting a heavy weight, or from any sudden twist on turning the body, or throwing up a window, &c, has given rise to the pain, Rhus toxicodendron must be had recourse to ; followed, if required, by Sulphur and Calearea. (Vide also Lumbago, Rheuma- tism, &c. ; and for pains in the back, or lumbosacral pains, occurring in females during pregnancy, see that article, Part II.)
592 DISEASES OF PARTICULAR ORGANS AND REGIONS.
DROPSY. Hydrops.
The term dropsy is used to imply an abnormal or unusual collec- tion of serous or watery fluid in the cellular tissue, or in any of the cavities of the body. It has, consequently, received the following different appellations according to the particular seat of the effusion : Hydrocephalus, when the fluid is deposited in the cavity of the cranium ; Hydrothorax, when in the chest ; Ascites, when in the abdo- men : Hydrocele, when in the scrotum ; Hydrometra, when in the uterus ; and Anasarca, when it is diffused through the cellular sub- stance.
The usual symptoms of dropsy are, pale and sickly complexion ; dryness of the skin ; red and parched, furred and moist, or, on the contrary, a preternaturally clean and florid tongue ; failure of appetite, and impaired digestion ; constipation, but sometimes diarrhoea, and, occasionally, an alternation between these two states ; urine scanty, high-coloured, in some instances coagulable by heat, and of low specific gravity; pulse variable, being sometimes quick, at others slow, and frequently irregular and intermitting ; general debility : feverishness, especially towards night. In some cases there is cough, with dyspnoea, or a feeling of suffocation, particularly in the recumbent posture ; and occasionally violent palpitation of the heart, with sudden starting during sleep.
The remedies which have hitherto been employed, with greatest advantage, by homceopathists, are : Arsenicum album, Helleborus niger, Lycopodium, Zincum rn.,* Ononis spin., Awrum m., Digitalis purpurea, Ledum palustre, Cinchona, Mercurkis, Stdphur, Euphorbium, Kali carlo- nicum, Dulcamara, Colchicum autumnale, Prunus spinosa, Sepia (especially in drunkards), Bryonia, Ferrum, Phosphorus, Rhus toxicodendron, Sam- ftucus, Solanum nigrum, Camphora, Cantharides, Scilla maritima, Convol- vulus arvensisy Teratrum, Lactuca virosa.
In dropsy supervening after the retropulsion of exanthema.tous dis- eases: Helleborus, Arsenicum, Digitalis, Rhus and Sulphur are found
* Zincum m. is one of the most important remedies in dropsical affections, and especially when pains or disagreeable sensations are experienced in the region of the kidneys.— Wahle, Neues Archiv. Dritter Band, Erstes Heft, p. 28.
ASCITES. 593
the most efficacious. In that resulting from intermittent fevers : Ar- senicum, Ferrum, Dulcamara, Mercurius, Solanum nigrum, and Sulph. In drunkards : Arsenicum, Hellehorus, Sulphur, 'Rims, and Ledum. In that from depletion : Cinchona, Ferrum, Mercurius, Sulphur and Phosphorus. And in that from the excessive use of mercurial preparations : Sulphur, Cinchona, Dulcamara, and Helleborus. For further particulars, see Ascites, Anasarca, Hydrothorax, Hydrocephalus, &c.
Hydrops occurring at an advanced period of life is chiefly to be relieved by the employment of Kali c, Conium, Sulphur, Lycopodium, and Oleum terebinthinm. The diet of patients affected with dropsy should be light, but of nutritive quality.
ascites.
Ascites, or dropsical effusion in the cavity of the peritoneum, may be complicated or not with hydrothorax or general anasarca. In the majority of cases there is also oedema of the lower extremities, or other parts of the body. The disease, in many cases, goes on gra- dually and insidiously, the abdominal distension being at first attri- buted to corpulency. In others, again, and especially the idiopathic and acute forms, whilst there is an equal absence of marked consti- tutional disturbance, the effusion takes place so suddenly, accom- panied with such characteristic indications, that there is little risk of falling into error as to the true nature of the enlargement. But on some occasions the invasion of the disease is announced by striking premonitory symptoms, such as fever, restless nights, thirst, impaired digestion, foul tongue, nausea or vomiting, costiveness, scanty high- coloured urine, pain in the lumbar or hepatic regions, &c.
The swelling of the abdomen in ascites is somewhat tense, the sound on percussion dull, and when the quantity of the effusion is con- siderable, the swelling gravitates to the side towards which the patient inclines, and a sense of fluctuation will be felt on placing one hand on one side of the abdomen, and striking the opposite side sharply with the* other. There is frequently more or less difficulty of breath- ing, with incapability of lying in the recumbent posture, either in consequence of accelerated circulation, or from the encroachment of the accumulated fluid on the thorax. Muscular attenuation is a common attendant on this form of the disorder, as well as on general
38
594 DISEASES OF PARTICULAR ORGANS AND REGIONS.
dropsy. Those parts of the body which are not puffed up by serous infiltration are accordingly found to be in a state of emaciation.
The prognosis in dropsy must be regulated by the nature of the case, and the age and temperament of the patient. When combined with any organic disease of the abdominal viscera, or the contents of the thorax, with effusion into its cavities, we can scarcely antici- pate any other than an unfavorable termination. When occurring in individuals at an advanced time of life, or in sickly children, accom- panied with emaciation and extreme prostration of strength, fever, cough and difficulty of breathing, scanty and offensive urine, feeble, irregular, and intermitting pulse, petechiae and hemorrhages, we must generally expect a like unfortunate issue. But when the disorder sets in as a consequence of scarlatina or other exanthemata, or arises sud- denly after the suppression of some accustomed discharge, or from exposure to cold, or exhaustion from fatigue, although properly held as a serious malady, it is yet, in such cases, by no means to be con- sidered in the light of a fatal one.
Therapeutics. Helleborus niger, Arsenicum, Cinchona , Mercurius, Sulphury Bryonia alba, Ledum palustre, Kali carbonicum, and Lycopodium., &c, are amongst the must useful medicaments.
Helleborus niger. This important medicine is often of equal service here, and in dropsy in general, as in anasarca, and particularly in the acute idiopathic form of the disease, in which indeed it is almost superior to any other remedy. Occasionally it will be found necessary to have recourse to Aconite in the first instance, in order to allay any excessive degree of arterial excitement; but when that is inconsiderable, or when the febrile symptoms are accompanied with great debility, and a tendency to torpor or lethargy; the urine extremely scanty, or almost suppressed, and the motions loose and gelatinous ; also when shooting or other pains are complained of in the extremities, Helleborus should at once be employed. In chronic dropsy, Helleborus is also sometimes of unequivocal utility as an inter- mediate medicament. Bryonia, Ledum, Lachesis, or Mercurius, are useful auxiliaries to Helleb., when required, in the acute variety of anasarca.
Arsenicum. As has already been stated, under the- head of Anasarca, this remedy is peculiarly valuable when extreme debility is a characteristic feature, and has arisen from the depressing effects of other maladies. It is of speedy efficacy in acute cases, when called for, but is also valuable in the chronic forms occurring in shattered
ASCITES. 595
or broken-up constitutions ; and even in cases connected with organic affection of some imporant viscus, it will be found a most useful palliative, however inadequate it may be to effect a cure in such hopeless cases. Digitalis, Ledum, Bryonia, Solatium nigrum, and Helle- lorus are sometimes useful after Arsenicum. (See Anasarca, for some of the principal symptomatic indications for this remedy.)
Cinchona. In ascites occurring in constitutions which have been much debilitated by loss of fluids, Cinchona can rarely be dis- pensed with. But also in chronic dropsy arising from organic disease of the liver or spleen, particularly the latter, considerable advantage is obtained from its employment. When, in connexion with either of the above conditions, we meet with a short distressing cough, accompanied or not with some expectoration, extreme paleness of the skin, general chilliness, small, feeble, and slow pulse, frequent calls to make water, which are usually ineffectual or followed by a scanty discharge, — there will be additional reason for having recourse to this remedy. Arsenicum and Ferrum are often found exceedingly useful after or in alternation with Cinchona.
Mercurius, together with Arsenicum, Cinchona, Belladonna, Bryonia, Lachesis, and Sulphur forms an important remedy in chronic cases associated with disease of some viscus, such as the liver or spleen, attended with great debility, incipient, short, and shaking cough, &c.
When we encounter symptoms of peritoneal inflammation Aconitum, Bryonia, Belladonna, Lachesis, or Mercurius are chiefly brought into requisition. In ascites connected with the suppression of accustomed discharges, Sulphur and Lycopodium, as also Sepia, Calcarea, Kali, Pul- satilla, and Silicea are the most useful medicaments.
Cantharides has been recommended as particularly serviceable in hydrops connected with deficiency of tone in the urinary organs, and attended with strangury, tenesmus, and pains in the limbs, &c.
In ascites consecutive on scarlatina or other exanthemata, Hellehorus, Arsenicum, Rhus,* Belladonna, Sulphur, and Digitalis form the most valuable remedial agents. And in the chronic forms of the malady, especially when occurring at an advanced period of life, the following are the most important : Kali c, Con., Sulph., lod., Lycopod., and 01. tereb. (See also Hydrops and Anasarca.)
* In general I found Rhus more useful than any other remedy in hydrops occurring after scarlatina, but the other remedies, and especially Hettebarus, occasionally proved useful. The extent of the anasarcous swelling does not always indicate the degree of danger, as children are often carried off by hydrothorax or by hydrocephalus, who have exhibited only a slight degree of tumefaction. (Rummell, Allg. horn. Zeit. 21 — 32.)
596 DISEASES OF PARTICULAR ORGANS AND REGIONS.
DROPSY OF THE CELLULAR TISSUE.
Anasarca.
This form of dropsy consists in a preternatural accumulation of serous fluid in the cellular membrane, immediately under the skin.
As the collection of fluid increases, the skin is frequently rendered inflamed and swollen, and exhibits an erysipelatous-like aspect. An outlet is eventually given to the effused liquid by the partition of the distended cuticle ; but the serous infiltration into the cellular texture continues with undiminished rapidity. The affection is, in the greater number of cases, symptomatic of some other disease, and is most frequently met with in combination with general dropsy. It sometimes, however, exists as an idiopathic affection, particularly in the sthenic form. The disease, in the acute form, generally affects those who are in the prime of life. It comes on suddenly, either after taking a large draught of cold water when the body is heated, or after exposure to cold under similar circumstances; and generally gives the first indication of its invasion by a feeling of oppression at the chest, occasionally attended with a distressing cough and pain, particularly on drawing a full breath. In the course of a few hours, dropsical swelling becomes apparent, at first, for the most part, in the face, from whence it spreads downwards to the trunk and extre- mities. The urine in this, as in the other forms, is scanty and high- coloured. The pulse is frequently neither above nor below the natural standard, although in some cases it is rather quick, and accompanied with heat and dryness of skin, whilst in others it is wTeak or irregular. If the disease be unchecked, the swelling increases, respiration is performed with increasing difficulty, and the patient is incapacitated from assuming the recumbent posture, or at the utmost can only recline in one particular position. A fatal termination may take place in a few days, but several weeks sometimes elapse before the patient sinks exhausted.
The asthenic form of anasarca generally comes on slowly. It is most frequent amongst the lower orders, who are necessitated to dwell in damp, dark, and ill-ventilated apartments, and who, from poverty, can only obtain the most unwholesome food. When met with in a higher walk of life, it is commonly superinduced by seden-
ANASARCA. 597
tary habits, depressing emotions, excessive depletion, arising either from the loss of blood, diarrhoea, or dysentery. The abuse of spirituous liquors, or debility resulting from chlorosis, scurvy, rheumatism, etc, may also be enumerated as appertaining to the predisposing causes of this variety. The feet are commonly first observed to be in a swollen state, especially towards evening, and are found to pit on pressure ; occasionally the face is also noticed to be puffy, and the anasarcous swelling then gradually ascends higher, until it, in some cases, per- vades and distends the cellular tissue of the entire body. The pulse varies ; sometimes there is considerable fever and dry skin ; but the temperature of the parts affected is in general diminished. The bowels, although usually costive, are sometimes met with in the oppo- site extreme ; the urine, small in quantity and dark red, depositing an abundant sediment. A great thirst is generally complained of. The skin becomes pale and often milk white ; soft, but deprived of its natural moisture, and as' the collection of fluid increases, its vitality is so depressed by the effects of prolonged distension, that the slightest injury will induce erysipelas, ulceration, and gangrene.
There is another form of anasarca which, from the circumstance of its supervening after exanthemata, has received the appellation of consecutive anasarca. This variety is much more frequently encoun- tered in children than in adults, and especially as a consequence of scarlet fever. It is apparently of an inflammatory nature, and con- nected with imperfect cutaneous transpiration, or obstructed secretions and excretions. Exposure to. cold or wet, or to a cold and damp atmosphere, favours its, occurrence.
Therapeutics. The remedies required for the treatment of anasarca are, for the most part, the same as those which are employed in general dropsy. The following may, however, be specified as more particularly applicable to meet the several varieties of this species : —
Helleborus niger, Bryonia, Phosphorus, Mercurius, Arsenicum, Cinchona, Ferrum, Sulphur, Ledum, Dulcamara, Colchicum, Lactuca virosa, Sepia, Lycopodium, Prunus spinosa, Digitalis, etc.
In the acute form of anasarca, Helleborus, Bryonia, Phosphorus, Arsenicum, and Mercurius are commonly the most serviceable. Helle- borus, especially where we encounter febrile symptoms, with constriction in the chest and lancinating pains in the extremities, and almost total suppression of urine ; or where there is coma somnolentum, with great debility and looseness of the bowels, the motions generally
598 DISEASES OF PAKTICULAB, OUGANS AND REGIONS.
presenting a gelatinous appearance ; prolonged shivering, short and rapid respiration, much thirst. [Arsenicum is sometimes required to complete the cure after the previous employment of Helleborus.)
Bryonia is of very great service in some cases of the acute, asthenic variety, whether idiopathic or otherwise, where there is op- pression at the chest, with acute pricking pain particularly during a full inspiration ; increase of the anasarcous swelling during the day. and diminution at night ; constipation. Should the foregoing symptoms have come on suddenly after partaking of a long draught of cold water when in a heated state, or should the dropsical swelling make its appearance during an attack of pneumonia, there wdll be additional reason for selecting this remedy. Occasionally, however, it may be found necessary to follow up the treatment with Cinchona or Lycopodium, the latter particularly where there are obstinate con- stipation and diminished activity of the skin.
Phosphorus is chiefly used in anasarca accompanied with inflam- mation of the lungs ; here it forms one of the most important remedies. Should it not prove sufficient to overcome the entire disease, Sulphur, Lycopodium, and perhaps also Arsenicum and Lachesis, will, in general, be found the most appropriate medicaments to combat the remain- ing symptoms.
Mercurius. In acute or chronic anasarca, attended with oppres- sion at the chest, incessant, short, and extremely fatiguing cough, this is a useful remedy, particularly in the asthenic form, with disordered liver, general heat, thirst, great weakness. Dulcamara and Colchicum have been found useful in anasarca resulting from the effects of a chill from exposure to cold and wret when heated.
In the asthenic or in the chronic form of anasarca, Arsenicum, Cinchona, Ferrum, Mercurius, Sulphur, Camphora, Lycopodium, Sepia, Ledum pa lustre, Rhus, Helleborus, &c.,form the principal medicaments. Arsenicum is one of the most invaluable remedies in anasarca with debility, either when the attack has come on suddenly as an idiopathic affection after a chill from drinking copiously of cold water while in a state of perspiration ; or when it has been induced by the depressing effects of other maladies, such as dysentery, diarrhoea, scorbutus, &c., and the habitual indulgence to excess in spirituous liquors ; or further, when the disorder occurs in combination with gastritis, pericarditis, and other affections of the heart or other viscera. The following symptoms constitute some of the leading characteristic indications for the employment of Arsenicum. Tightness in breathing,
ANASARCA. 599
or attacks of oppression at the chest, which threaten suffocation on assuming the recumbent posture, and particularly when lying on the back ; dry, harsh, and thickened skin, w7hich is, at the same time, of extreme paleness, or of an earthy, greenish hue, particularly at the face ; parched and somewhat reddened tongue ; excessive thirst ; aching or dragging and rending pains in the back and limbs ; extreme weakness amounting to complete prostration ; feeble or irregular pulse ; coldness of the extremities. Helleborus niger occasionally proves of essential service after or alternately with Arsenicum. In other cases Cinchona, Bryonia, Lachesis, Ledum, or Solanum nigrum may claim a preference.
Cinchona. In anasarca combined with affections of the liver or spleen ; or when the disorder has been induced by debility arising from loss of blood, diarrhoea, or dysentery, &c\, this remedial agent is of much utility, but will generally require to be succeeded by Arsenicum, Ferrum, Helleborus, Mercurius, or Sulphur, &c. Shooting or pricking pains in the parts affected with the dropsical swelling, together with a pale, sickly, or deathlike hue of the skin, are cha- racteristic indications for Ferrum.
Mercurius. Some general indications for the employment of this remedy have already been given. In anasarca with debility it is more frequently useful than in the sthenic form.
Sulphur is a useful general remedy in chronic cases, or in those with debility induced by Chlorosis, Scurvy, Diarrhoea, Syphi- lis, &c, Sepia, Lycopodium, or Kali, &c, are occasionally of some service after or in alternation with Sulphur. In other cases of anasarcous swelling with a deficiency of vital energy, Camphora, Rhus, Phosphorus, Prunus spinosa, Antimonium crudtim, &c, have been found of con- siderable efficacy.
Against consecutive anasarca, Hellehoms niger and Belladonna are the more generally appropriate remedies ; but in some cases it is necessary to have recourse to Arsenicum, Mercurius, Rhus, Digitalis, or Sulphur. When mortification threatens in consequence of anasarca, Lachesis, Cinchona, and Arsenicum are the remedies from which the greatest possible assistance is to be hoped. (See also art. Hydrops.)
In anasarca arising from a long-continued residence in a damp, unwholesome dwelling, Colchicum may prove a valuable palliative, if not a curative remedy. A radical cure was performed by it in a case which appeared to have been excited by the aforesaid cause, in which the following were the predominant symptoms : At the com-
600 DISEASES OF PARTICULAR ORGANS AND REGIONS.
mencement of the attack, slight gastric derangement, then very gradual anasarcous swelling, attended with pains in the joints and extreme sensibility of the skin to the slightest breath of air, no thirst, and a perfectly normal state of the urine. (Kurtz. A. h. Zeit. xxvi, 90.)
DROPSY OF THE CHEST. Hydrothorax. Hydrops pectoris. Hydrops thoracis.
Dropsy of the chest may exist without complication with effusion into the cavity of the abdomen or any other dropsical affection. The collection of fluid may take place in both sides of the chest, or in one only. Occasionally the exudation is lodged in the cellular tex- ture of the lungs as wrell as in the sacs of the pleura. The disease is often ushered in by a sense of uneasiness at the inferior portion of the sternum, attended by some difficulty of breathing which is greatly increased by any exertion, but more especially whenever the recumbent posture is assumed. An annoying cough, at first dry, but subsequently accompanied with expectoration of thin mucus, is experienced, and the feet are observed to be in an cedematous state towards evening. In addition to these symptoms, we encounter those which are met with in all forms of dropsy, such as paleness of the skin, thirst, and diminished secretion of urine, &c. ; further, a fluc- tuation of fluid is frequently perceived in the thorax, either by the affected party himself or by his medical adviser, on particular move- ments of the body.
Along with the above symptoms the existence of hydrothorax is to be detected by means of auscultation. Percussion gives a dull sound, and the respiratory murmur is either very obscure or entirely absent except in the vicinity of the spinal column. Enlargement of one or both sides of the chest is sometimes observed, together with an increased or. more prominent appearance of the intercostal spaces.
As the disease advances the dyspnoea increases, particularly at night, when it sometimes creates a dread of suffocation ; the extremi- ties become more and more swollen, and the patient is frequently affected with palpitation and fits of excessive anxiety. Numbness is often complained of in one or both arms. Eventually the patient
DROPSY OF THE CHEST. 601
finds it impossible to keep the recumbent posture, or even incline backwards, and cannot indeed fall asleep in any position, especially if the water is collected in both cavities of the pleura, without starting up suddenly with increased difficulty of breathing and apprehension of asphyxia. The cheeks and lips become pale from the impeded circulation, and the pulse becomes irregular and intermittent. Finally, the patient is carried off by suffocation and exhaustion, or becomes comatose. In some cases the termination is sudden, but in others death is preceded by a spitting of blood for the space of five or six days.
Organic lesions of the lungs, heart, or their great vessels form the most frequent sources of hydrothorax ; but disease of some of the viscera of the abdomen, and especially induration or scirrhus of the liver, is an additional frequent cause of the affection.
Therapeutics. The prognosis in this serious and distressing malady must, in a great measure, depend on the cause of the effusion. But in truth, in almost all cases we can rarely speak otherwise than in the most unfavorable terms. The remedies from which the greatest alleviation, and occasionally the ultimate cure, has hitherto been most frequently attained in homoeopathic treatment, are, Aconitum, Arsenicum, Carlo v., Helleborus, China, Lycopodium, Colchicum, Digitalis, Spigelia, Dulcamara, Sec,
The most important and more generally applicable remedy in hydrothorax, whether resulting from inflammation of the pleura, or organic affection of the liver or spleen, and even of the heart, is Arsenicum, particularly when the following train of symptoms are encountered ; distressingly impeded respiration, but especially after any exertion, such as going up stairs, &c.; incessant thirst with inclination to drink but little at a time; painfully obstructed breath- ing on getting into bed, notwithstanding that the act is performed with the utmost caution and slowness, attended with palpitation of the heart and excessive anguish as if from impending suffocation ; extreme dyspnoea on assuming the recumbent posture, or on changing the position in bed during the night; coldness of the extremities; oedema of the feet ; pale or greenish hue of the skin, pains in the back and loins ; complete prostration of strength. When the above symptoms do not arise from or are unconnected with organic lesion of the heart, lungs, &c, they will rarely fail to yield to the employ- ment of Arsenicum.
602 DISEASES OE PARTICULAR ORGANS AND REGIONS.
In complications with organic affections of the liver, spleen, or heart, a greater or less degree of melioration is generally the utmost we can look for from the use of this, and but too often it must be added, of any other remedy. Carlo v., Cinchona, Ferrum, and Mercurms are of considerable assistance after Arsenicum, where there is disease of some one or other of the abdominal viscera, such as the liver or spleen, &c. ; and Digitalis, Colchicum, and Shigella when there is organic lesion of the thoracic viscera, particularly the heart or large vessels.
Dulcamara has been found of considerable service in alleviating the sufferings in hydrothorax when they become aggravated during the prevalence of cold, foggy, damp, or rainy weather, and continue so until a change takes place in the form of a pure and dry state of the atmosphere.
Colchicum, as has already been stated, is a useful palliative along with Digitalis and Spigelia in dropsy of the chest connected with organic lesions of the heart or great vessels. It is to be preferred to Dulcamara in those cases where, in addition to the tendency to an increase of suffering during cold and humid weather, there is, moreover, extreme susceptibility to cold.
In hydrothorax resulting from inflammation of the pleura (chronic pleurisy), Arsenicum, Carlo vegetabilis, Lycojoodium, Lachesis, Kali car- bonicum are the most important remedies in the generality of cases.
When there are febrile symptoms accompanied by sharp pains in the chest, a dose or two of Aconitum is occasionally beneficial ; but, in most cases of this description we shall commonly find it more advantageous to have recourse to Bryonia, without the previous employment of Aconite.
The following medicines may also be enumerated as likely to prove of service in hydrothorax : Stannum, Ammonium carlonicum, Scilla marilima, Aurum, Mercurius, and Senna.
SCROFULA.
The most common form of this disease is that in which the con- globate glands in different parts of the body, but especially the neck, under the chin, and behind the ears, become converted into hard, indolent tumours, and subsequently pass through the stages of sup- puration and ulceration. The discharge which succeeds, instead of
SCROFULA. 603
consisting of pus, is found of a white curdled matter bearing some resemblance to the coagulum of milk. In some cases, and those, generally of an inveterate character, the eyes are the principal seat of the disease; whilst in others, of a still more virulent description, the joints become swollen and extremely painful, and if the course of the malady be not checked it extends to the ligaments, cartilages, and adjacent bones ; or tubercles are developed in the lungs ; hectic fever is then superadded, and often puts a fatal termination to the disorder.
Therapeutics. The remedies, which have hitherto been chiefly employed in homoeopathic practice in the early stage of this disorder,
are Belladonna, Silicea, Sulphur,* Calcarea, Arsenicum, Pulsatilla, Sepia ; and, when the glands of the neck, &c, are prominently affected, the following, in addition to the foregoing, are commonly of the greatest efficacy : Conium,f Dulcamara,% Mercurius, Hepar, Cistus, Staphysagria, Phosphorus, Aurum, Baryta c. et m.,§ Rhus, Clematis, &c. (See Disease
* A one and a half year old, highly scrofulous (hereditary) child ; treated for a length of time allopathically, by means of Baryt., Hydr. pot., and latterly Calomel, and then Iod. : around the neck glandular swellings partly commencing to suppurate, partly open and discharging thin yellow pus ; moist scabs on the head and ears ; eyelids reddened and swollen ; cornea obscured by old cicatrices and fresh ulcers ; excessive salivation ; dry cough ; violent fever from dentition. Tinct. Sulph. 1. a drop night and morning. After some little time the child became lively and vigorous, and the ulcers healed. • f Enlarged and indurated cervical glands of scrofulous children, which, if anything, rather increased than otherwise under the employment of Calc, Iod., and Silic, became strik- ingly diminished and softened within eight days from the use of Conium internally and externally. (Ohlhauth, Hyg. xvii, 262).
X Dulcamara (Tr. gtt. x, Sacch. lact. Dr. aliq.), about a fifth of a grain twice a day, for a period of from six to eight weeks), cured hard circumscribed, painless swellings of the cer- vical glands, the size of a pigeon's egg, occurring in young persons of from 14 to 18 years of age, who were otherwise of parents sound and healthy. (Diez. Hyg. xvii, 262.)
§ The sphere of action of Baryta mur., is more particularly confined to the lymphatic system. I have found it useful only in scrofulous cases, (inflammations of the eye, eruptions, diarrhoea, blenorrhoea of the lungs.) Dosis, 3d trituration, (4 : 96) scr. j, in aq. destil. Jij, for children of a twelvemonth old, a teaspoonful every three hours, and so on, increasing or diminishing the dose, according to the age and temperament of the patient. The following cases are examples of its successful employment: —
A child, two years of age ; — the neck surrounded with glandular indurations of about the size of an egg ; abdomen hard and distended ; tongue furred ; appetite only for dry bread ; stools hard, white, and take place only after clysters ; urine yellowish and fetid ; offensive otorrhcea ; emaciation ; swelling of the feet ; hump-back. (Had been treated allopathically for a twelvemonth. Milk, mucilaginous diet. Baryta mur., (9 xij), as above, effected a perfect cure, inclusive of the hump, in three months.
A child, one year and a half old, covered with ulcers ; thick offensive incrustations over
604 DISEASES OF PARTICULAR ORGANS AND REGIONS.
of the Conglobate Glands.) A careful selection from amongst these remedies, according to the nature of the symptoms, combined with great attention to cleanliness, ventilation, and the quality of the food, which should be wholesome and nourishing, will rarely fail to be attended with satisfactory results. In young subjects, indeed, it will frequently be found practicable after patient perseverance, completely to eradicate, by the said means, the scrofulous diathesis. When the joints or bones have become affected, Sulphur, Calcarea, and Silicea are of striking utility : in other cases, — Mercurius, Aurum, Lycopodium, Phosphorus, Cistus, &c, may be called for. And when the glands of the mesentery are in a diseased state (scrofula mesenterica), Sulphur, and Calcarea, as also Mercurius, Arsenicum , Baryta, Lycopod., Baryta c, Bella., China, Puis., Rhus, Nux, &c, are those from which we may generally look for the most important aid. (Vide also Enlargement and Induration of the Conglobate Glands in the Neck, &c, Atrophy, Rachitis, Ostitis, Ophthalmia, and Ulcers, &c.)
OSTITIS.
Caries. Necrosis. Exostosis.
Inflammation of bone may either be acute or chronic. It is usually characterised by pain, more or less severe, followed by swelling, and often with heat and redness of the integuments covering the affected parts. In chronic cases the enlargement takes place very slowly, and the pain varies according to the cause of the attack, being much more intense and accompanied by nocturnal exacerbation, in ostitis arising from syphilis or from the abuse of mercury, than when induced by the effects of external lesion. The accompanying fever is not often very intense, and displays itself chiefly towards evening and at
the head, fetid discharge from the ears ; inflammation of the eyelids, photophobia ; tumid belly; stools, watery and fetid ; swelling of the feet. In six months restoration to sound health.
A girl, six years of age, dismissed as incurable after having been under allopathic treat- ment for a twelvemonth. Complete dimness of the cornea, sclerotica inflamed and relaxed ; both nostrils inflamed and excoriated. After three weeks the inflammation was subdued ; after four months, the vision clear and normal. (Altmuller,Allg. Horn. Zeit. xxi, 213.)
DISEASES OF THE BONES. 605
night. When the inflammation is acute it soon, if unchecked, termi- nates in caries, in necrosis, or in suppuration of the cancellous texture. Caries or ulceration may either arise in consequence of an external injury followed by considerable inflammation and abscess ; or it may occur as a sequel of scrofula and syphilis. The latter is the more frequent source of the disorder. It may take place in any of the bones, but is most commonly encountered in those of a spongy texture, such as the bones of the tarsus and carpus, the sternum, vertebrae, and the extremities of the long bones. In the commencement of caries an obtuse, deep-seated pain is experienced in the affected bone, and the superincumbent integuments become discoloured^ flabby, and tender to the touch ; the soft parts then ulcerate, and a sinus is formed, which is in communication with the caries, and from whence a dark-coloured, thin, ichorous matter, having a peculiarly offensive odour, and occasionally containing osseous particles, is dis- charged. The diseased part of the bone is usually soft, moist, accompanied with the production of pale, spongy granulations, and sometimes perforated at innumerable points {wormeaten caries) ; at other times the surface of the bone is dry, brittle, and of a pale white colour. Partial absorption of the bony texture frequently takes place, some of which is rendered so fragile as to crumble away at the slightest touch. Caries may take place at any period of life, but is most frequently met with in young subjects, particularly when originating, as it so frequently does, in scrofula. The bones which are most liable to be affected with syphilitic caries are those of the cranium, the tibia, the sternum, the palate, and the nasal bones. While those which more commonly become carious from scrofula are the vertebrae, the bones of the carpus and tarsus, and the extremities of the long bones. The disease is attended with the greatest danger when it exists in the bones of the cranium, the large joints, the vertebrae, the carpus and tarsus, particularly if, at the same time, it arises from a consti- tutional cause. Necrosis, or the death of a portion of a bone, may be induced by violent inflammation of the periosteum, or by anything which affects the substance of the bone or the medulla in such a manner as to interfere with or interrupt the process of nutrition. Consequently severe contusions, compound fractures, the protracted exposure of the surface of a bone, which has been deprived of its periosteum, to the air; irritating applications, such as strong acids, caustics, &c, are frequent causes of the disease. But, in addition to these external means, it may also proceed from an internal or consti- tutional source ; and accordingly we find some of the worst forms of
606 DISEASES OE PARTICULAR ORGANS AND REGIONS.
it attributable to the effects of scrofula, lues venerea, scorbutus, the abuse of mercury, and the debilitating results of typhus fever, small- pox, &c. The symptoms of necrosis vary according to the nature of the cause and the extent of the disease. In scrofulous or syphilitic individuals the pain is deep-seated and extremely violent ; and it is in such cases that a large portion, sometimes indeed the whole shaft, of a long bone is destroyed. In all cases a swelling of a greater or less extent soon takes place, and the pain, when excruciating, is rarely relieved until matter forms and the abscess bursts. When the necrosis is inconsiderable and arises from external injury, the patient being, at the same time, of a healthy habit, there is little or no constitutional disturbance. But when the disease is more extensive and occurs in scrofulous or otherwise unhealthy habits, the derangement of the system is sometimes very violent. On the bursting of the abscess, and particularly in the severer forms of necrosis, there remains a large tumour of a firm, unyielding description, resulting in the effusion of coagulable lymph around the dead bone, together with the cedematous and thickened condition of the cellular membrane. If a probe be intro- duced through the orifice from whence the matter escaped, and passed down to the bone, the surface of the latter will often be found bare and rough. Cicatrization does not take place after the evacua- tion of the abscess, but, on the contrary, the openings are, for the most part, converted into fistulae, chiefly in consequence of the con* tinued irritation which is caused by the dead bone, and serve as a passage for the exit of any pus that may be formed as well as for the sequestrum itself.
We can never be certain of the existence of necrosis until we can touch a portion of dead bone with a probe, or can obtain a sight of the affected bone, and find it presenting either an excessive whiteness or a darker colour than natural. All the bones are liable to necrosis, but the tibia, femur, clavicle, humerus, maxilla inferior, radius, and ulna, are those which are most frequently affected. The diaphysis is the general seat of the disease. Regeneration of the long, cylindri- cal, or flat bones may take place, but those of the cranium, carpus, and tarsus cannot be reproduced.
Old age, lues venerea, cancer, scurvy, and rickets impede the regenerative process. Suppuration principally takes place in the spongy texture, or medullary cavity of a bone. Its invasion is speedily followed by absorption to a greater or less extent : and occa- sionally, while the interior structure is removed by the absorbents,
DISEASES OF THE BONES. 607
the external shell is expanded (spina ventosa). After the suppurative process has gone on for some time, the matter makes its way under the skin, and gives rise to the foundation of a soft swelling or abscess, which, on bursting, affords considerable alleviation of suffering. Necroses or caries frequently originate in disease of the medullary membrane, in consequence of the obstruction which is thereby offered to the nourishment of the bone.
Therapeutics. In inflammation of bone we shall rarely find occasion to have recourse to Aconitum ; at the utmost it may only be found useful as a palliative, and that chiefly in idiopathic ostitis occur- ring in young plethoric subjects. In some of the milder forms, attended with redness of the integuments, slight swelling of the bone and extreme sensibility to the touch, Bryonia and 'Pulsatilla have proved very serviceable ; the former particularly in persons of nervous or bilious temperament and of a dry meagre habit ; the latter in those of phlegmatic temperament, with relaxed, lymphatic constitutions. When external violence has given rise to the disorder, and the peri- osteum has been considerably injured, Ruta is a valuable remedy. Lastly, Mercurius may be named as one of the most important reme- dies in acute ostitis with excessive nocturnal exacerbations of pain, and especially when the disorder occurs in persons of lymphatic tem- peraments, or in those who from having been badly fed, ill lodged, or have had their constitutions otherwise much reduced and enfeebled. Warm fomentations may be beneficially applied along with the internal employment of the appropriate medicines ; spare diet and perfect rest must, at the same time, be enjoined. In chronic ostitis, which is the most common form of this inflammation, Sulphur, Calcarea, Silicea, Phosph., Acid, ph., Staph., and Assqf. are, in general cases, the most im- portant remedies at the commencement of the attack. In other cases, and more particularly when the affection has originated in the abuse of mercury, Hepar sulph., and Acid, nitr., are two of the most important remedies ; but when there is a considerable degree of erysipelatous redness, a dose or two of Belladonna wdll generally be found requisite ere we proceed to employ the aforesaid medicines, or any other remedy which may appear more appropriate to the aggregate features of the case. If traces of scorbutus accompany the inflammation, Carlo v., Merc, Staph., Sulph., Ac. nitr., Dulc, Sepia, &c, are the most appro- priate. And when syphilis, or the joint effects of mercury and syphilis, have evidently given rise to the disorder, the following medicaments, in addition to those described as the most applicable at the com-
608 DISEASES OF PARTICULAR ORGANS AND REGIONS.
mencement of ostitis in general, have hitherto been found the most useful, viz., Aurum, Assafatida, Staphysagria, Mezereum, Lycopodium, Manganum acet., Lachesis, Dulcamara, Baryta, Carlo v., Acid, fluoricum. Manganum aceticum and Mezerevm are more especially adapted to inflammation of the periosteum, attended with pains of an almost insupportable nature.* Mercurius, Aurum, Staphysagria, and Phosphorus generally claim a preference when the bones of the face form the seat of the inflammation ; Mercurius and Staphysagria when those of the hip ; and Assafoetida and Mezereum chiefly, when the shin and other superficial bones are affected. In the treatment of caries it is, as in ostitis, of importance to consider the cause from which the disease has arisen. In the early stage of the malady the remedies which wre have named as being very useful in the milder forms of acute, and at the beginning of chronic ostitis, are frequently of con- siderable service, and indeed will often prove sufficient, especially in cases which have arisen from a local injury, and unattended by signs of general constitutional derangement, to stay the morbid action and eventually effect a radical cure without the expediency of an operation. In cases depending upon a constitutional cause, such as scrofula, scorbutus, or from syphilis and the abuse of mercury, the same medi- cines, are required as have been quoted under Chronic Ostitis. We must, in a great measure, be regulated by the law similia similibus in the selection of the different remedies ; but when, from the paucity of the symptoms, or the absence of any of a characteristic or sufficiently well-marked character, there is some difficulty in finding the appro- priate remedy, the alternate or successive employment of two or more medicaments, which embrace the main features of the case, and which experience has proved to be remedies of great value in caries in general, may be resorted to. Thus, Sulph. and Calc.; Sulph., Calc, and Silicea; Silicea and Phosph., administered in alternation or rotation, have often succeeded in effecting a radical cure. In like manner, Perussel mentions three cases of caries which wTere cured by Hepar s. and Silicea in alternation. In another case he had recourse to Meze- reum and Rhus in addition to the foregoing. And in a fifth, in wThich there wTas considerable complication with mercurial disease, Sulphur and Acid, nitr., established the cure. (Bib. Horn. d. G., x, 321.) Caries articulationis cubitalis, cum ulceribus ossis fistulosis: Calcarea c.
* Hartmann's Therapie, zweite Ausgabe, p. 290. We have fomidAssafoetida andJcid. phosph. of much efficacy in periostitis. Mercurius and Silica, and sometimes Bella., Staph., Puis., China, &c, may also do good in particular cases.
DISEASES OF THE BONES. 609
{Rhus), Silic, Lycqp. et Sulph. (A. H. Z. viii, 120.) Caries femoris pueri scrophulosi: Sepia 10 et Acid. nitr. (Ann. 11, 365.) Caries fungosa manus: Rhus et Arsenic. (T. h. 1.) Caries ossium faciei: Calc. carl, et Silic. (A. H. Z. viii, 309.) Caries pedis cum febre hectica: Arnica, Lycopod., et Silicea. (Arch, xii, 191.) Caries radii with bluish red swelling of the fore-arm and hectic fever : Pulsatilla, Mezereum, Sabina, Silicea, Calc. c, and Lycopod. (Arch, viii, 1, 42.) Caries tibiarum et antibrachii sinistri, with several fistulous passages, debilitating diarrhoea, and utter prostration of strength. , Sulphur, Assafost, Acidum nitr., and Acid.phosph., accomplished the cure. One medicine alone, when homoeopathic to the entire disease, is often sufficient to stop the caries and bring about a healthy action in the carious part. Thus, Aurum has repeatedly effected cures in caries syphilitica ossium palati et nasi; as also in caries syphilitica pro- cessus alveolaris cum ozaena. Silicea, in several doses (at the thirtieth potency), frequently cured chronic caries in scrofulous children. Other cases required lower potencies of the same remedy (Kampfer, Allg. h. Zeit. xxiv, 135.) Silicea 30, cured, in two cases, caries of the mastoid process (Goullon, Gr. u. St. Arch, xv, 3,55.) Caries tibiae recens : Silic. 10 (Arch, viii, 1, 23.) Caries of the third phalanx of the middle finger, in a female who had applied all sorts of unguents to the part for a whole year, and from which a piece of bone had exfoliated. Eight days after the exhibition of Silicea the pain was removed, and another small exfoliation took place, after which cicatrization ensued. (Ruchert*s Therapie). Acidum fluoricum* has been employed in some cases of caries with striking effect, and promises to be a remedy of great value in diseases of the bones in general. We may quote the two following cases as illustrative of its curative powers in disease of the bones : Ci A boy became affected, after scarlet fever, with caries of the temporal bone, which, during a period of five or six years, periodically broke out afresh, discharged an offensive pus, and then healed again. The entire left side of the cranium was arrested in its growth, and consequently rendered much smaller than the other side ; the left eye also appeared strikingly smaller than the right one. The intellect of the boy was, nevertheless, not in any way affected. Several remedies improved, but failed in curing the caries. After the employment of fluoric acid the periodical
* The provings of this important remedy appeared in the Neues Archiv, zweiter Band, erstes Heft,
39
610 DISEASES OE, PARTICULAR ORGANS AND REGIONS.
attack came on earlier, and in a more aggravated form than usual, but never returned. From that time onward the left half of the cranium commenced to grow, and the previous inequality of size between the two sides of the head became gradually less, and finally imperceptible/' (Neues Arch. 3ter Bd. Istes Heft.)
" The first and second phalanx of the left index finger, particularly, the former, w7ere swollen to four times their natural size, so that the finger presented the shape and appearance of a pear. On the dor- sum of the ringer an opening sometimes made its appearance, from which pus and ichor oozed out. The entire tumour was very hard to the touch ; the skin otherwise unaltered ; the cause of the affec- tion was not ascertainable ; the pains were intermittent. With exception of some degree of dyspepsia, the health of the patient was good. Of Silicea x, two doses were prescribed. Twelve days after- wards, the patient returned, and said that she thought the finger better ; but there were no outward signs of improvement. Acidum fluoricum x, in two doses, was next prescribed. The patient did not come back again until about twelve weeks after her preceding visit. The affected forefinger was so much restored that it exhibited little or no difference in its appearance from that of the other hand. The patient had merely returned because her digestion, after having been rendered much stronger, had threatened to become somewhat dis- ordered again. Silicea x, two doses, was prescribed for the general symptoms remaining. The patient did not show herself again." (Neues Arch. 3ter Bd. Istes Heft, Seite 128.)
In caries of the ossa nasi, Acidum nitricum is, as well as Aurum, a most efficacious remedy. In that of the inferior maxilla (when the disease has not arisen from exposure to its vapour) PAospA. And in caries of the bones contributing to form the Antrum AigAmorianum, Arsenicum, Lycopoditim, and Silicea have repeatedly proved curative ; but in some instances it may be found necessary to have recourse to other medi- cines, as Sepia, SzilpA, etc. Where caries is attended with ulceration of the integuments, and thick, lemon-coloured discharge, Lycopodium acts beneficially. When caries fails to yield to the agency of medi- cines, and the symptoms of constitutional irritation increase in inten- sity, an operation for the removal of the carious portion of bone becomes necessary.
The medicaments employed in the treatment of the two preceding forms of disease of the bones, are also more or less requisite in necrosis. In the first stage of the disorder, if there be severe and
DISEASES OF THE BONES. 611
extensive inflammation of the soft parts, Aconitum, Belladonna, Bry- onia, Pulsatilla, Mercurius, and Sulphur, together with warm fomenta- tions and poultices, are more or less useful. (See Ostitis.) When matter forms, and is confined under the periosteum, it should be evacuated early, by means of a deep and free incision.
When the disease has reached the second stage, or that in which the sequestrum has been formed, yet remains adherent to the living portion of bone, the process of absorption or of exfoliation may be aided and quickened by the administration of Symphytum officinale, or by Silieea, Phosphorus, Sulphur, and Calcarea. These remedies, espe- cially the four latter, materially serve, moreover, to lessen the ten- dency to renewed inflammatory attacks and their sequelse, as also to mitigate any undue severity in the constitutional disturbance which is so prone to set in during this stage of the affection. When, not- withstanding all our efforts, the health of the patient begins to be seriously injured by the pain, profuse discharge, and hectic fever, an operation for the removal of the sequestrum, or even amputation of the affected limb, if the necrosis be extensive, becomes necessary. But as long as the health remains tolerably good, we should abstain from any harsh interference with the operations of nature, and endeavour to forward her efforts by judicious medical treatment. The principal medicines by means of which this commendable aim is most likely to be promoted are Sulphur, Calcarea, Silieea, Lycopodium, &c. These remedies are equally applicable, whether the disease may have arisen from the effects of external injury, or originated in internal causes — such as Scorbutus, Scrofula, Syphilis, or the abuse of mercury, which have affected the bones through the medium of the constitution, or has proceeded from a debilitated state of the system resulting from severe febrile disturbance. Sulphur is chiefly required when necrosis occurs in persons of lymphatic or bilious temperament ; also in those who are disposed to eruptions, enlarge- ment of the glands, hemorrhoids and constipation. Calcarea may generally be exhibited with advantage after the previous employment of Sulphur. Silieea is, if anything, still more frequently required than either of the two preceding remedies, when the sequestrum is completely formed, but is still firmly attached to the living part of the bone (second stage) ; or when it is loose (third stage), and there is an excessive discharge from the fistulous openings consisting of pus and ichor; further, when there is a considerable degree of nervous excitement, and the sleep is restless and unrefreshing.
612 DISEASES OF PARTICULAR ORGANS AND REGIONS.
Lycopodium is often useful when the matter discharged is very copious, thick, and lemon-coloured. In other cases Assafodida, Acid. nitricum, Phosphorus, Ruta, or Mezereum may be required. The alternate use of Sulphur and Calcarea, Silicea and Phosphorus ; or of these four in rotation at intervals of from six to eight or ten days is sometimes beneficial.
Suppuration of the spongy texture is to be treated at the beginning of the disease in the same manner as has been described for ostitis ; and on the bursting of the abscess, those remedies which have been noticed under caries and necrosis must be resorted to. In exostosis, or the growth of a bony tumor from the surface of a bone, — Sulphur, Calcarea, Silicea, Phosphorus, Assafcetida, Dulcamara, Mezereum, and Mercurius have chiefly been recommended. And in Tophus, or the formation of a soft swelling on a bone, Bella., Merc, Phosph., Acid, nitr., Sulph., Calc, Assa., &c.
RICKETS.
Rachitis.
This malady almost invariably begins to show itself at the tender age of from one to two years, and is distinguished by great develop- ment of head, abnormally prominent forehead, projecting sternum, flattened ribs, enlarged abdomen, with emaciation of the extremities, and extreme general debility. As the disease progresses, the muscles become more flaccid, the epiphyses of the limbs increase in size, the bones and dorsal spine become more or less distorted, the bowels relaxed and the motions frequent ; and frequently, if the disease be not arrested, slow fever, with cough, oppressed breathing and atrophy supervene, and a fatal termination results.
Therapeutics. The remedies which have hitherto been em- ployed with the greatest success in the treatment of this distressing affection by homoeopathists are : Belladonna, Mercurius, Arsenicum, Sulphur, Calcarea, Silicea; also, Assafoetida, Acidum phosph,, Phosphorus, Baryta muriatica, Staphysagria, Lycopodium, Acidum nitric, Mezereum, Petroleum, and Rhus. (See Atrophy, Hydrocephalus, and Scrofula.)
CASUALTIES.
CONCUSSION, BRUISES, SPRAINS OR STRAINS, WOUNDS, DISLOCATIONS,
AND FRACTURES.
In Concussion of the brain, (which may arise from a violent shak- ing of the brain or of the whole body, without any direct violence having been offered, such as a severe blow or fall on the head), the symptoms vary, according to the degree of injury which the brain has sustained. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result ; but when slight, a temporary stunning or confusion, with more or less headache, is produced, followed by increased action of the pulse, vertigo and sickness. When, on the other hand, the vio- lence done is greater than in the latter instance, though not so severe as to cause the fatal termination alluded to in the former, the patient is rendered insensible and incapable of movement; his limbs become cold ; the pulse weak, slow, and intermittent ; the respiration labo- rious, but usually without stertor. (This has been denominated the first stage of concussion) . As the patient begins to recover from this condition, the pulse and respiration improve, and warmth begins to be felt in the extremities ; the sensibility to touch then returns, and the contents of the stomach are in most cases rejected ; still he con- tinues to remain in a dull, confused state, and inattentive to, or almost unconscious of, slight external impression {second stage). On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to questions spoken in a loud tone. When, however, the stupor has considerably or entirely abated, inflammation of the brain, of an active character, will, in many cases, then begin to develop itself {third stage), rwith all its wonted symp- toms (see Phrenitis), and if not checked, suppuration or effusion within the head, preceded by rigors, will result.
614 CASUALTIES.
Therapeutics. In all cases of injury arising from external violence., Arnica is an invaluable remedy, and its timely administration in cases of concussion of the brain, will in most instances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes.* We may administer internally two globules in a tea- spoonful of water ; and, if there be an external wound, we may bathe the injured part with a lotion, in the proportion of a few drops of the Tincture of Arnica to an ounce or about two tablespoonfuls of water, twice or thrice a day ; should the swelling, pains, and other symptoms increase, after one or two applications, wre must discontinue the lotion, but shall almost always find a marked improvement follow such aggravation.
When, however, the contusion has been serious, and extreme rest- lessness or jactitation, and irritability of temper, with sensibility of the eyes to light, small quick pulse, delirium, or subsequently rigors, &c, supervene, the same treatment must be pursued as that described under Inflammation of the Brain, and also Hydrocephalus, which see.f After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to partake of any stimulating liquids, such as wine, spirits, &c, until at least three or four weeks have elapsed, even although he may appear to have entirely recovered from the effects of the accident ; he ought likewise to be kept quiet, and not be permitted to expose him- self to excitement of any kind, otherwise the most serious conse* quences may result. When the chest has been injured by a contusion or violent concussion, &c, and soreness, or a sensation as if from incipient suppuration, with heat and throbbing, is experienced in some particular spot; fever, or alternate chilliness and heat followed by fever, which becomes aggravated in the evening ; sleeplessness or disturbed sleep, with general heat, and sometimes perspiration towards morning ; short dry cough which increases the pain, or cough with spitting of blood ; further, when the pain in the chest is rendered more acute by taking a full inspiration, laughing or sneezing, or when pricking pains or a sensation of fulness or pressure, as if caused by
* In simple irritation of the brain, Arnica rarely fails to act beneficially. In some cases, Cicuta virosa is serviceable.
f In fracture of the cranium the same treatment must be pursued, but when compression of the brain takes place attended with its usual concomitants, such as stupor, stertorous breathing, &c, from the effects of a depressed portion of bone, the trephine must be employed if the symptoms continue unabated, notwithstanding the use of the medicines indicated.
CONCUSSION. SPRAINS. 615
extravasated blood, is experienced, together with a feeling of constric- tion that obstructs the freedom of respiration, — it will be necessary to have immediate recourse to Arnica and Aconitum alternately, at inter- vals of from three to six hours, until an improvement in the symptoms becomes manifest ; but should a degree of fever continue after the exhibition of several closes of these remedies, attended with a sensa- tion as if there were an internal excoriation or wound, Pulsatilla should be given. In the event of a continuance or even an increase of cough, with expectoration of thick, yellow mucus occasionally streaked with blood, Mercurius should be prescribed ; if, on the other hand, the expectoration has a sweetish t&ste, and is accompanied by difficulty of breathing, Nux v. is to be preferred. When a degree of delicacy of chest remains behind, after the employment of any of the preceding medicines, with tendency to suffer from shortness of breath, and a dry short cough, combined with paleness of the face, impaired appetite, and restless, unrefreshing sleep, Cinchona has been strongly recommended. In other cases, especially those which have been neglected, wThere we have reason to apprehend the development of Phthisis pulmonalis, the employment of Stannum, Acidum nltricum, Silicea, and Kali <?., or Phosphorus, Sulphw, Calcarea, and Lycopodium, may yet enable us to arrest the progress of that ruthless malady.
The effects of a shock to the nervous system, with pains in the limbs, &c, from stumbling or making a false step, are generally relieved by Bryonia or Pulsatilla. When the accident has been accompanied with fright, Opium may be prescribed in the first instance, Aconitum where there is syncope ; and Chamomilla when, from extreme pain, convulsions ensue.* But in almost all such cases, Arnica may be employed with advantage, either subsequently or at the commence- ment ; in the event of headache resulting from a contusion or from stumbling, and Arnica not being found to afford much relief, Bella- donna may be given ;t the patient should at the same time remain quiet, and avoid any exertion, whether of the body or mind, until the pain is removed.
Sprains. In the treatment of these troublesome casualties, at the commencement, prescribe a lotion of Arnica, when there is much tumefaction and redness, with great pain on the slightest movement-
* Ignatia has also been recommended in the event of convulsions ; and Coffea when uncontrollable agitation and agonizing jactitation result.
t Cocculus, Cicuta, or Acid, phosphoricum, may be required to remove prolonged head- ache arising from the above-named causes. (See also Cephalalgia.)
616 CASUALTIES.
After the employment of Arnica, we may in like manner have recourse to Rhus toxicodendron,* which is, properly speaking, more spe- cific to this description of external injury, and is often of speedy efficacy, even in cases of some standing, the remedy should also be taken internally,. If severe pain continue, notwithstanding the employ- ment of Arnica and Rhus, the following remedies have been recom- mended: Bryonia, Ammonium c, and Ruta, and in some instances, Belladonna, Pulsatilla, Nux v., Agnus, or Silicea.
Strains. When pricking or other pains are experienced in the back, &c, after a strain caused by any powerful or sudden exertion, such as lifting a heavy weight, or throwing up a window, with aggrava- tion from the slightest movement of the arms or trunk, Bryonia should be exhibited, and succeeded by Sulphur, if only partial relief is obtained. When headache results from a similar source, or when the pains are confined to the extremities, or if at all in the back or loins, are equally, if not more severe, during rest as well as on move- ment, Rhus may be prescribed, followed in turn by Calcarea, if the sufferings remain almost unmitigated. When sickness and great pain in the abdomen are produced by the effects of a strain, Veratmm has been recommended as being speedily serviceable.
Wounds are divided into incised, lacerated, contused, punctured, poisoned^ and gunshot wounds.
By an incised wound, is meant one which has been produced by a sharp instrument, as a sword, knife, &c, and is not accompanied with any contusion or laceration. Incised wounds, although more liable tp be attended with a greater degree of hemorrhage, are, generally speakings the least dangerous and the most easily healed.
Lacerated wounds are those in which the muscular fibres, instead of being divided by a sharp cutting instrument, have been torn asunder with some violence; the edges, in place of being even and regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely heal without suppurating, and are frequently succeeded by violent inflammation.
* When an individual muscle has been injured by the effects of a violent strain, Rhus will more readily restore its tone and remove the pain than any other remedy. A dose may be prescribed thrice a day, and locally Tr. Rh., gtt. xv — xx, in aq. libr., as a lotion. Fre- quently, every symptom is removed after a few hours ; but in bad constitutions, many troublesome sequelae occasionally arise, against which Sepia is often useful. (Goullon, Gr. u. St. Arch., xix, 3, 12/)
WOUNDS. 617
The terms contused wounds, or bruises, are applied to those injuries which are occasioned by some blunt instrument, or hard blunt surface, being brought in violent collision with a part of the body. When severe, they are dangerous, from being prone to terminate in morti- fication and sloughing.
Punctured wounds are those which have been caused by pointed instruments; they partake more of the nature of lacerated than incised wounds, and are dangerous from the great depth to which they frequently penetrate, and the serious consequences they often entail, by occasioning violent inflammation of the fascia, and tetanus.
Gunshot wounds partake of the character of lacerated and contused wounds.
For poisoned wounds, see Hydrophobia.
Therapeutics. In the treatment of wounds of all kinds, the first object is to arrest the hemorrhage. This is to be done by means of the tourniquet, by compression, by the ligature, by cold water or ice, and astringents, &c, according to the degree and source of the dis- charge.
Wounds of the arteries are, for the most part, the most serious : they are to be distinguished by the bright colour of the blood, which moreover issues very rapidly and in jets ; while that from a vein flows in a smooth, uninterrupted stream, and has a dark or deep purple hue.
When the injured vessels are of a small size, they spontaneously cease to bleed, or do so, at all events, as soon as the wound is dressed ; but when the hemorrhage is considerable, one or more of the above- mentioned arresting measures require to be immediately resorted to.
Bleeding from wounds, &c.', in the mouth, sometimes requires the application of styptics, such as alcohol, kreasote water, &c. The same may be said of slight superficial wounds, as also of fungous tumours, and other diseased surfaces, when cold water fails to answer the pur- pose. Arnica, Diadema, and Phosphorus, internally and externally, have likewise been strongly recommended in such cases.
Copious hemorrhage after the extraction of a tooth is usually readily suppressed, by pushing a compress of lint into the hollow space left ; or by the aid of styptics, and the medicines above mentioned, when requisite. A simple, and sometimes extremely efficacious mode of checking this current of blood is by replacing the extracted tooth, and keeping it in its former position, until the risk of further hemor- rhage is obviated.
618 CASUALTIES.
When we find severe syncope, with deadly paleness of the face, or when the countenance assumes a livid appearance, and subultus ten- dinum and other signs of extreme exhaustion set in from excessive loss of blood, Cinchona ought to be prescribed ; and if the patient should not exhibit any indications of rallying, a little wine may be given, and subsequently Arnica ; but if the stimulating effects of the wine prove only of temporary service, another dose of Cinchona must previously be had recourse to.
The next step to be taken in wounds of every description, after the hemorrhage is stopped, is to remove all extraneous matter, as sand, fragments of glass, splinters, shot, rags, &c. ; then relax the muscles so that the wound may not gape ; finally, to place the lips of the wound in accurate contact, and keep them so by bandages, plasters, sutures, &c. Bandages are usually indispensable in deep, and even in small, superficial, incised wounds, but care must be taken not to apply them too tight, nor when there is excessive inflammation.
Sutures are generally necessary in wounds of the face, or abdomen, and sometimes of the hands, and in old people generally. In the young and vigorous they are seldom called for, and are even improper and hurtful when the patient is of an irritable habit of body. Strips of ad- hesive plaster,— cut narrow in the centre or portion which is to cross the wound, and sufficiently long to retain their hold as firmly as possible, and act with the required compressive power, — form, in the majority of incised wounds, the most frequently useful means of bringing the sides into close approximation and effecting adhesion. It sometimes happens, however, that even incised wounds, particularly when deep and of considerable magnitude, terminate in suppuration; it is con- sequently necessary to leave intervening spaces between the strips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign substances, it ought to be only lightly, and so to speak, incompletely dressed, as it will be necessary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to facilitate the abstrac- tion of a splinter, &c.
With regard to the constitutional treatment of wounds of all kinds, we should commence with the administration of Arnica^ of which a few globules should be given, as soon as the patient has been made as comfortable as circumstances will admit. The patient should at
* See Dr. Kaser's remarks on the employment of Calendula officinalis, at the end of this chapter.
WOUNDS. 619
the same time be kept cool, free from anxiety or exertion, and as quiet as possible. He should live abstemiously, avoid everything of a heating nature, and drink cold water. If he be robust and strong, and sympathetic fever run high, a dose of Aconite should be prescribed; followed, in the course of from three to six hours, by Arnica, and so on alternately as long as may be found requisite ; in favorable cases one dose of each of these medicines is often found sufficient. The local application, in the first instance, if required by excess of pain, heat, and swelling, should consist simply of lint dipped in cold water, and frequently remoistened.
Lacerated wounds, after having been carefully cleansed, should have all the parts, that will admit of the process, closely approximated and retained in their place by means of plasters and an appropriate posi- tion of the body or limb, for, the purpose of promoting union by the first intention. Should the wound become inflamed, attended with much pain and swelling, it may be dressed with lint dipped in cold water, which should be frequently renewed. If, on the other hand, copious suppuration ensue, and the pain be very severe, the cold water must be discontinued, and Chamomilla exhibited, followed by Hepar s. ; and should these remedies fail to bring on an early healing action, Silicea will generally answer, or Silicea and Sulpkur in alterna- tion, to promote granulation. (See Ulcers.)
In contused wounds (or bruises) Arnica must be given internally, and cold water applied externally, in the first instance. When there is considerable extravasation of blood, Arnica* should be applied as a
* It has been already remarked that this useful medicament, when applied as a lotion to wounds, should always be discontinued whenever any aggravation of the pains, &c, is expe- rienced; and I take the opportunity to repeat here, that it ought to be employed with caution in cases occurring in persons of what is ordinarily designated an inflammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas ; in such instances the tincture should invariably be diluted with a larger proportion of water than is recommended in various parts of this work, and if that fail to prevent the occurrence of medicinal aggravation, in the form of greatly increased pain, redness and inflammation in fhe injured parts, and other pathogenetic symptoms of Arnica, as pains from contusion or dislocation in all the limbs, miliary, papular, or pustular eruptions,etc, — Helianthus annus may be used as a substitute in contusions, and Aqua calendula officinalis in wounds of all kinds. In recent contusions of glandular organs, such as the testes, Arnica is the best remedy ; but when induration has resulted, Conium is of greater efficacy. When the mammary gland is the seat of injury, Aconite is frequently required in preference to Arnica, as is generally the case in wounds or contusions of any part when they are followed by severe or extensive inflammation. If suppuration threatens, in a contused mamma, Phosphorus or Acidum phosph. should be employed. If induration has taken place, Conium is commonly of greater
620 CASUALTIES,
lotion, of the strength of about one part of the tincture in ten of water, to stimulate absorption, and otherwise forward the cure. In the event of an abscess resulting from the effects of a contusion, see that article.
When the joints,* synovial membranes, or tendons are injured by a contusion, Rhus has been particularly recommended : in some cases Silicea will be found of great utility, as we can testify from experience. If the periosteum be affected, Ruta is said to be useful ; we wTould, however, recommend an incision to be made in the membrane, if ecchymosed blood or matter is evidently pent up beneath it, and the patient's sufferings are great ; after which the treatment-to be pursued must be the same as described for open abscesses. When a bruise or contusion is so violent as to squeeze the limb nearly flat, or other- wise disfigure it, cold water ought to be constantly applied, and Arnica prescribed internally. But if gangrene threatens, Cinchona must be given, and when the skin has assumed a livid and black ap- pearance, amputation may still be avoided, and life and limb saved, by having recourse to Lachesis and Arsenicum alternately, in frequently repeated doses. In the greater number of such unfortunate cases, however, amputation becomes imperative, and ought to be performed without hesitation, when it becomes evident that the patient will fall a sacrifice to further delay. When amputation has been found neces-
and more speedy efficacy than any other remedy. In wounds of the eye, Aconite, as has elsewhere been observed (art. Ophthalmia) is the specific medicament. In superficial con- tusions of the trunk or limbs, and in those of long duration, Acidum sulph. has repeatedly been used, externally and internally, with much advantage.
* In cases of swelling, with considerable pain, stiffness, or inflexibility of the knee, from the effects of kneeling, to which housemaids (hence the name of Housemaid's knee) and others, from the nature of their occupations, are liable — and which affection, it may be added, consists of a degree of inflammation and consequent thickening of the bursa mucosa, situated between the patella and the skin, attended with increased secretion of the slippery lubricating fluid contained in the sac, — Silicea, either administered daily, or at intervals of four to eight days in susceptible habits, is a most important and eminently successful remedy.
The same medicament is equally efficacious in similar swellings in other parts, such as the ball of the great toe (where the tumefaction is commonly known by the name of a bunion), or the joints of the fingers, and indeed in most of the situations where tendons play : the use of these little sacs, or burses mucosae, being to facilitate the action or play of the muscles.
During the treatment of these swellings, it is very necessary that the patient should at the same time be careful to avoid pressure on the affected part, and that he should walk about as little as possible. In the case of a bunion, when there is active inflammation, his own suffering will sufficiently remind him of the necessity of these precautions.
WOUNDS. 621
sary, the stump ought to be dressed with lint dipped in cold water, and Arnica should be given internally ; subsequently the said medi- cine maybe employed in alternation with Aconitum, if required by the accession of traumatic fever, Hepar, Silicea, and Sulphur may also be required at the ensuing stages in the healing of the stump. Sub- sequent trials of Calendula officinalis, as recommended by Dr. Thorer, may confirm his opinion as to its superiority over all other remedies in severe wounds, or after important surgical operations, where ex- tensive suppuration is to be apprehended. (See Ulcer-s, for indi- cations for the employment of these and other remedies.)
In the case of punctured wounds, the treatment to be followed is the same as that described for wounds in general, but unless com- pression, by means of adhesive plaster or a bandage, can be brought to bear against their entire extent, the cure by the first intention must not be attempted.*
When suppuration ensues, Mercurius may be prescribed, followed by Hepar s., and then Silicea, if required. Chamo?mllas Belladonna, and Rhus may be found serviceable in the event of excessive local inflam- mation ; the two latter particularly, if the inflammation partake of an erysipelatous character. (See Erysipelas.) When spasmodic twitchings make their appearance, Oicuta is frequently serviceable; but Arnica will generally be found sufficient to subdue these symp- toms when timely administered ; when the constitutional disturbance is severe, Aconitum may be alternated with Arnica ; and when the wound arises from violent inflammation of the fascia, a transverse incision may in some instances be necessary ; in which event a dose of Arnica must be prescribed almost immediately afterwards.
If tetanus supervene, Arnica must be employed, and followed, if required, by Angustura or Cocculus, &c. (See Tetanus.)
Gunshot wounds must be treated by the exhibition of Arnica inter- nally, and cold water constantly applied by means of lint, externally. In some cases it may be found advantageous to apply a very weak lotion of Arnica, in preference to water simply, at the commencement. When splinters of bone, a ball, &c, are lodged in the wound, they ought to be extracted with as little irritation as possible, if they press
* In punctured wounds of the abdomen Aconitum should be given as soon as possible, in order to prevent the development of active inflammation, which is so prone to follow in such cases. Belladonna is generally required after Aconit,, when symptoms of peritonitis have already made their appearance. (See also Peritonitis and Enteritis.)
622 CASUALTIES.
on some important viscera, &c. ; but if not, they may be allowed to remain, particularly when deeply seated or difficult to be found, until loosened by suppuration, which process will be materially forwarded by the administration of Silicea. In other cases Hepar s. and SulpL may afford valuable aid. In the event of fever, gangrene, &c, see Contused Wounds.
When a joint is greatly injured, or much of the soft parts together with the blood-vessels and nerves of importance are carried away by a gunshot wound, the bone remaining entire ;— when there is a frac- ture of a bone with destruction of the soft parts adjacent; when the bone is shattered, and the principal vessels lacerated or ruptured — or when a limb is completely shot or torn off, or other serious injury done, which renders the prospect of saving the limb hopeless, ampu- tation should be performed.*
It may be added that Staphysagria has been recommended as a useful remedy in severe incised wounds ; and Aconitum, Cicuta, or Acid. nitr. in addition to Silicea and Hepar s.3 in wounds from splin- ters, &c. (For poisoned wounds, the treatment will be found under Hydrophobia.)
Dr. Thorer, of Gorlitz,f strongly recommends Calendula offi- cinalis in preference to Arnica, in wounds of every description, but especially incised, punctured, or lacerated wounds, and those with considerable loss of substance. The sphere of the latter as a trau- matic remedy he confines to contusions, sprains, bruises without abrasion of the surface, or laceration of the soft parts. Dr. Thorer speaks, moreover, in favorable terms of the effect which Calendula appears to exercise over the process of granulation and cicatrization. Very frequently, even after amputations, the cure, under the employ- ment of this remedy, was effected by the first intention, and in almost every instance where it was impossible to avoid suppuration, the extent to which it occurred was comparatively insignificant. He em- ployed two different preparations of this remedy as lotions, the one,
* "After amputations, extirpations, and other surgical operations, I have invariably derived the most important service from the employment of Aconitum. In most instances, a complete cessation of pain took place three hours after its administration; traumatic fever never supervened, and the patients almost always fell into a placid and refreshing slumber ; but rarely was it found necessary to have recourse to Opium, and that only when .startings from sleep took place from local or general convulsive jerkings or twitchings." — Dr.Wurzler. Allg. Horn. Zeit., No. i, 21 Band.
f Neues Arch., dritter Band, erster Heft.
wounds. 62 B
to which he gave the name of Aqua Calendula Officinalis, he prepared as follows :
"1 filled one third of a clean bottle with the petals or leaves of the flowers, the remaining two -thirds with fresh, pure spring water, corked it well, and exposed it for two to three days to the warm rays of the sun. The water was, by this process, rendered slightly aromatic, and having been poured off from the leaves, it was put into a bottle, well sealed up like wine bottles, then immediately placed in the lower temperature of the cellar. Whilst the bottle with the mixture of the leaves and water is exposed to the higher temperature of the sun it should be narrowly watched, and the moment that any signs of inci- pient fermentation make their appearance, measures must be taken to arrest it. The second preparation was a Spiritus Calendula, for which I employed the same quantity of the leaves of the flower as in the preceding instance, and pure rectified spirits of wine in place of the water. I employed the latter preparation only on one occasion, very much diluted, in order that the spirit of wine might not exercise a detrimental influence on the injured parts. Its effect was equally beneficial/'
We give the following cases as instances in which Dr. Thorer applied Calendula as a lotio vulneraria homoeopathica with success.
"1. R. K. had the under lip much bruised and lacerated from the kick of a horse. The lips of the wound were brought into approxi- mation, and retained there by means of a strip of adhesive plaster. In addition to this, the patient wTas furnished with a phial containing Aqua calendula and desired to keep the wound covered with a com- press saturated with the lotion. Already, after an interval of three days, healthy cicatrization began to set in, without suppuration. The process of healing went on quickly and uninterruptedly per primam intentionem, and the scar of the divided lip is now scarcely perceptible.
6i 2. M. A. had the misfortune to fall down a flight of stairs, and in addition to several contusions on the chest, two extensive wounds were inflicted, one on the forehead, and the other along the ridge and at the point of the nose, producing great disfiguration. In this case, also, the healing process proceeded most rapidly and favorably, with- out suppuration, and without leaving any disfigurement, such as a wound of so severe a character might reasonably have led me to anticipate.
" 3. This case was of infinitely greater importance than the above,
624 CASUALTIES.
Floder, a boy, 16 years of age, while engaged at His occupation in a cloth manufactory, had the misfortune to become entangled in the machinery; in consequence of which, the following injuries were sustained:
cc 1. Compound fracture of the left arm, the sharp extremities of the broken bone protruding through the integuments.
" 2. A deep wound at the bend of the elbow.
" 3. The bones of the left forearm completely stripped of their muscles, and laid bare to the extent of six inches.
" 4. The hand torn off, being only kept adhering to the stump by a slip of skin.
" 5. The skin and portions of the muscles of the exterior surface of the right leg were torn off, leaving a large and deep wound extending down to the bone.
" 6, Face and chest severely contused, and exhibiting many small flesh wounds.
" The unfortunate patient was reduced to a state of extreme exhaus- tion by loss of blood and excessive suffering ; amputation of the left upper arm was nevertheless rendered imperative, and was accordingly performed. Compresses, saturated with Aqua calendula, were applied to the exposed lacerated muscles of the right leg, up to the period of the recovery of the patient, and it was striking to observe how dry, and without suppuration, incarnation proceeded in the parts to which the Calendula was applied, in comparison with the extensive suppuration and slow curative process which took place in the stump of the am- putated arm, treated according to the ordinary surgical rules. I was not at the time aware of the peculiar properties of Calendula, but in consequence of the striking beneficial effects which it produced on the injured lower extremity of the patient, I subsequently applied it to the wound of the stump, and was gratified by the peculiarly favorable granulation which soon ensued there likewise. All the wounds hence- forward filled up and healed in so satisfactory a manner, that it was scarcely possible to conceive that they could have been of so serious a character, and attended with such loss of substance as they in reality were. The- patient was restored to perfect health, and I have no hesitation in attributing his recovery to the very favorable process of granulation and cicatrization which took place under the employ- ment of the Aqua calendula.
" 4. C. in G. lost his footing when in his mill, and had the third
wounds. 625
phalanx of the left index-finger, the second and third phalanx of the ring-finger, and the flesh of the point of the middle finger torn off. A small portion of the bone of the second phalanx of the ring- finger remained, but was entirely bared and exposed ; the patient was desirous that this remnant of bone should be removed. I refrained from doing so, however, in the hope that it might become covered by means of favorable granulation. And so the result proved. After the hemorrhage had been arrested by the application of cold-water dressings, Aqua calendula was employed, two days from the occur- rence of the accident. The wounds thereupon assumed a drier aspect, incarnation went on uninterruptedly, and a perfect cure was rapidly accomplished. On the ring-finger alone, a very minute exfoliation came off from the exposed bone.
" Mr. Surgeon Schulze, to whom I had recommended the Calendula as a remedy in wounds, and who had employed it extensively with much satisfaction to himself for the past two years, recently favoured me with the following cases, amongst others, in which he had used it with success.
Ci 5. A labourer received a comminuted fracture of the right index- finger, wThile engaged in lifting a heavy stone. The splintered and more or less loose pieces of bone were removed, and the Aqua calen- dula applied as a lotion. The cure followed rapidly, and without any particular suppuration.
" 6. A miller's apprentice had two of his fingers so completely crushed that, as in the foregoing case, it was necessary to remove the shattered particles of bone. The Calendula effected an equally rapid cure, with a very trivial degree of suppuration.
"7. In a case of complicated fracture of the leg, with a wound nine inches in length, from which the tibia was laid bare, Arnica, largely diluted, was employed for a few days, in consequence of the accom- panying extensive sugillation. The Calendula wTas then brought into requisition, and produced a speedy cure without extensive sup- puration.
" I could quote a multitude of other cases in which the Calendula alone was employed, and with singularly successful and satisfactory results; but I shall content myself with adding, that in all in- stances in which there is extensive loss of substance, and where it is found impracticable to bring and retain the lips of a wound to- gether by means of adhesive plaster, &c, 1 consider the Calendula to be the best aqua vulneraria. It has long been occasionally employed by the lower orders in the form of an ointment, made of fresh
40
626 CASUALTIES.
butter, mixed up with the ground or powdered leaves of the flower, and sometimes, though rarely, in the form of infusion, and taken internally. Its Jiommopathicity in wounds, as well as several other affections, has moreover been demonstrated and confirmed by the provings of Dr. Franz."*
Dr. Thorer concludes his remarks by expressing the hope that his statement, in respect to the properties of Calendula, as a remedy in wounds, may have the effect of calling the attention of surgeons to it ; and that if their observations tend to confirm its healing proper- ties in recent wounds, attended or not with loss of substance, the Chimrgia Homceopathica will possess a new remedy which presents the advantage of causing very slight suppuration, a circumstance of no mean importance in the treatment of extensive wounds, where there is often exhausting suppuration, lasting a long time, and severely taxing the strength of the patient.
Dislocations. Luxations. Violent pain, swelling, distortion of the joints, loss of motion, with an alteration in the shape, length, and direction of the limb, characterise the existence of this species of injury.
Therapeutics. The reduction of a luxation ought to be effected as soon as possible by the surgeon. When there is excessive pain and inflammation, a dose of Arnica ought to be given, followed by Aconitum in an hour or two, if the pain continue violent, and the inflammatory symptoms active. Cold water, or weak Amicated water, (one part of the tincture in ten of wrater) should be applied locally* When the luxation is reduced, the same treatment may be pursued if called for ; and the usual beneficial mechanical measures employed. In compound luxations, the same treatment must be pursued in the first instance as above described ; and the wound treated so that it may be healed if possible by the first intention. (See Wounds.)
Fractures. The symptoms of fracture are pain, swelling, deformity, and sometimes shortening of the limb ; loss of power, with preternatural mobility, when wTe attempt to bend the limb, and crepitation on rubbing the broken surfaces of bone together.
Fractures are divided into transverse, oblique, and longitudinal ; and also into simple, compound, complicated, and comminuted. By
* Arch., Bd. 17, Heft 3.
FRACTURES. 627
a simple fracture is understood one in TOhich the bone is broken, with- out there being at the same time a wound of the soft parts. A compound fracture consists, not only of a solution in the continuity of the bone, but also in the coexistence of an external wound, caused by the protrusion of the extremity of one or both fragments of the bone through the integuments. Again, a fracture is termed compli- cated, when it is attended with a wound of a large artery, extensive laceration of the soft parts, or with dislocation of a joint. Lastly, it is designated comminuted, when the bone is broken into several pieces.
Therapeutics. As soon as a limb is discovered to be fractured, the patient ought to be placed on a litter of any kind which happens to be at hand, such as a board or shutter, and removed to some neighbouring place of shelter, or to his own abode if it be not far distant. Great care and gentleness ought to be exercised in lifting and transporting the patient from one place to another ; otherwise a fracture, originally of the simple kind, is liable to be converted into a compound or at all events into a complicated one, from laceration of the soft parts, &c. by the serrated extremities of the fractured bone, whereby the probabilities of recovery will be rendered much more unfavorable, particularly if the accident has happened to a debilitated or aged individual. In the case of a simple fracture, the reduction should be immediately effected. When that is accomplished, a dose of Arnica should be administered, for the double purpose of prevent- ing the invasion of undue inflammation, and of promoting the reunion of the fracture. Bymphitum officinale has also been most favorably spoken of as being extremely valuable in facilitating the last-named important object.* Those who have had ample oppor- tunities of testing the virtues of these remedies, and the homoeo- pathic treatment generally, in cases of fracture, unhesitatingly de- clare that the patients are thereby enabled to regain the use of their limbs, and to be discharged with safety from the hands of the surgeon at an earlier period than when treated according to the old method ; and further, that the formation of false joints is less liable to occur tinder the new mode of treatment.
In fracture complicated with a wounded artery, or with a dislocated joint, the artery should be ligatured, and the luxation reduced before the bone is set.
* Ruta has likewise been mentioned as useful in some cases.
628 CASUALTIES.
In compound fracture, the protruded extremities of the bone should be restored to their natural position as soon as possible, the limb supplied with splints, &c, and the external wound attempted to be healed by the first intention. Consecutive inflammation and con- stitutional disturbance must be suppressed by the measures alluded to in the treatment of wounds.
It is foreign to our purpose to occupy further space, by entering into a description of the means to be adopted, in the reduction of the various specific fractures which are liable to be encountered in different parts of the body : such a proceeding would come more within the province of a purely surgical work. Let it suffice, there- fore, to remark, in closing these observations, that in all cases, the same medical treatment is to be pursued, as we have already prescribed for that of contusions, wounds, and fractures in general. Finally, it may be stated, that from the great success which has attended the homoeopathic practice, as employed by continental surgeons, in the treatment of those numerous and serious diseases which are usually considered of a surgical character, it is earnestly to be hoped that their colleagues in this country may be induced to emulate their example, and thereby become enabled to raise their important branch of the profession to a still higher standing than it already, in many respects, has attained.
BURNS AND SCALDS.
Burns have generally been divided by most authors into three kinds : — First, those which only excite an inflammation of the skin, accompanied or not with vesication ; second, those which injure the vitality of the cutis, inducing separation of the cuticle and suppu- ration of the dermal surface ; third, those in which the vitality of the integuments is either at once destroyed or so seriously affected that sloughing ensues. The amount of danger from the effects of a burn depends upon several conditions. A scald or burn of great extent frequently proves fatal immediately or after the lapse of a few hours, the patient never rallying from the collapse. The extent and depth of the burn, wherever its seat may be, together with the age, tempe-
BURNS AND SCALDS. 629
rament, and habit of body of the patient, determine the degree of danger to be apprehended.
Therapeutics. In slight burns or scalds the injured part should be held for a couple of minutes to the fire; a temporary increase of pain will be amply repaid by the prevention of future suffering and annoyance. The application of Arnica is of speedy service in super- ficial burns. When the pain is excruciating, Carlo v. often relieves, and failing it Coffea. If, however, the injury be more severe, the affected part may be dressed with heated alcohol, or oil of turpentine, taking care to keep the surface continually moist, and well protected from the external air.
The application of raw cotton to the part, is frequently found very efficacious, particularly when the injury presents a large surface ; having previously punctured any blisters that may have arisen, and bathed the sore with tepid water, cover it with carded cotton or wad- ding, in three layers ; when suppuration sets in, remove the upper layer only, and substitute fresh. At the same time we may prescribe Hepar sulphuris, a grain to an ounce of water, a dessert-spoonful every twelve hours. China is sometimes serviceable after Hepar, when the discharge has been excessive.
Soap, a remedy generally at hand, is extremely serviceable in burns, where not only the cuticle, but the true skin has been de- stroyed : pure white or curd soap is the best for this purpose.
Its application will, as in the instance of dry heat, &c. at first increase the pain; but this temporary inconvenience will be super- seded by a marked amelioration ; after a lapse of about twenty-four hours, the plaster may be gently removed, and a fresh one substi- tuted ; generally speaking, however, we must be guided by the feelings of the patient, and renew it as often as a return of pain is complained of; and so continue until the injury is completely healed.*
* " When erythema alone results from a burn, warm alcohol, oil of turpentine, or radiated heat are the most appropriate applications. When the epidermis is destroyed, the principal object to be kept in view, in order to facilitate the cure, is to protect the injured part from the atmospheric air, and from any other irritation or pressure. The best mode of effecting this is by covering the affected surface with thick layers of carded cotton, having previously opened the blisters with the point of a needle, and bathed the part with tepid water. Pen- cilling with white of egg, which has been beat into a froth, is sometimes attended with beneficial results. Should the cotton have become hard and inflexible, like a coat of mail,
630 CASUALTIES.
Aconitum is essential in the event of extensive inflammation, with considerable fever ; or when the system has received a severe shock from fright at the time of the injury. Opium is also of use under the latter circumstances.
Urtica urens has recently come into repute as a valuable re- medy in burns. The mode of application recommended consists in applying linen cloths, saturated with the mother tincture, to the injured part ; and in severe cases, a drop of the tincture may be taken internally also, either in a little water, or on a piece of lump sugar.
Kreasote water has likewise been recommended as a lotion in burns of all kinds, either at the commencement or subsequently, to induce healthy granulation and cicatrization. Crocus sativus (applied externally) has also been favorably spoken of as most serviceable for the latter purpose, in burns or wounds with considerable loss of sub- stance, and disposition to mortification and sloughing. It is pro- bable that Calendula officin. may prove useful in similar cases. (See also Ulcers.) Arsenicum,, and sometimes Acid, nitric, favor the sloughing of eschars.
FATIGUE.
When a feeling of contusion is experienced in all the limbs, Arnica will generally be found the most appropriate remedy to afford relief.
Pains in the joints, &c, arising from lifting heavy weights, or from violent physical exertion of any kind, are usually speedily removed by Rhus toxicodendron.
Cinchona will frequently assist in renovating the strength, when there has been profuse perspiration.
Veratrum, when tendency to fainting ensues from the effects of extreme fatigue ; and
Coffea, when abstinence from food, combined with violent exer- cise, has produced a state of exhaustion.
Coccultjs, when fatigue occurs after the most trivial exertion
in which case some effluvium is also more or less perceptible, it may be moistened once a day with largely diluted kreasote water. If the dermis be also injured, it cannot be healed without suppuration ; in such cases thick warm soap lather or paste is the best external remedy." — (Kurtz. Allg. Horn. Zeit. xxvi, 368.)
OVERHEATING. 631
either of body or mind. (Veratrum and Calcarea are sometimes necessary when Cocculus does not give much relief.)
In fatigue from long watching Cocculus is the most generally useful medicament ; but Nux v., Ipecac, Puis., and Carlo v. are also of service occasionally. Aconitum is a valuable remedy when dyspnoea, with palpitation of the heart, pain in the side, or aching in the extremities, arises from running a short distance, or even from walking quickly, (Bryonia is sometimes necessary when these symptoms continue not- withstanding the employment of Aconitum. At other times Arnica will be found more efficacious, particularly when the pain resembles what is termed a stitch in the side. Ranunculus bulbosus is also very useful in the latter case.)
OVERHEATING. EXPOSURE TO HEAT.
When heat in the head and flushing of the face have arisen from over-exertion in hot weather, care should be taken not to drink cold water until a sufficient time has elapsed to admit of a diminution of the temperature of the body. The early employment of Aconitum in such cases affords speedy relief, and acts as a preventive to any ulterior troublesome consequences. Violent headache, with con- gestion, fever, vomiting, sleeplessness, great anguish or despair, and a sense of weight at the forehead on bending forward, or on stooping, as if the contents of the cranium would burst forward out of their containing cavity, Belladonna should be given, and repeated from six, twelve, or twenty-four hours, if required, shortening or lengthening the interval according to circumstances. Bryonia may be selected in preference to Bella., w7here there is ill-humour and apprehension of some future misfortune. When headache with loss of appetite, a degree of fever wdth thirst, or diarrhoea is brought on by expo- sure either to the rays of the sun or to the heat of the fire during any exertion, Bryonia is again the most useful remedy in most instances. If nausea is the only or principal symptom which is produced by exposure to heat, Silicea wrill generally be found the more efficacious medicament in. removing the said susceptibility. Against headache from over-heating, with weight over the orbits and pain in the ball of the eye on looking intently at any object, Carlo v., usually affords speedy relief.
632 CASUALTIES.
STINGS OF INSECTS.
The severe pain and febrile irritation which sometimes ensue from the stings of insects, such as bees, wasps, &c. is frequently speedily alleviated by the olfaction of spirits of Camphor. Should, however, considerable inflammation with swelling supervene, Aconitnm should be administered, and subsequently Arnica, internally and externally, as described under Wounds. Should the tongue or any part of the mouth be the part where the sting has been inflicted — as occasionally happens to children when biting a piece out of an apple or pear, &c, into which a wasp may have greedily inserted itself — the mouth ought to be rinsed with diluted Arnica tincture ; and should that not suffice, Belladonna should be prescribed. In some instances it will be found necessary to have recourse to Mercurius after Belladonna.
The bites or stings of gnats require an Arnica lotion ; lemon-juice will likewise be found useful in relieving the pain and itching caused thereby.
Immediate relief, when a person has been severely stung by net- tles, will often be found by the application of a lotion of Arnica, pre- pared according to the formula given under Bruises.
SEA-SICKNESS.
Therapeutics. The medicaments found most useful in the treatment of this distressing and painful malady are Nux vomica, Cocculus, Tabacum, Arsenicum, and Ipecacuanha.
Nux vomica should be taken fasting, from six to twelve hours before embarkation ; this precaution will, in some cases, prove suffi- cient to ward off the attack. {Nux v., and Arsenicum alternately every hour or so, at the commencement of the voyage, or oftener should a degree of nausea have already come on, frequently ward off the sick- ness, or at all events afford great relief. As soon as decided improve- ment is experienced, the remedies must be discontinued, or taken at much longer intervals.)
Should, however, a feeling of giddiness, or a sensation of emptiness in the head be experienced, shortly after going on board, attended
APPARENT DEATH. 633
with headache, nausea, and inclination to vomit/ as the motion of the vessel increases, which is aggravated by standing erect, Cocculus may be had recourse to, and repeated every one, two, or three hours, as those symptoms recur. (This remedy has also been found useful in sickness arising from travelling in a carriage.)
Tabacum. Excessive giddiness, attended with distressing nausea, headache, and deadly paleness of the face; or nausea, with sickness, or a sensation of burning in the stomach, renewed by the slightest movement of the head or body, This remedy is further indicated, when the symptoms are somewhat relieved by exposure to the fresh air.
Arsenicum is useful when the sickness becomes excessive, and is attended with a feeling of utter prostration and helplessness, violent retching, burning sensation in the throat, and the other severe con- comitants of this malady. It should be administered between the paroxysms, and will rarely fail of relief. This medicine may be followed by Tabacum or Cocculus, to dissipate the symptoms of nausea and swimming in the head that may supervene.
Ipecacuanha is serviceable in attacks of vomiting unattended with great prostration of strength given under Arsenicum. Of course, in order to avoid interfering with the action of the medicines, the homoeo- pathic regimen should be carefully observed during the period of their administration.
Petroleum,* Silicea, and Therideon, from the close analogy of their pathogenetic symptoms to those of the ordinary forms of this distressing malady, deserve a trial.
apparent death.
Asphyxia,
Apparent Death. Asphyxia. In every instance where an individual has to all appearance suddenly expired from external causes, animation may only be suspended ; there are many cases, of
* " I have found that Petroleum is the best specific for sea-sickness. It has become quite a celebrated remedy among those who travel on the lakes. As soon as the nausea, swimming in the head, etc., sets in the patient takes three or four pellets, 6 upon the tongue, and the symptoms disappear almost instantaneously, without ever returning. I know that numbers have been relieved by Petroleum, and that it has so far failed only in one instance." — (Dr. D. Chase, Homceop. Examr. Vol. iv, No. 2.)
634 CASUALTIES.
course, where sudden death is no mere suspension of animation, but there are others where apparent death is far from uncommon ; in all cases, therefore, where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in.^
Apparent death from hunger. Give small injections of warm milk repeatedly ; great care must be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given drop by drop, and gradually increased to a tea- spoonful, and after some interval a small quantity of beef tea and a few drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given ; but it . is best that the patient should eat little at a time, but often, so that he may gradually return to his natural mode of living. It must be borne in mind, that in all persons suffering from starvation, eating too much and too quickly, is in the highest degree dangerous.
Apparent death from a fall. Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet ; put a few globules of Arnica on his tongue, and wait till a medical man visits him to see if there is any fracture, or whether there are still signs of life ; bleeding may be here sometimes of benefit, but it requires great caution. Arnica may be repeated, and also administered in injec- tions. If the patient has been bled, give China; but it is obvious that if much blood has been lost by the fall or wound, venesection would be injurious.
Apparent death from suffocation, (hanging, pressure, chohing.) Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently but constantly with clothes, give an injection of a dozen or two globules, or a drop of Opium, dissolved in a half pint of water, and injected slowly. This may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Hold from time to time a mirror before the mouth, to see if the breath dims it ; open the eyelids, and see if the eyes contract ; put warm clothes on ; hot stones wrapped in blankets to the feet, between the thighs, to the sides, neck, and
* The subjoined directions have chiefly been taken from Hering's- Hausarzt.
APPARENT DEATH. 635
shoulders. If in an hour no change is produced, take a bitter almond, pound it fine, mix it in a pint of water, put a few drops into the mouth, or into the nose, and give" the rest in injections.
Apparent death from lightning. The body should be immediately removed into a current of cool fresh air ; and cold water dashed fre- quently on the neck, face and breast. If the body be cold, warmth with friction must be employed in the same manner as recommended for the drowned in the*next article ; as well as the means therein pre- scribed for inflating the lungs. A few globules of Nux vomica may be put upon the tongue, and repeated in half an hour, when, if no effect is produced, a little Nux vomica in water rubbed on the neck, and some injected, may be of service. It has also been recommended to place the patient in a half-sitting, half-recumbent posture, and to cover him over with newly-excavated earth (leaving the face alone exposed, which should be turned towards the sun, until the first signs of returning animation become apparent, after which Nux v. is to be had recourse to, as above directed.
Apparent death from drowning. Observe the following cautions: 1, lose no time ; 2, avoid all rough usage ; 3, never hold up the body by the feet ; 4, do not roll the body on casks ; 5, do not rub the body with salts or spirits ; 6, do not inject smoke or infusion of tobacco, though clysters of warm water and salt, or spirits and water may be used, and the following means should not be delayed : —
1. Convey the body carefully with the head and shoulders in a raised position to the nearest house.
2. Strip the body and rub it : then wrap it in hot blankets, and place it in a warm bed in a warm room, or in warm sand or ashes.
3. Wipe and cleanse the throat, mouth, and nostrils.
4. If the foregoing measures produce no reaction, administer a few globules of Lachesis on the tongue, and in injections, and resume the rubbing. Solatium mamosum has also been recommended, and may be tried after Zachesisi when that remedy fails to do any good.
5. Again, should our efforts still fail, or should the medicines quoted not be at hand, we may, in order to restore the natural heat of the body, move a heated, covered warming-pan, over the back and spine ;— place bottles, or bladders filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet ; — put the body in a warm bath, in the sun, or at a
636 CASUALTIES.
proper distance from the fire : use friction with hot flannels, flour of mustard, or other stimulants ; rub the body briskly with the hand, and at the same time not suspend the employment of other means.
To restore breathing, introduce the pipe of a- common bellows into one nostril, carefully closing the other and also the mouth, at the same time drawing downwards, and gently pushing backwards, the upper part of the windpipe, to allow a more free admission of air ; blow the bellows gently in order to inflate the lungs till the chest be a little raised, the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest ; continue this process until signs of life appear.
6. Electricity, or a stream of galvanism passed through the chest, promises to be of great service.
7. Apply pungent salts, as sal volatile or spirits of hartshorn, to the nostrils.
These means should be persisted in for several hours, and till there are evident signs of death.
When the patient shows signs of life, and can swallow, small quan- tities of warm wine, or spirits and water may be taken ; but till then, nothing should even be poured down the throat, either by a flexible tube or otherwise. At this period the patient should never be left alone, as some have been lost for want of care who might otherwise have been saved.
Apparent death from leing frozen. When an individual is found in a state of frost-bitten asphyxy, arising from exposure to intense cold, he should be removed with great gentleness and caution, to guard against any injury, as fracture, etc., to a place of shelter, such as a barn or unheated apartment, since even a moderate degree of heat might anni- hilate all hope of restoring animation ; at the same time the patient ought to be protected from the slightest draught.
He should then, especially if the limbs have become stiffened by the frost, be covered over with snow to the height of several inches, the mouth and nostrils alone being left free.
The patient ought to be put into such a position that the melted snow may run off readily, and its place be supplied by fresh. When there is no snow a cold bath, the temperature of which has been reduced by ice, (or a bath of cold sea or salted water), may be substi- tuted, and the body immersed therein for a few minutes.
The process of thawing is by these means to be effected, and when
HYDROPHOBIA. 637
every part has lost its rigidity*, the patient should be undressed by degrees, or the clothes cut from the body, if requisite. As the mus- cular or soft parts become pliable, they may be rubbed with snow until they become red; or the body should be wiped perfectly dry, if snow is not to be had, placed in flannel, in a modetately warm room, and rubbed with the warm hands of several parties simultaneously.
In the event of no signs of returning animation declaring them- selves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symptoms of approaching restoration become perceptible, small injections of lukewarm black coffee (coffee without milk) maybe thrown up ; and as soon as the patient is able to swallow, a little coffee may be given, in the quantity of a teaspoonful at a time.
The measures above detailed ought to be persevered in for several hours. Against the excessive pain which is generally experienced when life is restored, Carlo v. should be prescribed in repeated doses, and if it fails to relieve the sufferings, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of the fire or stove for a considerable length of time after his recovery, as serious consecutive ailment, and particularly disease of the bones, is liable to result therefrom.
Apparent death from noxious vapours. The treatment consists in re- moving the body into a cool, fresh current of air ; dashing frequently cold water on the neck, face and breast ; if the body be cold, applying warmth, &c., as above recommended to the drowned ; inflation of the lungs ; early and judicious application of electricity or galvanism ; — after life has been restored Op. or Aeon, may be given with advantage.
HYDROPHOBIA.
It is acknowledged that no allopathic cure has hitherto been ound for this disease, when fully established. The plans of treatment, which are reported to have been successful in some few instances, have generally failed in all others ; thus rendering it probable that in these supposititious cases of success, the persons bitten might have escaped without any treatment whatever* But it is not to my pur-
638 CASUALTIES.
pose to enter into the multitude of ineffectual remedies which have been recommended by the Allopathists.
Hydrophobia is a disease which arises in consequence of the bite of a rabid animal, and sometimes spontaneously, particularly in the course of some other disease ; in which form it is known under the term of symptomatic hydrophobia.
Ere proceeding to the homoeopathic treatment, a few remarks descriptive of the disease as it appears in the human subject, may not be misplaced. The first symptoms that show themselves in a person who has been bitten, are usually, general uneasiness, anxiety, and disturbed sleep ; the eyes are glassy, inflamed, and sensitive to light ; there are also ringing in the ears, giddiness, and paleness of counte- nance; frequent paroxysms of chilliness ; oppressed respiration, and quickness of pulse, which latter is usually at the same time small, contracted, and irregular; and loss of appetite. These symptoms generally come on at some indefinite period, occasionally after the bitten part seems quite well. In the second or convulsive stage, the wound, which may have already become completely cicatrized or healed, begins to assume a somewhat inflamed appearance, and a slight pain and heat, now and then attended with itching, is expe- rienced in it. It now breaks out afresh, and an ulcer, with elevated margins of proud flesh, which secretes a dark coloured and offensive discharge, is subsequently formed; and wandering, drawing, and shooting pains from the lacerated part upwards towards the throat, present themselves. These symptoms, with the state of testiness and anxiety, increase daily ; and the patient complains of a state of confu- sion in the head, or giddiness, with sparks before the eyes ; is afflicted with sudden startings, spasms, sighing, and is fond of solitude ; the pulse is small, irregular, and intermittent; the breathing laborious and uneasy ; the skin cold and dry, and general chilliness, especially in the extremities, is complained of ; then hiccough, colic, and palpita- tion come on ; the patient looks wild, and the eyes have a fixed, glassy, and sJdning appearance ; the act of deglutition is impeded by a sense of pressure in the gullet, which occasionally renders every attempt to swallow liquids impracticable ; convulsions also take place in the muscles of the face or neck. In this stage, however, the deglu- tition of any solid substance is performed with tolerable ease. In ordinary cases the sufferer remains affected in the above manner for a few days, after which, the disease passes into* the JuycH/rophobic stage,
HYDROPHOBIA. 639
in which it is utterly impossible for him to swallow the smallest drop of liquid ; and the moment that any fluid, especially water, is brought in contact with the lips, it occasions the individual to start back with dread and horror, although he may, at the same time, suffer the most excessive thirst ; even the sight of water, or the very noise produced by pouring it from one vessel into another, in fact, anything that tends to remind him of that fluid, produces indescribable anxiety, uneasiness, convulsions, and even furious paroxysms of madness ; he dreads even to swallow his own saliva, and is constantly spitting ; vomiting of bilious matter soon comes on, succeeded by intense fever, great thirst, dryness and roughness of the tongue, hoarseness, and fits of delirium or madness, with disposition to bite and tear everything within reach, followed at intervals by convulsive spasms. These attacks commonly last for a quarter or half an hour, and at their expiration, the patient is restored to reason, but remains in a state of great despondency; finally, the paroxysms come on more violently and frequently, and in some instances a fit of furious delirium closes the frightful scene ; in others, nature sinks exhausted after a severe attack of convulsions. The disease may be communicated to the human subject, from the bites of cats, and other animals not of the canine race, which have been previously inoculated with the virus.
It may be remarked in this place, that the best and most expe- rienced of our writers upon this subject, consider the human species as the least susceptible of contagion from the hydrophobic virus; scarcely one out of twenty, or even thirty, of those actually bitten by an animal in a state of rabies, suffering from its effects. I cbnsider it my duty, while making this statement, which I hope may prove a means of relieving the minds of many from painful apprehensions, to enforce, at the same time the necessity of taking those precautions, which are about to be pointed out, against the danger.
It may also be added, before proceeding to the treatment of the malady, that the possibility of the poison being communicated through the medium of the epithelium is exceedingly questionable; but scarcely a doubt exists of the incapacity of the cuticle to absorb it. As many have been made wretched from having allowed a dog, which has afterwards shown symptoms of rabies, to lick their hands, it may be stated with confidence that if no abrasion of surface exists, there is not the slightest danger.
In the homoeopathic treatment of this disease, and its prevention,
640 CASUALTIES.
the following are the principal remedies employed : Belladonna, Lachesis. Hyoscyamus, Stramonium, and CantharidesJ*
* The use of dry or radiating heat in this disease, and in envenomed wounds by snakes, &c., is recommended by Dr. Hering, of America, whose directions for the treatment of envenomed wounds in general, are as follows :
Envenomed wounds. The best domestic remedy against the bites of venomous serpents, mad dogs, &c, is radiating heat. This should be done by the readiest means at hand, — a red-hot iron or live coal, or even a lighted cigar, for instance, must be placed as near the wound as possible, without, however, burning the skin, or causing too sharp pain ; but care must be taken to have another instrument ready in the fire so as never to allow the heat to lose its intensity. It is essential also that the heat should not exercise its influence over too large a surface, but only on the wound and the parts adjacent- If oil or grease can be readily procured, it may be applied round the wound, and this operation should be repeated as often as the skin becomes dry ; soap, or even saliva may be employed, where oil or grease cannot be obtained. Whatever is discharged in any way from the wound ought to be carefully removed. The application of burning heat should be continued in this manner, till the patient begins to shiver and to stretch himself; if this takes place at the end of a few minutes, it will be better to keep up the action of the heat upon the wound for an hour, or until the affections produced by the venom are observed to diminish.
Internal medicines must be judiciously administered at the same time. In the case of a Bite from a Serpent, it will be advisable to take from time to time a gulp of salt and water, or a pinch of kitchen salt, or of gunpowder, or else some pieces of garlic.
If, notwithstanding this, bad effects manifest themselves, a spoonful of wine or brandy, administered every two or three minutes, will be the most suitable remedy ; and this should be continued till the sufferings are relieved, and repeated as often as they are renewed.
If the shooting pains are aggravated, and proceed from the wound towards the heart, and if the wound becomes blueish, marbled, or swollen, with vomiting, vertigo, and fainting, the best medicine is Arsenicum. It should be administered in a dose of three globules in a tablespoonful of water ; and if after this has been taken, the sufferings are still aggra- vated, the dose should be repeated at the end of half an hour ; but if, on the contrary, the state remains the same, it should not be repeated till the end of two or three hours ; if there is an amelioration, a new aggravation must be waited for, and the dose ought not to be repeated before its appearance.
In cases in which Ars. exercises no influence, though repeated several times, recourse must be had to Bell.; Sen. also frequently proves efficacious.
Against chronic affections arising from the bite of a serpent, Phos. ac. and Merc, will generally be most beneficial.
For the treatment of persons bitten by a mad dog, after the application of dry heat, as directed and described above — see Hydrophobia, p. 641.)
If morbid affections or ulcerations exhibit themselves, in consequence of a bite from a rabid man or animal, Hydrophobine, administered in homoeopathic doses, will often render essential service.
For wounds that are envenomed by the introduction of animal substances in a state of putrefaction, or of pus from the ulcer of a diseased man or animal, Ars. is generally the best medicine.
Lastly, as a Preventive against bad effects, when obliged to touch morbid animal sub-
HYDROPHOBIA. 641
Belladonna. HAHNEMANN states, in the introductory arti- cle to Belladonna, in his Materia Medica Pura, that he considers the smallest dose of that medicine, repeated every three or four days, to be the most certain preventive against Hydrophobia; and when we refer to the pathogenetic effects of Belladonna, described in the aforesaid work, it is impossible not to be struck with the great resemblance which many of them bear to the symptoms of this malady ; and it is from this circumstance, according to the great law of Nature, on which Hahnemann's doctrine of similia similihus is founded,* that this medicine is found to be both a prophylatic and curative remedy.
These precautions taken, the patient may be allowed to pursue his usual occupation, those around him being careful to avoid making any allusion which may tend to remind him of his misfortune. Belladonna, in the same dose, should be repeated on the third or fourth day, and subsequently at longer intervals. The effect of each exhibition should be attentively watched, and care taken that a fresh one be not given, as long as any symptoms of the action of the pre- vious dose are perceptible.
Lachesis may generally be given as soon as convulsions set in.
stances, envenomed wounds, or ulcers of men and animals, under the influence of contagious diseases, the best method that can be pursued is the application of dry, burning heat, at a distance. To effect this purpose, it will be sufficient to expose the hands for five or ten minutes to the greatest heat that can be borne ; and after this, it will be proper to wash them with soap.
The use of Chlorine and muriatic acid, in similar cases, is well known.
Hydrophobia. Apply distant or radiated heat to the recent wound, as described under " Envenomed Wounds," or until shudderings appear ; and continue this practice three or four times a day, until the wound is healed, without leaving a coloured cicatrix.
At the same time the patient should take, every five or seven days, or as often as the aggravation of the wound requires it, one dose of Bell, or Lach. or of Hydrophobine, till the cure is completed.
If, at the end of seven or eight days, a small vesicle shows itself under the tongue, with feverish symptoms, it will be necessary to open it with a lancet or sharp-pointed scissors and to rinse the mouth with salt and water.
If the raging state has commenced, before assistance can be procured for the patient, the medicines that ought to be administered, are especially, Bell, or Lach. ; or else again, Canth., Hyos., Merc, or also Stram. or Verat., according to symptoms, &c. (See the indi- cations above given for Belladonna, Lachesis, Hyoscyamus, Stramonium, and Cantharides.)
* The curing of a disease by the administration of a remedy which has been found to possess the property of producing a train of symptoms in a healthy person, similar to those observed in the disease
41
642 CASUALTIES.
Dose. A few globules repeated every two or three hours, or at every return of the convulsions, until benefit result, or decided symptoms of medicinal action make their appearance ; but should this remedy appear to exert no perceptible influence in checking the progress of the malady we must again have recourse to
Belladonna^ particularly when the following characteristics are present : drowsiness, with constant but useless efforts to sleep, chiefly in consequence of excessive anguish and great agitation : sense of burning ; great burning in the throat, with accumulation of frothy mucus in the mouth or throat, frequent desire for drinks, which are imme- diately pushed aside when presented, or a suffocating or constricting sensation in the throat on attempting to perform the act of deglutition, or complete incapacity to swallow, with glowing redness and bloated appearance of the face ; pupils immoveable, and generally dilated ; great dread ; occasional desire to strike, spit at, bite, or tear every- thing ; inclination to run away ; continual tossing about ; and great physical activity, with twitching in various muscles, especially those of the face : ungovernable fury, with foaming at the mouth ; and tetanic convulsions.
Dose. A few globules to be placed on the tongue at every threatening of a return of the convulsions, but with the same precaution as enjoined under Lachesis.
Hyoscyamus is more particularly indicated either before or after Belladonna, when the convtdsions are severe and of long dtiration ; wrhere there is not so much inclination to bite or spit, but a desire to injure those that stand around, in some manner or other. The spasms in the throat are not so violent, but great dryness and burning are com- plained of, attended with a sense of shooting or pricking, which causes a difficulty in swallowing, resembling a sensation of constric- tion in the throat, and threatening to produce suffocation on attempt- ing to satisfy the thirst ; dread of liquids in consequence of the pain and difficulty that is experienced in deglutition, with ejection of the saliva for the same reason ; excessive convulsions, with loss of consciousness come on soon after the distressing act of swallowing has been performed. There is, moreover, foaming at the mouth, with constant raving; sometimes the patient seems wrapped up in his own thoughts ; or is full of fear, and inclined to run away from the house, being afflicted with a sort of Anthropophohia ; there are also attacks of excessive fury,
HYDROPHOBIA. 643
attended with apparently supernatural physical power ; or excessive anguish and fear, alternating with fits of trembling and convulsions ; the individual exhibits a peculiar dread of being bitten by animals ; the pupils are dilated ; sleep is much disturbed by great nervous excite- ment ; starts, and agonizing dreams.
Dose. Same as Belladonna.
Stramonium is chiefly indicated in this disease, when we observe severe convulsions taking place whenever the eye becomes fixed on brilliant objects, or on whatever tends to remind the patient of water ; great thirst ; dryness of the mouth and throat, with hoiror of water and all liquids; spasmodic constriction in the gullet, with foaming at the mouth, and frequent spitting ; mania, with great loquacity and ges- ticulations; fits of laughter and singing, sometimes alternately with acute fits of passions and moaning ; the convulsions, when severe, are generally attended with ungovernable fury, restless, agitated sleep, sudden shrieks, and starting up with wild gestures ; insensible and dilated pupils ; and great disposition to bite or tear everything with the teeth.
Dose. Same as Belladonna.
Cantharides. This medicine also posesses various pathogenetic properties, wrhich bear a close resemblance to the symptoms that are met with in many cases of this disorder,* and should be selected in preference to any of the foregoing remedies when we meet with the following indications : great dryness and burning in the mouth and throat, much aggravated on attempting to swallow ; paroxysms of fury, alternating with convulsions, which are renewed by any pressure on the throat or abdomen, and also by the sight of water ; fiery redness and sparkling of the eyes, which become prominent and frightfully convulsed ; spasms in the throat, excited by the pain produced by the
* Drs. Hartlaub and Trinks consider Cantharides to be the most certain prophylactic against hydrophobia, when administered early ; they recommend a drop to be given every three or four days, and are of opinion that the virus is not eradicated as long as the cicatrized wound presents a livid hue, and is attended with induration, but affirm the danger to be over as soon as the part assumes a healthy and natural appearance. (Vide Hartlaub and Trinks, R. A. M. L., vol. i, p. 173.)
644 CASUALTIES.
act of swallowing^ especially fluids ; continual burning, titillation and other irritating sensations in the lower part of the abdomen, &c.
Dose. Same as Belladonna.
We have now enumerated and described the characteristic indica- tions for the principal Homoeopathic remedies, which have been suc- cessfully employed against Hydrophobia;* others have also been strongly recommended, but those mentioned have repeatedly proved sufficient, when administered early, and exclusively adhered to through- out the course of the disease. Belladonna has frequently been tried by the Allopathists, but the cases in which it seemed to fail, were evidently attributable to the improper manner in which it was administered. We shall not treat of the several remedies which have from time to appeared, and have, by their inventors, been highly eulogised, as time and experience alone will prove whether they possess any virtue or not.
MENTAL EMOTIONS.
We shall conclude this part of the work with the consideration of those particular Mental Emotions, which exercise so great a control over the human organism, among which, fright, passion, or anger, and concentrated grief, are the most prominent and continually recurring.
Therapeutics. The remedies found most serviceable for derange- ments of the system, arising from the above-mentioned causes, are, Opium, Aconitum, Pulsatilla, Belladonna, Ignatia amara, Chamomilla, Nux vomica, Staphysagria, Arsenicum album, Bryonia, Sec.
Opium : — when the sufferer has been exposed to sudden fright, with terror, horror, or fear, is generally efficacious, if administered im- mediately, in restoring the patient, and obviating any evil conse- quences, such as convulsive fits, swooning, lethargic sleep, involun- tary evacuations, diarrhoea, &c. (When Opium is not sufficient to
* Vide Hartmann's Therapie acut. Krank, vol. ii, p. 77, 2d ed.
MENTAL EMOTIONS. 645
remedy the mischief, Aconitum may be administered, or Aconitum and Opium alternately. In some case Ignatia will answer better than Aconitum, especially when the convulsions continue : Belladonna or Hyoscyamus, and Veratrum, are also serviceable, when none of the other remedies are sufficient to remove all the effects. Causticum is a useful remedy when a constant dread haunts the child after a previous fright, Sec.) See also Samb.
Aconitum is the appropriate remedy, when the system is labour- ing under the joint influence of fright and passion : and especially when there is headache, feverishness, heat in the face and head (con- gestion) ; fear.
Pulsatilla, in cases of fright, fear, or timidity, particularly when accompanied with an effect upon the stomach and bowels, as also heat of the body, with coldness of the extremities ; or passion, in people of generally mild temper ; it is also suitable for highly sen- sitive persons.
Belladonna. Two globules, when there is particular liability to be startled by trifles, or extreme general nervous excitement, after a fright, &c.
Ignatia : — Where the cause is gnawing, inward grief. Acid.phosph. and Staphysagria are sometimes requisite after Ignatia.
Chamomilla : — Where suffering has arisen from vexation or a dis- position to irritability ; or great anguish and mental depression, are present.
Nux vomica. Suffering arising from a sudden fit, or outbreak of passion or rage.
Staphysagria. Anger and vexation, arising from just cause.
Arsenicum is useful where passion is followed by great weakness and dangerous prostration of the vital powers.
Bryonia is indicatedNvhere a fit of passion is followed by coldness and shivering over the whole body, great irascibility, want of appetite, nausea, vomiting, and bilious sufferings.
Colocynth : — when indignation accompanies the above described effects of a fit of anger.
Against the injurious effects which occasionally result after excessive joy, such as headache, trembling, and tendency to fainting, Coffea is the most useful remedy. But when the consequences are more serious, and violent headache, with congestion to the head, frequent vomiting, diarrhoea, swooning, &c, result, Opium must be given.
Hyoscyamus is a serviceable remedy against any injurious con-
646 CASUALTIES.
sequences arising from jealousy, or disappointed love. In the latter instance Ignatia and Acid, johosphoricum are also beneficial.
Against the effects of mortification or wounded vanity or self-esteem, Colocynth, Ignatia, Staphysagria, Pulsatilla, Plalina, or Belladonna have proved useful.
Sambucus : — When oppression at the chest, with stertorous breath, has ensued in consequence of a fear or fright, and failed to yield to the employment of Opium.
END OF PART I,
PART II.
TREATMENT OF FEMALES,
THEIR PECULIAR AFFECTIONS.
PART II.
TREATMENT OF FEMALES, AND OE THEIR PECULIAR AEEECTIONS.
CHLOROSIS.
This complaint generally declares itself in young females about their fourteenth year. Its proximate cause is an obstruction of the first menstruation ; a disease very similar may be produced by great loss of blood.
Diagnosis. Pale/ blanched complexion and lips (sometimes with flushes of heat and redness) ; cantm carotidum ; a depravity of appetite, a longing after innutritious substances, such as chalk, &c, and a general languor both mental and physical ; the patient complains of weariness, lassitude, and debility, and becomes emaciated; the lower extremities frequently assume an cedematous appearance, gene- rally attended with cold in those parts, and headache with flatulent distension of the abdomen, particularly after meals, and in the evening; bowels irregularly confined, sometimes at a later period very easily irritated and relaxed ; a harsh, harassing cough, occasionally with periodical expectoration of dark-coloured coagulated blood, and hur- ried respiration, frequently declares itself, if the affection has been allowed to proceed unchecked ; and to an experienced eye the sufferer appears to be on the verge, or even passing through the different stages of a decline, the disease appearing to stand in closer relation
650 TREATMENT OF FEMALES,
to the functions of the stomach and lungs than to those of the uterus, as indeed it virtually does, in the generality of cases.
Therapeutics. The medicines which have hitherto been found most useful in ordinary cases of this affection are, Pulsatilla, Sepia, Bryonia, Sulphur, Natrum muriaticum, Calcarea carbonica, Ferrum, By co- podium, and Plumbum.
Pulsatilla is, together with Bryonia, Sulph., By cop., &c, peculiarly efficacious in emansio mensmm, when the complaint seems to have been excited by and is intimately connected with deranged digestion, and when it is accompanied by frequent attacks of semilateral headache, with shooting pains, extending to the head and teeth, sometimes shifting suddenly to the other side ; also when we observe aching in the forehead, with pressure at the crown of the head, and sallow complexion; difficulty of breathing, and sense of suffocation after the slightest mo vement; palpi- tation of the heart; coldness of the hands and feet, often changing to sudden heat ; disposition to diarrhoea and leucorrhoea ; pains in the loins ; sensa- tion of weight in the abdomen; almost constant chilliness and shivering; spasms in the stomach, with nausea, inclination to vomit, and vomiting ; periodical expectoration of dark, coagulated blood; hunger, with repugnance to food, or want of appetite with dislike to food ; swelling of the feet and ankles, great fatigue, especially in the legs. This medicine is peculiarly adapted to females of mild or phlegmatic dis- position, disposed to sadness and tears.
Graphites, when there is retention of the period with congestion of the vessels of the head and chest ; dark red flushing of the face, oppression at the chest ; and a feeling of anxiety w7hen in the recum- bent posture. Graphites is, moreover, one of the most important remedies in scanty, insufficient menstruation. Belladonna is often called for when the congestion of the head and chest is of an active cha- rater, and accompanied with violent throbbing of the carotids.
Sepia is also a very valuable remedy in this affection, when many of the above symptoms are present, with, at the same time, hysteri- cal megrims ; complexion sallow, with dark-coloured spots ; frequent colic and pain as if arising from bruises in the limbs. It may, when the above symptoms declare themselves, advantageously follow Pulsatilla; if the latter have failed to relieve, which it generally does, if the pathognomonic sign of chlorosis, denominated cantus carotidum, be absent.
Bryonia : — Frequent congestion in. the head or chest ; bleeding at
CHLOROSIS. 651
the nose ; dry cough ; coldness and frequent shivering, sometimes alternated with dry and burning heat ; constipation or colic ; bitter taste in the mouth, tongue coated, yellow ; sense of pressure in the stomach as if from a stone ; irascibility.
Sulphur is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to the nape of the neck ; or, pulsative pain in the head, with determination of blood ; humming in the head; pimples on the forehead and rotmd the month ; pale and sickly complexion, with red spots on the cheeks ; voracious appetite ; general emaciation ; sour and burning eructations ; pressive fulness and heaviness in the stomach under the lower ribs and in the abdomen; bowels irregular ; difficulty of breathing ; pain in the loins and fainting ; excessive fatigue, especially in the legs, with great depression after talking ; great tendency to take cold; irritability, and inclination to be angry; or sadness and melancholy, with frequent weeping.
Calcarea carb. is often of the most striking benefit in chlorosis. Sometimes a complete cure is effected by it alone, even in the worst cases, with oedema of the extremities, and extreme dyspnoea. Occa- sionally it is found necessary to follow up the treatment, on the dis- appearance of the more important symptoms under the employment of Gale, with Ferrum carb. in repeated doses, in order to prevent a relapse. Ferrum is especially required when the pale and sickly hue of the face continues, as it frequently does, notwithstanding the previous use of Calc. When Ferrum is employed at the commencement of the treat- ment, it has been found to aggravate the anxiety, cough, and other pectoral symptoms. Where there is a complication with tubercular diathesis, accompanied by cough, &c, coeval with the first appear- ance of chlorosis, Sulphur and Calcarea often prove highly beneficial in alternation.* In the generality of cases, during the employment of Calcarea, a dose of Lycopodium is required when there is obstinate constipation and extreme languor, or Sepia when oppressive headache is complained of.f Sometimes the menses do not appear for some time afterwards, although the general health may have been thoroughly renovated by the remedies prescribed.
Valeriana has been found of great service in daily repeated doses, when a feeling of constriction was experienced in the gullet or chest, accompanied with signs of threatened suffocation, and followed by frequent yawning, as soon as the patient sat down to dinner.
* Allg. Horn. Zeit., Gr. u. St. Arch, xx, 3, 58. t Arch, xx, 3, 58.
652 TREATMENT OF FEMALES.
Natrum muriatic um is a most valuable remedy in many obsti- nate cases of chlorosis with habitual constipation.
Plumbum aceticum has repeatedly been found useful in inveterate cases with dyspnoea, oedema, and anasarca, but no organic disease either in the chest or abdomen. Ammonium c, Phosphorus, Conium, Lycopodium, Kali, China, Ignatia, Aurum, Acid, nitricum, &c, have also been advantageously employed in chlorosis.
In enlargement of the abdomen, occurring in young girls at the critical age, Lachesis has been employed with success.
AMENORRHEA.
Suppressio Mensium.
Suppression of the menses occasionally takes place suddenly from some accidental cause, such as exposure to cold, powerful mental emotions, &c. In other instances the suppression is symptomatic of some other disease, either organic or . functional, and can only be removed by the cure of the primary malady. It is of the former that we here propose to treat.
When a suppression takes place from the sudden effects of a chill, we may have recourse to Pulsatilla, wThen the symptoms generally correspond to those of that remedy, as detailed under Chlorosis. In other cases arising from this cause, Nux moschata, Dulcamara, Sepia, or Sulphur may be necessary. (See Chlorosis for indications for Stilph. and Sep., which are remedies of great service in a large number of cases, when the affection has become chronic.)
When a sudden fright has given rise to the affection, Aconitum should be immediately administered, followed by Lycopodium, Opium, or Veratrum, if the bad consequences which frequently result do not yield, or if only partial relief is obtained from the employment of Aconitum. (See Mental Emotions, Parts I and II.)
In chronic cases occurring in weak or debilitated individuals, in addition to Sulphur and Sepia, the following remedies are useful : Natmm m., Conium, Arsenicum, Cinchona, Graphites, Iodium. Whilst in those which occur in plethoric subjects, whether of a chronic or* recent description, Aconitum, Belladonna, Sulphur, Bryonia, Nux v.,
MENORRHAGIA. 653
Sabina, Opium, Platina, &c, will generally be found the most serviceable. When there is not a complete suppression, but the menstrual discharge is scanty and insufficient, Graphites, Kali, Conium, Natrum m., Phosphorus, Pulsatilla, Sulphur, Lycopodium, Magnesia, Silicea, Veratrum, or Zincum, are the most important remedies.
MENSTRUATIO NIMIA. MENORRHAGIA.
The quantity of the menstrual discharge varies a good deal in different women. Considerable influence is for the most part exerted by climate, constitution, and the manner of living. The duration of the discharge and the period of return are also variable. In some women it continues from four to ten days, in others it lasts only a few hours ; from three to six days is, however, the most usual period. The regularity is in many, exact to a day, or even an hour, while in others a variation of several days is a usual occurrence, without the slightest disturbance to the general health resulting therefrom. When the discharge is excessive, and attended with pains in the back, loins, and abdomen, resembling those of labour^ it becomes necessary to prescribe remedies calculated to arrest it, and to correct the tendency thereto. Amongst these the following are of great utility : Ipecacuanha, Crocus, Sahina, Cinchona, Nux v., Chamomilla, Platina, Sulphur, Calcarea, &c.
Ipecacuanha is one of the more generally useful medicaments in severe cases of this derangement, as well as in flooding after labour, and may, in most instances be administered first, unless there are strong indications for a preference being given to any of the others.
Crocus is more especially called for when the discharge is of a dark colour, viscid, and very copious ; and the menses have appeared before the usual time.
Sab in a, when the discharge is excessive, of a bright colour, and occurs in plethoric females who are prone to miscarry ; rheumatic pains in the head and limbs ; great weakness ; pains in the loins similar to those of labour.
Cinchona is of considerable utility after the previous employment of either of the foregoing, and in all cases were there is great debility in consequence of a more copious menstrual discharge than natural.
Nux v. when the discharge is of too frequent occurrence, too
654 TREATMENT OE FEMALES.
profuse, and of too long duration ; and when it commonly stops for a day or so and then returns, attended with spasms in the abdomen ; sometimes nausea and fainting, especially in the morning ; pains in the limbs ; restlessness ; irascibility. Nux v. 'is especially serviceable when the above symptoms occur in females who are addicted to the daily or frequent use of coffee, liqueurs, and other stimulants.
Chamomilla is frequently useful after Nux v., but particularly when there is a discharge of dark, clotted blood, with severe colic, or pains like those of labour ; great thirst ; paleness of the face, and coldness of the limbs.
Ignatia is of considerable service when the derangement happens in hysterical females.
Platina. Pre tern atur ally increased menstrual discharge, with painful bearing-down pains, and venereal orgasm; thick, dark-coloured menstrual blood; great excitability.
Veratrum. Too early or too copious menstrual discharge, always attended with diarrhoea.
Kreosotum has been found of great service in metrorrhagia, ■where the discharge was excessive, dark-coloured, frequently in large clots, and very offensive. The cervix uteri and uterus itself being, at the same time, swollen and very sensitive ; and the accompanying pains of a severe burning or corroding description.
Sulphur administered thrice during the intervals, allowing ten or twelve days to elapse between the second and third doses, and followed by Calcarea, in the same manner, has frequently been found successful when any of the previous remedies had afforded but temporary relief. In other cases, Belladonna, Cortex mali granati (often where Sabina, Bella., and other remedies fail), Bryonia, Bycopod., Natrum m., Magnesia m., Sepia, Silicea, or Phosphorus, &c, may be useful. In menorrhagia occurring at the change of life, and coming on in daily paroxysms for eight, ten, fourteen days, and then ceasing for a time, after which the discharge broke out anew, Laurocerasus has been found of great efficacy. The blood was dark-coloured, and frequently in large coagula.*
* Allg. Horn. Zeit., vol. xxxi.
HYSTERICS. 655
DYSMENORRHEA.
In painful and difficult menstruation, or menstrual colic, the most important remedies are the same as those enumerated under Menor- rhagia and Chlorosis, but particularly Chamomilla, Pulsatillas Bella., Nux, Coffea, Sulph., and Calc, &c. When the disorder occurs with great vehemence at the critical age [tour d'age) Laches is is of invaluable assistance, and particularly when diarrhoea, attended wTith almost insupportable tormina, usually sets in before and after the menstrual period.* The following are likewise of considerable utility against the sufferings which are often experienced at the critical age : Pulsatilla, Sepia, Sulphur, Cocculus, Rtita, Conium. Against uterine spasms, Coccuhis, Pulsatilla, Ignatia, Platina, Cuprum, form the most valuable remedial agents; but in some instances Nux v., Cinchona, Sulphur, Graphites, Conium, or Natrum m., &c, may be more ap- propriate.
HYSTERICS.
Hysteria. Passio Hysterica.
This disease appears in paroxysms, is preceded generally by de- pression of spirits, anxiety, effusion of tears, dyspnoea, nausea, and palpitatio cordis; also with pain in the left side, which seems to advance upwards till it gets to the throat, when it feels as if a ball were lodged there (globus hystericus) ; if it advances further, there is a sense of suffocation, stupor, and insensibility, with spasmodic clenching of the jaws ; the trunk of the body is moved about, and the limbs agitated ; alternate fits of laughing, crying, and screaming ; incoherent expressions ; foaming at the mouth ; relief ensues gene- rally with eructation, and frequent sighing and sobbing, followed by a sense of soreness over the whole body. Hiccough is sometimes a concomitant, and a very distressing one, in hysteria. These are the usual symptoms indicating this disease, but the complaint appears
* Against flushes of heat occurring after the change of life, Acidurn sulphuricum is an excellent remedy.
656 TREATMENT OF FEMALES.
in a great variety of forms ; and in many cases the patient is attacked with a violent spasmodic pain in the back, which extends from the spine to the sternum, and eventually becomes fixed at the epigastric region, and is often so intense as to cause clammy perspiration, a pale cadaverous countenance ; coldness of the extremities ; and a feeble, thread-like, or scarcely perceptible pulse.
Hysteric affections are more frequent in single than in married life, and usually occur between the age of puberty and that of thirty-five, and generally about the period of menstruation.
The disorder is readily excited in those who are subject to it, by sudden mental emotions. Hysterics have also been known to arise from sympathy and imitation.
Women of delicate habit, and of extreme nervous sensibility, are chiefly prone to be affected with hysteria, and are predisposed to the attack by an inactive or sedentary life, distress of mind, suppression or obstruction of the periodical illness, excessive depletion, or con- stant use of spare or unwholesome diet.
Females of a nervous, sanguine, or plethoric temperament are chiefly liable to this disease.
The best medicines against hysterical affections are, A%irum, Bella., Cole, Caust., Cocc, Con., Crocus, Ign., Lack., Mosch., N. mosch., N. vom., Phosph., Plat., Puis., Sepia, Sil., Stram., Siilph., Verat., Valeriana, Viola odorata, &c.
When the affection arises from Chlorosis or Amenorrhcea, see the remedies mentioned under these headings.
When from Menorrhagia, see that article.— Mental Emotions, see that subject.
When the attacks are attended with clenching of the jaws, or ge- neral spasm, coldness of the extremities, and clammy sweat, particu- larly on the face and forehead, Veratrum is a valuable remedy. (See also the remedies mentioned under Tetanus, and likewise Lockjaw in Infants.)
When violent, spasmodic hiccough predominates ; Nux vomica, Bel- ladonna, and Stramonium ; — or Hyoscyamus, Veratrum, Ignatia, Pulsa- tilla, Cicuta, Bryonia, and Sulphur will be found the most frequently useful.
INFLAMMATION OF. THE OVARIES. 657
INFLAMMATION OF THE OVARIES.
Ovaritis.
Inflammation of the ovaria is more particularly liable to occur a short time after delivery ; but the affection may arise at other times,, and particularly in highly excitable females who are addicted to per- nicious habits, such as venereal excesses, onanism, or to over-indul- gence in spirituous liquors. The signs by which the disorder is to be recognised consist in pain in the ovarian region, sometimes of a severe shooting, pulsating character, which is occasionally, however, only experienced under the influence of external pressure over the part. After a careful examination, per vaginam aut rectum when necessary, a small, hard, circumscribed swelling is detected. In combination with these symptoms, a constant itching is frequently complained of in the internal organs of generation, also gastric dis- turbance, headache, constipation, diminished secretion of urine, fever, frequently of an active, inflammatory type, and derangement of the entire nervous system. But it is chiefly in the subacute or chronic form that the inflammation is encountered ; coming on gradually and insidiously, materially implicating the nervous system, and often occurring in association with a species of nymphomania.
Therapeutics. In phlegmonous inflammation of the ovarium, attended with a high degree of fever and shooting pain, a few doses of Aconitum are necessary, after which we must select another remedy to meet the remaining local symptoms ; being guided in our choice by the exciting cause of the malady, where known, as well as by the particular nature of the pain, or the circumstances under which it be- comes aggravated, &c. &c.
When the pain in the affected parts is increased by movement, Bryonia is, generally speaking, the most efficacious remedy, and when, on the other hand, movement somewhat relieves, whereas rest is only productive of aggravation, — Rhus will rarely fail to produce consider- able relief, if not a radical cure. Should the pains be so violent as to cause the patient to toss about with agony, and continually shift the position of the feet, from experiencing some slight temporary allevia-
42
658 TREATMENT OF FEMALES.
tion of the sufferings by so doing, they will commonly yield to the use of Arsenicum or Colocynth.
In cases where the disease has gradually arisen from the habitual use of spirituous liquors, material service will commonly be derived from the employment of Nux vomica ; but where there is reason to apprehend that the inflammation has terminated in suppuration, Lachesis will be more appropriate, and subsequently Staphysagria, Mer- curius, or Hepar s.
In the event of excess in venery or onanism having given rise to the disorder, Cinchona may be employed with advantage. Nuoo v. and Staphysagria are also calculated to be of assistance in similar cases. Ignatia, Staphysagria, and Acidum phosphoricum have been recommended where unrequited love and consequent perpetual dwelling of the imagination on sensual subjects has proved the originating cause. In those cases where the affection is accompanied with a continual prurient irritation in the internal genital organs, and where nympho- mania has thereby been developed, where, moreover, the local pain which is commonly experienced changes to a beaten or bruised feeling on the application of external pressure, and the patient is affected with anxious oppression at the chest, palpitation at the heart, pricking in the forehead, together with alternate fits of elevation and depres- sion of spirits, Platina is often capable of effecting a radical cure. Belladonna may be beneficially employed where there is no nympho- mania, or internal itching, but the symptoms otherwise analogous to those above given. It rarely happens that a cure is to obtained from the employment of one remedy alone ; it therefore becomes requisite to select others which seem appropriate to meet the remaining symp- toms, when we have derived all the assistance that the remedy first selected seems capable of accomplishing. Ambra., Cantharides, Ptdsa- tilla, and Antim. crudum have also been named as likely to prove of efficacy in ovarian inflammation.
In ovarian induration, ulceration, or dropsy, &c. : Lachesis, Pla- tina, Belladonna, China, Cantharides, Calcarea carbonica, &c, have been found more or less successful, according. to the state of the constitu- tion and the stage of the disease. But in the great majority of cases which have been of long duration, or in which the tumour has attained a large size, all that can be done is to endeavour to afford as much palliative relief as the circumstances will admit of by means of such remedies as Aconitum, Belladonna, Bryonia, Arsenicum, Prunus spinosa, China, Sepia, Lycopodium, Kali c, Merc*, Sulphur, Cannabis, Graph., Hep.,
INFLAMMATION OF THE OVARIES. 659
Sil., &c. It often happens that ovarian diseases are not detected until they excite peritoneal inflammation or other disturbances in ad- jacent parts, by the pressure arising from their increasing bulk. Their progress is sometimes very rapid, but frequently it is slow, even for a succession of years. A sudden and inexplicable invasion of dangerous activity in cases which had long been in a dormant state is not of rare occurrence.
INFLAMMATION OF THE LABIA MAJORA AND VAGINA.
This inflammation develops a painful, burning, red, hard, dry, and very sensitive swelling of the labia pudendi. It chiefly occurs in new married females after the rupture of the hymen, and especially when the orifice of the vagina is of small size ; in which latter case, more- over, the sheath itself becomes implicated in the swelling, and is consequently productive of considerable impediment to locomotion, or even the assumption of a sitting posture. Difficult and tedious labours also form a not unfrequent source of the inflammation. The inflammation, when arising from the above cases, yields very speedily to the application of a lotion of Arnica (one part of the tincture in ten of water). When traumatic fever results, which is prone to happen in neglected cases, the internal administration of Arnica be- comes requisite ; but should the fever partake of an inflammatory type Aconitum must be resorted to.
If the inflammation and tumefaction partake of a lymphatic cha- racter, and is attended with considerable induration, Mercurius forms the specific remedy. On the other hand, when an erysipelatous swelling and inflammation affects the labia, accompanied with burning pain, and an internal feeling of fulness, tension, and bearing down is complained of, Belladonna is to be preferred^ from whatever cause the disorder may have arisen. Should there be only an internal swelling of the vagina, somewhat analogous to a partial prolapsus, attended with burning, pricking pains, increased by external pressure, Nunc v. will give the required relief.
In the event of a termination of the inflammation in ulceration, Arsenicum and Sulphur are the remedies most likely to be required*
OBSERVATIONS ON PREGNANCY.
This period may be looked upon as one of the most interesting- eras of a woman^s life. She is now no longer acting for herself alone, but becomes invested with a new and serious responsibility, and upon some of the most apparently trifling of her actions may depend the future health and happiness of a being bound to her by the fondest ties.
From the mass of evidence collected by careful observers of the operations of Nature, we are warranted in drawing the conclusion that the actions of the mother exercise a great influence over, not only the constitutional and physical, but also the mental organization of her offspring. Keeping this fact in view, we shall endeavour to point out the course that mothers, who prefer the welfare of their future offspring to their own indulgence, should pursue, and from which they will derive a double benefit, — an improvement in their own health, with exemption from suffering, and the delight of seeing their children pass safely through the anxious period of infancy; whilst in after life beholding them flourishing around them, in the full enjoyment of health and vigour, they will reap the additional rich reward of a slight temporary self-denial, in the delightful conscious- ness of having performed their duty.
The leading causes of a weak and sickly offspring are, ill health, or constitutional taint of both or either of the parents ; very early or late marriages ; great inequality between the ages of the parents ; errors in dress, diet, and general habits of life; and lastly, powerful mental emotions.
Medicine, under the present enlightened system, possesses power considerably to obviate the first of these causes, not only by materially modifying or destroying the hereditary taint in the parents, but also
OBSERVATIONS ON PREGNANCY. 661
by nipping it in the bud when transmitted to the infant. Whilst upon this subject^ we may remark, that in many families hereditary diseases are fostered, and even exacerbated in virulence by inter- marriages between their different members, sometimes disappearing in one generation, and again declaring themselves in the next ; but when the habits or mode of life of communities become more adapted to the natural law, and Homoeopathy, as it must do eventually, com- pletely supersedes the present system of medicine, we may safely calculate upon the gradual extinction of all hereditary diseases ; and so far, at least, children will not have to suffer for the faults and follies of their progenitors.
Females should seldom, at least in this country, enter into the marriage bond before their twenty-first or twenty-second year ; prior to that period, their organization is scarcely ever fully developed ; those who marry at sixteen or eighteen years of age incur the risk of a severe after-suffering themselves, and also of giving birth to weak and delicate children. How very often we see the first children of such marriages perish in infancy, or after contending through a child- hood of continued delicacy, sink into a premature grave. Women who marry late in life incur considerable personal risk and severe suffering in giving birth to children, and the offspring is seldom healthy.
The children of old men, although by a young wife, are very often extremely delicate and susceptible to illness ; they not unfrequently precede their father to the grave, or linger but to drag on a miserable and wearisome existence.
In concluding these observations, we may remark that so far is the period of pregnancy from being destined for one of suffering or danger, that Nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the expectant mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and even chronic complaints are frequently suspended ; in fact, with , the exception of some slight morning sickness, and occasional trifling- uneasiness, a well- constituted organism should enjoy as good health during pregnancy as at any other time; and many women pass through this period, and give birth to vigorous children, without even the most trifling inconvenience.
Though, as we have said, Nature seems during this period to adopt every possible precaution for the health and preservation of the parent
662 OBSERVATIONS ON PREGNANCY.
and her future offspring, yet are her wise arrangements, in too many- instances, rendered nugatory by a direct contravention of her laws. The expectant mother should therefore bear in mind, that the duty of leading a regular and systematic course, so essential to every individual, devolves upon her with double force, since every neglect or breach of these ordinances of Nature upon her part, is frequently visited with fearful energy upon her yet unborn infant.
AIR AND EXERCISE.
Nothing tends more to the preservation of health than a proper attention to these two important points, and yet, unfortunately, there are perhaps few more completely lost sight of. Neither air nor exercise is individually sufficient, and females of the more opulent classes in this country, w7ho merely take the air in their carriages, and shun the slightest physical exertion, from long-continued habits of acquired indolence, and who feel any attempt of the kind at this period at- tended with increased inconvenience, can scarcely expect to enjoy the benefit that Nature has annexed to the observance of her laws, in a course of pregnancy free from suffering, and the production of a fully- developed and healthy offspring.
During this epoch, therefore, passive or carriage exercise is not sufficient ; walking brings not only the physical, but the whole of the organic muscles into play, and communicates the increasing vigour of the mother to her offspring ; whilst, on the contrary, con- tinual passive exercise in a carriage has been found particularly inju- rious during, and towards the end of the second period of pregnancy, and is frequently the cause of premature and abnormal births ; exer- cise on horseback, even without taking into consideration the risk of fright or accident to the rider, and the fearful consequences that may thence result, is still more objectionable for many reasons.
A second class, that of thrifty housewives, take a great deal of ex- ercise, yet without a corresponding benefit^ from their work occupy- ing them wholly in-doors ; this is a strong proof of the inutility of exercise in itself, unless combined with pure air. Moreover, many of these women, either from too great activity of temperament, or coerced by hard necessity, frequently over-fatigue themselves, go to bed late,
CLOTHING. 663
rise early and sometimes unrefreshed, and thus in a manner deaden the energies of the organic powers, to their own injury, and that of the unborn child.
A third class of females injure their health, and frequently induce miscarriage, through their excessive levity and thoughtlessness, by unrestrained indulgence in active exercise, riding on horseback, danc- ing, &c. A female ought to recollect that, if through her own folly she has brought on miscarriage, the greatest possible care is necessary to prevent its recurrence ; that a second attack increases her liability in future; and that she who has suffered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Furthermore, continued casualties of this nature not unfrequently terminate in premature death, from that serious and painful disease, uterine cancer.
The best exercise, therefore, for a female during this epoch, is walking every day (when the weather permits) in the open air. In order to prove beneficial, and not to interfere with the process of digestion, exercise ought to be taken two or three hours after a mode- rate meal, about mid-day, or in the afternoon, except during hot weather, when the evening may be preferred, care being taken to avoid the night damps, by not remaining out too late.
CLOTHING.
The dress of the female should of course be suited to the season, and if she pass from a warm into a cold atmosphere, she ought to have her neck and throat well protected, so as to avoid any risk of taking cold. But a point of far greater importance is the adaptation of her clothing to her form, so as to preclude all unnecessary pressure upon any part of the frame, calculated to interfere with the functions of those important organs, which are destined for the birth and nourishment of the infant ; tight lacing therefore, at all times most objectionable, is particularly so during this period, inasmuch as it cramps the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatics, and the whole intestinal economy, produces narrowness of the chest, disturbed cir- culation, and induration or other derangements of the liver, and exercises a most baneful effect upon the breasts and uterus. We
664 OBSERVATIONS ON PREGNANCY.
should bear in mind that a pressure upon these organs during de- velopment, takes place in direct contravention of the operations of nature. Females, in their efforts to preserve the elegance of their shape during pregnancy, are little aware that the constringing force thus exercised upon the abdominal muscles, destroys their elasticity, prevents a proper retraction after parturition, and thus proves one of the most common causes of permanent abdominal deformity. Moreover, to the culpable vanity of their mothers, in this and other respects, many, it is probable, owe their club-feet and other mal- formations ; and in addition to these evils, this practice not unfre- quently deranges the position of the foetus, — a displacement which, together with the consequent want of energy in the muscles and the parts concerned, generally brings on protracted and dangerous labours. Besides this, continual pressure on the uterus is liable to produce premature labours. To tight lacing also may be attributed the difficulty many women of the present day experience in suckling their offspring, from the incipient process required for the subsequent secretion of milk being deranged by the unnatural pressure on the beautifully constructed mechanism of the mammae ; from this also sometimes those dangerous indications, cancers and other affections of the breast, and also retraction and diminution of the nipple, from which the act of suckling is rendered difficult, and in some cases impracticable.
Young girls of seventeen or eighteen are frequently found with pendulous breasts, owing to the artificial support having usurped the office of the muscles, intended by Nature for that purpose, and throwing them out of employment.
Garters too tightly bound are generally injurious, more par- ticularly to pregnant females, for the pressure, thereby exercised upon the blood-vessels, encourages the development of varicose vessels in the inferior extremities (to which affection the system is already sufficiently predisposed), which, in many instances, become exceedingly painful and troublesome.
DIET. HABITS. 665
DIET.
The greatest simplicity should regulate the diet of the pregnant female ; she should avoid taking too great a quantity of nourishment, because any excess in this respect, besides causing dyspepsia and general uneasiness, has a bad mechanical effect upon the future offspring ; and, moreover, the foetus shares in the derangements of the mother.
Much depends upon the quality of her food ; nothing should be taken that is not of a simply nutritive nature, and everything pos- sessing a medicinal property avoided. Coffee and strong tea should be laid aside. Wine, liquors, beer, and other stimulating beverages are also injurious. If, however, the female has been long habituated to wine, it may be taken, if of good quality, in extreme moderation, and diluted with water ; but it will be far better if stimulants of every hind are altogether avoided; indeed, the usual homoeopathic diet (for which see the article Regimen) should be adopted as closely as possible during pregnancy.
EMPLOYMENT OF THE MIND AND HABITS DURING PREGNANCY.
It is not sufficient that the body may be in perfect health ; the mind must also be kept in a state of serenity. An easy cheerfulness of temper is essentially useful in promoting the well-being of the unborn infant. Experience has presented us wdth many instances in which the predominant feeling on the mind of the mother during pregnancy has influence on the future mental organization of the child. This showrs how essential it is for females to keep their minds well employed during this period, to avoid all improper meditation, and dissipation, and to abstain from reading works not calculated to improve their understanding. Nothing can act more effectually against the future mental and corporeal health of the unborn infant than an oscillatory state of intellect, in combination with physical indolence on the part of the mother ; the late hours, turning day into night, and other practices of fashionable life, injurious as they are to the most robust constitutions, are doubly reprehensible on the part of the expectant mother.
666 OBSERVATIONS ON PREGNANCY.
INFLUENCE OF EXTERNAL OBJECTS UPON THE UNBORN INFANT.
The effect of any unpleasant or unsightly object upon the ima- gination of the mother, and the transmission of that effect to the offspring, evidenced in various mental or physical peculiarities after birth, is a theory as old as tradition ; without entering upon the various arguments brought forward both for and against it, we would simply advise females to keep as much as possible out of the way of such objects, to preserve both body and mind in a state of health, which will lessen every fear of being affected by such occurrences ; and endeavour, as constantly as possible, to direct their attention to pleasing subjects ; as it must be perfectly evident that brooding over such unpleasant impressions can scarcely fail of being both physically and mentally injurious.
MENTAL EMOTIONS.
This subject has been already treated of in Part I, to which the reader is referred, as the remedies there mentioned are equally appli- cable to affections arising from these sources in either sex.
A not unfrequent symptom during pregnancy is great despond- ency of mind, and uneasiness about the future; some females, whose spirits are generally good at other times, suffer much from this affection during this period ; and in others, we find the same feeling and excessive low spirits, during the time of nursing ; this symptom, however, is not permanent, and when it commences early in gestation, usually disappears before delivery, without material injury to the general health.
Therapeutics. As this affection is apt to create some uneasi- ness, both to the sufferer herself and her friends, we have thought it advisable to mention it, and at the same time to point out remedies which will frequently be found efficacious.
MENTAL EMOTIONS. 667
Such are Aconitum, Bryonia alba, Nux vomica, Natrum muriaticum, Phosphorus, Calcarea carbonica, and Cinchona.
Aconitum : — If the state of despondency is preceded by one of excitement^ marked by heat of skin and frequency of pulse, attended with apprehension and presentiment of approaching death.*
Bryonia: — Great inquieUide and fear of the future, attended with irascibility and derangement of the digestive functions.
Nux vomica: — Morning sickness and melancholy, with great uneasiness, impaired appetite, constipation, fretfulness.
Natrum muriaticum : — Melancholy, with weeping, uneasiness about the future; also obstinate cases of morning sickness, not yielding to Nux vomica.
When the affection comes on during lactation, arising from an over-secretion of milk, so that this fluid escapes involuntarily, and is attended with great emaciation, melancholy, and apprehension of the future, we may give Phosphorus.
Calcarea is also efficacious when the above symptoms present themselves, and more particularly so, when there is excessive dejection with great lassihide.
This remedy is further very serviceable when there is suppression of the secretion, and also excessive obesity, or the individual is of plethoric habit. Both the last-mentioned remedies are also valuable, when there is a disposition to consumption.
When there is lowness of spirits, attended with dyspepsia, which may arise from the energies of the mother being too severely tasked in the nourishment of her offspring, either from keeping the child too long unweaned, or from rearing twins, we may administer Cin- chona. The practitioner will further find occasion to select the following remedies in particular cases : Belladonna, Pulsatilla, Veratrum, Stramonium, Platina, Aurum, Cuprum, Lachesis, and Sulphur.
* In the treatment of pregnant women of exalted nervous sensibility, considerable caution is frequently requisite in the repetition of the doses. (See also the rules laid down for the Repetition of the Dose in ordinary cases, in the Introduction.)
DERANGEMENTS DURING PREGNANCY.
MENSTRUATION.
Virtual diseases during gestation are of rare occurrence, but when they do happen, they ought to be treated accordingly.
A continuance of menstruation at this period is not an actual dis- ease, but rather an exception to the general course of nature ; nor must we here mistake her operation for an indication of the utility of the lancet, for neither in this, nor in any other case, can the artificial supply the place of natural bleeding ; however, when the female appears to suffer from the continuance of the menstrual flux, we must call in the assistance of medicaments, among which the prin- cipal are Cocculus, Phosphorus, and Platina.
Cocculus. A sanguineous mucous discharge, and very severe spasmodic pains in the lower part of the abdomen.
Phosphorus. Discharge of blood, with incisive pains in the back, and occasionally vomiting.
Platina. Discharge very profuse, attended with a severe pain and bearing down. (See also the remedies given under Dys- menorrhea and Menstruatio nimia.)
MORNING SICKNESS.
Morning sickness, nausea, vomiting, and heartburn, are the most distressing symptoms attendant on the course of pregnancy. These troublesome complaints harass women most upon their first rising from a horizontal position in bed. They generally disappear soon after quickening, but sometimes continue during the whole period.
CONSTIPATION. 669
The numerous palliative remedies recommended by allopathists — leeches, cupping-glasses, blisters, aperients, sedatives, &c, &c, unfor- tunately too often fail in effecting their object ; and in severe cases, when the stomach becomes enfeebled, the hazardous expedient of artificially produced premature labour is resorted to.
Therapeutics. The homoeopathic treatment of this derangement at once simple, prompt, and efficacious, has in almost all cases been stamped by the signet of success. In instances free from complica- tion, with a tendency to relaxation of the bowels, Ipecacuanha is generally sufficient.
Nux vomica : — When there is nausea or vomiting every morning on rising, heartburn, depraved appetite, or craving for chalk, earth, beer, &c, constipation, and irritability of temper.
Arsenicum. Excessive vomiting after eating or drinking, with attacks of fainting ; great weakness and emaciation.
Pulsatilla. Nausea after every meal; vomiting of ingesta, heartburn, depraved appetite, or longing for particular articles, such as acids, beer, wine, &c. Disposition peevish and sensitive, though naturally mild.
Conium, Acidum nitricum, Magnesia, Phosjphorus, Bryonia, and Lgcopo— dium, &c, will also be found useful in particular cases.
When this affection shows itself in a mild form, we may leave it to Nature, adopting at the same time the homoeopathic rules for regimen, and being careful not to overload the stomach. In severe cases, depending upon a plethoric tendency, Aconitwm is an excellent substi- tute for the venesection recommended by the old school.
CONSTIPATION.
Constipation is a very common attendant upon pregnancy, and those females usually suffer most from it who are naturally of a costive habit ; when it does not arise from a mechanical cause, active exercise in the open air, and avoiding indigestible food, coffee and other stimu- lating liquids, are often sufficient to remove the complaint, or at all events to render it less troublesome. When Nature requires further assistance : —
Nux vomica will often answer the purpose ; if after the completion
670 DERANGEMENTS DURING PREGNANCY.
of its action, there still remains some inconvenience, Ignatia should be given as an immediate remedy, followed by a Nux vomica ; in other cases, when Nux vomica does not show a marked improvement, and the temper is extremely irritable, Bryonia will sometimes cure, or Opium globules,* which is especially indicated to follow Nux vomica when there appears to be a weight in the stomach, dryness of the mouthy and deep flushing of the face. In other cases Sepia, Lycopodium, Alumina, &c, will be found useful. (See Constipation, Part I.)
Dysuria. Pulsatilla, Cocculus, Nux v., and Acid, pJiosphoricum, as also Sulphur, and Conium are the remedies which are of the greatest service in the generality of cases of this derangement in pregnant women.
DIARRH(EA DURING PREGNANCY.
See Diarrhosa, Part I, and Diarrhoea in Lying-in-Women, in this division of the work.
FAINTING AND HYSTERIC FITS.
Many delicate and nervous females are frequently attacked with fainting fits during pregnancy. The attack generally passes over easily and without deleterious consequences. Exercise in the open air, and attention to the rules of regimen, are the best safeguards against the affection ; but in cases where these are insufficient, and the attacks prove distressing, we must endeavour to ascertain their origin. If the fits arise from tight lacing, warm rooms, or any other obvious excitant, the simple removal of the cause will prove sufficient ; should the sufferer remain long insensible, the speediest means of revival is sprinkling the face with cold water. When arising from plethoric habit, returns of the attack may be prevented by Aconite, of which we have had occasion to speak several times, as a general regulator of the circulation.
* See page 144 for additional indications for the employment of this remedy.
TOOTHACHE. 671
Chamomile a : — When the fainting is excited by sudden fits of anger.
Nux vomica: — When from general irritability of system, and con- sequent gastric derangement.
Belladonna : — When there is determination of blood to the head, with simultaneous flushing of the face and perceptibly increased action of the arterial system. (Alternately with Aconite when required.)
Cinchona: — When arising from general weakness, and especially from loss of blood.
Pulsatilla. General excitability and disposition to hysteria, with hypochondriasis, and great general susceptibility.
Coffea. Abdominal spasms, with oppressed respiration, subsultus tendinum, cold perspiration, and uncontrollable agitation and jactita- tion. When the symptoms are generally preceded by a pain, which proceeds upwards from the lower part of the bowels, on the left side, into the stomach, and from thence into the throat, where it creates a disagreeable and suffocative sensation, as if a ball were lodged there, Lachesis, JBelladonna, Sepia, and Plumbum, or Ignatia, Sulpfaor, Ntix v., Conium, &c, will prove useful, a preference being given to that remedy which corresponds the most closely to the whole features of the case.
Ignatia : — When the patient suffers from severe headache, as if a nail were driven into the head; sadness; concealed sorrow, and sighing. (See Swooning.)
Viola odorata. Constant and unassignable inclination to weep.
Administration of the above remedies. The dose as prescribed repeated, if necessary, every two or four days, according to the urgency of the symptoms, until relief is obtained, or another remedy is required.
TOOTHACHE.
This is a frequent affection with pregnant women, and is sometimes too valuable an indication of some taint lurking in the constitution, to be neglected ; the female should, as soon as she is in a proper state, put herself under a course of proper treatment, as until this tendency is eradicated, no remedies can prove otherwise than palliative. We
672 DERANGEMENTS DURING PREGNANCY.
must particularly caution females in this situation against having teeth extracted, as the affection frequently occurs in sound teeth.
Therapeutics. To relieve the sufferings, the following medicines may be often given with advantage: Sepia, Calcarea, Alumina, and Magnesia carbonica.
For the Administration of the remedies, see Toothache, Part I, where, moreover, other useful remedies will be found.
Sepia is particularly indicated when there is pulsative, shooting, drawing toothache, with pain, extending to the ears, or to the arms and fingers, excited by compressing the teeth, or by cold air, and attended with impeded respiration, swelling of the cheek, and enlargement of the submaxillary glands.
Calcare a : — When the toothache is excited or aggravated by cold air, or anything hot or cold, and attended with painful sensation of the gums, and pulsative gnawing or shooting pains, which are aggravated by noise.
Alumina : — When the pains are excited by mastication, or in the evening in bed, and when they are of a tearing nature, extending to the cheek-bone, temple, and forehead.
Magnesia carbonica: — Noctttrnal pains 'in the teeth, insupportable when lying down, and compelling the patient to get up and walk ; pains generally boring, burning, drawing, tearing, and resembling those of ulceration, attended with swelling of the cheek on the side affected ; throbbing and shooting in the teeth after a meal ; pain aggravated by a cold. The above are the four leading medicines, though there are others which may be called for by peculiar symptoms.
Mezereum: — Continuous dull pains; teeth feeling as if elongated; sensibility to the touch.
Coccionella : — Pains in hollowr teeth, particularly of a throbbing description. {Cynips rusarum has likewise been found useful in similar cases.)
Sarsaparilla : — Rending pains in the teeth, especially in the evening, on exposure to a current of air.
Carbo v. : — Gnawing, pulsative constriction, or dragging pains, especially in hollow teeth, usually increased by partaking of food or drink, whether hot or cold. (See Toothache, Part I.)
The following remedies are those which are generally of the greatest efficacy when the pains are excited, aggravated, or relieved under the circumstances hereafter mentioned:
TOOTHACHE. 673
Air (toothache, on exposure to) cold : Stop A., Sep., Sil., Nux v., Sass.,
Merc, Hoscy. Air, (diminution of pain from) cold : 'Puis., Natrum s.
— (aggravation from exposure to) damp : Nux moscA., Rod., Bor.
— (aggravation from exposure to) the evening : Nux moscA., Sass., Merc.
Air, (toothache excited or aggravated by inhaling, or drawing in) :
Natr. m., and StapA. ; or, Nux v., Alum., Mags., Mags. arc. ; or Alum.;,
Bella., Sil., Spig., Clem., Sabina. Air (toothache in the open) : Bella., Nux v., SulpA., PAospA. ; Con.,
Magn. s., Ant., CAina. Air (diminution of, or exemption from pain in the open) : BAus, Con.,
Magn. s., Nux v.
Bed (aggravation of pain in) : CAam.,Merc., Puis., Acid. sulpA., chiefly;
but also : Ant., Alum., Ammon. c, GrapA., PAospA., Ac. nitr., Kali,
Sab. Bed (diminution^ or cessation of pain in) : Lye, Magn. s.
— (diminution or cessation of pain on getting out of) : Oleander, Sabina, Antim. crudum.
Clenching, or compressing the teeth, or masticating (aggravation from) : Am. c, GrapA., ColcA., Sep., Hep., Petr., Tab., Guaj., Sab., PAospA., TAuja, Veratr., StapA., SulpA., Alum., CAina, Zinc, BupA.
Clenching the teeth, amelioration on : CincAona.
Cold substances (aggravation from the introduction of, into the mouth) : Merc, SulpA., Spig. ; Ant., TAuja, Plumb., &c.
Drinking (cold fluids, aggravation from) : Nux v., SulpA., StapA., GrapA., Ac mur., Bor., Nux moscA., Merc, chiefly : but also, CAam., Calc, LacA., Puis., Carb. a., Sass., Mags.
Drinking coffee (aggravation from) : Nux v., CAam.
— hot fluids (aggravation from) : Agnus, CAam., Brosera, Nux v., LacA.
Drinking tea (aggravation from) : TAuja.
— wine — Nux v.
Eating (aggravation while): Bella., Kali, Lye, Merc, Natr., Mags, arc, chiefly; but also, Ant., Bry., Carb. a., Cocc, GrapA., Hep., Ign., Magn. m., Puis., SulpA., TAuja, &c.
43
674 DERANGEMENTS DURING PREGNANCY.
Eating (aggravation after) : Bella., Cham., Lack., Nux v., Staph., Sabin., Spiff., Mags. arc. ; or, Ign., Graph., Magn., Natr. m., China, Bryonia, &c.
Eating cold food (aggravation from) : Conium.
— hot food — Agn., Phosph., Sil. Evening (aggravation of the toothache towards) :
Hot substances (aggravation from the introduction of, into the mouth) : Nux v., Calc. ; Bryon., Carl, v., Lack, Sulph., Merc, Phosph. Sec.
Hot substances (mitigation on the introduction of, into the mouth) :
Nux mosch., Kali h.
Morning (aggravation of suffering in the) : Nux v., Lack, Phosph.; Tart. ' emet., Kali, Kreos., Ban.
Night (aggravation or accession of the toothache during the) : Bella.,
Cham., Nux v., Ars., Puis., Rhus, Spig., Sulph., Staph., Merc, Phosph., Magn., China, Cyc, Gran., Am. c, Sep., Rhod., Baryta c et m., &c.
Noise (aggravation of pain from) : Calc. c
Noon, in the after-, Nux v., Lach., Puis., Berh.
Quotidian toothache : Diadema, Tart., Sec.
Reading, Reflecting, Meditating (aggravation from) : Nux vomica,
Belladonna. Repose, Rest, Quietude (aggravation from) : Magn. Room (aggravation in a warm) : Puis., Nux v., Hepar s.
Posture (aggravation while in the horizontal) : Clem,
— (aggravation whilst lying on the affected side) :
Salt food, (toothache increased or excited by partaking of) : Carl. v. Smoke (aggravation from tobacco) : Spig., Clem., Sabin.
— (mitigation from ditto) : Speaking (aggravation while) : Sepia. Sucking the teeth (aggravation or accession of toothache from) :
Nux mosch. Sweetmeats (sugar, &c, aggravation from) : Natrum.
TOOTHACHE. 675
Tea (aggravation from) : Thuja.
Toothache, with extension of pain to the arms and fingers: Sepia,
— with extension of the pain into the ears : Merc, Ars.,
Nux v., Puis., Sulph., Sep., Cham., Natr. m., &c. Toothache, with pains extending into the face: Merc., Puis,, Nux v.,
Hyos., Sulph., Rhus, Mez., &c. Toothache, with pains extending into the eyes : Puis.
— with pain extending into the head : Ant. c., Ars., Baryta c, Hyos., Merc., Nux v., Rhus, Puis., Sulph., Cham., chiefly.
Toothache, with pain extending to the neck : Natr. muriaticum.
— attended with coldness in the ears : Lach., — with gene- ral coldness, Veratr. alb.
Toothache attended writh dyspnoea : Sep., Puis.
— despair : Nux v., Ars., Cham.
— with great irascibility : Nux v., Sep., Alum., Cham.
— with extreme agitation or anguish : Coffea, Clem., Spig., Ars., Magn., Mang., Natr. s.
Toothache, with paleness of the face : Puis., Spig.
— redness of the face ; CJiam., Veratr., Bella, Nux.
— with virulent pulsation in all the arteries : Sepia.
— writh whining, or plaintive humour : Nux v., Cham.
— with salivation : Merc., JDaph., Phosph., Stront., chiefly.
— with tendency to shivering : Daphne indica, Lach., Merc, Puis., Sulph., JEup.
Toothache, with tendency to sweating: Daphne indica.
— with cold sweat on the forehead : Veratrum album.
— with tendency to syncope : Veratrum album.
— with vomiting : Veratrum album.
Tooth-pick (accession, or aggravation of pain on using the) : Puis.
Vinegar (mitigation of pain from) : Tongo.
Walking (mitigation from) : Mags. arc.
— in the open air (mitigation from) : Mags, arc, Nix v.
— — after, (mitigation) : Magn. s. Warmth (aggravation, or accession of pain from): Mags, arc, Puis.,
Nux mosch. ; Hep., Graph., Hell. Warmth of the bed (aggravation or accession of the pain from) :
676 DERANGEMENTS DURING PREGNANCY.
Puis., Merc, Phosph.; or Cham., Acid, phosph., Sabin., Ant., Alum.,
Add. ph., Am. c, Graph., Kali, Baryta c, &c. Wind (aggravation from) : Puis. Wine (aggravation from) : Nux v.
SWELLED FACE.
Tumefaction of the cheek arises from different causes ; frequently it is the consequence of toothache, and will then be cured, or at all events much diminished, by the remedy given for the removal of that affection. Sometimes it happens, nevertheless, that whilst the tooth- ache diminishes from the employment of the proper remedy, the swelling of the cheek remains unaltered. In this case Arnica is generally of great service, especially when the swelling is hard and stiff. If this treatment is of no avail we may have recourse to Pulsatilla, or to Mercurms vivus, which is of especial service when the swelling of the cheek is accompanied with a drawing, tearing pain, an increased flow of saliva, and considerable erysipelatous redness -, followed by Belladonna, and Hepar s., if the inflammation threatens to extend. (See Erysipelas.) Cham., Bryonia, Sec, are also oc- casionally of service.
Where the employment of the appropriate remedy has been neglected at the proper time, or the swelling has been maltreated by some external application, the tumour is frequently rendered of an obstinate character.
In most cases, however, the dispersion of the tumour, or, when matter is forming, the speedy completion of the suppurative process and consequent bursting of the abscess, will be readily, enough affected by means of Hepar sulphuris, one grain, repeated if necessary in from six to twelve hours.
In obstinate cases, Lachesis and Hepar, or Mercurius and Hepar, in alternation, are sometimes required; and occasionally Silicea, par- ticularly in strumous habits. The application of a poultice to the cheek, or a fig boiled in milk and placed in the mouth between the affected cheek and gums, is sometimes useful. If the tumour has burst, and the opening is internal, no especial care need be taken of it, but if it has burst externally, a simple bandage, smeared with melted suet or fresh butter, must be applied.
VARICES, OR SWELLED VEINS. 677
VARICES, OR SWELLED VEINS,
Many females suffer much during pregnancy from distension of veins in the thigh and other parts, which, becoming exacerbated, eventually cause great pain and inconvenience. These varicose veins generally arise from obstructed circulation caused by the pressure of the gravid uterus upon the blood-vessels, but are also frequently a sure indication of the existence of constitutional debility, particulary when they occur in an aggravated form. They are much increased by partaking of stimulating liquids, which should consequently be avoided. Considerable alleviation is experienced by constant bathing with water, or with diluted alcohol ; also by bandaging from the foot upwards with a gentle and equable pressure, and by preserving a recumbent posture, which is requisite in severe forms of the com- plaint, accompanied with considerable swelling of the feet, ankles &c. In order to afford relief, we may have recourse to the following remedies : —
Pulsatilla is one of the most useful medicines, particularly when there is excessive pain and swelling, with a good deal of inflammation, or when the veins are of a livid colour, which is imparted to the whole limb. Should Pulsatilla give some relief, but the swelling and livid discoloration continue in much the same state, Lachesis may be substituted. Arnica is of material service when the occupa- tions of the patient render it impossible for her to lay herself up, or avoid much standing and moving about in discharge of her domestic duties. Arnica and Pulsatilla in alternation, every six or eight days, have been found of great efficacy in such cases.
Nux vomica, when the affection is attended with constipation, hemorrhoids, and irritability of temper. Sulphur is sometimes very beneficial after Nux v\
Arsenicum, when the veins are of a livid colour, and are attended with severe burning pain.
Carbo vegetabilis, where Arsenicum is not sufficient to subdue the constant scalding or burning.
Belladonna. Varices, with considerable erysipelatous inflam- mation.
678 TREATMENT OF FEMALES.
Ly co podium has been employed with success in some inveterate cases.
The simultaneous external application of the remedy employed is occasionally attended with benefit.
For a permanent eradication of the affection, a course of treatment is requisite, in which — Agaricus muscarius, Sulphur, Graphites, Carlo vegetabilis, Sepia, &c., are the most effectual medicaments. (See Ulcers, Part I.)
PAINS IN THE BACK DURING PREGNANCY.
Lumbosacral pains.
Some females suffer much from pains in the lower part of the back during pregnancy, which occasionally prove extremely distressing, particularly when they occur during the. night, and tend to disturb sleep. They generally consist of an almost indescribable aching, or of an obtuse, heavy, dragging, or pressure, as if caused by a dead weight resting on the affected part. Kali carbonicum is frequently adequate to remove them, especially when they partake of the character described. In other cases, Bryonia, Rhus, Sulph., Lycopodium, Pulsatilla, JSlux v., Sepia, Platina, Natrum m., &c, may be given with advantage. If hemorrhoidal sufferings become added to these troublesome pains, and Kali c. prove insufficient to relieve the complaint in this com- plicated form, Nux v., Sulphur, or Sepia, may be prescribed with ad- vantage. (See Hemorrhoids; as also the indications given for the remedies under the heading of False Pains.)
MISCARRIAGE.
Abortus.
Women who have once suffered from this affection are exceedingly obnoxious to its recurrence, and this liability is still further increased, if the event has taken place a second or third time. Miscarriage may occur at any period between the first and seventh month, but, in the majority of cases, it takes place about the third, or the beginning of
MISCARRIAGE. 679
the fourth. When it occurs before or about this period, it is frequently attended with but little pain or danger, although repeated miscar- riages, from the great discharge that is generally present, break down the constitution, and frequently develop severe chronic diseases. When miscarriage takes place at a more advanced period, it assumes a very serious complexion, and is often accompanied with a consider- able degree of peril to the sufferer.
The premonitory and accompanying symptoms of miscarriage vary much in their nature ; sometimes the discharge is exceedingly pro- fuse, at others moderate or inconsiderable; the pains, in many in- stances, extremely severe and protracted, are in others very slight and of short continuance.
Sudden mental emotions, or great physical exertion, mechanical inju- ries, a luxurious mode of life, fashionable habits, powerful aperients, neglecting to take air and exercise, are a few of the exciting causes of this affection, which is particularly apt to occur both in highly ple- thoric and delicate or nervous habits. An abnormal condition of the constitution is undoubtedly the predisposing cause.
Miscarriage is, in most cases, preceded and attended by the majority of the following symptoms : — A sensation of chill, followed by fever, with more or less bearing down, particularly when occurring late in pregnancy ; also, severe pains in the abdomen, draioing and cutting pains in the loins, or pains frequently bearing a close resemblance to those of labour; discharge of viscid mucus, and blood, sometimes of a bright red, not unfrequently mixed with coagula, at other times dark and clotted, followed by the emission of a serous fluid. The miscarriage generally takes place during this discharge, which occasionally conti- nues, if not properly checked, to flow for hours after, placing the sufferer in considerable jeopardy. When the pains increase in in- tensity, and the muscular contractions become generally established, with their characteristic regular throes and efforts to dilate the mouth of the womb, miscarriage is almost inevitable.
Therapeutics. As preventives of this affection the principal reme- dies are Sabina, Secale cornutum, Kali c, Lye, Sep., and Calc.
When the premonitory symptoms declare themselves, Chamomilla, Nux vomica, Ferrum metallicum, Ipecacuanha, Sabina, and Calcarea. The same with the addition of Hyoscyamus, Crocus, and Secale cornutum, after the misfortune has taken place. Cinchona is also valuable when the indications which we shall give for that medicine are present.
680 TREATMENT OF FEMALES.
In cases where there is an evident disposition to miscarriage, or where, from a variety of reasons, it is apprehended, the employment of Sabina, in the early stage of pregnancy, will frequently prevent its occurrence.
Administration. We may allow four or five days to elapse between the first and second dose, and gradually lengthen the interval between each successive administration, until the period of danger be past, being careful, however, to watch the effect of each dose, to dis- continue the medicine whenever any indications of its action on the system become apparent, and to abstain from repeating until the symptoms attributable to the medicine have passed away, and then only with increased caution and at longer intervals.
Hartmann* strongly recommends Sec ale cornutum, two glo- bules, as useful in similar cases, but particularly when this misfortune has already occurred more than once ; it should be administered every fourteen days, commencing immediately after the cessation of the monthly period, and continuing until the period at which miscarriage usually occurs is past ; one dose more, at the utmost, being allowed after this period.
Both these remedies are also extremely valuable after miscarriage has taken place, the latter particularly in weak or exhausted persons, or in those cases of hemorrhage in which the discharge consists of dark liquid blood, and is followed by considerable debility ; this remedy is also efficacious in cases of inevitable miscarriage, attended with feeble expulsive efforts; the former [Sabina) when there are dragging and forcing pains, extending down the back and loins ; profuse, bright- coloured hemorrhage ; sensation of sinking or faintness in the abdo- men ; frequent desire to relieve the bowels ; diarrhoea ; nausea or vomiting ; chilliness and heat, with fever.
Lycopodium and Kali carbonicum have also been recommended as useful preventive remedies against habitual tendency to abortion, the latter especially when the symptoms are always preceded or attended by severe pain in the loins.
We shall now treat of miscarriage when the premonitory symptoms have set in, giving, under the same head, the indications for the use of the medicaments, where the result is unavoidable or has already taken place, as even in these cases their administration is decidedly beneficial in obviating further injurious consequences, and in alle-
* Therapie akut. Krank. Form., vol. ii, p. 352, 2d ed.
MISCARRIAGE. 681
viating the sufferings of the patient. The remedies in these cases are, in addition to the two above mentioned, Arnica, Chamomilla, Nux vomica, Ipecacuanha, Hyoscyamus, Belladonna, Crocus, Fermm metallicum, and Calcarea.
Arnica : — When the symptoms have been excited by an accident, such as a fall, blow, or concussion, &c, this remedy should be imme- diately administered.
Chamomjlla :-— When there are present: excessive restlessness, convulsions, twitching in the back and limbs : severe pains in the loins and back, worse at night, generally of a sharp cutting description, ex- tending downwards, strongly resembling those of labour : sometimes also abdominal spasms, with a species of sanguineous discharge ; or dis- charge of deep red or dark coagulated blood; frequent yawning; coldness and shivering.
Nux vomica : — Obstinate constipation, with a varicose condition of the internal organs of generation : also when the patient has been accustomed to a stimulating diet, and the use of coffee ; severe burn- ing, or wrenching pains in the loins*; painful pressure downwards and mucous discharge. {Bryonia is sometimes of benefit when Nux v. fails to do much good.) See also Calcarea.
Ipecacuanha.:- — Chilliness and with heat; violent pressure down- waxds, flooding j cramp and rigidity of the frame; sometimes convul- sions ; vomiting, or desire to vomit ; disposition to faint whenever the head is raised ; cutting pains in the umbilical region. (Platina or Cina have been recommended when Ipec. fails.)
Hyoscyamus: — When the convulsions are very severe, with cries, great anguish, oppression of the chest, and loss of consciousness.
Belladonna is perhaps more frequently required either at the commencement, or subsequently, than any other remedy. The fol- lowing are its leading indications: great pains in the loins and entire abdomen ; severe bearing down, as if the whole of the intestines would be pressed out ; pain in the back, as if it were dislocated or broken ; bruised pain in the sacral region ; sensation either of spasmodic con- striction, or of expansion in the abdomen. It is also particularly valu- able in cases of profuse hemorrhage, the discharge of blood being neither very bright nor dark-coloured after miscarriage. Blatina is sometimes to be preferred to Belladonna, when, along with bearing- down pains, there is a thick and dark-coloured discharge, attended with venereal orgasm.
Ferrum metallicum is a useful medicine in cases of miscar-
682 TREATMENT OF FEMALES.
riage attended with fever, labour-like pains, and considerable san- guineous discharge.
Crocus is especially indicated in cases which are attended or followed by discharge of dark, coagulated or viscid blood, with a sen- sation as of something moving or fluttering about in the umbilical region, and increased sanguineous discharge on the slightest move- ment. This medicine is frequently useful in obstinate cases, after the employment of one or more of the above-mentioned remedies.
Cinchona is valuable in restoring the exhausted energies, after the hemorrhage, and materially assists in checking the discharge if there be spasmodic pain in the womb, or a bearing-down sensation, with considerable discharge of blood at intervals.
Caloarea is a remedy of considerable importance in the treat- ment of cases, where the affection has apparently been induced by a varicose state of the veins of the parts. It is also of value as a pre- ventive, and especially where the patient is of a plethoric habit, with a tender or irritable skin, and other strumous appearances.
Sepia : — In threatening attacks of abortus from general plethora, or from local congestions and obstructed circulation, with sensation of weight in the abdomen, determination to the head and chest, and excessive nervous excitability, this remedy has been employed with success.
When Mental Emotions have given rise to the symptoms of miscarriage, see the remedies given under that heading, Part I.
Administration. A few globules, or where necessary, one minim in an ounce of water, a teaspoonful every few minutes to half an hour, or only three or four hours, according to the nature of the case, lengthening the intervals or discontinuing the medicine when decided benefit, or a stoppage of the hemorrhage is effected. When a favorable effect does not follow after the second or third dose in serious cases, another remedy must be had recourse to. When violent hemorrhage is present, and does not cease under the employ- ment of any of the before-mentioned medicines, Acidum nitricum may be administered. Cold water is also useful. (See Menorrhagia.)
In concluding the subject, I shall briefly notify a few precautionary measures^ which the patient ought to observe while threatened with, or after having suffered from the affliction.
When miscarriage is threatened, the individual must assume the recumbent posture, and in some cases indeed, should be strictly con-
MISCARRIAGE. 683
fined to bed, sleeping with few bed-clothes ; the apartment should be kept cool, and every means must be employed to ensure perfect tran- quility of mind. The diet prescribed in cases under homoeopathic treatment should be closely followed, and warm fluids generally avoided. When the misfortune has proved unavoidable, or has actually taken place, before assistance has been sought, the patient ought still to be confined to bed for a few days, lest a fresh discharge should be brought about by too early a change from a horizontal to an upright posture ; and on future occasions, when a similar period comes round, great care should be taken that the mishap may not again occur : in the attainment of this desirable object we feel confi- dent, that nothing will tend so fully to ensure success as a timely exhibition of one or other of the preventive remedies already com- mented on in this article.
TREATMENT BEFORE PARTURITION.
PREPARATION OF THE BREASTS.
Young mothers frequently find great difficulty in suckling their children, in consequence of some organic defect or incapacity of the nipple. In almost every case, a preparation of the breasts is neces- sary some weeks before delivery, in order to prepare them for their future office. In many instances the structure of the breasts is dis- organised from an ignorant nurse having compressed them in child- hood, under the idea of such a process being needful for the expulsion of some matter in the breasts of a child — a vulgar error, against the practice of which mothers ought to be particularly watchful. Inability of function is also likely to occur from the pressure of stays in after life, by which the cuticle is rendered so tender, as to preclude suckling.
The first two cases are beyond the power of art. If suckling be attempted, induration of the nipple and mamma ensues, attended with severe suffering : when, however, a simple tenderness of the epidermis exists, this evil is much alleviated by bathing the nipples with brandy twice a day, for several weeks anterior to delivery. Another difficulty, frequently accompanying this state, is a shortness or retraction of the nipple, so that the infant cannot take hold of it ; this defect is frequently the cause of the first, from the ineffectual efforts of the child to suck injuring the part ; in this case appropriate shields of soft wood may be applied to accustom the nipple to elon- gate and protrude, so as to present sufficient hold for the infant, when the period for suckling arrives, and when the efforts of the child will still further contribute to effect this object. In this case also, bathing with brandy will naturally tend to correct any tender-
FALSE PAINS. 685
ness of the skin, and prevent subsequent excoriation. It may also be here remarked, -that when any tenderness exists during the period of lactation, between the intervals of the infant being applied to the breast, the shield should be resumed, and the bathing continued, due care being always taken to lave the nipple carefully with tepid water, before it is again offered to the child.*
REMEDIES BEFORE LABOUR.
Many things are recommended by the old school previous to labour, such as frequent bloodlettings and aperients ; but these, instead of promoting the object desired, have a contrary effect, by lowering the energies requisite at such an eventful period, and by placing the nervous system in an abnormal state of irritation and excitement ; when this loss of humour is brought about in the first period of preg- nancy, it defeats its own object, by developing what are commonly called plethoric symptoms, induced by the reaction in the organism, necessary to supply this uncalled-for waste, and which always takes place with a correspondent expenditure of vital power. Where an evident plethoric state exists, the desired result may be safely and effectually attained by a dose or two of Aconite, which may be fol- lowed by Belladonna, should there be symptoms of active conges- tion, with fiery redness of the face, accelerated action of the carotids, &c.
An action on bowrels previous to delivery, may be obtained by a lavement of lukewrarm water, repeated with a small quantity of linseed* oil, when necessary from a failure in the first attempt to obtain the desired effect.
FALSE PAINS.
Before proceeding to notice parturition, a few words may be said upon the (so-called) false, spurious, or intestinal pains, brought about
* When severe pains are experienced in the breast after each application of the infant, the employment of Phellandrium aquaticum has been found advantageous.
686 TREATMENT BEFORE PARTURITION.
by congestion of blood to the uterus, errors in regimen, emotions of the mind, effects of chill in the abdomen, and a variety of other causes : they sometimes precede labour but a few hours, but in many cases come on some days, and even weeks, before delivery ; they chiefly differ from labour-pains in the irregularity of their recurrence, in being unconnected with uterine contraction, and chiefly confined to the abdomen, with sensibility to touch and movement, and in not increasing in intensity as they return : sometimes, from their close resemblance, it is extremely difficult to discriminate between them and the real labour-pains, but in such cases we must be chiefly guided by the period of gestation ;* and our safest mode of procedure is to endeavour to mitigate the patient's sufferings, if they be considerable, or come on a week or two before labour is expected, by the administration of a proper remedy, as, if we allow them to proceed unchecked, they not unfrequently continue till the moment of delivery, rendering the labour much more painful, exhausting, and difficult.
Therapeutics. The following medicaments may generally be had recourse to with effect : Bryonia, Nux v., Pulsatilla, Dulcamara, and Aconitum, — the one most suitable for the affection being selected, according to the causes and symptoms.
Bryonia, when there are pains in the loins resembling a dragging weight, attended with constipation and irritability, much increased by motion, with abdominal pains preceding those in the back, (This remedy is more particularly indicated, when the above symptoms have been excited by a fit of passion.)
Nux vomica. Similar pains in the abdomen and back; also *when there is pain in the region of the pubis, as if from the effects of a bruise ; the symptoms arise chiefly at night. When the exciting cause appears to be constipation, or mental irritation, or a too luxu- rious mode of living, stimulants, coffee, or spirituous liquors, there is additional reason for selecting Nux v.
Pulsatilla : Similar abdominal pains ; pains in the loins resembling those from continued stooping, or the pressure of a tight bandage, attended with a sensation of rigidity, and painful dragging and aching in the thighs; constipation or relaxation; mild-
* If the os uteri be found unaltered, and consequently not enlarged or elongated, it way with certainty be concluded that the pains are spurious.
PARTURITION. TEDIOUS LABOURS. 687
ness of temper or great sensibility. This remedy is particularly valuable, when these pains appear to have arisen from indigestion brought on by rich, indigestible food.
Dulcamara : is chiefly useful when the origin may be traced to cold, and the pains are of a violent, shooting, and drawing nature, situated in the small of the back, generally coming on at night. When spurious pains arise from emotions of the mind, we may consult Mental Emotions.
Aconitum : — When these pains occur in young plethoric subjects, attended with accelerated and strong pulse, flushing of the face, and increased temperature of the skin.
The employment of this remedy completely obviates the necessity for venesection.
parturition.
Natural labour takes place at the end of the ninth month of preg- nancy ; the uterine contractions are regular and effective, and the whole process does not continue beyond twenty-four hours, rarely above twelve, and very frequently not longer than six. Were it not for the acquired hahits of civilized life — improper diet — the distortion of the proportions of the female frame by tight-lacing,* and the conse- quent displacements and disturbances of the regular functions of the abdominal viscera — diseases generated by the want of proper air or exercise, or both — hereditary maladies, &c, parturition would be comparatively free from pain and remote from danger, as in fact it so generally is, even at the present day, among savages.
TEDIOUS OR COMPLICATED LABOURS.
When labour is protracted beyond the normal period stated, or is attended with an excessive degree of suffering, which is more prone to happen when the female is of a slender form, and of a highly ner-
* It is to be regretted that the attention of mothers is not more particularly directed to the development of the female frame by means of calisthenic exercises, instead of distorting its symmetry by means of stays and tight-lacing ; health being destroyed for the sake of that fashionable and unnatural absurdity — a thin waist.
688 TREATMENT BEFORE PARTURITION.
vous and sensitive habit, it becomes incumbent on us to avail our- selves of all the means which art affords, in order to endeavour to alleviate the sufferings of the patient as much as possible.
Amongst the medicines best suited to attain this desirable result, we shall frequently find Coffea cruda of considerable service in miti- gating the pains, when they are extremely violent and occur in rapid succession, scarcely allowing the female an interval of ease, and are attended with excessive agitation, bordering on despair. When Coffea affords but little relief, which is generally the case when the patient has constantly or frequently been in the habit of using coffee as a beverage, Aconitum should be resorted to, followed by Chamomitta if required.
If little or no benefit ensue after several doses, another medicine may be prescribed. When we find that the throes are insufficient to accomplish their object, and the female becomes exhausted by the protracted nature of the labour, —
Belladonna is a medicine of the greatest value, and will generally prove serviceable in almost every case of tedious labour, which arises from the rigidity and unyielding state of the parts, (as is so frequently the case with elderly females giving birth to their first child ;) but it is more particularly where labour is protracted by a spasmodic con- traction of the inferior portion of the uterus, owing to which circum- stance, notwithstanding the existence of powerful throes, the os uteri does not become correspondingly dilated, that Belladonna is indicated. On the other hand, this valuable remedy is further of equal efficacy when, on the escape of the waters, an almost complete cessation of labour- pains ensues, or the uterine contractions are rendered so feeble as scarcely to be perceptible, and are only made known to the patient by a periodic sensation of pressure and aching at the sacral region — while the dilatation of the os uteri is found, as in the above instance, to make no further progress?*
The following remedies will also occasionally claim attention : — Nux v., Pulsatilla, Secale cornutum, and Opium.
Nux v., when the labour is somewhat protracted, from the irregu- larity and insufficiency of the pains, and the female complains of a continual urgency to relieve nature.
Pulsatilla, where the labour-throes are imperfect, and frequently extend upwards from the sacral to the epigastric region, attended with spasm of the stomach and vomiting ; or when they are almost
* Kallenbach.
TEDIOUS LABOURS. 689
unfelt, and occur only at long intervals, attended with acute pains in the loins, and painful drawing sensations in the thighs, which tend much to weaken the woman, without furthering the labour.
When Pulsatilla has not had the desired effect, and there is a con- tinual deficiency of uterine contractile power ; or when the labour- pains return every quarter of an hour, not increasing in intensity, Secale cornutum ought to be administered. Again, when we find the pains, although powerful at first, suddenly cease, followed by a tremor of the whole body, and occasionally interrupted by violent jerkings, and when the patient falls into a sort of lethargic slumber, with open mouth, stertorous breathing, eyes half closed,* — and there is great difficulty in arousing the sufferer, even by violent means, Opium is indicated.
Dose. A few globules of the remedy may be dissolved in about an ounce of water, and a dessert-spoonful given between each pain, until benefit results, or a marked action of the remedy calls for a pause. When the pains suddenly disappear without other indications, one or two drops of the Mother Tincture of Cinnamon may prove of service, especially where the labour is far advanced.
We have now, in a great measure, treated of the course to be pursued when Nature seems to call for our assistance to further her exertions ; but we must, at the same time, reprobate a rash and ill- advised interference with her operations ; and we cannot, in common with most men of eminence of the other school, too strongly repre- hend the practice of administering spirituous beverages, or stimulants, such as chamomile tea, and other ptisans, coffee, etc., under the absurd idea of thereby facilitating delivery.
Spirituous liquors are objectionable, from their accelerating circu- lation, and consequently producing difficult labour, and too great a loss of blood ; Coffee, from its causing high nervous excitability : Chamomile, from its pathogenetic property of producing, or creating a tendency to metrorrhagia ; ptisans, whose peculiar properties wre need not enter upon here, are all more or less of a stimulative or irri- tative nature.
As a general rule, every substance, possessing a medicinal property, administered upon the false premises above noticed, tends to injury, and must therefore be carefully avoided.
With regard to the after-birth, when common, gentle^ and rational
44
690 TREATMENT BEFORE PARTURITION.
mechanical means* for its expulsion fail, we may have recourse to Belladonna, Pulsatilla, Secale cornutnm, or Opium, selecting by the symptoms already mentioned, and shall rarely be disappointed in our expectations of their beneficial effects.
When the parturition is complete, the administration of a few globules of Arnica, in a little water, is always followed by the happiest results, frequently preventing much severe after- suffering : and we are convinced that many critical cases of inflammation, etc., might thereby be warded off. In instances where the labour has been very protracted, the Arnica in lotion, one teaspoonful of the Tincture to two ounces of tepid water, applied externally, will be found to afford great relief.
SPASMODIC PAINS, CRAMPS, AND CONVULSIONS.
In complicated labours we sometimes find spasmodic pains set in, which occasion considerable suffering, without advancing the birth.
Therapeutics. The principal remedies against these affections are Chamomilla, Belladonna, Hyoscyamus, Stramonium, Ignatia, Cicuta virosa, Ipecacuanha, and Cocculus. With regard to their administration, a globule or two may be given in a teaspoonful of water, and repeated after a shorter or longer interval, if necessary, according to the effects produced, the selection of the several Remedies being guided by the following symptoms :
Chamomilla : — Where there is extremely acute pain, chiefly of
* We do not understand or mean to express by the said term, the exercise of brute force : it is truly melancholy, and almost impossible to conceive, that men, who have received a medical, education, and have had opportunities both of reading and hearing the warnings of enlightened and experienced obstetric practitioners, against the distressing and serious con- sequences which almost inevitably result from the employment of harsh and inconsiderate measures, whenever the expulsion of the placenta happens to be somewhat tardy, could be guilty of such culpable and infamous conduct. Some of these reckless individuals do not appear to wait for any signs of tardiness, but as if in anticipation of an obstinate and pro- longed retention, they set to work with their ruthless proceedings immediately, and are, consequently, but too often the authors of all the mischief and danger, and even the fatal termination which sometimes result after the natural process of labour.
SPASMODIC PAINS. 691
a cutting description, extending from the lumbar to the hypogastric region, attended by spasmodic convulsions ; redness of the face, especially of one cheek ; excessive sensibility of the nervous system, • and excitement.
Belladonna: — When the bearing-down is excessive, as if the entire contents of the abdomen were about to be protruded : convulsive movements in the limbs ; great agitation with continual tossing ; occasional throb- bing and distension of the vessels of the head; bloated redness of the face with profuse sweat. (See also the indications for this invaluable remedy at page 505.)
Hyoscyamus: — When the convulsions are still more severe, accompanied with great anguish and cries; oppression of the chest and loss of consciousness.
Stramonium: — Convulsions, without loss of consciousness, and trembling of the limbs.
Ignatia : — Spasmodic and compressive pains, wTith sensation of suffo- cation; confused feeling in the head.
Cicuta virosa : — General convulsions, or cramp-like contortions of the limbs ; pallor or sallow hue of the face.
Ipecacuanha : — Spasmodic convulsions ; paleness or bloatedness of the face, occasionally with desire to vomit.
Cocculus: — Cramps or convulsions of the limbs and whole body, more especially in the lower part of the abdomen, with heat, redness, and puffiness of the face. Acidum hydrocyanicum, Platina, and Cina have also been recommended against convulsions during labour.
TREATMENT AFTER DELIVERY.
After the termination of delivery, both body and mind must be kept in a state of perfect repose ; everything which may tend to arouse the excitability of the patient, such as noise, strong light, and odours, must be carefully avoided, and the room kept at a moderate tempera- ture. After the birth, the female should be allowed to enjoy that slumber, which in natural cases generally follows, without interrup- tion ; but it is commendable to feel the pulse from time to time, to ascertain if a healthy action is going on. Sometimes this desirable state of rest is kept off by great nervous excitement on the part of the female, with incessant tossing in bed and restlessness. A few globules of Coffea cruda will often suffice to dissipate these symp- toms, and procure a refreshing slumber ; should it be insufficient and any febrile symptoms be present, Aconite will generally produce the desired effect. When these remedies, which answer in the ma- jority of cases, fail of their accustomed success, we must endeavour to trace the cause of the derangement, and shall generally discover symptoms, pointing out a different remedy, which, if judiciously chosen, will, with almost absolute certainty, afford a satisfactory result. (See the article Sleeplessness, Part I.)
Here again we must severely reprobate the practice of administer- ing stimulating, and even spirituous, beverages to females after delivery, which, far from possessing a strengthening property, tend only to excite and irritate the whole nervous system. For some time after parturi- tion, Nature calls for but little nourishment ; it should be given only when the female herself expressly feels the want of it, and then be of the lightest and most digestible kind, and in very small quantities. It is highly reprehensible to endeavour to induce a female to partake of food, under the absurd idea of strengthening her. We must allow Nature to pursue her own course, which prescribes but little nourish-
AFTER-PAINS. 693
ment for the first five or six days after delivery, and thereby avoids the necessity of calling the bowels into action, which state of Consti- pation (if it may be so called), is ordained for the wisest purposes, and attended with the most beneficial results ; while the temporary in- activity of the alimentary canal is compensated by the vicarious action of the skin (demonstrating itself by increased perspiration), and the balance of the system thus kept up. We cannot, therefore, suffi- ciently condemn the use of aperients, which only tend to promote irritation, and bring on puerperal fever, and other evil consequences ; in many cases, also, this artificial relaxation interferes with the proper secretion of milk. After the fourth or sixth day, Nature generally acts spontaneously, and when it appears necessary to afford mecha- nical assistance, we may do so by the application of warm friction to the abdomen, or the employment of a simple lavement, consisting of tepid water, with a little linseed oil or thin gruel. When this state, which seldom happens, continues so long as to cause inconvenience, Bryonia, or Nux vomica, Pulsatilla, and Opium, may be resorted to. (See article Constipation.)
AFTER-PAINS.
These pains are considered salutary, and perhaps justly so to some extent ; at the same time, when they occur in an aggravated form^ and are unduly protracted, as frequently occurs in females of exalted nervous sensibility, they tend to deprive the patient of her rest, and ought, under such circumstances, to be subdued as speedily as possible ; their early mitigation, in all cases, by means of homoeopathic remedies, is, moreover, always attended with the most satisfactory results.
In many instances the employment of Arnica internally, and like- wise externally as a lotion, (a few drops of the tincture to an ounce or so of tepid water,) when the labour has been somewhat severe, is sufficient to prevent the excessive development of these pains, as also in most cases to ward off fever and inflammation.* But when the
* The soothing effects of Arnica are properly appreciated by those females who have had opportunity and occasion for its employment ; and we believe there are few who, having once experienced the beneficial effects of the homoeopathic treatment generally, during the entire period of confinement, would willingly return to the old method of treatment.
694 TREATMENT AFTER DELIVERY.
pain still continues, and the patient is highly excitable and sensitive, we should give Chamomilla, followed in about an hour by Nux v., if no change is effected by it. If the pain is of an insupportably intense description, or followed by convulsions, coldness, and rigidity of body, Coffea cruda ought to be selected. We may give Pulsatilla, when the convulsions do not supervene, but the pains are protracted, and the patient is of a mild and gentle disposition, but sensitive and easily alarmed about herself. Again, when the after-pains are very severe, and there is a continual inclination to re- lieve the bowels when in a recumbent posture, but passing away when rising, followed by spasmodic pains in the lower parts of the abdomen, they are usually readily relieved by Nux vomica.
Secale cornutum and Cuprum metallicum have been strongly recommended in preference to any of the foregoing remedies, in severe and protracted after-pains occurring in females who have already borne many children.
With regard to the dose, we may dissolve a few globules in a wine- glassful of water, and give a teaspoonful every hour, or only every three or four hours, according to circumstances ; carefully watching the effect produced, and discontinuing the medicine as soon as relief is afforded ; in many cases a single dose will suffice. When, on the other hand, no improvement follows after a dose or two of the same remedy, another must be selected.
In the event of flooding, the following remedies must be had recourse to : Ipecacuanha — or Crocus, Flatina, or Sabina ; also Belladonna, Cha- momilla, or Cinchona, in particular cases, according to the symptoms. (For indications see Miscarriage.)
duration of confinement.
Even a strong and healthy female, during the first five days, should remain in bed; in the four following, if she feel herself perfectly strong, and desirous to rise, she may gradually accustom herself to longer periods of sitting up ; the great risk is from the extreme sus- ceptibility of the system to cold. After this period a female who still finds herself weak and languid, should prefer the horizontal to the half-recumbent posture ; and if this prove wearisome she may sit up for an hour or two, but not so as to fatigue herself. The diet should
DURATION OF CONFINEMENT, 695
be regulated according to the habit of body and the state of the di- gestive functions ; in all cases it should be light, and, at first, ex- tremely light, and not of a very nutritious quality ; the patient ought only gradually to partake of food of a more nourishing nature, never having recourse to anything in the least degree stimulating, and all strong odours, from flowers or other aromatic substances, must be carefully avoided, the mind being also kept in as perfect a state of tranquillity as possible^ and the room dark.
DISEASES FOLLOWING PARTURITION.
SUPPRESSED SECRETION OF MILK.
It is of paramount importance that the normal operations of the organism peculiar to this state, proceed with due regularity. Among these the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, determination of blood to the head, and the usual array of symptoms, which form the disease, commonly denominated puerperal fever, wThich, however, also results from internal injuries, consequent upon difficult or protracted labour ; but if the precaution of administering Arnica, already enjoined, has been taken, that source of danger will almost always have been effectually guarded against.
When, however, puerperal fever arises or threatens to set in, from a sudden suppression of the lacteal secretion, the immediate administra- tion of Pulsatilla, three globules in a teaspoonful of water, repeated in six, twelve, or twenty-four hours, according to necessity, will frequently be found sufficient to check it at the outset, restore the flow of milk, and re-establish the equilibrium of the organism ; if any unpleasant symptoms still remain, they will, in most cases, yield to the administration of Calcarea, followed by Zincum, if it appear called for. In other cases, particularly where serious metas- tases result, Belladonna, Bryonia, Rhus, or Sulphur may be required.
If the suppression of the secretion arise from any sudden mental emotion, we may select one of the remedies mentioned in that article, which see — giving perhaps a preference to Bryonia, CJiamomilla, Pul- satilla, or Coffea.
Should active feverish symptoms, such as hot, dry skin, &c. set in, Aconite should be given at short intervals, until a favorable impres-
EXCESSIVE SECRETION OF MILK. 697
sion is made : — when there is excessive restlessness along with the above, considerable advantage will accrue from the alternate use of Aconitum and Coffea.
We may here refer back to our remarks upon the evil effects of aperients, which, by their action upon the intestines, frequently cause a suppression of the lacteal fluid, and the consequent fever.
EXCESSIVE SECRETION OF MILK.
Sometimes, on the other hand, it happens that too abundant a secre- tion takes place, causing distension of the breasts, and involuntary emission of milk, and productive of extreme emaciation, and some- times development of phthisis. Calcarea will be found useful in this affection ; or, should it fail to relieve, Phosphorus.
When febrile symptoms arise from distension of the breasts, induced by an excessive secretion, and indications of what is gene- rally denominated milk-fever, (which, however, frequently arises from other causes,) we may have recourse to Rhus toxicodendron.
Aconite may be exhibited, as a precautionary measure, when there is high febrile action of the whole system, and we are ignorant of the exciting cause. The dose to be repeated every six hours, or oftener, if necessary, until the rapidity of the circulation is dimin- ished, and the skin rendered moist.
PERSPIRATION AFTER DELIVERY, SUPPRESSION OR EXCESS OF-
The increased perspiration, which takes place after childbirth is, as we have before observed, a substitute for the suspended action of the alimentary canal ; consequently its sudden suppression is unavoid- ably followed by an injurious result, and, not unfrequently, puerperal fever.
Exposure to cold, or a sudden chill, is the most frequent cause of this affection ; wre consequently find that the immediate administra- tion of Dulcamara, will often suffice to restore the action of the
698 DISEASES FOLLOWING PARTURITION.
skin, and prevent further injurious consequences. Should it fail, Nux vomica will frequently be found efficacious, or Chamomilla : this latter remedy particularly, when there is excessive restlessness and excitability, with colic and relaxation of the bowels. When severe one-sided headache arises, combined or not with distressing pain in the neck, Belladonna may be prescribed. In other cases, Bryonia or Sulphur may be called for.
On the other hand, an excessive perspiration is almost equally pre- judicial ; it is generally brought about by keeping the room of the female at too high a temperature, the use of too great a quantity of bedclothes, or stimulating beverages ; it is chiefly injurious from the extreme debility and high susceptibility of taking cold, which it occasions. Our first care must be a removal of the exciting causes ; and should the malady still continue, we may administer Sambucus niger, which will generally be found effectual in its removal. In other cases, China, Cocc, Sulph., Calc, or Acid, sulph. The latter especially when the sweating is most profuse when lying still, and diminished by movement.
MILK FEVER.
The secretion of milk must be looked upon rather as an operation of Nature, than one requiring medical aid for its regulation. Never- theless, many females suffer some slight uneasiness for a few days following confinement, during the first period of that process ; but when any of the undermentioned group of symptoms present them- selves, the affection is known by the name of milk-fever : —
Thirst, shivering, and heat, terminating in perspiration ; the pulse, at first weak, changing to various phases, sometimes quick and frequent, at others soft and regular ; in some instances, these symp- toms are attended with a drawing pain in the back, extending to the breast, a disagreeable taste in the mouth, thirst, oppressed breathing, anxiety, headache, and diminution or suppression of the secretion of milk, etc.; the exacerbation declares itself regularly about evening, and towards morning perspiration comes on, with alleviation of suffering, or temporary termination of the attack, which not unfre- quently recurs on the following day, but rarely rises to such a height as to threaten danger ; Nature herself, if not disturbed by improper
MILK FEVER. LOCHIAL DISCHARGE. 699
treatment, will, in most cases, suffice to restore the equilibrium of the system. When the secretion is re-established, and the lochial dis- charge resumes its normal course, the derangement generally ceas*es ; should, however, the affection become aggravated, we may dread the setting in of puerperal fever.
When the symptoms are as above described, and medical assist- ance is required for their alleviation, we must, if possible, in the first place, endeavour to discover the exciting cause ;* when the affection is traceable to mental emotions, we may consult that article for the remedy.
Aconite may be employed in all instances, where considerable fever is present, or administered alternately every six hours, with Coffea, when there is extreme restlessness, anxiety, and dread.
Bryonia may with great advantage follow Aconite, when the active febrile symptoms are in a great measure subdued; and is further particularly indicated, when there are oppressed and laborious breath- ing, intense headache, and obstinate constipation.
Pulsatilla will be found particularly useful in severe cases, especially when caused by taking cold, and bearing a closer approxi- mation to a rheumatie affection than to the general symptoms of milk fever; this medicament is very efficacious in restoring the lacteal secretion, and may be regarded as a prophylactic against puerperal fever, especially when the precautionary measure of the administra- tion of Arnica has been neglected.
Belladonna is very useful in particular cases : a reference to Inflammation of the Breasts, and other parts of the work where that medicament is mentioned, will serve to point out in what instances it is most likely to prove efficacious.
Rhus is also of considerable service in some cases of milk fever. (See the indications given for this remedy under the heading of Excessive Secretion of Milk.)
IRREGULARITIES OF THE LOCHIAL DISCHARGE.
This discharge varies considerably in different females ; with some it continues for several weeks, in others only a few days ; sometimes
* Neglecting to put the infant sufficiently early to the breast, with consequent absorption of the milk into the circulation, is a frequent source of the derangement.
700 DISEASES FOLLOWING PARTURITION.
it is thin and scanty, at others so profuse and long continued, as imperatively to call for medical assistance, which may be frequently traced to sitting up too soon after confinement, to errors in regimen, keeping the chamber of the female at too high a temperature, or mental emotions. If, after nine days, the discharge continues pro- fuse, containing pure blood, whereby an abnormal state is indicated, Crocus, Bryonia, and Calcarea are the principal remedies.
Crocus : — In most cases where the discharge is of too long dura- tion, and particularly when the blood is of a black or dark colour, and viscid consistency.
Bryonia : — When of a deep red, with internal burning pains in the region of the uterus.
Calcarea is more particularly indicated, when there is an itching kind of sensation in the uterus.
When the lochia are suddenly suppressed, which they sometimes are, from a variety of external causes, such as mental emotions, &c. and from this source puerperal fever threatens, the danger may fre- quently be warded off by the employment of Pulsatilla.
When the sudden suppression arises from fright, and is attended with febrile symptoms, Aconite will generally be found sufficient, or Opium, when the indications given under Mental Emotions are present. (See also the other remedies mentioned under that heading.)
When the suppression is caused by exposure to cold or damp, Dulcamara will be found efficacious, and may be advantageously followed by Pulsatilla.
On the other hand, wThen the discharge continues, but becomes sanious, fetid, and offensive, Belladonna will generally suffice to restore it to its normal state ; if this remedy prove inefficient, we may administer Carbo animalis in the same manner; and, if the occasion still seem to require it, Sec ale cornutum, until benefit results.
Silicea, when pure blood is discharged with the lochia, each time that the infant is applied to the breast.
The following remedies may also prove useful : Nux v., Hyoscyamus, Zincum, Colocynth, Veratrum, and Secale cornutum, chiefly in the event of a suppression ; and Platina, Secale cornutum, Hepar s., Rhus, against too copious or protracted lochia.
ABDOMINAL DEFORMITY. 701
DIARRHCEA IN LYING-IN WOMEN.
Diarrhoea, during this period, is a state to be looked upon as highly injurious, and immediate means should be taken for its suppression, by the administration of Dulcamara, Hyoscyamus, Rheum, Antimonium cmdum, Phosphorus, and Acidum phosphoricum, &c.
The first remedy is generally indicated by the cause being a check of the naturally increased perspiration in lying-in women, from a chill: and, when timely administered, it will generally be found sufficient to answer the purpose required.
In painless and almost involuntary evacuations, Hyoscyamus is most effectual.
Rheum and Antimonium crudum, in watery or very offensive evacuations ; the former when they emit a sour smell.
In very obstinate cases, when the discharge is watery, almost in- voluntary, and painless, Phosphorus followed, if necessary, by Acidum phosphoricum. (Vide also Diarrhoea, in the First Part of this work, and administer or repeat the remedies as there directed.)
ABDOMINAL DEFORMITY.
Although, in natural cases and healthy constitutions, no abnormal derangement should follow parturition, still we frequently find that a number of unpleasant symptoms, generally arising from maltreat- ment, supervene. Among these we may mention the thickening of the abdominal coats, occasionally ending in a permanent malforma- tion and pendulous appearance. Abdominal deformity is more com- monly incident to females who have borne many children, or who present a predisposition to corpulency ; and is found especially difficult of treatment, when tight stays which we have already re- marked upon as one of the principal exciting causes, have relaxed the abdominal muscles, and by so doing, increased the existing bias
702 DISEASES FOLLOWING PARTURITION.
to the affection. When, however, it is caused by the natural strain upon these muscles during pregnancy, the inconvenience may be considerably alleviated by the internal and external use of Rhus
TOXICODENDRON.
The internal administration of Sepia is recommended by Dr. Gross* as still more effectual ; he, at the same time, advises the adoption of an elastic bandage, laced at the back, and exerting an equable pressure over the whole of the abdominal region. In some cases where there is a tendency to this affection, particularly in cor- pulent habits,f we may, soon after delivery, have recourse to mechanical aid, by transferring the weight from the abdominal muscles to the shoulders, by the aid of a properly constructed apparatus ; but we must, in the strongest manner, object to this or any other pressure being exercised upon the abdominal region during pregnancy, as such a measure is obviously calculated to entail malformation, as, for instance, club-feet, &c, upon the offspring.
FALLING OFF OF THE HAIR.
Another evil that some females, particularly those who nurse their infants themselves, suffer after confinement, is a falling off of the hair.
This frequently arises from an innate delicacy of constitution against which the following medicaments have proved efficacious, and may be repeated every eight days.
Tinctura sulphuris six globules, Natrum muriaticum six globules, Carbo vegetabilis six globules, Sepia six globules* Lycopodium six globules, and Calcarea six globules. The last, particularly in those cases in which the lochial discharge has proved very profuse, or in which the catamenia are generally too abundant.
* Das Verhalten der Mutter und des Sauglings, p. 95.
f Against Polysarcia (occurring in either sex), Calcarea is one of the most useful reme- dies, especially in lymphatic persons. In other cases, Sulphur, Arsenicum, Baryta, Anti- monium are very useful. When the abnormal secretion of fat takes place exclusively, or chiefly, in the abdomen (omentum), and forms the pot- or Falstaff -belly, Colocynth has been recommended as a medicine of considerable utility. One or more of the remedies mentioned as applicable to general corpulency may, however, be called for after the previous employment of Colocynth. Spare diet and regular exercise must, in both varieties of corpu- lency, be inculcated.
LEUCORRHCEA. PROLAPSUS. 703
China, followed by Ferrum, is useful in debilitated females particularly if there has been flooding after labour. Mercurius is serviceable when there is excessive perspiration at the head. In females who have suffered much from hysterical affections, Hepar is often of con- siderable efficacy. If the hair falls off after metritis or other inflam- matory attacks. Hep., Lye., and SiL, — Sulph., Calc., Ac. phosph., Natr. m., or Carlo v. may be employed with advantage.
With regard to the other medicines we would, in most instances, recommend a commencement with Tinctura sulphuris.
LEUCORRHGEA AFTER PARTURITION.
A third evil is Leucorrhcea, which, although at the commencement merely a consequence of the relaxation of the internal uterine economy, after the completion of the lochial discharge, and at first of an innocu- ous character, frequently proves exceedingly troublesome, and finally puts on a morbid appearance, becoming acrid, and productive of excoria- tion. We generally find a predisposition to the disease in scrofulous, torpid, and leuco-phlegmatic temperaments ; in some families this malady is hereditary, and only to be removed by a careful course of anti-dyscratic treatment. It is frequently of a very obstinate cha- racter, requiring the exercise of considerable study and attention on the part of the medical attendant, on the one hand, with much patience and strict attention to dietetic rules on that of the patient, on the other, ere a successful result can be attained.
The remedies which have been found the most efficacious against the affection, either occurring after parturition, or at other times, are Pulsatilla, Sulphur, Sepia, Bovista, Calcarea, Lycqpodium, and Carlo v., Causticum, Conium, Mezereon, Natrum, Magnesia c. et m., Ammonium c, Cannabis, Iodium, Petroleum, Stannum, &c.
INTERNAL, OR UTERINE SWELLING AND PROLAPSUS.
A swelling of the interior economy is frequently the result of a difficult labour, and in some cases of mismanaged parturition: we sometimes find it complicated with uterine or vaginal prolapsus ;
704 DISEASES FOLLOWING PARTURITION.
if the precaution of exhibiting Arnica, which we have before noted (page 690), have been taken, this will frequently be pre- vented; but should symptoms of prolapsus set in, attended with a painful burning sensation, and bearing down, a dose or two of Nux vomica will generally remove the evil. Sepia, Belladonna, Aurum, Mercurius, Lycopodium, Stannum, Cannabis, China, Platina, and Calcarea, &c, have been employed with material benefit in cases of this description of long standing, as also in other uterine affections, such as Metritis, Retroversio uteri, &c.
INFLAMMATION OF THE WOMB.
Inflammatio uteri. Metritis.
Diagnosis. Continuous, burning, pricking, or shooting pain, in the hypogastric region, sometimes of a very acute description, accom- panied by a sensation of weight. At the commencement of the attack, the pain occupies only a small extent of surface, but it soon afterwards extends to the perineum, rectum, and even the entire ab- domen. On examination, the vagina and os uteri generally feel hot, and are tender to the touch. The abdomen becomes subsequently tumefied, sensible to the touch, and considerably increased in tem- perature. The utero-vaginal secretions are suppressed, sometimes also the evacuation of faeces and urine ; and, in lying-in women, the secretion of milk is likewise arrested. These form, in general, the more constant symptoms of uterine inflammation ; but as the entire womb is very rarely affected, the symptoms are liable to vary some- what according to the precise seat of the inflammation.
Causes. Severe, unnatural labours, maltreatment, such as harsh manual interference, the administration of powerful stimulants, &c, during protracted labours, or labours with deficient contraction, re- tention of the placenta, coagula, mental emotions, &c, are the most frequent exciting causes of the disease ; but it is likewise prone to occur, though, for the most part, in a less active form in married women who have never borne children, or during the period of utero- gestation, in consequence of cold in the feet or abdomen, inflammation
INFLAMMATION OF THE WOMB. 705
in neighbouring organs, external injury, &c. Organic defects and menstrual ataxia are frequent predisposing causes.
Therapeutics. The remedies which have hitherto been chiefly employed in homoeopathic practice against metritis are : Aconitum, Belladonna, Arnica, Nux, Mercurius, Ckamomilla, and Cqffea.
When the accompanying fever partakes of a synochal type, a few doses of Aconitum are requisite, particularly at the commencement of the treatment. As soon as the violence of the fever has been miti- gated some other remedy must be prescribed, according to the ex- citing cause of the attack, when known, and the characters of the symptoms. Belladonna will thus claim a preference in cases which have resulted from adherence to the placenta ; or if the inflammation has taken place after confinement, without any assignable cause, and is attended with the following symptoms : suppression of the lochia ; distressing sensation of weight, dragging, or bearing down in the hypogastric region ; burning, shooting pains in the lower part of the abdomen ; shooting pains in the hip-joint ; severe pain in the back, as if it would break ; tenderness of the abdomen to the touch. When metritis has arisen in consequence of severe and protracted labour, with laceration of the parts, Arnica should first be prescribed, or it should be given in alternation with Aconitum, or with any other remedy which may seem called for by the symptoms. The early employment of this remedy, both externally and internally, after delivery, is always attended with more or less benefit, and is undoubtedly frequently the means of warding off mischief in cases of unnatural labour.
Nux vomica is a most useful remedy in various uterine derange- ments. In this inflammation it may be employed with advantage when the pains in the region of the uterus are very severe, partaking chiefly of a shooting or cutting description ; and are accompanied by ischuria or dysuria, constipation or costiveness, and tenesmus ; when a feeling of soreness or pain, as from a bruise, is constantly expe- rienced in the epigastrium ; when there is severe aching in the lumbo- sacral region ; and when all the symptoms become exacerbated towards morning.
Mercurius is useful when frequent fits of perspiration or shivering take place, and when shooting, pressive, boring, or piercing pains are complained of in the region of the uterus.
Chamomilla, Ignatia, Coffea, or Bryonia may be of much service in some cases, particularly when mental emotions hav% preceded the
45
706 DISEASES FOLLOWING PARTURITION.
attacks. (See the different indications which call for the one or the other of these remedies in the article Mental Emotions.)
Cinchona is indicated in metritis, by most of the symptoms which have been mentioned under Belladonna, The latter is better adapted to plethoric habits^ whereas the former is more appropriate in feeble or exhausted constitutions,, who have suffered from excessive hemor- rhage, or other debilitating causes.
' In other cases recourse may be had to Lachesis, Platina, Pulsatilla, Rhus, Sec, Thuja, &c.
In irritable litems, so-called, the. most important remedies are: Nux v., Plat,, Bella., Stan., Cham., China, Ipec. ; and also : Sepia, Sulph., Calc, Coc., Con., Graph., Natr. m., Kali, Kreos., Croc., Ac. muriat., Magn., &c.
Against uterine spasms: Cocculus, Ignatia, Conium, Magn., Magn., m. j — Bella., Cham., Nux, Hyoscy., Natr. m., China, are the principal homoeopathic remedial agents.
Against uterine polypus : Staphysagria, Thuja, Calc, Ac. nitr., Carl, v., have been chiefly recommended.
Against ulcerations at the os uteri, &c. : Carlo v., Graph., Sulph., Silic, Sep., Ars., Merc, or Thuja, may be successfully employed.
In indurations of the uterus : Aurum, Bellad., Sep., Staph., Tad., Ca- lendula, have hitherto claimed the principal attention.
And in carcinoma : Bellad., Ars., Staph., Thuja, Carlo v. et a., Clem., Con., Sil.
WEAKNESS AFTER DELIVERY.
We frequently find a high degree of weakness or exhaustion re- maining after delivery ; when it has been caused by very considerable hemorrhage, during or after that period, Cinchona is particularly indicated, and will generally be found efficient in restoring the vital energies.
When, however, the derangement is attributable to nervous weak- ness, and is attended with restlessness and want of sleep, we may administer Aconite, followed, if necessary, by Coffea, or substi- tute Veratrum for the latter medicine, when the prostration of strength is excessive.
In some instances we must have recourse to Kali carbonicum, or to Sulphur, Calcarea, or Acid, phosphoricum.
OBSTACLES TO SUCKLING.
DISINCLINATION OF THE INFANT.
Where there is a tendency to consumption in the mother, or she is of a strumous habit, the infant ought, for its own sake, to be reared with the spoon, or a nurse provided. But even some healthy mothers find a difficulty, before they become accustomed to it, in nursing their children, which, however^ a little perseverance will soon effectually overcome ; but when the child itself refuses to take the breast, (a rare instance, if it be applied soon after delivery,) the administration of Cina, followed, if not speedily efficacious, by Mercurius solubilis, is often found to remove this repugnance in the course of a few hours. Silicea is also an excellent remedy in some cases, particularly when the child takes the breast readily enough, but returns the milk almost immediately after ; the remedy selected ought to be given to the mother as well as the child.
EXCORIATION OF THE NIPPLES.
In the majority of those cases in which no malformation of the parts is present, the main difficulty arises from the nipples having become sore and cracked, which the efforts of the infant tear open afresh, and cause to bleed.
This excoriation of the nipples is frequently prevented by following up the treatment, of which we have already spoken, under the head of Preparation of the Breasts, of course taking the precaution of laving the nipples with a little warm milk and water, before the
708
OBSTACLES TO SUCKLING.
child is applied to the breast ; the shield before mentioned ought always to be worn during the intervals of suckling.
When there is a tendency, however slight, to rawmess or excoria- tion, great care must be taken lest the shield adhere to the skin ; it ought to be frequently removed, and together with the nipple, kept perfectly dry ; attention to these particulars will generally remove this difficulty. The mother ought, however, gradually to accustom herself to nourish the infant, using a sucking-glass, which should be carefully washed every day. Should, however, the nipples have already become very sore and irritable, from the neglect of these precautionary measures, it will be necessary to have recourse to specific remedies, without which, if suckling be persisted in, sup- puration frequently ensues.
In the first stage of the affection, Arnica, should be employed internally, and the breast laved with a weak lotion,* say about a teaspoonful of the Mother Tincture, a few globules to one ounce of water. If this fail, we must have recourse to anti-dyscratic remedies, as this disease almost always arises from a constitutional cause, females of healthy temperament being generally exempt from it. Among these Tinctura sulphuris seems particularly indi- cated for most cases of this affection, and a dose of one or two globules may be administered every five or six days until improve- ment sets in, wThich w7ill generally be the case in the space of a few days ; and if this fail, Calcarea administered in the same manner, will in most instances suffice. We may also mention Graphites, Sepia, Lyco podium, Merc, and Silic, as remedies of much value in some obstinate cases. In the choice of the fitting medica- ment in complicated cases (as indeed in all others), the physician must be guided by the aggregate of the symptoms. (Nux v. has been found of considerable service in soreness of the nipple, with painful excoriation of the adjacent surface.
inflammation of the breasts.
Another, and one of the greatest obstacles to a mother nourishing her infant, is an erysipelatous inflammation and swelling of the
* This lotion may also be applied with advantage in the preparation of the breasts r when irritation or inflammation appears to arise from the pressure of the shield.
INFLAMMATION OF THE BREASTS. 709
breasts, of which anything tending to disturb the lacteal secretion, such as fright, passion, cold, &c, serves for an exciting cause, although we frequently find it present, without being able to trace its origin; it not unfrequently arises from a too tardy application of the breast to the infant, or from a sudden cessation of suckling, — occasioned by the death of the child, or other reasons, — causing a distension of the lactiferous tubes. When a sudden suppression of the secretion occurs, the breasts become red, inflamed, and indurated, occasionally suppurating in some parts, which open and discharge, while others remain still hard and inflammatory, and ultimately either ending in suppuration, or in the formation of obstinate nodosities.
This disease, if not checked, as but too frequently happens under allopathic treatment, exhibits a variety of phases ; and the suppura- tion that takes place leaves behind it disfiguring cicatrices ; frequently the breasts are so far destroyed as to be rendered ever after incapable of performing their functions, and in some instances the foundation of cancer is laid.
The principal remedy in this affection, before the inflammation becomes fully developed, is Bryonia, especially when the breasts are hard and tumefied, and the secretion of milk is suppressed. Bella- donna, when the inflammation is more intense, and the erysipelatous appearance of the skin clearly defined; after which remedy, the disease is generally vanquished.
When, however, a degree of induration still remains, Mercurius solubilis, three globules, should be given, and repeated in from two to three days; in more severe cases, Acid um phosphoricum should be resorted to, or Hepar sulphuris, when suppuration has already commenced.
In instances in which wTe find a fetid and serous discharge, wrhich is frequently brought about by neglect or by improper treatment, such as the application of deleterious unguents, &c, Silicea will generally have the effect to restore the breast to its former condi- tion ; in some extreme cases, however, it will be found necessary to follow up the treatment with Phosphorus, Calcarea, or one or more of the remedies above mentioned, such as Mercurius and Hepar sul-
If this disease has evidently arisen from the effect of a sudden chill, Dulcamara ought to be given immediately, and will frequently obviate all injurious consequences.
In cases where the disease has arisen from external injury, Arnica
710 OBSTACLES TO SUCKLING.
should be employed, and a lotion, one part of the tincture to seven of pure water, locally applied. When the consecutive inflammation is of an intense description, Aconitum is preferable to Arnica. When induration has taken place, Conium is required. And when suppura- tion has ensued, Phosjohoms is, in general, the most effective remedy ; when given sufficiently early, it will rarely fail to promote rapid absorption of the collected matter.
In strumous habits, Tinctura sulphuris, Calcarea, Gra- phites, and Iodium, will occasionally be found necessary to com- plete the cure after Belladonna has removed the active inflammatory symptoms.
MENTAL EMOTIONS AFFECTING THE MILK.
It is a well-known fact, confirmed by numerous examples, that Mental Emotions have a most powerful effect upon milk, in a moment changing it from a source of nutriment into a substance most inju- rious to the infant. Mothers ought to bear this in mind, and after having suffered from fright, passion, &c, should desist from suckling until they are perfectly composed ; and ere the infant be again applied to the breast, a portion of the milk should be drawn off. Fortunately for evils arising from these causes, Homoeopathy presents prompt and efficacious remedies, (for which see Mental Emotions,) which, if at hand, should be administered immediately, according to the cause and symptoms.
DEFICIENCY IN THE SECRETION OF MILK. SUPPRESSED SECRETION
OF MILK.
Sometimes a deficiency of milk is found to arise from a want of energy, either functional or general. For disturbance of the secretion arising from an inflammatory action, vide Inflammation of the Breasts.
When the deficiency or suppression arises from the first cause, the chief medicines useful in restoring a proper and healthy flow of milk, are Pulsatilla and Calcarea. In simple cases Vitex
MOTHERS NOT SUCKLING THEIR CHILDREN. 711
agnus castus, and Pulsatilla will frequently be found efficacious ; in others, but particularly where there is simply a scanty secretion without any apparent abnormal state of the system which might give rise to the deficiency, Calcarea c. rarely fails to increase the secretion.* It is, however, more generally requisite for the female to undergo a complete course of treatment, if she is anxious to persevere in nursing, in which the two latter remedies, together with Aconitum, Bryonia, Chamomilla, Belladonna, Sulphur, Sepia, lodium, will be found of very great value, where the case is one that is capable of being remedied.
DETERIORATION AND DISCOLORATION OF MILK.
If the milk becomes too clear and watery (or otherwise deteriorated in quality, or is distasteful to the child,) Cina, three globules, and Mercurius solubiliSj three globules, ought to be administered alternately every twenty-four hours, for three or four days; or Silicea, three globules, in obstinate cases, (particularly if the infant vomits immediately after suckling,) will frequently bring .about an amelioration.
Rheum will frequently be found of efficacy, when the milk becomes thick and yellow, and disagrees with the child, rendering it restless and fretful.
MOTHERS NOT SUCKLING THEIR CHILDREN.
In the present state of society there are many mothers who, from a variety of circumstances, find themselves necessitated to engage the services of a nurse for their offspring ; in such cases,, a female, who has the slightest regard for her health, should be particularly careful in her diet, and until the secreting process has completely ceased, she should live as low as possible. The employment of dry cupping at the outer surface of the arm, a little below the shoulder, or at the inferior extremities, will materially hasten the suppression of the lacteal secretion. At the same time, material aid will be
* Journ, de la Med. Horn., tome i, cap. 1.
712 OBSTACLES TO SUCKLING.
derived from the internal administration of Pulsatilla ; indeed, the employment of that remedy alone will often be found sufficient to stop the secretion. When suffering from inflammation ensues, we may have recourse to Phosphorus, Belladonna, and Bryonia, for which indications are given under Inflammation of the Breasts ; Calcarea is serviceable, when the breasts are consider- ably distended with milk. These directions will also serve as a guide during the period of weaning.
END OF PART II.
PART III.
TREATMENT OF INFANTS AND CHILDREN.
PART III.
TREATMENT OF INFANTS AND CHILDREN.
INTRODUCTORY REMARKS.
Homoeopathy possesses many peculiar advantages in the Treat- ment of the Diseases of Infancy and Childhood. In the first place, when any constitutional taint exists, this system, by the selection of specific remedies, meets disease upon the very threshold of life, and destroys it in the germ ; it substitutes a rational mode of treatment for the nostrums of the nursery, since the application of the reme- dies, even in the most trifling cases, requires a certain degree of education, and a careful study of medicinal action. There can, indeed, be no doubt that many lives, which have unfortunately been sacrificed by the overweening self-confidence and prejudices of those intrusted with the life of man, at the most precarious period of his existence, might have b,een preserved, had this system been more extensively known and acted upon.
Again, the receptivity of the infant organism to the influence of homoeopathic remedies, is a fact established by experience. Here, therefore, from the minuteness, yet sufficiency of the dose, all risk is obviated of producing hurtful and even fatal consequences by the accidental exhibition of one medicine in place of another, — an event unfortunately of but too frequent occurrence in the old mode of practice.
The tasteless nature of the medicaments is another point of no
716 TREATMENT OE INEANTS AND CHILDREN.
small importance in affections of infants and children, and by means of which nausea and annoyance are completely avoided.
In such complaints as occur at all periods of life, and which have been treated in the First Part of this work, we should be guided in the selection of the dose by the age of the patient ; with infants we may use the highest potencies, and rarely, even in acute diseases, give more than a single globule ; children from four to eight years of age, may take about one fourth to one third of the dose prescribed for an adult, and above that age, one half to two thirds. A great deal, however, depends upon the constitution of the patient, whether delicate or robust, and upon the child's susceptibility to medicinal influence, a point only to be determined by experience ; in very acute diseases we may sometimes be called upon to administer as low as the sixth potency, and even lower, particularly when employing such remedies as Sambums, Tartarus emetims, &c. ; from the great recep- tivity, however, of the system in early life, as above remarked, we should be particularly careful in repeating the medicines.
TREATMENT AFTER BIRTH.
As soon as the child is born, it should be wrapped in fine flannel, with a piece of soft linen rag inside, the flannel itself being too rough for its delicate skin ; the wrapper should be heated to a temperature of 98 degrees, as it is only gradually that the infant becomes inured to the temperature of the surrounding atmosphere. The skin should be gently washed with a little lukewarm water and bran, applied with a sponge, but care must be taken not to continue the first washing too long, for fear of irritation; soap must on no account be used ; the room should be kept rather dark, and perfectly quiet, and all strongly-scented substances removed. After washing, the body ought to be dried immediately, to avoid the risk of taking cold ; the child should be bathed twice a day, to keep up the action of the skin? the temperature of the water being gradually lowered, after weaning.
The best time for bathing the infant is in the morning, when it is taken out of bed, and again on returning to it for the night; im- mersing the whole body, with the exception of the head, is preferable to any other mode of washing, as the practice of placing it in a tub,
ASPHYXIA. 717
with part of the frame alternately laved with tepid water, and ex- posed to the action of the atmosphere, is apt to bring on a chill.
Nothing can be more evidently opposed to Nature and the dictates of common sense — although, like many other absurdities, it bears the impress of custom, — than the practice of swathing and bandaging the tender bodies of infants, and loading them with a superfluity of clothing, which, by its weight and length, presses upon their lower extremities, and is the frequent cause of deformity and weakness in after life ; in this opinion we are fully borne out by the corroborative testimony of the most eminent practitioners of the old school.
ASPHYXIA.
The first danger that the infant incurs on its entrance into life is Asphyxia.
Symptoms. Suspension of the functions of vitality, respiration, circulation, and motion.
Causes. Natural debility ; difficult parturition ; injury from the forceps ; pressure of the umbilical cord round the neck ; tying the navel-string too tightly ; accumulation of mucus in the throat ; too sudden an alteration of temperature, the respiratory action of the lungs not having commenced. The usual mechanical means, under the direction of a competent person, must, of course, be instantly had recourse to; I shall, therefore, content myself with simply pointing out the homoeopathic remedies most useful in such cases.
They are Tartarus emeticus, Opium,, Cinchona, and Aconitum.
Tartarus emeticus.
Dose. A grain in eight ounces of water, a few drops into the month of the child every quarter of an hour.
Opium : — If after half an hour no change for the better takes place, and the face is livid and bluish.
Dose. A few globules in a wine-glassful of water, a few drops into the mouth of the child every ten or fifteen minutes, until some effect is produced.
Cinchona: — If the face be pale during the affection; and also
718 TREATMENT OF INFANTS AND CHILDREN.
when the infant is reviving and respiration commencing — if the same indication present itself.
Dose. Same as Opium.
Aconitum : When the child is reviving and beginning to breathe, if the face has been previously flushed, or of a bluish tint.
Dose. One globule on the tongue, repeated if necessary, after a shorter or longer interval, according to the effects produced.
SWELLING OF THE HEAD.
Immediately after birth, the head of the infant appears more or less swollen ; this is in most cases but a trifling affection, and gene- rally goes off of itself. The administration of Arnica, one globule, will materially hasten its disappearance ; should, however, the swell- ing be at all excessive, bathe the part affected in a weak lotion, consisting of three drops of the tincture of Arnica to a wine-glassful of water.
Occasionally a considerable swelling in the larger mould (fontanel,) consisting of fluid is observable ; this affection is of greater import than the other, though seldom dangerous ; if it does not disappear in a day or two, we may administer Rhus toxicodendron, one glo- bule, to the infant ; or Calcarea carhonica, one globule, in six days, in cases where the fontanel is long in closing. In some instances Silicea or Sulphur is also requisite in addition, if not in preference to Calcarea.
NAVEL RUPTURE IN INFANTS.
In cases where there is an evident tendency to navel rupture, a properly made bandage* should be applied, and will usually prove
* The following is a simple, and commonly efficacious mode of applying a compress : take a piece of lint, just sufficiently large, when folded five or" six times, to cover the rupture
MECONIUM, EXPULSION OF. 719
sufficient to effect a cure; but if not, we must prescribe Nux vomica ; if, however, we discover no amelioration from the employ- ment of Nux vomica, we may have recourse to Veratrum. Obsti- nate cases are frequently found to yield to the application of the North Pole of the Magnet.* These medicines are equally useful in cases of inguinal hernia. In scrotal hernia, Magn. m., Nux v., and Lycopod. have, more especially, been recommended. (See Hernia, Part L)
This disease being frequently brought on by the violent fits of crying, to which delicate children are subject, the bandage may be worn, and retained for some time after the cure, as a precautionary measure against its return. In cases of soreness of the umbilicus or navel, remaining after the falling off of the ligature, or even before, we may give Sulphur, one globule, a single dose, and repeat in six days. If, however, during that time, no amelioration has been observ- able, we should exhibit Silicea, one globule, which, if marked benefit result, may be at the same interval repeated with advantage.
MECONIUM, EXPULSION OF.
After having been permitted to sleep for five or six hours undis- turbed, the infant should be applied to the breast as soon as the mother feels herself sufficiently recovered to permit it, which is gene- rally from six to eight hours after delivery, and this should never be deferred, as we elsewhere observed, longer than twelve hours ; the milk of the mother exciting a mechanical action of the alimentary canal, and assisting in the expulsion of the meconium. Here again we cannot too strongly reprobate the too general practice of adminis- tering laxative medicines for this purpose, possessing, as they do, a most deleterious effect upon the tender organism of the infant, and, if not productive of jaundice — a too frequent consequence of their
effectually ; then press in the protrusion, and keep it reduced with the hand, until the com- press is rightly adjusted and secured in its position by means of two strips of adhesive plaster (which have been previously warmed by being held at the fire, so as to make them adhere) placed over the compress in the form of a cross. It is still better, however, to get an efficient bandage made to measure by an intelligent and experienced maker.
* Chamomilla, Aurum, and Sulphur are occasionally found necessary, particularly the last- named, in order to effect a permanent cure.
720 TREATMENT OF INFANTS AND CHILDREN.
repeated administration— at least laying the foundation of bowel complaints, debility of the stomach, and a host of diseases in after- life.
Mothers need not be under apprehension, should a temporary delay occur in the passing of the meconium ; far greater evil results from the violent methods taken for its expulsion, than could possibly occur from its continuance in the alimentary canal for a few hours later than ordinary.
Should, however, an unusually long period elapse, and the child appear costive, which in many instances arises from the mother hav- ing indulged in the use of ptisans, such as chamomile tea, &c. or coffee, the administration of a few teaspoonfuls of warm sugar and water will generally answer every purpose ; if it should fail to pro- duce immediate relief, we may then make use of a lavement of equal parts of sweet oil (or pure honey) and water ; and if these simple means do not effect the desired object, and the infant appear to suffer from inconvenience, more particularly when the origin of the consti- pation seems to be from the mother or nurse, we may administer Nux vomica, Bryonia, Tinctura sulphuris, one globule, or Opium, one globule, to the female herself — for the indications of which medicines see Constipation.
SUCKLING OF THE INFANT.
While upon this subject we shall quote the expression of a well- known writer, in whose opinion, in this respect, we perfectly coincide.
" Unless very peculiar urgent reasons prohibit, a mother should support her infant upon the milk she herself secretes. It is the dictate of Nature, of common sense, and of reason. Were it other- wise, it is not probable that so abundant a supply of suitable food would be provided to meet the wants of an infant, when it enters upon a new course of existence.
" It is difficult to estimate the mischief resulting from infants being deprived of their natural nourishment ; for, however near the resemblance may be between food artificially prepared and breast milk, still reason and observation demonstrate the superiority of the latter to the former." [Conquests Outlines of Midwifery, p. 193.)
SUCKLING OF THE INFANT. 721
And again : —
"As a further inducement it should be remembered that medical men concur in their opinion, that very rarely does a constitution suffer from secreting milk ; whilst the health of many women is most materially improved by the performance of the duties of a nurse/" (Ibid. p. 194.)
Upon this subject the same author also remarks in another place :
(C But few mothers, comparatively, are to be found who, if willing^ would not be able to support their infants, at least for a few months ; and parental affection and occasional self-denial would be abundantly recompensed by blooming and vigorous children.
" Presuming that the laudable determination is formed to indulge the child with that nutriment which is designed for its support, it becomes necessary to state, that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and .the advantages of allowing it to suck soon after birth are many and important, both to the mother and child.
" By this commendable practice, the patient is generally preserved from fever, from inflamed and broken breasts, and from the distress- ing and alarming consequences resulting from those complaints.
66 If the breasts should not have secreted milk previous to delivery, the act of sucking will encourage and expedite the secretion. Thus the mother will be saved from much of the pain connected with distended breasts. Besides which, if the infant be not put to the nipple till the breasts become full and tense, the nipple itself will sometimes almost disappear on account of its being stretched ; and without much, and often ineffectual, labour on the part of the child it cannot be laid hold of, and even then the pain endured by the mother is exquisitely severe, and not unfrequently the cause of sore nipples." '(Ibid. p. 195.)
Having premised thus much upon the advantages resulting to both mother and child from following the law of Nature, which enjoins the female to nourish her own offspring, and having, moreover, elsewhere noted some of the causes which may prevent its being fully carried into effect, we shall now proceed to that important point— for those who do not intend nursing their own children — the choice of a nurse, and also the regimen to be observed, which is equally applicable to both parties.
46
72.3 TREATMENT OF INFANTS.
THE CHOICE OF A NURSE.
In the selection of a nurse, the medical attendant ought generally to be consulted ; and the following points merit particular attention :
She should be apparently of sound health, full and moderate plump- ness, with a fresh complexion, and clear eyelids, free from any ap- pearance of redness, scurfiness, or thichening. She should be thoroughly exempt from glandular enlargements ; possess deep-red lips without cracks, sound white teeth ; and well-formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions ; the child of the nurse is one of the best criterions to judge by — its being plump and healthy is a great point in her favour. We should also endeavour to discover if she is free from any hereditary taint ; she should, moreover, be of a mild, patient, and equable temper, not irritable or disposed to fits of passion, nor nervous ; of regular and temperate habits, neat in person, and fond of children. She ought also to be about the same age, and delivered about the same, time, or, at least, within three months of the same period as the mother; with respect to the age we must, of course, avoid extremes. A woman, having given birth to a child very late in life, should choose a nurse several years her junior, and fully qualified for her duties ; the reverse of the rule applies to extremely young mothers.
DIET DURING NURSING.
As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers, by the suppression of the menstrual discharge, and a moderate increase of appetite, which may be safely indulged ; but all food of a highly concentrated, nourishing nature, is injurious, causing the milk to become too rich, and unsuited to the delicate digestion of the
SUPPLEMENTARY DIET OF INFANTS. 723
infant ; the best guide is the regular homoeopathic regimen, which may be consulted with advantage.
We cannot too strongly repudiate the too prevalent, but deeply erroneous idea, that women, during the period of suckling, require stimulants to keep up their strength ; under this impression, both wine and malt liquors — and, among the latter, more particularly porter — are frequently resorted to. Porter is not only injurious from its stimulating properties, but the deleterious effect, which the different ingredients composing it produce upon the milk, forms one of the most prolific causes of the many evils that attack infancy. Our own opinions in this respect are corroborated by the physicians of the old school, though, we regret to say, not to the same extent. We shall conclude this part of the subject with a single quotation from a well- known medical writer :
" There is an evil too generally prevalent, and most pernicious in its consequences on individuals and society, and by no means con- fined to mothers in the lowest classes of the community, which cannot be too severely reprobated; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is tempo- rary, and is invariably followed by a greater degree of languor, wThich demands a more powerful stimulus, which at length weakens, and eventually destroys the tone of the stomach, deteriorates the milk and renders it altogether unfit to supply that nutriment, which is essential to the existence and welfare of the child."
SUPPLEMENTARY DIET OF INFANTS.
Unfortunately, some mothers do not possess sufficient milk for the proper nourishment of their offspring ; if this arise merely from a deficiency in the secretion, and the female is in other respects healthy, we must have recourse to supplementary diet, to make up for the diminished quantity of the natural nutriment. Goats5, asses', and cows5 milk are excellent substitutes, especially the latter, diluted with one third of water; goats' milk being apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought,
724 TREATMENT OE INEANTS.
when possible to be obtained, and, if given undiluted, to be boiled ; — cow's milk being generally considered too heavy, which boiling, in a great measure, obviates ; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse ; it should, more- over, be about the same temperature, say from ninety-six to ninety- eight degrees, a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exist in the mother, the sooner the child is transferred to another breast the better for both parties ; if a nurse be not procurable, the above will generally prove sufficient nourishment until the front teeth ap- pear, which is a clear indication that the digestive organs are pre- pared for more solid food; if, however, the milk diet appears to disagree with1 the infant, we may mix a little thin arrow-root, rusk, or well- toasted bread in water, to which the milk may be afterwards added ; such alterations in diet are, however, but rarely required.
We may here observe, that no portion of the milk ought to be retained for a subsequent meal, from the quickness with which it becomes sour ; the same remark applies to any of the above prepara- tions, in which milk forms the principal ingredient.
In the cow's milk, at first diluted as above described, we may, after two or three weeks, gradually diminish the quantity of water, as the digestive organs become stronger, but wre cannot too strin- gently press the point that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which Nature intended for it at its birth.
When it is necessary to give supplementary nourishment, a suck- ling-bottle ought to be used, as the best imitation of nature in giving the food slowly ; particular care being taken to observe the utmost cleanliness. The child ought, in feeding, to be kept in a reclining, not supine, position, as the latter frequently causes it to incur the risk of suffocation ; and when it evinces disinclination to its food, no more should be offered. When the front teeth appear, which is about the fifth or sixth month in healthy children, an alteration may take place in the diet ; and a well-made panado, diluted milk sweetened, and thickened with a small quantity of arrow-root, sago, semolino, or rusk, may be given twice a day. When milk, even when prepared with farinaceous substances, disagrees, we may substitute barley- water, fine well-boiled gruel, or weak chicken-broth, and beef- tea, adhering to that which seems best to agree with the infant, and taking
DURATION OF SUCKLING. WEANJNG. 725
care to vary according to circumstances, as too long an adherence to barley-water may occasion looseness in the bowels, while the animal diet is liable to lead, if too long continued, to a contrary result ; the best precaution in these cases, when the predisposition becomes evident, is an immediate change of aliment.
The child should be accustomed to take its nourishment from each breast alternately; as, if this precaution be not adopted, inflammation is likely to arise in the breast not used, and the child is apt to become crooked, from being always retained in the same position.
The physician is frequently asked how often the child ought to be applied to the breast ; the best rule on this point is, to give the breast when the infant appears to desire it, and to withdraw it when the child appears satisfied. As the infant increases in strength, it may easily be accustomed to regular hours, the breast being given late at night, and again early in the morning ; but during the first six weeks or two months, three times during the hours of rest, late in the evening, the middle of the night, and early in the morning, will generally be found sufficient.
DURATION OF SUCKLING. WEANING.
The period of suckling ought seldom to last longer than forty weeks ; but in this we must be guided, in a great measure, by the constitution of the infant ; weak, ill-conditioned children, in whom the teeth are long in making their appearance, it has been recom- mended to continue at the breast for eighteen months, or even a longer period. Weaning ought, in fact, to be regulated both by the constitution and mother of the child; in full development of the front teeth, which in healthy children is from nine to ten months, but in delicate or scrofulous constitutions is delayed for several months later, is the best indication for weaning. If, however, the strength of the mother appear unequal to the task, and the supply of milk begin to fall off, the child may be gradually weaned, even before the teeth appear ; but if the infant is healthy, a continuance of suckling beyond the tenth month is injurious to both parent and child. Weaning should not take place suddenly, but the infant should be gradually accustomed to other food, and a less frequent administration of the
726 TREATMENT OE INEANTS.
breast, till entirely weaned ; the time to commence this gradual course is upon the first appearance of the front teeth, so that the weaning may terminate with their full development ; thereby the secretion lessens by degrees, preventing all evil consequences of swollen or in- flamed breasts, and the child becomes quietly reconciled to the de- privation. Weaning ought not, however, to take place, if the child suffers considerably from the irritation of teeth, or any acute infantile disease. When, however, it is absolutely necessary to wean, Bella- donna, one globule, should be given, as a precautionary measure against the inconveniences and not unfrequent dangers which sudden wean- ing entails. Among these may be mentioned, restlessness, sleepless- ness, fretfulness, and excitability, nay, even a degree of irritability sometimes amounting to inflammation of the brain. The value of this remedy in affections of that organ has already been commented upon in several parts of this work. Although, perhaps, slightly out of place, it may be here remarked that Phosphorus is the remedy best calculated to prevent inflammation of the breasts consequent upon a sudden cessation of suckling.* See the articles relative to this subject in Part II, Treatment of Females and their peculiar Affections.
After the child has been weaned, his nourishment should generally consist of the same simple food as before mentioned, with an occa- sional light pudding, without spice or eggs, made from semolino, tapioca, or other farinaceous substance. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made, till after the appearance of the eye- teeth.
SLEEP. SLEEPLESSNESS.
The sleep of the child is the next consideration ; from the inability of the infant itself to maintain a proper degree of warmth, it should sleep by its mothers or nurse's side, for at least the first six weeks, particularly during winter or early spring. Care must be taken not to overburden it with bedclothes, and to place it in such a position as to prevent it slipping under them, and thereby becoming exposed
* A. H. Z., p. 8, No. 23.
SLEEP. 727
to the risk of breathing a vitiated atmosphere, or even of suffocation ; after six or eight weeks, when the organism becomes stronger, and able to preserve a proper degree of natural warmth, a separate bed or cradle will be more conducive to the health of the infant ; this change of arrangement will be found beneficial to both parties — to the child, from its breathing a purer air, and the continual appetite for the breast diminished ; and the mother, being freed from the necessary watch- fulness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutri- tious milk. Moreover, it is generally known, that sleeping in the same bed with an adult is detrimental to the health and proper deve- lopment, not only of infants, but even of children ; a child sleeping in the same bed with a very old person, will very soon begin to exhibit signs of a falling off in its general appearance.
With regard to the kind of bed best suited to the infant, the sus- pended cradle seems the most eligible ; we must, however, be careful not to allow the nurse to abuse its use by continual rocking, which frequently causes irritation of the brain: it should not be closed up with curtains, but the room may be a little darkened ; and in cases where there is danger of draughts, a screen will answer every purpose.
As to the length of sleep allowed to the infant, the chief business of the first months of its existence being sleep and nourishment, we may safely leave the point to Nature, and not attempt to coerce the inclinations of the child ; if the infant is lively on waking, we may conclude it has not slept too much ; and as it increases in vigour, and is able to endure longer intervals of wakefulness, we may proceed (recollecting that night is the proper period for sleep), so to regulate its habits of taking its food and rest, as to accustom it to a uniform system, and particular hours. Children, up to two years of age, require rest during the day, and the nurse ought to endeavour to get them into the habit of taking it in the forenoon, for if it be taken in the afternoon, it generally interferes with the night's sleep. Whether by night or day, we must carefully exclude both light and noise from the nursery, for although they may be insufficient to arouse the infant, still they cause its sleep to be disturbed and unre- freshing, and, by acting upon the nervous sensibility, predispose the child to convulsions or spasmodic attacks from slight accidental causes.
It is true, that during the first month, the child sleeps immediately
728 TREATMENT OE INEANTS.
on leaving the breast, and no evil consequences ensue ; but it must be borne in mind, that it takes but little at a time, and the tenuity of the milk is at that time wisely adapted to its delicate digestion, but as the secretion becomes richer, and suited to the increasing power of those organs, it is injurious to put the child asleep immediately after a full meal ; his rest is then unquiet and disturbed, from the process of digestion being interfered with, more particularly when nurses foolishly endeavour to force nature, by resorting to the baneful practice of rocking.
Nothing causes greater annoyance, and even anxiety to the mother than a disposition to wakefulness on the part of the infant. A healthy child should always be prepared for its rest at the usual hours ; if, instead of going to sleep, it appear restless, fretful, and disinclined for its accustomed rest, it is an evident indication of some derangement of the child's general health ; frequently, through igno- rance, nurses, instead of attending to this warning voice of Nature, — which by the sleeplessness of the infant demands appropriate relief, — endeavour to stifle it, and sometimes to free themselves from a little temporary annoyance, administer opiates, which induce an unrefresh-* ing slumber, and not unfrequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital power. This baneful practice has not only been the ruin of many constitutions in after-life, but to it, conjoined with improper diet, stimulating or unwholesome drinks, carminatives, and other quack medicines, together with the highly erroneous practice — sanctioned though it be by names of medical repute — of a frequent administra- tion of that active mineral preparation, calomel, in infant maladies, to say nothing of laxatives, an infinite number of diseases and deaths are annually attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to detect any breach of her injunctions, which should be visited with the immediate discharge of the person so offending ; for she must be truly unfitted for such an important trust, who, after being wrarned of its injurious tendency, will persevere in a practice placing in jeopardy the .life of her infant charge.
Amongst the homoeopathic remedies which have been found the most generally useful in removing restlessness and sleeplessness in chil- dren, Cqffea, Opium, Chamomilla, and Belladonna, deserve notice. Coffea is very efficacious when the child seems unusually lively,
EXERCISE. 729
restless, and wakeful; but will commonly fail to answer its purpose when the nurse is in the daily habit of taking coffee as a beverage. In such circumstances^ Opium may be substituted, particularly if the face of the child is flushed. Chamomilla will generally answer our purpose when the child is tormented with flatulence, and dis- tension of the bowels, and appears to suffer from colic, indicated by drawing up the legs, screaming, &c. Against sleeplessness after weaning, Belladonna is the most efficacious remedy. When these remedies do not seem indicated, or fail to relieve, an experienced homceopathist ought to be consulted. (See also Crying and, Wakefulness.)
EXERCISE.
For the first six or seven months the great business of Nature seems to be the proper development of the infant organism, and par- ticularly of the respiratory and digestive functions. During this period, the cartilage is gradually forming into bone, and the infantas delicate muscles are acquiring power and strength. We find also that con- sciousness is yet indistinct, and the infant evinces no anxiety to in- dulge in voluntary motion, the muscles of the neck and back not possessing sufficient power to support the head, or to keep the body in an erect position; for this reason, children during this period should, when carried in the arms, be kept in a reclining position, so as to avoid an undue pressure upon the vertebral column ; a neglect of this precaution, and a premature carrying of the infant in an up- right position, are a too frequent cause of deformities of the spine, and derangement of the internal functions in after life.
As its powers gradually develop, the infant seems inclined to exer- cise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength by keeping it sitting up during the greater part of the time it is awake. A careful atten- tion to Nature in this, as in all other cases, is the best guide.
The practice of dandling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of pa- rental affection, than from any benefit the child can, by any possibility, be expected to derive from it ; in fact, it is highly injurious, even at
730 TREATMENT OF INFANTS.
a rather more advanced period, as exciting a premature involuntary exercise of the muscles, and consequent deformity. The act of respi- ration bringing into play a great variety of muscles, occasional crying seems sufficiently active exercise during this period.
In mild spring and summer weather the child may, after the first fortnight has elapsed, be carried out into the air for a quarter of an hour at a time, and the period of exercise gradually increased ; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, advantage may be taken of a fine day, after it is a month or five weeks old, as the frame is gra- dually acquiring the power of generating heat ; but, at the same time, great care must be taken to prevent its catching cold ; and should the child exhibit the slightest sign of being affected by the atmosphere, the practice of carrying it out of doors should be imme- diately discontinued, and it should be carried up and down in a well ventilated room, the nurse moving it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by accustoming them to endure cold ; this can occur only through ignorance, for Nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-protracted chill. We may recommend an occasional gentle friction of the hand over the body and limbs, which materially assists in the promotion of the circulation of the blood, and will, in unfa- vorable weather, serve in some measure as a substitute for exercising the infant out of doors.
In carrying the child, it should be from time to time transferred to different arms, as a continuance on one side is a frequent cause of deformity, and in some cases of squinting.
The child, as the organization develops itself, seems to evince a desire for independent movements, in which the nurse may very properly indulge it, by removing every impediment in its dress, and allowing it to roll about, or crawl upon a soft carpet. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing curvature of the limbs, the bones not being yet sufficiently formed to bear the burden imposed upon them. By allowing Nature to act, the infant's powers will become more gradually, but at the same time, more fully developed, its carriage will be more firm and erect, and its limbs straight and well-formed ; moreover, it will walk with greater confidence and independence by the expiration of the first year, than
EXERCISE. 731
those who have been taught to walk by the assistance of the nurse, leading-strings, or mechanical inventions. When the period at which a child should make attempts to walk is retarded by evident debility of constitution, this evil is to be overcome by many of such remedies as Calcarea, Silicea, Sulphur, Belladonna, Mercurius, or Staphy- sagria, &c.
DISEASES OP INFANCY,
INFLAMMATION OP THE EYES IN NEW-BORN INFANTS.
A sudden exposure to the strong light of day, or the glare of a fire, is the general cause of this affection ; and no doubt many chil- dren who are what is vulgarly denominated born blind, owe their misfortune to the neglect of those precautions which we have so strongly enforced under the head of Treatment of Infants, in many cases the external indications of this affection being so very slight as to escape observation.
As soon, however, as, on a careful examination, we become aware of the existence of this evil, we should administer Aconite, which will generally be found promptly efficacious in its removal.
When, from the constitution of one or both of the parents, we have reason to suppose that the exposure to light has been merely the exciting cause, but that the real origin of the evil is more deeply seated, or if the Aconite, seems to produce no effect, and the disease continues to increase, we may have recourse to Tinctura sulphu- ris, and in some cases Calqarea, alternating these remedies every eight or ten days, if we find it necessary to resort to the Calcarea.—*- Tincttira sulp/mris having been found in many cases to act as a specific.
Chamomilla is useful some weeks after birth, when the percep- tive faculties are more developed, and the child exhibits great into- lerance of light ; also when redness, swelling, and agglutinations of the eyelids, with other indications, given under Acute Inflamma- tion of the Eye, (Part I, which see,) are present. Lycopodium
COLD IN THE HEAD. 733
clavatum, and Rhus toxicodendron may also be named as useful remedies in this inflammation, the former especially in invete- rate cases.
The eyes may be gently but repeatedly bathed with tepid water.
COLD IN THE HEAD.
This affection frequently becomes exceedingly distressing to the infant, when it appears in the form of an obstruction of the nose, impeding the action of sucking, by not allowing the breath to pass through the nostril, obliging the infant to release the nipple fre- quently in order to breathe, and causing it to become fretful and irritable ; sometimes also leading to irritation and excoriation of the nipple, and thus, in its repeated efforts to suck, the child causes suffering both to itself and the nurse.
Whilst this state continues, it operates considerably against the infant's thriving, both by hindering it from taking a sufficient quan- tity of nutriment, and, by the impediment it causes to respiration, preventing the child sleeping at night. When the nose is dry, and the secretion of mucus suspended, we may, whilst administering a remedy calculated permanently to relieve the evil, afford relief, by imitating the natural secretion by the application of & little almond oil or cream to the interior of the nostrils with a feather.
This malady is often excessively obstinate, and presents itself under many different phases, which of course demand remedies suited to the entire group of the symptoms. Among these, Nux vomica is most frequently successful, particularly when the following symptoms are present : —
Obstruction of the nose, with dryness or nocturnal obstruction, slight discharge during the day ; irritability and peevishness.
Sambucus niger is frequently efficacious when Nux v. fails to relieve ; but is also of service in cases when there is an accumulation of thick and viscid .mucus in the nostril; when, in addition to the cold in the head, there is a suffocating cough, with wheezing in the chest, and quick laborious breathing, Tartarus should be had recourse to if Sambucus does not soon relieve the latter symptoms.
Chamomilla is very useful when there is cold in the head, with a
734 DISEASES OF INFANCY.
watery discharge from the nose, more particularly when there are febrile symptoms, soreness of the nostrils, and redness of one cheek.
Carbo v. is chiefly useful in obstinate cases, and particularly when the cold in the head becomes aggravated towards evening. Calcarea, when the nose is stuffed with mucus, and the affection occurs in stout, lymphatic children. Pulsatilla, thick green or yellow, or purulent-looking discharge from the nose, attended with frequent sneezing.
Dose. A globule of the remedy selected, may be dissolved in half a wineglassful of water and one teaspoonful given at bedtime and another in the morning. Sulphur may follow Pulsatilla, after an interval of a few days, if the latter fails to act beneficially. Mercurius, Aurum, or Lycopodium may be required after Sulphur, if the discharge continues to present a purulent appearance. (See also Cgryza, Part I.)
CRYING AND WAKEFULNESS OF NEW-BORN CHILDREN.
As we have already remarked, the occasional crying of new-born children is a wise provision to bring the respiratory organs into play, and to expand t\\e chest. When, however, the crying becomes excessive, and threatens to prove injurious, we must, in the first place, endeavour to discover its origin, which frequently will be found to be some mechanical cause, such as derangement in the infant's dress, or a pin sticking into its flesh, &c.
Therapeutics. When, however, no exciting cause or guiding symptoms of disease present themselves and the infant is peevish and irritable, affected with incessant whimpering and wakefulness, or prolonged fits of crying, Belladonna will 'frequently be found sufficient to remove the evil.
When a fit of crying arises from the child having been irritated or excited by any cause, such as suddenly rousing it from its rest, and when it seems willing to sleep, but finds a difficulty in composing itself to slumber, Coffea cruda, will prove efficacious. (Aconitum may follow Coffea, when there are considerable heat of skin, and extreme restlessness.)
CRYING. 735
Chamomilla is often more efficacious than Belladonna when the infant is of a very spare and delicate habit ; or when we can trace the fits of screaming and wakefulness to a derangement of the diges- tive functions, and the child appears to suffer from griping pains indicated by contortions of the body, drawing up of the little limbs upon the abdomen ; and when a whitish, yellowish, or greenish, or watery excoriating diarrhoea is present.
Jalapa, in similar cases, but without diarrhoea, or with motions tinged with blood.
In other cases, when the screaming and vigilance are attended with colic and flatulence, Senna will answer best.
Rheum is more appropriate when, in addition to screaming and wakefulness, combined with griping, there are ineffectual efforts to relieve the bowels by frequent straining, or when, at the utmost, only scanty, sour-smelling motions are passed, of grayish appearance, and which seem to afford no relief.
When flatulent colic, accompanied by sudden fits of crying, draw- ing up of the legs or of the scrotum, and a costive state of the bowels, appears to be the source of the disturbance, Nux v. will com- monly succeed in restoring ease to the little sufferer.
Pulsatilla is very efficacious when the derangement arises from overloading the stomach, or improper food, and the crying or wake- fulness is accompanied with flatulence and diarrhoea, or with con- stipation.
Remarks. The milk of a nurse who has suckled for some months previously is much too heavy for a new-born infant ; here the only alternative is a change of nutriment. When, however, the above- named or any other infantile derangement arises from congenital weakness of the stomach, the most useful remedies, in addition to Nux v. and Puis., are Sulphur, Calcarea carhonica, and Baryta c.
736 DISEASES IN INFANCY.
REGURGITATION OF MILK. ACIDITY, FLATULENCE, ETC.
Children, in sucking, sometimes overload their stomachs, and regurgitate a portion of the milk ; so far, mothers have no cause for uneasiness, nor is medical assistance requisite ; but when this changes into vomiting, and the whole of the nutriment is returned from the stomach, or w7hen sickness and regurgitation of food occur in chil- dren who have been weaned, at times followed by mucus and watery fluid and even bile, it must be looked upon as a disease, and treated accordingly.
Therapeutics. Ipecacuanha will generally afford relief, and may be repeated, if not soon followed by some amendment. In the case of spoon-fed infants, or in children at a more advanced age, this remedy is equally efficacious, when the derangement is evidently owing to their having been over-fed, (a most culpable error, which most nurses are prone to fall into by cramming the stomach of their little charges, and but too often with food of an indigestible nature, whenever they are seized with a fit of crying.) Should the vomiting or flatulence, and also the diarrhoea when present, not decrease after some doses of Ipecacuanha, Pulsatilla may be given, and succeeded in turn by Antimonium crudum, if the symptoms continue, though in a mitigated form.
■Nux vomica, and that failing, Bryonia may be prescribed when the disease is attended with flatulence, constipation, uneasiness, or irritability of temper.
Gentle friction with the extended hand, which has previously been warmed, is a simple and frequently efficacious mode of affording tem- porary relief in cases of flatulent distension of the stomach and bowels. But permanent relief is only to be attained from Pulsatilla, Nux v., Chamomilla ; or Carlo v. and Sulphur, when the former are insufficient. The diet must at the same time be attended to, and altered if of an indigestible nature and the undoubted cause of the mischief. When there are diarrhoea and excessive flatulency, China is very useful.
Chamomilla : — When the disease is attended with convulsions, or
SPASMODIC ASTHMA. 737
diarrhoea, as described elsewhere under this medicine (see those Articles).
A single dose of Sulphur, followed by Calcarea carhonica, in from five to ten days, and then again one or more of the preceding reme- dies, according to indications, will often be the means of effecting a cure in inveterate cases,
SPASMODIC ASTHMA. SPASMS IN THE CHEST.
Children are sometimes seized during the night with sudden attacks of suffocating spasm in the chest. The little patient suddenly awakes from sleep, and utters a shrill cry, in consequence of the feeling of suffocation which is experienced. The countenance soon assumes a livid hue, and is expressive of extreme anxiety. A dull, hollow-sounding, dry cough usually accompanies the attack, and the breathing is rapid, very laborious, and painfully distressing to wit- ness. In such cases a globule or two of Ipecacttanha ought imme- diately to be dissolved in about a wine-glassful of w'ater, and a few drops of the liquid put into the mouth of the patient. If relief follows, the medicine must be allowred to act, and only repeated when the symptoms threaten to become worse again. But in the event of no favorable signs resulting in from an hour to half an hour or so, according to the severity of the symptoms, Samhucus may be given in the same manner.
In other cases Arsenicum will be found more efficacious than either of these remedies ; or Ipecacuanha and Arsenicum may be administered alternately until improvement takes place. Whenever a sudden aggravation ensues after the administration of any of these remedies, nothing further should be done, as on waiting patiently for a short time, if the change arise from the effects of the medicine, the symp- toms will subside, and gradually give way to unequivocal signs of improvement. (See Asthma of Millar.)
Some children are liable to be seized with obstructed respiration or asthma, although otherwise in good health, whenever they are exposed to sudden changes of temperature, or to a cold and high w7ind. This form of asthma is always attended with considerable, hard distension
47
738 DISEASES OF INFANCY.
of the pit of the stomach and region of the lower ribs ; the child affected is at the same time thrown into a state of great anxiety and uncontrollable restlessness, attended with crying or screaming, tossing about, &c. Against this indisposition Chamomilla has repeatedly proved to be an effectual remedy. A dose ought therefore to be given as soon as possible after the attack declares itself*
MILK-CRUST. MILK-SCAB. MILK-BLOTCHES.
Crusta lactea. Porrigo larvalis. Eczema faciei. Tinea faciei.
This affection, as it occurs in infants at the breast, usually consists of an eruption of numerous small, whitish vesicles, which appear in clusters upon a red ground. These generally show themselves, in the first instance, on the face, particularly the cheeks and forehead, but sometimes spread over the whole body. The lymph contained in them soon becomes yellow, dark, or even sanguineous, and on their bursting forms into thin, yellowish crusts.
Frequently there is considerable surrounding redness and swelling, with distressing itching, which renders the little patient excessively restless and fretful, and causes it to keep continually rubbing the affected parts, by which the discharge and crusts are repeatedly renewed, and increased in thickness, often to such extent that the whole face becomes covered ; the eyes and nose alone remaining free. The eyes and eyelids, as also the parotid and mesenteric glands, occasionally become inflamed, and sometimes marasmus supervenes.
Therapeutics. The following medicines have been found ser- viceable in this affection : Aconitum, Rhus toxicodendron, Viola tricolor, Rhus, Sulphur, Sarsaparilla, Mezereum, Belladonna, Hepar mVphuris, Euphrasia, Staphysagria, &c.
Aconite should commence our treatment, when we find excessive restlessness and excitability produced by this affection, and when the skin around the parts is red, inflamed, and itching.
As soon as beneficial effects have resulted from the employment of the above remedy, we may follow it up with Viola tricolor, wThich is often sufficient to effect a cure in the simple uncomplicated form of the disease.
Rhus toxicodendron may sometimes succeed or supersede Viola
THRUSH, OR APHTHA. 789
tricolor, when the scalp is considerably affected and thickly studded with incrustations. When Rhus is insufficient to complete the cure^ Calcarea or Lycopod/tum are generally to be selected in preference to other remedies ; the former more particularly when there is little or no discharge, the latter when there is considerable oozing (suppura- tion), and the temperament of the patient lymphatic.
If, after the employment of Rhus, the affection is found to have made but little favorable progress, Sulphur may be given and repeated, in four days.
The alternate use of Rhus and Sulphur every four or five days, has been found very efficacious in cases of the aforesaid description, and when the eyes are a good deal affected.
Sarsaparilla and Mezereum have also been strongly recommended in Crusta lactea. The former in the earlier stage of the malady, when small, burning, itching pustules appear on the face. Mezereum, when from the bursting and discharge of the contents of the pustules^ incrustations have formed, from which an acrid exudation flows, and gives rise to a fresh eruption of vesicles wherever it comes in con- tact with the skin. Graphites, as also Sepia, Bella., Hepar, Baryta c, Bulc.) dc, Iod., Merc., Natr. m., Acid.fluor., have been recommended as likely to prove of service in complicated cases. (See also Scald Head.)
THRUSH, OR APHTHA.
This disease commences by the formation of small, isolated, round, white vesicles, which, if not checked, become confluent, and some- times present an ulcerated appearance, or form a thin white crust, which lines generally the whole of the cavity of the mouth, and in severe cases extending to the throat, and even throughout the alimentary canal. Although the affection is of itself neither malignant nor dangerous, it frequently causes not only considerable suffering to the child by preventing it from sucking, but great pain and in- convenience to the mother, by being communicated to the nipples, and causing excoriation, &c.
The complaint is most commonly produced by the want of proper attention to appropriate ventilation and temperature, and to cleanli-
740 DISEASES OF INFANCY.
ness, as regards the constant personal laving of the infant, but more especially from the suckling-glass, when employed, not having been carefully washed after use. Improper aliment is another of the principal causes ; thus we find that children who are what is com- monly called reared by the hand, either partially or wholly, are more liable to this affection than those whose sole nourishment has been from the breast.
One of the remedies in this affection, although perfectly homoeo- pathic in its action, has long been in use, in its external application, by practitioners of the old school, namely, Borax ; and a weak solution applied to the mouth with a brush has not unfrequently been found efficacious. Mercurius is, however, still more frequently useful than Borax, and especially when there is much salivation, or the thrush indicates a disposition to ulceration, we may administer Mercurius solubilis, one globule twice in forty-eight hours, followed in a few days, if the symptoms do not improve, by Sulphur, and then Acid* sulphuricum, one globule after a similar interval, if necessary. Natr. m. and Sulph. are sometimes required after Merc, Borax, or Sulph., in protracted cases. In very bad cases, when the aphthae assume a livid, blue, or violet appearance, attended with excessive weakness and diarrhoea, Arsenicum, one globule, is highly useful, Acidum nitr. may follow Arsen. if the mouth and fauces become covered wTith aphthous ulcerations. Nux v. and Pulsatilla are useful in some cases where there is much acidity and excessive regurgitation or vomiting of milk. (See Regurgitation of Milk, Acidity, Flatulence, &c.)
Great cleanliness ought to be observed in all cases.
When the disease, notwithstanding every precaution, frequently reappears in infants at the breast, we may safely infer that it arises from some virus in the constitution of the mother, or nurse, who ought to be changed, or immediately put through a proper course of treatment, under the direction of an experienced homoeopathic practitioner.
BOWEL COMPLAINTS. 741
CONSTIPATION.
Obstructio Alvi Neonatorum,
This derangement generally appears in children who are either wholly or partially reared by the hand, and also in those whose mothers or nurses are similarly disposed ; if it arises from a peculiar diet or want of exercise, such as too much animal food, &c, on the part of the last mentioned, it may be removed by a proper attention to these points ; but in many instances it is necessary for them also to have recourse to proper remedial agents at the same time with the infant.
Therapeutics. Nux vomica, Bryonia alba, and Opium are the principal remedies, and in more obstinate cases, Sulphur, Veratrum album, Lycopodium, and Alumina.
Most of the medicaments have been already mentioned under Constipation, (Part I,) which see.
Dose. One globule of the three first-mentioned remedies, every three to four days, until relief is obtained, or another remedy called for ; and of the last, the dose at intervals of a week.
An enema of tepid water may occasionally be resorted to, if re- quired, or a suppository consisting of a small slip of paper, or linen, spirally twisted, and lubricated with oil, may be introduced by a gentle rotatory movement, until the medicine has remedied the irre- gularity. Rubbing the stomach and bowels, frequently in the course of the day, with a warm hand, sometimes assists the other means employed.
BOWEL COMPLAINTS OF INFANTS. Diarrhoea Neonatorum.
Diarrhoea, like constipation, is to be regarded merely as a symptom, not as a disease ; the real disease here consists in irritation or inflam-
742 DISEASES OE INFANCY,
mation of the mucous membrane of the intestines, arising from the effects of aperients, indigestible food, cold, fright, &c.
It has already been mentioned (article Meconium) that much mischief is too often occasioned by the deleterious practice of admi- nistering laxative medicines, and even drastic purgatives, to the tender new-born infant, for the purpose of hurriedly expelling the blackish green-looking matter, technically known by the name of Meconium, that collects in the large intestine of the foetus during the last month or two of its uterine existence. This unwarrantable and extremely reprehensible conduct is frequently persevered in, even for some time after the expulsion of the first discharge has taken place, and is in many cases the too evident cause of bowel complaints and other suffer- ings in infants.
The introduction of inappropriate, indigestible food, such as thick gruel, &c, into the delicate stomach of a new-born infant is another very frequent source of intestinal derangement ; this unpardonable error is not unfrequently committed by ignorant nurses, in order, as they say, to keep it from starving during the few hours of necessary repose to which the mother is left after delivery.
This disturbance is moreover likely to be excited in those cases in which, either from a deficiency in the secretion of milk or other causes, it becomes requisite to administer supplementary diet to make up for the diminished supply, and again at the period of weaning, when serious disturbances are occasionally produced in the stomach and bowels, from want of proper attention and caution in the selection and administration of the food. (See art. Supplementary Diet of Infants.)
Fright and exposure to cold are, as already noted, two other most frequent exciting causes of the disorder.
Therapeutics. A healthy child at the breast passes, on an average,, from three to six motions in the twenty-four hours, but in some instances the evacuations are more frequent, while in others they are much less so, yet without in any degree affecting the health of the child ; in such cases then, little or no interference ought to be made, so long as the stools remain free from fcetor, possessing merely the slightly acid smell peculiar to the infantile state, and are evidently unattended with pain, or any other abnormal indication. When, however, the stools become green and watery, or yellow and watery, brown and frothy, or white and frothy, as if fermented, mixed with
BOWEL COMPLAINTS. 743
mucus or consisting entirely of mucus, and emit an offensive odour, and are generally preceded or accompanied by signs of suffering, it becomes imperative to have recourse to remedial aid.
The following are the principal remedies employed in homoeopathic practice against this derangement : Aconitum, Belladonna, Chamomilla, Rheum, Pulsatilla, Ipecacuanha, and also Mercurius, Nux vomica, Arseni- cum album, Sulphur, Sepi$$ Opium, and Veratrum album.
When there is inflammation, the constitutional symptoms are pretty clearly indicated by heat of the surface of the body, quickness of pulse, and rigors ; in this case, we must have immediate recourse to Aconi- tum, one globule, and follow it, if necessary, with
Belladonna,— when the more acute symptoms have been re- moved, but the infant continues to suffer much and scream constantly. Lachesis may be preferred to Belladonna, when constipation suddenly supervenes, attended with swelling and apparent tenderness to the touch over the entire abdomen, but especially at one particular spot. Mercurius may follow Lachesis, if the symptoms do not yield to the latter remedy.
Chamomilla is one of the most invaluable remedies in the treat- ment of the diseases of children, and particularly in bowel-complaints, whether arising from acidity, irritation caused by indigestible food, excited by a chill, or occurring during teething ; when the following symptoms are apparent : redness of the face, or of one cheek, hard- ness and tension, and fulness of the abdomen, attended by severe colic, which is indicated by a state of peevishness, restlessness, constant crying, and drawing up of the legs towards the abdomen, sickness, fre- quent evacuations, of a bilious, watery, slimy, or frothy description, of a whitish, yellowish, or greenish colour, sometimes bearing a resem- blance to beat-up eggs, and of an offensive odour, similar to that of rotten eggs. Chamomilla may be preferred to Belladonna after Aconite in cases of inflammation, when any of the above symptoms present themselves. (See also Infantile Remittent Fever.)
Rheum is another remedy of great utility in the treatment of this affection, provided the disorder has not been actually excited by fre- quent use of this medicine itself in allopathic doses, in which case it will be necessary to have recourse to Pulsatilla, Chamomilla, or Mer- curius, as antidotes, according to the nature of the symptoms. Bheum is particularly appropriate when acidity or bilious derangement has been generated by indigestion, or has arisen from the prolonged use
744 DISEASES OF INFANCY.
of antacids, such as magnesia, &c, and when there are flatulent dis- tension of the abdomen, colic, crying, restlessness, tenesmus before and after the evacuations, which are either of the consistence of pap, or watery and somewhat slimy, occasionally of a grayish, or of a brown colour, and when a sour smell is emitted from the body of the infant. It is sometimes necessary to give Chamomilla after Rheum, to com- plete the cure ; in other cases, and particularly those of an obstinate character, Magnesia c. is more efficacious,
Pulsatilla : — Diarrhcea arising from "indigestion" or from a chill, with watery, slimy, whitish, or bilious, greenish-looking evacuations, oc- curring chiefly at night; want of appetite, fretfulness. Pulsatilla, as before stated, is also very serviceable in obstinate cases, where the affection has been brought on by the abuse of Rhubarb, or by Rhubarb and Magnesia, when the symptoms are as above described ; it is further often efficacious under similar conditions, when fright has been the exciting cause, and Opium has not sufficed, or has been administered too late to procure relief. (See Veratrum.)
Ipecacuanha is particularly valuable when the diarrhcea is ex- cited at the period of. weaning (weaning-brash), from the sudden change of food, which the stomach is unable to digest; and when the follow- ing symptoms result in consequence: bilious derangement, with repeated attacks of vomiting, paleness of the face, frequent crying, diarrhoea with stools of a bilious, slimy, or greenish yellow, sometimes blackish, or streaked with blood, and of a putrid odour ; on other occasions, evacuations resembling matter in a state of fermentation, or containing substances like white flocks or flakes, followed by strain- ing. When this remedy is insufficient to effect a complete cure, we should have recourse to Ptclsatilla, or to Antimonium crudum, should the vomiting not speedily subside.
Mercurius: — This medicine will be found very serviceable in some cases where the irritation owes its origin to the abuse of aperients, such as Rheum, &c. ; or wrhen it has arisen from a chill. The following are the principal indications : watery, slimy, or bilious stools (sometimes streaked, or mixed with blood), of a blackish, green- ish, or whitish-yellow colour : frothy, or having the appearance of beat-up eggs ; attended with symptoms of severe colic, and fre- quently also severe tenesmus and protrusion of the intestine ; diarrhcea, with redness of the whole body, as from general excoriation.
Dulcamara .:— This is an admirable remedy in derangements of every description arising from exposure to a cold, damp atmosphere ;
BOWEL COMPLAINTS. 745
and is Indicated in cases of diarrhoea from this cause with the follow- ing symptoms : watery, bilious, or slimy evacuations, of a greenish yellow colour, and occurring chiefly at night. {Merc, or Cham, may be required to complete the cure in some instances.)
Nux vomica is very useful in cases arising from a chill, or from indigestible food at the period of weaning, or earlier; it is also use- ful in some cases, in which the disorder has been created by the frequent employment of laxative medicines.
Its indications are : very frequent but scanty evacuations of watery, slimy, whitish or greenish stools, attended with colic and tenesmus, sometimes followed by protrusion of the intestine ; extreme fretful- ness. This medicine is also of great service in many cases when the diarrhoea alternates with constipation.
Bryonia is a useful remedy in cases of diarrhoea, which recur whenever the weather becomes very wrarm. {Carlo v. has been found efficacious, when only temporary benefit had resulted from Bryonia, in diarrhoea during the heat of summer.)
Arsenicum : — This medicine becomes indispensable in neglected cases, or in those at an advanced stage of the disorder, when there is reason to fear that it will terminate in marasmus.
The following are its characteristic indications : watery or slimy stools, mostly profuse, of a greenish, whitish, dark, or brownish colour, or of a putrid or gangrenous odour, taking place chiefly during the night, or after drinking or partaking of any kind of food, often preceded by crying and restlessness, and followed by exhaus- tion or tendency to faint in children of a more advanced age; great thirst, sleeplessness, paleness of the face, sunken cheeks, and blue circles round the eyes, enlargement of the abdomen, with extreme weak- ness and excessive emaciation. In diarrhoea attended with vomiting, Arsenicum is one of the most valuable remedies.
Sulphur is an invaluable remedy in protracted cases, or in those occurring in children who are the offspring of delicate parents, — when there are great weakness, emaciation, distension of the abdomen, redness or soreness of the anus, and excoriations between the thighs and adjacent parts, or a sort of miliary eruption over the whole body. (CalcareaAs sometimes required to complete the cure after Sulphur.) In other cases, Sepia, Hepar s., Acid, sulph., Magnesia, Graphites, or Feratrum may be required. (See Diarrhoea, Part I.)
Opium, as has been stated in another part of the work,* is a most
* Vide Mental Emotions.
746 DISEASES OF INEANCY.
valuable remedy, when immediately employed, for averting the bad results which sometimes arise in consequence of a sudden fright. When convulsions, with derangement in the stomach and bowels are excited in children by such a cause, we ought to administer Opium, followed by Veratrum, should Opium prove insufficient, and the vomit- ing and diarrhoea become excessive ; or we may select a remedy from amongst those above mentioned, in preference, such as Pulsatilla, &c, if the symptoms correspond.
Against Diarrhcea unattended with pain (painless diarrhoea) the most useful remedies are : Ferrum, Ars., Lye, Hyos,, Phosph., Phosph. ac, Stram.- — China, Sulph., Baryta m., Clem., Cina, Nitr., Mgs., Cham., Bella., Chel., Puis., Ban. lull., Bhod., Rhus, Merc., Ign., Graph., Con., Calc, Acid nitr., Op., &c. Diarrhoea, stercoral : Cm., Rep., Gran., Led., Ac. mur., Plmmb.,
Mosch., Prun., Spig., &c. Diarrhoea arising from acids (acid food, fruit, lemon-juice, &c.) :
Lachesis* — Arsenicum, Pulsatilla. Diarrhoea after exposure to cold : Merc, Cham., Bulc, Bry., Bella.,
Nux moschata. — Puis., Nux v*, Sulph., Veratr., &c. Diarrhcea which manifests itself on exposure to the cool, fresh air
of the evening : Mercurius. Diarrhcea which manifests itself in damp weather : Lachesis
Rhododendron. Diarrhcea which manifests itself day and night : Sulphur.
— — - after drinking : Ars., Cina.
— -—in the evening : Lachesis, Kali c
— — - after eating (after a meal) Ars., Col., Bry., China, Lach., Am. m.. Rheum, Bor., Per. mg., Veratr.
Diarrhcea which occurs after eating and drinking: Bry., Ars., Bhus.
— — - eating fruit : Lach, China, Bhod., Cist. Ars., Puis,
Diarrhcea which occurs after drinking milk: Bry., Lye, Sepia,
Sulph., Natrum. Diarrhcea which takes place in the morning : Bry., Caps., &c,
— — at night : Ars., Puis., Merc, China, Cham., Mosehus, Sulph., &c.
Diarrhcea which takes place (during sleep) : Puis., Am., Rhus,
Mosch., &c. Diarrhcea which occurs during warm weather : Bry., Lach.
BOWEL COMPLAINTS. 747
Concomitant Symptoms.
Diarrhcea attended with distension of the abdomen (flatulent) :
Veratr., Colch., Sulph., Graph., &e. Diarrhcea attended with distension of the anus, pain (burning) in
the : Merc, Puis. — Lack., Veratr., &c. Diarrhoea attended with excoriation of the anus : Cham., Merc,
Sulph., Ferr., Sass. Diarrhcea attended with loss of appetite : Niece mosch, — Antim. c,
Puis., &c. Diarrhcea, attended with pains in the back : Ferrum.
— — cephalalgia: Rhus to®.
— — coldness : Spig., &c.
— _ Colic : Ars., Merc, Fids., Cham,, Nm v., Veratr., Ipec, Bry., Bheum, Jalap, Bhus, Bat., Sulph., CantL,Baryt. c9 Ant., Agar., Fetr., &c.
Diarrhcea, attended with crying or screaming (in the case of chil- dren) : Cham., Ipec. — Bheum, Jalap, Sen., Carb. v., Sulph. Diarrhcea attended with dyspncea : Sulphur.
— — eructations : Merc, Con., Bulc, &c.
— — flatulency : Ferrum mg., &c.
— — pains in the limbs ; Bhus, Ammon. m.
— — lassitude, debility : Ipec, Ays., Veratr. % Kali, Ferr* mg.
Diarrhcea attended with nausea : Merc, Ipecac, Ars., Bach,, Bella.,
Gran., Hell. Diarrhcea attended with cold perspiration on the face : Merc,
Veratr. Diarrhcea attended with pains in the rectum : Alum.
— — shivering: Merc, Puis., Sulph,, Veratr., Cast., Cop., Big.
Diarrhcea attended with shuddering : Merc, Puis., Veratr., Shewn,.
— — inclination to sleep : Nux mosch.
— — tenesmus: Merc, Bach., Ars., Nux v., Ahm. — • — thirst : Ars., Magn. s., Bulc
— — tremor: Merc
— — vomiting : Ipec, Ars., V#ratr.~r-Cup., Tart., Bheum, Lach., Ant., Phosph., &c.
748 DISEASES OF -INFANCY.
Colour of the Faces.
Ash-coloured: Digitalis purpurea, Asarum europcmm.
Black, or very dark : Ars., Ipec, China, Veratr., Camph., Ac. sulph.
Brownish : Ars., Rheum, Veratr., Camph., Merc, c, Dulc, Sulph., Magn.
m., Tart., Sec. Clay-coloured : Calcarea carlonica, Hepar sulphuris, Petroselinum, Dig.,
Puis., Sulph., &c. Frothy: Lach., Rhus, Calc, Coloc, Merc. — Iod. mag., Natr. s., Sulph*
ac, Op. Grayish : Digitalis, Merc, Phosph., Rheum, Ac. phosph., Asar. Greenish : Chamomilla, Puis., Arsenicum, Mercurius, Sulphur, Phosph.,
Veratrum. — Bella., Ipecac, Hep., Nux v., Magn. m., Sep., &c. Pale : Lycopodium, Carbo vegetabilis. Whitish : Pulsatilla, Sulphur, China, Digitalis, Chamomilla, Hepar, Colch.,
Ign., Aeon. — Nux v., Merc, Rhus, Ars., Calc, &c. Yellowish : Chamomilla, Mercurius, Puis., Ipecac, Ars., Phosph., Tart.,
Calc, Magn. m., Coloc, China, Sec.
Nature of the Ahine Discharge.
Acrid (producing excoriation of the anus) : Merc, Ars., Lach., Cham., Puis., China, Ign., Veratr. — Ferr., Sass., Lach., Staph., Sulph.) Kali, Phosph., Graph., Nux v., &c.
Bilious : Pulsatilla, Chamomilla, Ipecac, Veratr. — Merc, Nux v., Dulc, Ars., Oleand., China — Bism., Coloc, Sulph.
Ingesta containing (lienteria) : China, Ferrum, Oleander. — Ars., Bry., Men., Phosph., Phosph, ac. — Ant. c, Am., Asar., Bar., Calc, Can., Nitri. ac, Rheum, Rhus, Sil., Sulph. ac.
Gelatinous: Colch., Hell., Rhus, Sep.
Membranes^ (containing portions of false) : Cantharis, Colchicum, Sepia.
Mucous : Pulsatilla, Capsicum, Chamomilla, Borax, Nux vomica, Phos- phorus, Sulphur asarum, Am., Ars., Carl, v., Coloc, Graph., Hell., Ipec, Kali, Magn. m.,Merc, Petr., Rheum, Rhus, Sep. — Ant. c, Canth., China, Colch., Hep., Hyos., Ign., Iod., Led., Natr., Nitr. ac, Phosph. ac, Salad., Salin., Stann., Veratr., Viol, tr., Sec.
Pitch, or tar, resembling : Lachesis, Ipecacuanha, Mercurius, Nux vomica.
BOWEL COMPLAINT. 749
Purulent : Mercurius, Silicea.—Puls., Sulph., Canth., Am., Lye— Col., Kali, China, Bella., Cocc, Sep., &c.
Sanguineous : Mercurius, Cantharis, Nux vomica, Pulsatilla, Ipecacuanha, Sepia, Sulphur. — Am., Ars., Asar., Bry., Cole, Caps., Carlo v., China, Bros., Ferr., Led., Lye, Nitr. ac, Phosph., Rhus, Sahin., Sil. — Alum., Amm., Ant. c, Bella., Cham., Coloc, Con., Croc, Cupr., Bute, Graph., Hep., Hyos., Magn. m., Mur. ac, Natr., Natr. m., Sabad., Sec com., Selen., Stram., Sulph. ac, Zincum, &c.
Viscous, glutinous : Mercurius, Asar., Sassap., Hell., Nux v., Plumb., Ars., Cole, Carb. v., Hep., Kali, Mezer., Natr., Veratr.
Watery : Ars., Puis., China, Lach., Cham., Rhus, Ferr., Hyos., Sec, Nux v.* Ant., Ipecac, Phosph., &c.
Smell of the Alvine Evacuations. Acid :1 Rheum, Mercurius, Sulph., Cale, Graph., Natr. — Cham., Am.,
Hep., Sep., Magn., Phosph., &c. Cadaverous: Bismuthum. Mouldy: Colocynthis. Eggs, rotten, resembling : Chamomilla. Fetid, putrid : Ars., Carb. v., Ass., Puis., Sil., Sulph. — Am., Bry.,
Aur., Bor., Cale, Cham., China, Graph., Nitr. ac, Nux v., 01., Plumb.,
Scill., Stram., Phosph. ac, Carb. a., Bule, Mgs., Lach., Mar., Asar.,
Ant. tart., Iod., Sep., &c. Involuntary discharge of faeces: Phosph. ac, Phosph., Veratr. — Ars.,
Bella., Muriat. ac, Natr. m., Sulph. — Rhus, Bry., Lach., China, Nux v.,
Am., Op., Sec com., Staph., Hyos., Colch., Big., Hell., Merc, Laur.,
Puis., Sep., Zincum, &c. When urinating : Ac mur. When expelling flatus : Ferr. mag. When sleeping : Rhus., Puis., Am., Moschus, &c.
In Coma occurring in children from the depleting effects of neg- lected or protracted diarrhoea, China and Arsenicum in alternation are of considerable efficacy. Supplementary nourishment ought at the same time to be given in the case of infants at the breast ; and diet of a nutritive quality to children of more advanced age.
Diet. When the derangement can be traced to any particular kind of food, an alteration in the diet becomes imperative ; at the same time the quantity of food or drinks must be diminished, until improvement sets in.
750 DISEASES OF INFANCY.
EXCORIATIONS.
Excoriationes Neonatorum. Intertrigo.
Against this affection cleanliness is the best preventive ; however, we frequently find it proceed to such an extent as to require the aid of medicine for its removal.
Chamomilla will be found, in most instances, speedily effective, when we are certain the disease is not the medicinal result of cha- momile-tea taken by the nurse or child, in which case Ignatia, Pulsatilla, Borax, or Carbo vegetabilis, have been recom- mended to be given.
Mercurius: — When a yellow colour of the skin is present, which Chamomilla has not removed, and when the excoriation is extensive and severe. In very obstinate cases we may have recourse to Carbo v., followed in four to six days by Tinctura sulpkuris; Graphites, lycqpodium, Acidum suVphurieum, Silicea, and Sepia, are also useful in this malady.
JAUNDICE.
Icterus Neonatorum.
This disease, as we have before observed, frequently takes its rise from the mischievous practice of administering aperients immediately after birth ; exposure to cold is also one of its exciting causes.
When it has arisen from the latter cause, and when there is, toge- ther with the distinguishing characteristic of the disease — a yellow hue of the skin — considerable distension of the stomach, the admi- nistration of Chamomilla will be found prompt in affording relief. Mermrius may, in many cases, follow this remedy, if it has only par- tially relieved ; after which, if any symptoms still remain, we may exhibit Cinchona.
N'ux vomica, when the complaint is combined with costiveness, and the little patient appears generally of an irritable temper.
For more particular' indications for the medicines above given, and further information, see article Jaundice, in Part I of this work.
INDURATION OF THE CELLULAR TISSUE. 751
INDURATION OF THE CELLULAR TISSUE. INFANTILE ERYSIPELAS.
Erysipelas Infantum.
Symptoms. Fever with red spots, generally appearing first upon the nates, but sometimes on the extremities, afterwards upon the abdomen and genital organs, accompanied with induration of the skin and even of the maxillary muscles, which prevents the child from uttering other than a dull sound ; the skin at last becomes as dry and hard as parchment. Sometimes, instead of fever, the indu- ration is accompanied with cold.
This affection generally presents itself in the first two months of infancy; its duration is from four to fourteen days, and if not promptly treated, it is generally fatal.
Therapeutics. The remedies principally required in this affec- tion are Aconitum, Belladonna , Uhus toxicodendron, Arsenicum album, LacJiesis and Sulphur.
Aconitum : — At the commencement, when fever is present.
Belladonna may follow the exhibition of Aconitum, particularly when the spots present an erysipelatous appearance.
Rhus toxicodendron, if the appearance of the skin exhibits a vesicular character. (In some cases Belladonna and Rhus alternately may be found necessary.)
Arsenicum, should the dryness and hardness of the skin remain undiminished, or become increased; should we also find rejection of food from the stomach, evacuations green, watery, acrid, and very offensive; moreover, when there is a tendency to gangrene, with livid spots and vesications, and when the scrotum is especially affected.
Lachesis may, in some cases, be called for after Belladonna, when that remedy does not appear sufficient to combat the malady ; or it may sometimes be advantageously exhibited in alternation with
When the joints, particularly the knee of ankle, are the principal seat of the disease, and the bowels are in a very costive state, Nux v. is useful.
Sulphur may be usefully employed against the sequelae of this affection, such as torpidity of the intestines^ and is also indicated
752 DISEASES OF INFANCY.
where we have reason to suspect some constitutional taint. Silicea, Graphites, Hepar s., or Clematis, may also prove useful.
The body, during this disease, must be kept as dry as possible, and lint applied to the parts affected; when practicable, the infant's only nourishment should be from the breast, to which it should be fre- quently applied, but only allowed to suck little at a time.
LOCK-JAW OF INFANTS.
Trismus Nascentium.
This serious and, under the old mode of treatment, so generally fatal disease, usually occurs in the first few days of infant life ; at first the child vainly attempts to suck, and even if it succeed, the milk is returned. On examination, from stiffness of the masticator muscle, the lowTer jaw cannot be depressed — the jaws gradually close, the whole frame becomes rigid, and death ensues.
The duration of the malady is from two to four days.
Causes. Foul air ; vitiated milk ; taking cold ; and local irrita- tion, for example, the umbilical cord being too tightly tied.
Therapeutics. We must in the first place remove the causes where known. When local irritation has given rise to the attack, Arnica ought to be immediately given internally ; at the same time the seat of the injury may be bathed once or twice with a weak ami- cated lotion, a few drops of the tincture to a wineglassful of water. When we can trace the originating cause to a bad state of the milk, Lachesis may be first prescribed, followed by Belladonna (which, it may be observed, is to be held as a most important remedy in all cases where the affection cannot be assigned to any particular cause), if no signs of improvement transpire after the first or second dose. Mercurius may also prove useful in similar cases. If cold or sudden chill has evidently given rise to the disorder, Chamomilla may first be administered, and then Belladonna, if required ; or Nux v. may be given, in preference to Ghamomilla, when catarrhal symptoms are present and indicate that remedy especially. (See Cold in the Head, Parts I and II.) Hyoscyamus, — or Belladonna, Lachesis and Hyoscyamus in alternation, may be found useful in some cases. (See also Trismus and Tetanus, Part I.)
DERANGEMENTS DURING TEETHING. 753
HEAT SPOTS.
New-born infants and young children are often affected with an eruption consisting of small vesicles filled with a pellucid or slightly- tinged fluid, surrounded by an inflamed base. When the vesicles break, they generally form into thin incrustations, but sometimes the parts are inclined to ulcerate. The eruption is commonly at- tended, especially at the outset, by more or less fever, and is occa- sionally ushered in by sickness and languor. . The duration of the affection is uncertain; and it is prone to return again soon after receding. A hot state of the atmosphere, or confinement to a close, warm apartment, and an excess of clothing, appear to favour the development of the eruption.
The daily use of the bath, with proper attention to ventilation and clothing, are sufficient to remove the disorder in a few days in trivial cases ; but when there is considerable fever, restlessness and sleep- lessness, a globule of Aconite may be dissolved in three teaspoonfuls of water, and a teaspoonful given every twelve hours. Rhus, one globule, may follow Aconite after an interval of twelve to twenty-four hours, when the eruption is extensive. Should the affection continue to spread, and the vesicles increase in size, notwithstanding the employment of these remedies, Sulph,, one globule, may be adminis- tered, and then again Aconitnm if renewed irritation succeed the exhibition of the former.
Chamomilla and Bryonia are also useful in some instances ; the first named especially when the restlessness does not yield to Aconite, and the child is fretful and much excited; the latter when it is peevish and sleepless, yet seems languid, and cannot bear to be moved.
DERANGEMENTS DURING TEETHING.
About the fifth or sixth month, as already stated, the teeth gene- rally begin to protrude. Under a proper system of treatment, if due attention has been paid to the rules for exercise and diet which we
48
754 DISEASES OE INFANCY.
have already laid down, and the child is free from any constitutional infirmity, we may safely calculate upon the period of dentition being exempt from much suffering.
Broths and jellies should, during the acute stages, be wholly pro- hibited, and if the infant take other nourishment than the breast, its food should be of the lightest and simplest description. The mother or nurse should also pay particular regard to her regimen, and avoid all substances of a stimulating and indigestible nature. Here, again, we may remark, that the indulgence in vinous or fermented liquors is,, from their irritating properties, one of the most frequent causes of the suffering of children during this period.
During dentition there is always a tendency of blood to the head, which from simple irritation may, if not quickly checked, terminate in inflammation of the brain ; the best preventive against this affec- tion is keeping the head perfectly cool.
In order, as much as possible, to allay the anxiety of parents, who may be led to mistake the natural symptoms attendant upon dentition for those of disease, we shall in the first instance briefly enumerate those which frequently take place in healthy children, and may be safely left to Nature ; and afterwards proceed to point out in what cases, from any of the symptoms diverging from the usual track, it may be necessary to have recourse to medicines, or to call in the assistance of the physician.
During the teething, the child is more restless than usual, espe- cially at night ; has flushes of heat, alternating with paleness ; the gums gradually swell and become hot; it evinces a difficulty in sucking, sometimes Forcibly bites, and frequently lets go the nipple; it drivels at the mouth, and its bowels become relaxed ; the two latter symptoms may, in some measure, be looked upon as a wise precau- tionary measure of Nature, to prevent a congestion to the head and lungs, to which all children are at this time more or less disposed ; and the sudden cessation of either, after having once set in, is a sign of a derangement of functions, demanding prompt attention.
Therapeutics. The medicines most generally required are,
Coffea, Ckamomilla, Nux vomica, Belladonna, Cuprum aceticum, Kali nitri- cum, and Calcarea carhonica.
When the child is in an excited state, and unable to sleep, irritable, liable to start, and difficult to soothe, Coffea may be administered; if the symptoms remain without alteration, we may have recourse
DERANGEMENTS DURING TEETHING. 755
to Aconitmn. When benefit results from either one or the other re- medy, the dose must only be repeated in the event of a threatening relapse.
Chamomilla may be given after the foregoing remedies, when they are merely productive of partial relief; or it may be given in preference thereto, if the following symptoms are encountered : extreme excitability ; the infant starts at the slightest noise ; evinces great thirst; spasmodic twitches or convulsions in the limbs, during sleep : short, quick, and loud respirations, sometimes with a hacking cough ; excessive diarrhoea, with green, whitish, or watery evacuations ; and especially when the mother has been in the habit of taking coffee, which we have already so strongly reprobated as an article of diet to women nursing. Mercurius and Sulphur are sometimes requisite after Cliamomilla against the diarrhoea. (See Diarrhcea.)
When in the assemblage of these symptoms, constipation takes the place of diarrhoea, wre may prescribe Nux vomica.
When strong symptoms of cerebral irritation set in, we should have instant recourse to Belladonna, or
Cuprum [aceticum : when marked cerebral sensibility declares itself, and the child almost spasmodically clenches the spoon or cup with its gums when drinking.
Zincum is strongly recommended by Dr. Elb, of Dresden, in apparently hopeless cases, with symptoms of incipient paralysis of the brain, such as sopor, half-closed eyes, or motionless eyes with insen- sible pupil ; loss of consciousness ; moaning ; icy coldness of the whole body, and bluish colour of the skin; pulse nearly imper- ceptible; respiration interrupted.
Dose. Gr. ss. every two hours, until the temperature of the skin in- creases, and consciousness returns, upon which the intervals between the doses may be lengthened ; but if some other remedy, as Belladonna for instance, should be called for by the nature of some of the remaining symptoms, it ought to be given in alternation with Zincum, until all signs of danger are removed.
When the irritation seems to arise from difficulty of teething, we may administer Calcarea, and repeat it every eight days for about a month, which will materially assist the protrusion of the teeth. Kali nitrieum is a useful remedy when inflammatory symptoms set in during dentition.
When obstinate constipation is present, see that article in this part
756 DISEASES OF INFANCY.
of the work. (See also Convulsions in Children where ad- ditional indications will be found for the selection of Belladonna, Chamomilla, and other remedies which are frequently required in fever and other derangements during teething.)
CONVULSIONS IN CHILDREN.
Early childhood is, from various causes, peculiarly predisposed to this distressing malady. Convulsions generally arise from the anatomical and physical peculiarities of infancy, in the preponderance of the nervous and cerebral systems over the other parts of the frame ; hereditary predisposition called into activity by dentition — repelled eruptions, irritating substances in the stomach, intestinal worms, mechanical injuries, fright, and lastly, from some occult cause, fre- quently a derangement of the organic structure, in many instances bidding defiance to the powers of medicine. When no physician or medicines are at hand, and the danger is imminent, we may, in the first place, recommend immersing the lower extremities up to the knees in water, as hot as can be borne with safety to the infant, for the space of eight or ten minutes, until the paroxysms seem in a measure subdued; after which the child should be wiped perfectly dry, and placed in a warm wrapper; if the first immersion be followed by no relief, it should be repeated, at the same time we may pour a small stream of cold water upon the crown of the head, until reanimation becomes apparent ; when the child ought again to be warmly covered up ; this course, frequently repeated, has been found to restore children, although the prior attempts have proved inefficient — when improper food or foreign substances in the stomach or intestines are the causes, lavements of equal parts of sweet oil and warm milk should precede the foot-bath ;* if homoeopathic medicines be not immediately at hand, the careful administration of Camphor by olfaction, or a drop or two of the tincture, considerably diluted, placed on the tongue, will frequently be found efficacious in giving relief, awaiting the arrival of a physician.
* Some useful remarks upon this subject may be found in the ' Homceopathic Exa- miner' (published in New York, vol. i, No. 2).
CONVULSIONS IN CHILDREN. 757
Therapeutics. Chamomilla, Belladonna, Ignatia amaras, Cina, Mercurius, Cicuta virosa, Arsenicum, Bryonia, Sulphur, Nux vomica, Bui- satilla, Arnica, Opium, Stramonium, Secale cornutum, and Hyoscyamus, form the most important remedies in the majority of cases.*
Among these Chamomilla stands in the first rank, particularly in very young children, when the convulsions have been excited by dentition, as well as for children who have passed that period, who are of a nervo-sanguine temperament, extremely sensitive and peevish, or when the attacks have been excited by fever, colic, or chill, or a fit of passion or vexation. The characteristic indications for its employ- ment are, restlessness, fretfulness, and disposition to drowsiness when awake ; one cheek red, the other pale, diarrhoea ; (if this remedy be exhibited at this stage of the disorder, it will frequently prevent the fit from becoming fully developed ;) eyes half closed ; great thirst ; quick and loud breathing ; rattling in the throat ; moaning ; cessation of consciousness ; twitches of the eyelids and muscles of the face ; contortion of the eyeballs, jerks and convulsions of the limbs, with clenched thumbs ; constant rolling of the head from side to side ; loss of .consciousness. (Belladonna may be exhibited after Chamomilla, should this fail to do much good.)
Dose. We may, for very young children, prescribe one globule in four teaspoonfuls of water, one teaspoonful to be given at the commence- ment of the attack ; if fresh paroxysms come on some hours after, but decreased in intensity, we ought not to repeat the remedy, but allow it to exhaust its action ; if the convulsions increase, on a second or third attack, we may give another spoonful ; unless other symptoms declaring themselves, intimate that we ought to have recourse to any other of the under-mentioned medicaments.
Belladonna : — Besides being useful in cases of suppressed erup- tions, is more particularly indicated when the child starts suddenly, when asleep, or stares about wildly; the pupils are much dilated; the body or individual members become rigid ; the forehead and hands dry and burning ; occasionally followed by clenching of the hands ; involuntary micturition after returning to consciousness ; the slightest touch will sometimes provoke a renewal of the attack. This medicine is also indicated when the paroxysms are preceded by smiles or laughter*.
* It may be remarked, that in plethoric, well-nourished children, great advantage will frequently be derived from administering a dose of Aconite prior to any of the other remedies.
758 DISEASES OF INFANCY.
It is frequently found that Chamomitta and Belladonna answer in alternation, and that when one has alleviated the evil, the other, some- times followed by the one first administered, will dissipate the remain- ing symptoms.
In cases that withstand the exhibition of these two remedies, par- ticularly during dentition, we frequently find Ignatia successful^ more especially in children that appear of a melancholy temperament, or in pale, delicate infants, of peevish dispositions, with alternations of vivacity and sadness, and laughing and crying almost in the same breath.
The characteristic symptoms are : the infant, while reposing in a moaning, light slumber, becomes suddenly flushed with burning heat, awakes, and springs with a convulsive start, and the utmost soothing scarcely quiets the excitement ; a tremor of the entire body, attended by violent crying and agonising shrieks ; and the muscles of single limbs seem convulsed. Ignatia is further indicated when the fit returns every day at a regular hour, followed by fever and perspiration, or every other day at variable hours. (In other instances Belladonna will be found requisite after Ignatia!)
Ipecacuanha is useful when great difficulty of breathing, nausea, aversion to food, and vomiting, either precede, accompany, or follow the attacks ; and when the child has a constant inclination to remain in the recumbent posture.
Cina is useful, particularly during the second teething, for children of a melancholy temperament, scrofulous constitution, and who are troubled with worms, or habitually wet the bed ; the characteristic symptoms are : spasms, commencing with constriction of the breast, followed by stiffness of limbs, pallor, and rigidity of the whole frame.
Mercurius is useful in spasms which are caused by the presence of worms : the stomach is swollen and hard before, during, and after the fit; the child is attacked with painful eructation, and a species of salivation ; the limbs tossed and convulsed, attended by fever and moist skin; after the paroxysms, the child lies for a long time exhausted and apparently dying.
The foregoing are the more generally useful remedies in ordinary cases ; but the subjoined are sometimes called for in the particular instances specified.
Cicuta virosa is exceedingly serviceable wThen there is a clear indication of the presence of worms ; when the child is first attacked with severe griping and colic, terminating in convulsions ; the charac-
CONVULSIONS IN CHILDREN. 759
teristic features of the fit are : tremor of the limbs ; jerks like electric shocks, terminated by insensibility.
Arsenicum has proved very valuable in severe cases of convulsions, during dentition, with the following symptoms : a burning heat diffuses itself over the whole body of the child ; it stretches its feet out, and the hands convulsively backwards, then throws its hands about, and rolls over with violent shrieks ; changes its position, and bends for- ward with clenched fingers and extended thumbs; it is irritable, restless, and perverse ; evinces insatiable thirst, but drinks little at a time ; is affected with diarrhoea, sometimes of 'undigested food ; frequently vomits immediately after taking food, the paroxysms recur frequently, and all attempts at soothing seem only to irritate the child.
Bryonia is valuable in convulsions arising from suppressed measles. (See Measles.)
Sulphur is particularly indicated in spasms arising from repelled chronic eruptions.
When the disease arises from indigestible substances being taken into the stomach, Nux vomica or Pulsatilla may be given, according to the symptoms and disposition ; for these remedies the indications have been already given in different parts of the work, to which the reader is referred. (See Tabular Index.)
In cases arising from mechanical lesion, Arnica, externally in lotion, where any wound or contusion exists.
In cases of convulsions from fright, we may have recourse to Opium, when the following appearances are present ; general tremb- ling ; throwing about of the limbs ; vacant stare ; cries, seemingly unconscious ; stertorous breathing, and final insensibility.
Stramonium, when the child becomes suddenly convulsed and senseless from fright.
Secale cornutum, in alternation with Stramonium, in cases where the latter does not afford relief.
Hyoscyamus, when sudden fright causes very violent convulsions. (See Mental Emotions, Part I.)
760 DISEASES OF INFANCY.
WATER IN THE HEAD. DROPSY OF THE BRAIN. DROPSY OF THE HEAD. Hydrocephalus membranarum et ventricularum.
General pathognomonic signs : headache, particularly frontal, nausea, vomiting, dilatation of the pupils, stupor, abnormal slowness of pulse, and convulsions.
This fatal and frequent disease is liable to be excited by a variety of causes, and is particularly prone to take place in scrofulous children, who are born with unusually large heads, and in whom the fontanels remain long unclosed. The symptoms of acute hydrocephalus are sometimes so mild and insidious, that parents are thrown off their guard, and attribute the apparently slight indisposition of the little patient to some comparatively trivial circumstance ■; such as teething, or gastric derangement. In other instances, the symptoms are much more striking, and in many respects strongly resemble those described under Inflammation of the Brain. In general, the skin is hot; pulse rather quick, chiefly at night — but often very variable. The child becomes peevish whenever it is raised from the horizontal position; at other times it is affected with fits of screaming ; grinding of the teeth; redness of the face and eyes; peculiar expression of countenance; strabismus ; convulsions and stupor.
Dropsy of the brain is liable to be confounded with other diseases, as invermination, inflammation and ulceration of the mucous membrane of the small intestines (ileum particularly), coma from exhaustion, occurring after protracted debilitating diseases, &c. The history of the case, together with a close scrutiny of the whole of the symptoms, will rarely fail in establishing the diagnosis.
Therapeutics. The most appropriate remedies are : Aconite, Belladonna, Bryonia, Helleborus, Mercurius, and Sulphur, or Sulphuris tinctura. The indications for the first two have already been given under Inflammation of the Brain, Part I.
Bryonia may be administered after Aconite, or Belladonna, if necessary, or may be given at the commencement, when there are heat in the head, with dark redness of the face, and great thirst ;
WATER IN THE HEAD. 761
eyes convulsed, or at one time closed, and at another time wide open or fixed ; delirium ; sudden starts, with cries, or constant inclination to sleep; continual movement of the jaws as if engaged in chewing ; tongue coated yellow ; abdomen distended ; urine suppressed or the passing of urine appears to cause pain ; great thirst, especially at night ; skin hot and dry ; respiration hurried, laborious, and anxious, constipation.
Helleborus niger: — This remedy, as stated by Dr. Wahle,* will generally prevent a fatal termination, when Bryonia merely produces only temporary benefit. The same authority quotes it as being the most important medicine in all serious cases, and recom- mends it to be given in these at the very commencement, in prefer- ence to all other remedies ; followed by Sulphuris tinctura when danger is not removed within a few hours, and when spasms are present.
Mercurius will sometimes be found useful after Belladonna, or previous to that remedy, when the bowels are much relaxed. Hyo- scyamus, Opium, Cina, and Stramonium may likewise prove valuable in cases wherein the indications correspond with those described in Part I, and in some cases, Lachesis, particularly when the disease has reached an advanced stage.
Zincum, (gr. ss, every two hours) has been successfully employed by Dr. Elbf in the last stage of hydrocephalus with symptoms of incipient paralysis of the hrain. As soon as the signs of immediate danger have been removed, some other remedy, appropriate to the remaining symptoms should be prescribed ; but it is recommended by Dr. Elb to give Zinc, at first in alternation with the new remedy, otherwise a relapse is liable to happen. Kali hydriod., Digitalis, Arnica, and Conium have also been named as likely to prove service- able in this malady. In chronic hydrocephalus, Dr. Wahle recommends Helleborus, Arsenicum, and &ulphur% in particular. (See also the reme- dies enumerated under. Scrofula and Rachitis, with which diseases, chronic hydrocephalus is generally connected.)
* British Journal of Homoeopathy, No. vii, p. 286.
f Allg. Horn. Zeit. No. 15, 31ter Bd.
% According to my experience Sulphur (30) is the most important remedy in the treat- ment of inflammatory and exudatory affections of the brain. It is more effective in the erethic than in the torpid stadium. The previous or intercurrent employment of Aconitum and Belladonna is often necessary. In the torpid stage I consider Helleborus, and, in some cases, Acid, phosphoricum, fully equal to Sulphur. — (Rummel, Allg. Horn. Zeit. No. 22, 32ster Bd.)
762 DISEASES OF INFANCY.
ASTHMA OF MILLAR.
La
This affection is by some denominated the Spasmodic Croup, or Acute Asthma of infants ; it bears a considerable resemblance to croup, yet differs from it in many respects, as, for instance, by the extreme suddenness of the attack, while that of croup is generally preceded one or two days by hoarseness and a slight cough, and by the cessation from suffering the patient enjoys between the attacks, whereas when croup has once set in, the excitement is permanent ; moreover, this disease generally attacks in the evening or at night, whereas croup in most cases makes its first appearance during the day.
Croup, as we mentioned in the article upon that subject, is an inflammation of the membrane of the windpipe, exciting the forma- tion of a peculiar secretion, which, if not checked, concretes into an abnormal membranous tissue, constituting wrhat is technically called the false membrane of croup ; whereas, in the Asthma of Millar, the suffering appears to arise from a spasmodic contraction of the top of the windpipe, impeding the progress of respiration.
The attack commences with a sudden spasmodic inspiration, accompanied by a species of stridulous or crowing noise ; if the fit continues, the face becomes purple, and the extremities partake of the same hue, frequently attended, as in convulsions, with a clenching of the thumbs inside the palm, and spasmodic constriction of the toes, giving an appearance of distortion to the foot ; if proper means are not promptly taken, these attacks recur frequently, and at short intervals, and occasionally the little patient perishes during one of the paroxysms.
The disease rarely occurs except in infants of delicate constitution, when due means should be taken to endeavour to eradicate it by a proper course of treatment ; it frequently accompanies the period of dentition, and is excited by similar causes to those bringing on con- vulsions.
Therapeutics. Aconite, Ipecacuanha, Arsenicum, Sambucus, Mos- chus, or Pulsatilla, are the medicines which have hitherto been em- ployed by homoeopathists with the most successful results.
The dose to be repeated every one or two hours, according to the symptoms.
REMITTENT FEVER. 763
Aconite, when a suffocating cough comes on at night, with shrillness and hoarseness of voice ; respiration short, anxious, and difficult, more particularly if any marked febrile symptoms be pre- sent, or we have reason to dread determination of blood to the head.
Ipecacuanha, when there is rattling in the chest, from an accumu- lation of mucus, with spasmodic constriction, and symptoms as from suffocation ; anxious and short, or sighing respiration, with purple colour of the face, and cramps, or rigidity of the frame; it may be advantageously followed by
Arsenicum, when many of the above symptoms are still present, or in a measure subdued : also if we find great anguish, cold perspira- lion, . and considerable prostration of strength, during and after the paroxysms ; when these last indications are particularly prominent, Arsenicum may supersede Ipecacuanha at the commencement.
Sambucus : — Lethargy, or ineffectual inclination to sleep, with oppressed respiration and wheezing ; livid hue of the face, agonizing jactitions, dry heat of the trunk; no thirst; pulse small, irregular, and intermittent.
Moschus is frequently of value in cases that occur at a more advanced period of life, when a constriction in the larynx, as if caused by the vapour of sulphur, is complained of; difficult respiration and short breathing ; severe spasms in the chest, with inclination to cough, after which (especially in children) the paroxysms become much exacerbated,
Pulsatilla will often be found successful in cases in which the foregoing remedy fails in producing the desired effect.
INFANTILE REMITTENT FEVER.
By infantile remittent is here chiefly meant that form of fever which occurs in infants and children, arising from morbid irritability, inflammation or even ulceration in the mucous membrane of the stomach and bowels.
The affection is usually preceded by languor, irritability of temper, want of appetite, nausea, thirst, slight heat of skin, and very restless nights. Ere long these symptoms present themselves in a more
764 DISEASES OF INFANCY.
aggravated form, together with a further development of abnormal phenomena, such as hurried and oppressive breathing, quickness of pulse, with occasional flushes in the face, vomiting of food or bile, distension and tenderness of the abdomen ; obstinate constipation ; sometimes diarrhoea, or frequent desire to go to stool with but little effect ; motions discoloured, fetid, frequently mixed with mucus, and occasionally with blood. The hands and feet are often cold, while the rest of the body is parched ; the head hot and heavy, or attended with other symptoms resembling hydrocephalus, such as coma, &c. The tongue, at first moist, loaded, and occasionally very red along the margins, often becomes dry over a triangular spot at the point. When the febrile exacerbation takes place at night, it is accompa- nied by violence and jactition ; when during the day there is, on the other hand, drowsiness and stupor. An annoying cough with bron- chitic indications, succeeded by wheezing and expectoration, some- times appears. Although, as is characteristic of remittent fever, the febrile symptoms never entirely subside, still the patient will fre- quently appear to be steadily recovering for a time, and the unwary or inexperienced may consequently be led to pronounce an unduly favorable prognosis, which will too often be contradicted by the occurrence of a relapse, followed perhaps again by another encou- raging but deceptive remission and so on, unless the progress of the disease be checked, until either the mesenteric glands become affected, or dropsical effusion into the cavity of the abdomen, or unequivocal signs of cephalic disease supervene, or the little sufferer is so emaciated and reduced by protracted disease, that the vital powers give way, and he sinks exhausted.
Therapeutics. In mild attacks occurring in tolerably healthy children, the disease is generally readily subdued in a few days, by means of one or more of the following remedies : Ipecacuanha, Pulsa- tilla;, China, Nux v., Aconitum, Belladonna, Mercurius, Bryonia, Lachesis, Chamomilla, and Sulphur, combined with light farinaceous diet. Solid food must be strictly prohibited, even though the appetite should be good, which it occasionally is, and even ravenous at times.
With regard to the indications for the remedies quoted, Ipeca- cuanha may be given, if, as is commonly the case, the attack has been excited by over-feeding, or by indigestible food, and particularly when the patient has contracted a habit of bolting the food without having previously masticated it properly, and the symptoms encoun-
REMITTENT EEVER, 765
tered are as follows : — General dry heat, or harsh and parched skin, especially towards evening; thirst, extreme restlessness, burning heat in the palms of the hands; perspiration at night, quick oppressed breathing, foul tongue, nausea, vomiting, or fastidious appetite, with sickness after eating ; great languor, apathy, and indif- ference. Should these symptoms remain unaltered after several doses of Ipecac, or should the bowels become very relaxed, the mo- tions fetid, whitish, bilious, or of variable colour at different times, and accompanied with griping and distension of the abdomen, fever during the night — Pulsatilla may be prescribed, followed, if required, by Cinchona, especially if the nausea or vomiting has subsided, but the bowels remain relaxed, and are considerably dis- tended, or tense and tympanitic.
Nux vomica is also a most efficient remedy in mild cases, or in the early stage of any variety of the disorder, when the bowels are confined, or very costive, with frequent inclination to go to stool ; or when there is tenesmus, followed by scanty watery motions, gene- rally mixed with mucus, or occasionally with a little blood ; abdomen tumid and rather painful ; further — when the child is excessively peevish and ungovernable ; the tongue foul ; appetite impaired, or there is nausea with disgust at food ; restlessness ; fever towards morning, but also in some degree during the night.
Chamomilla is sometimes useful after Nux v. when bilious diar- rhoea or vomiting supervenes. It is further indicated if the tongue is red and cracked, or coated yellow ; sleep lethargic, or restless and agitated, attended with frequent starts and jerkings of the limbs ; flushes of heat in various parts of the body. Also when the little patient is of a plethoric habit, and in all cases in which the head is hot and heavy, the skin hot or parched, the face flushed, the pulse quick ; and when there is thirst, foul tongue,, nausea, bilious vomiting, no motions, or frequent and scanty evacuations, with tenesmus.
Belladonna may succeed Chamomilla, if the head continue hot, the pulse excessively quick and full, the tongue loaded, or coated white or yellow in the centre, and very red at the edges; thirst; nausea or vomiting ; great heat of the abdomen with tenderness on the slightest pressure; oppressive breathing. If the more active inflammatory symptoms yield to the action of Belladonna, — Mercu- rius will often serve to complete the cure ; but more particularly when the following symptoms remain; loaded tongue, nausea or vomiting, with continued tenderness of the abdomen ; thirst, some-
766 DISEASES OF INFANCY.
times with aversion to drinks when offered ; no motions, or diarrhoea with excessive tenesmus. If, on the other hand, the head continue hot and heavy, the pulse quick, the tongue foul, and other symptoms of gastric derangement are prominent, together with a tumid and painful state of the abdomen, constipation, excessive restlessness, and quick, laborious respiration, particularly at night, with drowsi- ness during the day, Bryonia is to be preferred.
Lachesis may follow Belladonna or Mercurius, when the signs of intestinal irritation or inflammation continue with but little abate-? ment. Or it may precede these remedies, when the tenderness and distension are more marked at one particular spot (the most trivial pressure there being intolerable,) than over the entire abdomen ; and when the fever is highest at night.
Sulphur : — May be given with advantage to complete the cure in many cases, after the previous employment of any of the foregoing medicines. It is, however, when the attack is characterized by the following features, that this remedy is more directly called for: feverish heat, especially towards evening, but also in the morning, or during the day ; flushes, alternately with paleness of the face ; dryness of the skin ; hurried and laborious breathing ; palpitation of the heart ; nocturnal perspiration ; languor and great weakness, particu- larly in the inferior extremities ; tense, tumid and painful abdomen ; dry, hard, or loose and slimy motions.
These, then, are the most generally useful remedies in cases of the above description, and will materially tend to facilitate recovery, and prevent the disease from assuming an obstinate character. When, however, the malady occurs in children of relaxed and feeble habits, or of a decided strumous diathesis, it becomes, especially if neglected, and not checked at the commencement of its course, a most intract- able and frequently fatal disease, from the proneness which it then has to become complicated, and terminate in one or other of the serious forms alluded to in the diagnosis.
The remedies from which the most benefit is to be anticipated under such unfavorable circumstances are, in addition to those previously mentioned, Silicea, Sulphur, Calcarea, Baryta c, Arsenicum, Cocculus, Cina, Sabadilla, &c.
Silicea : —When there is great emaciation, languor and debility, paleness of the face, want of appetite, or craving for dainties ; short- ness of breath on movement ;' feverish heat in the morning or towards evening. This remedy is also a most important one when the patient
REMITTENT FEVER. 767
is afflicted with worms, and when the disease is in a great measure attributable to invermination. Cina and Sahadilla, may likewise be found useful along with Silicea in the latter instance. (See Inver- mination.) The indications for Sulphur have already been given.
Calcarea : — Great debility, with flabbiness of the muscles, dry- ness of the skin, and excessive emaciation; frequent flushes, or general heat, followed by shivering towards evening ; exhaustion, or dejection after speaking; impaired, fastidious appetite, with weak and slow digestion, or, on the contrary, extreme voracity ; perspira- tion towards morning, hard, tense, and tumid abdomen. [Baryta c. is sometimes useful after Calcarea.)
Arsenicum : — Extreme prostration of strength and emaciation, with desire to remain constantly in the recumbent posture; dry, burning heat of the skin, wdth great thirst, but desire to drink little at a time, or merely to moisten the lips, which are frequently parched ; impaired appetite, and sometimes excessive irritability of the stomach, so that very little food can be retained ; hard and tense abdomen ; restless, unrefreshing sleep, and frequent starts, or subsultus ten- dinum ; fretful and capricious disposition.
Cocculus : — Great weakness, with excessive fatigue, depression, and tremor after the slightest exertion ; heavy expressionless eyes ; flushes of heat in the face ; nausea, or aversion to food, distension of the abdomen, constipation ; oppressed respiration ; perspiration on attempting any trivial exertion; lowness of spirits; mildness of temper.
Belladonna, Lachesis, or Baryta c, will be required when the head becomes much affected. Belladonna, especially when there are heat, heaviness, flushing and delirium ; or deep and protracted sleep, with subsultus tendinum, coldness of the hands, pale cold face, small quick pulse, hot, tumid, and tense abdomen.
Lachesis : — Either before or after Belladonna, when we encounter deep, prolonged sleep ; grinding of the teeth ; or somnolency alter- nately with sleeplessness ; tremulous, intermittent, or scarcely per- ceptible pulse.
Baryta: — Lethargy, jactitation, or agitation, moaning and muttering, feeble and accelerated pulse. (See Hydrocephalus.)
Other remedies, such as Antimonium, Acid, phosphoricum, Phosphorus, Ilepar s., Kali, Acidum nitr., Lycopodium, Rhus, &c, may be required according as the symptoms happen to vary : we have merely given some of the medicines which have been found of valuable service,
768 DISEASES OF INFANCY.
when the indications of the disease have corresponded with those above given. It may be added, that when the skin is hot and parched, the sleeplessness and restlessness are often temporarily removed by sponging the body with tepid water; this expedient is, however, only to be had recourse to when the remedies fail to afford this relief, and that in a more permanent degree. (See also Atrophy.)
ATROPHY. Atrophia.
The medicines from which the most appreciable benefit has hitherto been obtained in this serious malady are : Sulph., followed by Calcarea; also Ars., Bar. c, Bell., Chin., Nux vom., Phosph., and Bhus.
Sulphur in almost all cases at the commencement of the treat- ment ; craving appetite ; enlargement of the inguinal or axillary glands ; slimy diarrhoea, or obstinate constipation ; pale complexion, sunken eyes, &c
Calcarea : — Great emaciation, with craving appetite ; enlarge- ment and induration of the mesenteric glands; great weakness^, clayey evacuation, a dry and flabby skin; too great a susceptibility of the nervous system.*
Arsenicum : — Dryness of skin, which resembles parchment ; hollow eyes ; desire to drink often, but little at a time; excessive agitation and tossing, especially at night; short sleep interrupted by jerks ; faeces of greenish or brownish colour, with evacuations of ingesta ; extreme prostration.
Baryta : — Enlargement of the glands of the nape of the neck ; continual desire to sleep ; great indolence, and aversion to exertion and amusement.
Bell. : — Capriciousness and obstinacy ; nocturnal cough, with rattling of mucus; enlargement of the glands of the neck; unquiet sleep ; precocity of intellect, blue eyes and fair hair.
* Calc. <?., 3 — 4, gtt. j, once or twice a day for the space of six or eight weeks, is (toge- ther with embrocations of oil (?) and, perhaps also, single intermediate doses of Sulphur) one of the most efficacious remedies in Tabes mesent. infant.; and, in general, a much superior remedy to Iod., Cicuta, Baryta, &c. In most instances the abdomen becomes smaller, the stools more regular, in from eight to fourteen days after its employment. Furuncles and a sort of miliary eruption then frequently break out. — Hygea.
VACCINATION. 769
China: — Excessive emaciation; voraciousness; diarrhoea at night, with frequent white motions or evacuations of ingesta; frequent per- spirations^ especially at night ; unrefreshing sleep.
Cina : — Vermiculous symptoms ; wetting the bed. (See Worms.)
Rhus : — Slimy or sanguineous diarrhoea ; debility ; voracity.
In children past the age of infancy, great attention should be paid to the diet ; pure air and exercise are also of great importance.
VACCINATION.
This is an operation purely homoeopathic, and one which, from its efficacy in the prevention of a disease exhibiting analogous symptoms, has been frequently quoted by our Great Founder and his disciples, as one of the best illustrations of the immutable law of similia
SIMILIBUS CURANTUR.
Vaccination, when the child is strong and healthy, may be safely performed during the fourth or fifth month ; but when the smallpox is rife as an epidemic, we may have recourse to this prophylax with infants of a still more tender age. If, however, we are allowed a choice of time, summer is the best period for performing the operation, as then the infant, after having taken the infection, incurs least risk of catching cold.
It is of the utmost importance to obtain the lymph from a per- fectly pure source, as experience has too truly proved, that other diseases have, from a neglect of this precaution, been frequently trans- mitted to healthy children. For this reason, a child that has suffered from eruptions of the skin, affections of the glands, or soreness of the eyes, or one born of scrofulous parents, is an unfit subject for taking the vaccine matter from, although at the time apparently in health.
49
INDEX.
PAGE
Abdomen, determination of blood to
the . . . 163,533
Abdominal deformity
Abortus
Abscess
acute
chronic . Abscessus nucleatus Abscesses in ano Acidity in children Acute inflammation of the eyes
inflammation of the liver
inflammation of the spinal cord
rheumatism of the heart Aegylops After-pains Affections of the knee Ague . Agrypnia Air and exercise Aliments allowed
prohibited Alvine discharge, colour of the (see
Bowel Complaints of Infants). Ambustiones Amenorrhoea Anasarca
integumentorum scroti Aneurism of the aorta Angina faucium . aphthosa .
maligna
pharyngea
parotidea
perniciosa
membranacea Anorexia Anthrax
Aorta, aneurism of the Apepsia Aphthae
Appetite, want of Apparent death .
from hunger
from a fall
701 678 419 420 421 416 154 736 534 200 345 411 539 693 532 31 561 662 3 4
628 652 596 476 411 100
ib. 107 110 112 258 258 125 417 411 125 739 125 633 634
ib.
Apparent death from suffocation (hang- ing, pressure, choking)
from lightning . .
from drowning
from being frozen .
from noxious vapours Apoplexy Apoplexia
Arteries, inflammation of the Arthritis
PAGE
Arthritic nodes . Ascites Asphyxia Asthma
humidum
moist
of Millar Atrophy Atrophia Attenuations in general
Balanitis
Balano blenorrhcea
Bilious fever
Black water
Bladder, inflammation of the
chronic inflammation of Blear-eyedness . Bleeding from the nose Blenorrhcea . .
ventriculi intestinorum . recti Blepharitis
Blindness, sudden attack of Blood, vomiting of
spitting of Bloodshot eye . Boils .
Bowels, hemorrhage from the Hemorrhoids).
inflammation of the looseness of the Bowel complaints of infants
634 635
ib. 636 637 339
ib. 412 515 517
ib.
593
633, 717
324
330
ib. 762 768
ib.
Hi
472
ib.
56 140 447 448
ib. 547 226, 466 226 228 229
ib. 540
ib. 314 539 416
(see
212 164 741
|
772 |
INDEX. |
||
|
PAGE |
PAGE |
||
|
Brain, inflammation of the |
335 |
Chronic abscess . |
421 |
|
fever |
ib. |
laryngitis |
239 |
|
concussion of the |
613 |
bronchitis |
274 |
|
dropsy of the |
760 |
inflammation of the bladder . |
448 |
|
Breath, offensive |
557 |
rheumatism |
524 |
|
Breasts, preparation of the |
684 |
Cingulum |
435 |
|
inflammation of the |
708 |
Cirsocele . . |
475 |
|
Bronchial tubes, inflammation of the |
Clap .... |
466 |
|
|
mucous membrane of the |
268 |
Clavi pedis |
419 |
|
Bronchitis |
ib. |
Clavus hystericus |
361 |
|
chronica |
274 |
Clothing during pregnancy . |
663 |
|
Bronchocele . . . |
559 |
Cold on the chest |
268 |
|
Bruises |
617 |
in the head . 240 |
,733 |
|
Bubo . |
486 |
Colic .... |
159 |
|
Buboes |
507 |
from hemorrhoids |
160 |
|
venereal |
487 |
from worms |
ib. |
|
sympathetic |
ib. |
spasmodic . |
ib. |
|
scrofulous |
489 |
indigestible food |
ib. |
|
sycosic . |
499 |
from passion or indignation |
ib. |
|
Burns |
628 |
external violence |
ib. |
|
painters' . . 160 |
,348 |
||
|
Camp fever |
29 |
of Poictou . |
348 |
|
Cancer nasi |
552 |
lead . . 160,347 |
|
|
Cancerum oris |
ib. |
Devonshire |
160 |
|
Canker of the mouth |
ib. |
from a chill |
ib. |
|
Carbuncle . |
417 |
in infants . |
734 |
|
Cardialgia |
134 |
hysterical . |
160 |
|
Carditis |
409 |
menstrual . |
ib. |
|
Caries |
604 |
Colica pictonum . 160,348 |
|
|
Catarrh |
231 |
Common cold |
231 |
|
pulmonary |
268 |
Concussion of the brain |
613 |
|
Catarrhus bronchiarum |
299 |
Condylomata |
509 |
|
Catarrhal fever . |
231 |
Confluent smallpox |
85 |
|
Cataract |
538 |
Congestio ad caput |
331 |
|
Cephalalgia |
361 |
Congestio viscerum abdominis 163, 533 |
|
|
arthritica |
ib. |
ad abdomen . > . |
163 |
|
nervosa |
ib. |
ad pectus |
265 |
|
Cephalsea |
. ib. |
Congestive fever |
13 |
|
Chancre, Hunterian |
479 |
Constipatio |
143 |
|
superficial, with raised edges |
ib. |
Constipation . . 143, 669, 741 |
|
|
phagedenic |
. ib. |
in aged persons |
147 |
|
sloughing |
. ib. |
When travelling |
ib. |
|
Chest, determination of blood to |
from exposure to the va- |
||
|
the |
. 265 |
pour of lead |
ib. |
|
Chicken pock |
. 90 |
from congestion, or ful- |
|
|
Chilblains |
. 417 |
ness of the vessels oi |
|
|
Children, diseases of |
. 732 |
the head . |
ib. |
|
Chimney-sweeper's cancer . |
. 415 |
from duodenitis |
148 |
|
Chlorosis |
. 649 |
Constitutions . |
lxvii |
|
Choice of a nurse |
. 722 |
Contagious typhus |
29 |
|
of the remedy |
xix |
Consumption, pulmonary . |
319 |
|
Chbleia |
. 177 |
Convulsions during labour . |
696 |
|
Asiatic . |
. 180 |
in children |
756 |
|
malignant |
. ib. |
Convulsio cerealis |
41 |
|
Asiatica . |
. ib. |
Costiveness |
143 |
|
epidemica |
. ib. |
Corns |
. 419 |
|
spasmodica |
. ib. |
Cornea, specks on the, or opacity |
. 538 |
|
preliminary symptoms of |
. 185 |
Coryza |
. 240 |
|
first stage, of |
. 185 |
Cough |
. 242 |
|
fever, or hot stage of |
. 187 |
hooping . i |
. 254 |
|
causes of ' ■ |
. 192 |
Coup de soleil (see Exposure to heat) |
|
|
accessory treatment |
. 199 |
Coxalgia |
. 528 |
|
Cholerine . . |
. 200 |
Coxagra |
. ib. |
|
INDEX. |
7/6 |
|||
|
PAGE |
PAGE |
|||
|
Cramps in the legs |
558 |
Dropsy ■ . . |
. 592 |
|
|
Croup |
258 |
of the belly (see Ascites). |
||
|
Crusta lactea |
738 |
of the pericardium (see Pericarditis, |
||
|
Crying and wakefulness of new-born |
L |
chronic). |
||
|
infants |
. 734 |
ovarium . |
. 659 |
|
|
Cynanche tonsillaris |
. 100 |
of the cellular tissue |
. 596 |
|
|
maligna |
. 107 |
of the chest |
. 600 |
|
|
pharyngea |
. 110 |
of the brain |
. 760 |
|
|
laryngea |
. 258 |
of the head |
. ib. |
|
|
tracheitis |
. ib. |
Duration of confinement . |
. 694 |
|
|
Cystitis . . 447,471 |
suckling |
. 725 |
||
|
Dysecoia, or deafness |
. 546 |
|||
|
Deafness, congestive |
546 |
Dysenteria |
. 170 |
|
|
nervous |
. ib. |
alba . |
. ib. |
|
|
catarrhal, or rheumatic |
. ib. |
rubra |
. ib. |
|
|
from the repercussion o |
f |
rheumatico-catarrhalis . ib. |
||
|
eruptions |
. ib. |
inflammatoria |
. 171 |
|
|
after scarlatina . |
ib. |
biliosa |
. ib. |
|
|
from the abuse of mercury |
ib. |
putrida |
. ib. |
|
|
Death apparent . |
633 |
Dysentery |
. 170 |
|
|
Deficiency in the secretion of milk |
710 |
suppressed |
. 176 |
|
|
Derangement of the stomach |
129 |
rules of conduct and diet in 171 |
||
|
Derangements during teething |
753 |
Dysmenorrhea . |
. 655 |
|
|
Derbyshire neck |
559 |
Dyspepsia |
. 114 |
|
|
Deterioration and discoloration oi |
Dysuria |
. 451 |
||
|
milk |
711 |
|||
|
Determination of blood to the abdo- |
Ears, inflammation of the , |
. 543 |
||
|
men . . 16 |
3,533 |
Earache |
. ib. |
|
|
chest |
. 265 |
Eclampsia typhoides |
. 41 |
|
|
head |
. 331 |
Ectropium |
. 541 |
|
|
Delirium tremens potatorum |
351 |
Eczema faciei |
. 738 |
|
|
Diabetes |
. 460 |
Emansio mensium |
. 649 |
|
|
mellitus |
. 461 |
Employment of the mind and Habits |
||
|
insipidus |
ib. |
during pregnancy |
. 665 |
|
|
Diarrhoea |
164 |
Encysted hydrocele of the |
spermatic |
|
|
biliosa |
165 |
cord |
. 478 |
|
|
mucosa, s. pituitosa |
ib |
Endocarditis |
. 384 |
|
|
stercoralis |
ib.. |
Entropium |
. 542 |
|
|
serosa |
ib. |
Enteritis |
. 212 |
|
|
lienteria |
ib. |
Encephalitis |
. 335 |
|
|
torminosa |
166 |
Ephialtes |
. 577 |
|
|
during pregnancy |
670 |
Epilepsy |
. 353 |
|
|
in lying-in women |
. 701 |
Epilepsia |
. ib. |
|
|
neonatorum |
741 |
Epiphora |
. 539 |
|
|
Diaphragmitis . |
312 |
Epistaxis |
. 547 |
|
|
Diet during pregnancy |
665 |
Evacuations, abnormal, colour of the |
||
|
rules for . . |
3 |
(see Diarrhoea in Infants). |
||
|
to be observed in fevers |
5 |
Errata |
. lxxi |
|
|
during nursing |
722 |
Eructations |
. 129 |
|
|
Difficulty in discharging the urine |
451 |
Eruptive fevers . |
. 58 |
|
|
Dilatation of the heart |
410 |
Erysipelas |
. 413 |
|
|
Discharge of blood from the urethra |
466 |
bullosum |
. ib. |
|
|
Disease of the conglobate glands |
419 |
phlegmonodes |
. 414 |
|
|
venereal |
479 |
cedematodes |
. ib. |
|
|
Diseases of the heart |
373 |
erraticum |
. ib. |
|
|
of the valves of the heart |
410 |
pseudo |
. 415 |
|
|
Disinclination of the infant to suck |
707 |
gangrenosum |
. ib |
|
|
Dislocations |
626 |
scroti |
. ib. |
|
|
Dispensation, and the preservation oJ |
F |
infantum |
. 751 |
|
|
homoeopathic medicines |
lxiii |
Excessive secretion of milk |
. 697 |
|
|
Dispositions |
lxvii |
Excoriation of the nipple |
. 707 |
|
|
Dose and its repetition |
xxvi |
Excoriations |
. 750 |
|
|
Dreams (see Sleeplessness). |
Excoriationes nee |
matorum |
. 756 |
774
INDEX.
PAGE
Exercise . . . 729
Exostosis . . . 604
Exposure to heat . .631
Eyes, acute inflammation of the . 534
inflammation of in infants . 732
Eye, fungus nematodes of the . 538
weeping or watery . .539
bloodshot . . ib.
Eyelids, inflammation of the margins
of the . . .540
catarrhal inflammation of the 541
Face, swelled . . .676
warts on the . . 543
Face-ache . . . 358
Face-ague . . . ib.
Fainting . . .589
and hysterical fits . 670
False pains . . .685
Falstaff belly . . .702
Fatigue . . .630
Favus confertus . . . 428
Febres . . .5
intermittentes . .31
Febris simplex . . .8
inflammatoria simplex . 9
synochalis . . ib.
nervosa . . .12
nervosa versatilis . .15
nervosa stupida . . ib.
lenta nervosa . .30
hectica . . .48
gastrica biliosa . .56
pituitosa . . .52
mucosa . . . ib.
dysenterica . .170
helminthiaca . .219
bullosa . . .433
rheumatica . .517
Feet, sweating . . .560
Females, diseases of . . 649
Fevers . . .5
simple or ephemeral . 8
Fever, general treatment of . 7
inflammatory . . 9
synochal . . .9
nervous . . .12
slow . . . ib.
typhus . . . ib.
congestive . .13
putrid . . .27
pestilential . . ib.
malignant . . ib.
jail . . . 29
camp . . . ib.
petechial . . . ib.
intermittent . .31
marsh . . .34
remittent . . .46
yellow . . . ib.
hectic . • .48
mucous . . .52
contagious . . 29
Fever, gastric bilious eruptive . scarlet catarrhal . rheumatic
Fistula in ano
lachrymalis
Fistulae in perinaeo
Fractures
Flatulence in infants
Flatulency
Flatulentia
Flatus
Furunculus
malignans
Fungus haematodes
Gangrena oris
Gastric fever
Gastrodynia
Gastralgia
Gastritis
Giddiness
Glands, conglobate, disease of
Glandular swellings
Gleet
Glossitis
Goitre
Gonorrhoea
glandis Gout
Gravel (see Hematuria). Gum-boil
Gums, hemorrhage from the (see Cancrum oris and Odontalgia).
PAGE
56
ib.
58
ib.
231
517
154
538
458
626
736
132
ib.
ib.
416
417
538
552
56
134
ib.
209
334
419
419
511
556
559
466, 510
512
515
555
Haematemesis , . . 140
Haemorrhage from the bowels (see Piles).
Haemorrhagia pulmonum . .314
Haemoptysis . . . ib.
Hematuria . . . 463
Haemorrhagia urethrae . .466
Head, determination of blood to the . 331
Head, cold in the . .240
water in the . .760
dropsy in the . . ib.
Headache . . .361
Heart, diseases of the . .373
valves of the . 410
dilatation of the . . ib.
acute rheumatism of the . 411
Heartburn . . . 140
Heat, exposure to . .631
spots . . . 753
Hectic fever . . .48
Helminthiasis . . .219
Hemicrania (megrim) . . 361
Hemorrhoids . . . 148
with mucous discharge . 150
Hemorrhage from the lungs . 314
Hepatitis . . .200
chronica . . 204
INDEX.
775
Hernia
humeralis Herniae incarcerate Herpes circinnatus serpigo . zoster Herpes preputialis Hip, pain in the gout rheumatism in the
Hoarseness
Homoeopathic attenuations Hooping-cough •
second, or convulsive stage Hordeolum Humid asthma . Hydrocele
funiculi spermatid
PAGE
. 578
, 473
. 582
. 427
. 427
. 435
. 496
. 528
. ib.
. ib.
. 530
. 238
. Hi
. 254
256 540 330 476
478
encysted of the spermatic cord 478
cystata funiculi spermatici ib.
tunica vaginalis . 476
Hydrops . . .592
pectoris . . 600
thoracis . . ib.
Hydrothorax . . . ib.
Hydrophobia . . .637
Hydrocephalus membranarum et ven-
triculorum . . .760
Hypertrophy . . .410 Hypopium (see Ophthalmia gonorrhoeal).
Hysterics . . . 655
Hysteria . . . ib.
Ictus solis (see Coup de Soleil).
Icterus . . .205
neonatorum . .750
Ignis sacer . . . 435
Ileo typhus . . .15 Ileus ■ *
Index-table of the medicines con- tained in this work . lxix Incontinence of urine . . 459 Induration of the cellular tissue . 751 Incubus . . .577 Indigestion . . .114 Infantile erysipelas . .751 remittent fever . .763 Influenza . . . 262 Inflammatory fever . .9 Inflammation of the oesophagus . Ill of the spleen . . 207 of the stomach . . 209 of the bowels . .212 of the peritoneum . .218 of the arteries . .412 of the mucous membrane of the
bronchial tubes . .268
of the lungs . . 276
of the pleura . . 302 of the brain and its tissues . 335
of the larynx . .236
PAGE
Inflammation of the kidneys , 444
of the bladder . .447
of the urethra . .466
of the glans penis . .472
of the testes . .473
of the testicle . .512
of the psoas muscle . 526
of the margin of the eyelids or
meibomian glands of the ears, earache of the tongue of the ovaries
of the labia, majora, and vagina of the womb of the breasts of the eyes in new-born infants
Inflammatio uteri
Influence of external objects on the unborn infant
Ingina pectoris .
Intermittent fever
Intertrigo . . 432, 750
Internal or uterine swelling and pro- lapsus
Invermination .
Irritation or itching of the skin
Iritis arthritica . mercurialis
Irichiasis
Irregularities of the lochial discharge
Ischuria
Ischias
Itch .... watery . . .
540 543 556 657 659 704 708 732 704
666
370
31
703 219 426 538 ib. 542 699 449 528 422 424
Jail fever . . .29
Jaundice . . 205, 750
Kidneys, inflammation of . . 444
Knee, affections of the . . 532
Labour, remedies before . . 685
tedious or complicated . 687
Laryngitis . . 236
chronic . . 239
Larynx, inflammation of the . 236
Laryngismus stridulus . .762
Lead colic (see Colic and Palsy). 347
Legs, cramps in the . . 558
Leucorrhcea after parturition . 703
Lienteria . . .165
Liver complaint . . 200
acute inflammation of . ib.
chronic inflammation of . • 204
Lips, swelling of the . . 542
Lippitudo . . . 540
List of medicines adapted to particular
temperaments . * lxix
Lockjaw of infants . . 752
Loins, pains in the * . .591
Looseness of the bowels I . .164
Lues venerea . . .479
Lumbago . . .525
|
77b |
INDEX. |
||
|
PAGE |
PAGE |
||
|
Lumbo-sacral pains |
. 678 |
Nipples, excoriation of the |
. 707 |
|
Lungs, inflammation of the |
. 276 |
Nodes |
. 512 |
|
hemorrhage from th |
e . 314 |
Nose, swelling of the |
. 550 |
|
Luxations |
. 626 |
caries of the bones c |
>fthe . 551 |
|
Lymphatic tumours |
. 419 |
Notalgia |
. 591 |
|
Mamma, diseases of the |
.708 |
Observations on pregnancy |
. 660 |
|
Marsh fever |
. 34 |
Obstacles to suckling |
. 707 |
|
Malignant quinsy |
. 107 |
Obstructio alvi neonatorum |
. 741 |
|
putrid or gangrenous |
sore-throat ib. |
Obstipatio |
. 143 |
|
Measles |
. 81 |
Obstipation |
. ib. |
|
repercussion of the < |
eruption in 83 |
Obstructio alvi . |
. ib. |
|
Meconium, expulsion of |
. 719 |
Occulta |
. 299 |
|
Menorrhagia |
. 653 |
Odontalgia |
. 96 |
|
Mental emotions |
644, 666 |
(Esophagitis . . |
. Ill |
|
affecting th |
3 milk . 710 |
Opacity |
. 538 |
|
Menstruatio nimia |
. 653 |
Ophthalmia |
. 534 |
|
Menstruation |
. 668 |
syphilitic |
. 491 |
|
Meningitis spinalis |
. 345 |
catarrhal |
. 537 |
|
Metritis |
. 704 |
rheumatic |
. ib. |
|
Mictus cruentus |
. 463 |
sclerotitis |
. ib. |
|
Milk, regurgitation of the |
. 736 |
scrofulous |
. ib. |
|
crust |
. 738 |
syphilitic |
. ib. |
|
scab |
. ib. |
sycosic |
. ib. |
|
blotches . |
. ib. |
gonorrheal |
. ib. |
|
fever |
. 698 |
Orchitis |
473, 512 |
|
Miliaria |
. 91 |
Otalgia |
. 543 |
|
alba |
. ib. |
Otitis |
. ib. |
|
purpurea |
. 64 |
Otorrhcea |
, . 545 |
|
Miliary fever |
. 91 |
catarrhal or mucous |
. ib. |
|
Miliaris Hahnemann! |
. 64 |
purulent |
. ib. |
|
sudatoria |
. 91 |
sanguineous |
. ib. |
|
repercussion of the |
eruption . 93 |
suppressed |
. ib. |
|
Miliformis papulosa |
. 64 |
Ozaena |
. 551 |
|
Miscarriage |
. 678 |
Offensive breath |
. 557 |
|
Moist asthma |
. 330 |
Ostitis |
. 604 |
|
Morbus, sacer . |
. 353 |
Overheating |
. 631 |
|
caducus . |
. ib. |
Ovaritis |
. 657 |
|
divinus . |
. ib. |
Ovarian disease |
. 659 |
|
herculeus |
. ib. |
||
|
comitialis |
. ib. |
Palsy . |
, 347 |
|
coxarius |
. • 530 |
Paralysis of the brain (s |
ee Scarla- |
|
cerealis . |
. 31 |
tina, Water on the |
Brain, and |
|
Mouth, canker in the |
. 552 |
Dentition). |
|
|
scurvy in the |
. ib. |
Paralysis of the chest (s |
see Scarla- |
|
Morning sickness |
. 668 |
tina). |
|
|
Mothers not suckling their |
children . 711 |
Paralysis |
. ib. |
|
Mucous fever |
. 52 |
Painters' colic . |
. 348 |
|
Mumps |
. 112 |
Panaris |
. 425 |
|
Myelitis |
. 345 |
Paronychia |
. ib. |
|
Myopia |
. 539 |
Parotitis |
. 112 |
|
Paraphymosis |
* 495 |
||
|
Navel rupture in infants |
. 718 |
Pain in the hip . |
. 528 |
|
soreness of the |
. ib. |
Pains in the loins |
. 591 |
|
Necrosis |
. 604 |
in the back during pi |
•egnancy . 678 |
|
Nearsightedness |
. 539 |
Parulis |
. 555 |
|
Nephritis |
. 444 |
Passio hysterica |
. 655 |
|
Nervous fever . |
. 12 |
Parturition |
. 687 |
|
Nerve pain |
. 358 |
Pemphigus |
. 433 |
|
Nettle rash |
. 94 |
Pendulous belly |
. 702 |
|
Neuralgia |
. 358 |
Penis, inflammation of the |
. 472 |
|
facialis . |
. ib. |
Pericarditis |
. 373 |
|
Nightmare |
. 577 |
Peritonitis |
. 218 |
|
INDEX. |
777 |
||
|
. |
PAGE |
PAGE |
|
|
Peritoneum, inflammation of the |
218 |
Psoitis |
526 |
|
Periostitis |
608 |
Psoas muscle, inflammation of the |
526 |
|
Peripneumonia . |
276 |
Pulmonary catarrh |
268 |
|
notha . |
299 |
consumption |
319 |
|
Perniones |
417 |
Pulmonitis . |
276 |
|
Perspiration after delivery |
697 |
Purpurea rubra . |
64 |
|
Pertussis |
254 |
Pustula nigra |
417 |
|
Pestis . ■ . |
44 |
Pustular ringworm |
428 |
|
Pestilential fever |
27 |
Putrid fever |
27 |
|
Petechial fever . |
29 |
Pyrosis |
140 |
|
bubonica |
ib. |
||
|
Pharyngitis . . |
110 |
Quinsy |
100 |
|
Phenomena of Asiatic cholera as it |
sphacelated (see Quinsy). |
||
|
appeared in this country |
188 |
||
|
Phthisis laryngea |
239 |
Rachitis |
612 |
|
pulmonalis |
319 |
Raucitas . . |
238 |
|
Phrenitis . . |
535 |
Ranula |
557 |
|
Phimosis |
494 |
Raphania |
41 |
|
Pharmaceutical signs |
xxxi |
Rash, scarlet |
64 |
|
Piles . |
148 |
nettle |
94 |
|
Plague |
44 |
Rectum, stricture of the |
151 |
|
Pleura, inflammation of the |
302 |
Regurgitation of milk |
736 |
|
Pleurisy |
ib. |
Regimen . . |
xvii |
|
spurious or bastard |
311 |
Remedies before labour |
685 |
|
chronic (see Pleurisy). |
Remarks |
xxxi |
|
|
Pleurodynia |
ib. |
Remittent fever . |
46 |
|
Pleuritis |
302 |
Retention of urine |
449 |
|
muscularis |
311 |
Rheumatic fever |
517 |
|
Pneumo-typhus . |
. 15 |
Rheumatism |
ib. |
|
Pneumonia vera |
276 |
without fever . |
523 |
|
chronic (see Pneumonia). |
chronic |
524 |
|
|
typhoid or congestive |
301 |
in the hip |
528 |
|
Pneumonitis . . |
276 |
in the head (see Head- |
|
|
Podagra (see Gout). |
ache and Rheumatism). |
||
|
Poictou, colic of . |
348 |
Rickets |
612 |
|
Porrigo scutulata |
428 |
Ringworm, herpetic or vesicular |
427 |
|
lupinosa |
438 |
of the scalp |
428 |
|
furfurans |
431 |
• pustular |
ib. |
|
favosa . |
ib. |
Rose . |
413 |
|
decalvans |
ib. |
Rubeola |
81 |
|
larvalis . |
738 |
Rupture |
578 |
|
Polysarcia |
702 |
||
|
Pompholyx |
433 |
Sarcocele |
474 |
|
Pot-belly |
702 |
Scabies |
422 |
|
Potencies of the medicaments |
xvii |
papuliformis |
. 423 |
|
Potency, attenuation, or dilution of the |
purulenta |
424 |
|
|
medicament |
xxi |
lymphatica |
ib, |
|
Pregnancy, observations on the |
660 |
Scald head |
428 |
|
Preparation of the breasts . |
684 |
Scalds |
628 |
|
of attenuations |
lix |
Scarlet fever |
. 58 |
|
of medicines in their primitive |
rash |
. 64 |
|
|
state ♦ |
lxiv |
Scarlatina anginosa |
59 |
|
Preservatives, rules for the selection of |
ib. |
miliaris |
. 64 |
|
Prohibited aliment |
4 |
Sciatica |
. 527 |
|
Proctalgia |
157 |
Scirrhus |
542 |
|
Protrusion of the intestine |
158 |
Scorbutus |
. 554 |
|
Prolapsus ani . |
ib. |
Scrofula |
. 602 |
|
Prosopalgia |
358 |
Scurvy |
. 554 |
|
Prostatitis (see Hematuria). |
in the mouth |
. 552 |
|
|
Prurigo |
426 |
Sea-sickness |
. 632 |
|
Pseudo-pleuritis . |
311 |
Shingles |
. 435 |
|
Psora . |
422 |
Short sight |
. 539 |
|
Psoriasis |
432 |
Simple or ephemeral fever . |
8 |
778
INDEX,
PAGE
Skin, irritation or itching of . 426
Sleep . . .726
agitated . .563
disturbed or prevented by
anxiety . . ib.
disturbed by acbing pains in the
body . . .563
disturbed by agitated anxious
dreams . ,564
disturbed or prevented by ex- citement . .568 abnormal state during . ib. position during . .576 positions in which it is impos- sible to recline during . 577 Sleeplessness . . ,561 of infants . . 726 Slow fever . . .12 Smallpox . . .84 confluent . .85 repercussion of the eruption in 88
|
modified |
. , |
89 |
|
diet to be observed in |
ib. |
|
|
Sore throat, or quinsy |
100 |
|
|
aphthous |
ib. |
|
|
Spasmodic pains during labour |
690 |
|
|
asthma |
737 |
|
|
Spasms in the chest |
ib. |
|
|
Specks on the cornea |
538 |
|
|
Sprains |
615 |
|
|
Spleen, inflammation of |
207 |
|
|
Splenitis . |
ib. |
|
|
Spitting of blood |
314 |
|
|
Spinal cord, acute inflammation of the |
345 |
|
|
Sputum cruentum |
314 |
|
|
Spurious peripneumony |
299 |
|
|
or bastard pleurisy |
311 |
|
|
St. Anthony's Fire |
413 |
|
|
Stings of insects . |
632 |
|
|
Stools of abnormal colour (see Diar- |
||
|
rhoea in Infants). |
||
|
Stomach, inflammation of the |
209 |
|
|
derangement of the |
129 |
|
|
spasm of the |
134 |
|
|
Stpmacace |
552 |
|
|
Strabismus |
538 |
|
|
Strains |
. |
616 |
|
Stranguria |
451 |
|
|
Stricture of the rectum |
151 |
|
|
urethra |
. |
456 |
|
Stye . |
540 |
|
|
Stymatosis |
466 |
|
|
Suckling of the infant |
720 |
|
|
Sudor miliaris . |
. |
91 |
|
Suffocating breast-pang |
367 |
|
|
Suppressed dysentery |
. |
176 |
|
secretion of mil |
£ 696 |
710 |
perspiration after delivery 697
Suppression of urine . . 454
Suppressio mensium . . 652
Supplementary diet of infants . 723
Sweating feet . . .560
Swelled testicle . . . 473
face . . .676
PAGE
Swelled veins . . , 677
Swelling of the lips . . 542
of the nose . . 550
of the head in infants . 718
Swooning . . . 589
Sycosis . . .497
Syncope . . .589
Synopsis of the rules for diet . 3
Synocha . . .9
Synochal fever . . ib.
Syphilis . . 479, 500
secondary symptoms of . 480
in infants . . 493
Syphilitic ophthalmia . ,491
Syphilides . . .481
Table of medicines with abbreviations lxix Tabes mesenterica (see Atrophy). Tears, involuntary flow of . . 539 Tedious or complicated labours . 687 Teething, derangements during . 753 Temperaments . . . lxvii Testis, inflammation of the . 473 Testicle, swelled . . ib. inflammation of the . 512 Tetanus . . .348 Thrush . . .739 Tic douloureux . . .358 Tinea capitis . . . 428 annularis . . ib. Tinea faciei . . . 738 Toothache . . 96,671 Tongue, inflammation of the . 556 Tonsillitis phlegmonoides . .100 maligna . .107 Tophus, (see article Ostitis). Tracheitis (see Croup). Treatment after delivery . . 692 of infants and children < 716 after birth . . ib. Trichiasis . . . 542 Trismus nascentium . .752 Tumours, lymphatic . .419 Tussis . . .242 convulsiva . . 254 Tympanitis intestinalis . .132 Typhoid or congestive pneumonia . 301 Typhus cerebralis . . 15 biliosus . . ib. gastricus . . ib. pulmonalis . . ib. abdominalis . . ib. sequelae of: — decubitus, me- tastatic abscess, furunculi, diarrhoea, nightsweats, oedema of the feet, intes- tinal ulcerations . 26 malignant . .27 putridus . ib. abdominalis . . ib. contagious . . 29 contagiosus . . ib. accessory treatment, prophy- laxes in . ib .
|
INDEX. |
77y |
||
|
PAGE |
PAGE |
||
|
Typhus pestilentialis |
. 44 |
Varicella |
. 90 |
|
icterodes |
. 46 |
Varicocele * |
. 475 |
|
Variola |
. 84 |
||
|
Ulcera |
. 437 |
spuria |
.90 |
|
Ulcerated sore throat |
. 107 |
Vehicles which serve for the prepara- |
|
|
Ulcers |
. 437 |
tion of homoeopathic medicines . xxxvi |
|
|
phagedenic |
. 441 |
Venereal disease . |
. 479 |
|
scrofulous |
. ib. |
Vomiting of blood |
. 140 |
|
putrid . |
. ib. |
||
|
gangrenous |
, ib. |
Wakefulness of new-born infants . 734 |
|
|
carcinomatous |
. ib. |
Want of appetite |
. 125 |
|
fistulous |
. ib. |
Warts on the face |
. 543 |
|
mercurial |
. ib. |
Water brash |
. 140 |
|
syphilitic |
. 441 |
Watery itch |
. 424 |
|
indolent |
. 441 |
Water in the head |
. 760 |
|
Ulcer of the rectum (see Stricture |
Weakness after delivery |
. 706 |
|
|
of the Rectum). |
Weaning |
. 725 |
|
|
Urethra, stricture of the |
. 456 |
Weeping, or watery eye |
. 539 |
|
discharge of blood from |
the . 466 |
Whitlow |
. 425 |
|
inflammation of the |
. ib. |
Womb, inflammation of the |
. 704 |
|
Urethritis |
. ib. |
affections of the |
> 704 |
|
Urethrorrhagia . |
. ib. |
Worms |
. 219 |
|
Urine, retention of |
. 449 |
Wounds |
. 616 |
|
difficulty in discharging |
. 451 |
incised . |
. 617 |
|
suppression of |
. 454 |
lacerated |
. 619 |
|
incontinence of |
. 459 |
contused |
. ib. |
|
Urinary abscess and fistula |
. 458 |
punctured |
. 621 |
|
Urticaria |
. 94 |
gunshot |
. ib. |
|
> |
poisoned |
. 622 |
|
|
Vaccination |
. 769 |
||
|
Vagina, inflammation of the |
. 659 |
Zona . |
. 435 |
|
Varices |
. 677 |
THE END.
PRINTED BY C. AND J. ADLARD,
BARTHOLOMEW CLOSE.
WORKS BY DR. LAURIE.
HOMCEOPATHIC DOMESTIC MEDICINE.
FOURTH EDITION;
8vo, bound in cloth, price 12s.
" The very fact of the publication of a third edition of such a large work as Dr. Laurie's, proves how widely the practice is spread among the public generally."
Dr. Forbes1 s British and Foreign Medical Review.
BGENINGHAUSEN'S MANUAL
HOMCEOPATHIC THERAPEUTICS ;
TRANSLATED FROM
M. ROTH'S IMPROVED FRENCH EDITION.